bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Healthcare Resource Use Outcomes between Dual-plane and Prepectoral Techniques in Implant-based Breast Reconstruction: A Multicenter Retrospective Study
Authors: Bruno James R. , Brown C. Coleman , Gabriel Allen , Parikh Mousam , Anastassopoulos Kathryn P. , Lee Kenneth R. , Daniel Shoshana , Naik Rupali , Patel Reema , Patel Vaishali D.
Published: March 2023

Background:

This multicenter, retrospective study compared clinical outcomes and healthcare resource use in patients who underwent dual-plane (DP) or prepectoral (PP) implant-based breast reconstruction (IBR) after mastectomy in the United States.

Methods:

Medical records were selected for patients at five sites undergoing immediate one-stage direct-to-implant (first hospitalization) or two-stage IBR (first and second hospitalization) using either DP or PP. Inverse probability of treatment weighting was used to adjust for potential confounders. Complications and healthcare resource use were assessed with logistic regression; pain severity was assessed with ordinary least-squares regression.

Results:

After inverse probability of treatment weighting, data from 255 patients (DP = 130, PP = 125) and 441 breasts (DP = 226, PP = 215) were analyzed. Mean pain severity scores were lower with PP versus DP immediately after IBR for first (P = 0.0002) and second hospitalizations (P = 0.0145), and before discharge for first (P < 0.0001) and second hospitalizations (P = 0.0002). A greater proportion of PP versus DP patients had a shorter hospital length of stay (≤ 23 hours) for first hospitalization (P = 0.0052); proportions were similar for second hospitalization (P = 0.5499). Intravenous narcotics were prescribed less frequently to PP versus DP patients during first (61.1% versus 69.8%, respectively; P = 0.1486) and second (37.5% versus 55.3%, respectively; P = 0.0172) hospitalizations. Complication rates were low in both groups after first hospitalization discharge (DP: 13.6%, PP: 12.5%, P = 0.7225).

Conclusion:

This retrospective study suggests that the PP technique in IBR may offer benefits related to clinical outcomes and health resource utilization; however, larger studies, including randomized controlled trials, are needed to confirm.
Useful Genioplasty for Repeated Recurrent Sleep Apnea of Congenital Anomalies and Its Evaluation
Authors: Kino Hiromi , Ueda Koichi , Hirota Yuka , Okamoto Toyoko
Published: March 2023

Background:

Congenital facial anomalies with hypoplasia of the midface or lower face are associated with obstructive apnea syndrome. Although such patients underwent bone advancement surgery and their sleep apnea improved in the short term, it often recurred several years after surgery. It is difficult to perform another major osteotomy because of impairment of the facial contour or prior orthodontic treatment. Genioplasty was performed for genioglossus muscle advancement in patients with congenital anomalies and repeated sleep apnea. In this study, we evaluated the usefulness of this procedure and the mechanism for the improvement of sleep apnea.

Methods:

Six patients were included: three with syndromic craniosynostosis, two with Treacher-Collins syndrome, and one with micrognathia by Goldenhar syndrome. Patients who had recurrence of sleep apnea after previous maxillomandibular osteotomies, or advancement and orthodontic treatment, received genioplasty for genioglossus muscle advancement. The patients were evaluated by body mass index, simple polysomnography, hyoid bone position on cephalogram, and the airway area on computed tomography images pre- and postoperatively.

Results:

Polysomnography showed a significant improvement in the apnea-hypopnea index. Cephalometric measurement showed significant results of the hyoid bone position from point B and the ramus plane. However, no significant results were obtained in the airway area assessment.

Conclusions:

Genioplasty for genioglossus muscle advancement can improve apnea-hypopnea index by moving the hyoid bone forward. Genioplasty was useful in patients with congenital anomalies who had a recurrence of sleep apnea after several procedures.
Multi-effective characteristics and advantages of acupuncture in COVID-19 treatment
Authors: Wang Lifen , Hu Xiyou , Geng Lianqi , Li Ningcen , Chen Yong , Zhang Jingyu , Yuan Xinru , Huang Lihong , Ba Dongsheng , Lian Jinyu , Lyu Xiaoyan , Chen Zelin , Zhang Yue , Chen Bo
Published: March 2023

Coronavirus disease 2019 (COVID-19) is a major disease that threatens human life and health. Its pathogenesis is complex and still not fully clarified. The clinical treatment is mainly supportive and lacks specific treatment methods. Acupuncture treatment can inhibit immune inflammatory reactions, neuroinflammatory reactions, oxidative stress levels, and hypothalamus-pituitary-adrenal (HPA) axis activity, improve lung function, and relieve migraine, fatigue, anxiety, and depression. However, whether acupuncture treatment is suitable for treating these symptoms in patients with COVID-19 still needs to be investigated. For this review, the literature was systematically searched for multiple databases to summarize the mechanisms of acupuncture treatment for COVID-19-related symptoms and complications. A complex network analysis of acupoints and symptoms was also performed to clarify acupoint selection in the acupuncture treatment of symptoms related to COVID-19. The evidence indicates that acupuncture can improve the respiratory, digestive, nervous, and mental and psychological symptoms related to COVID-19 by inhibiting immune inflammatory reactions, regulating intestinal flora, mitochondrial function, oxidative stress level, cardiomyocyte apoptosis, neurotransmitter release, and HPA axis activity, and alleviating basic diseases such as diseases of the vascular system. Acupuncture can improve various clinical and concomitant symptoms of COVID-19; however, its mechanism of action is complex and requires further study.

Graphical abstract:

http://links.lww.com/AHM/A54
Antibody Persistence After Primary SARS-CoV-2 Infection and Protection Against Future Variants Including Omicron in Adolescents: National, Prospective Cohort Study
Authors: Aiano Felicity , Ireland Georgina , Baawuah Frances , Beckmann Joanne , Okike Ifeanyichukwu O. , Ahmad Shazaad , Garstang Joanna , Brent Andrew J. , Brent Bernadette , Borrow Ray , Linley Ezra , Ho Sammy , Carr Christine , Zambon Maria , Poh John , Warrener Lenesha , Amirthalingam Gayatri , Brown Kevin E. , Ramsay Mary E. , Hoschler Katja , Ladhani Shamez N.
Published: March 2023

Background:

Antibodies are a measure of immunity after primary infection, which may help protect against further SARS-CoV-2 infections. They may also provide some cross-protection against SARS-CoV-2 variants. There are limited data on antibody persistence and, especially, cross-reactivity against different SARS-CoV-2 variants after primary infection in children.

Methods:

We initiated enhanced surveillance in 18 secondary schools to monitor SARS-CoV-2 infection and transmission in September 2020. Students and Staff provided longitudinal blood samples to test for variant-specific SARS-CoV-2 antibodies using in-house receptor binding domain assays. We recruited 1189 students and 1020 staff; 160 (97 students, 63 staff) were SARS-CoV-2 nucleocapsid-antibody positive at baseline and had sufficient serum for further analysis.

Results:

Most participants developed sustained antibodies against their infecting [wild-type (WT)] strain as well as cross-reactive antibodies against the Alpha, Beta and Delta variants but at lower titers than WT. Staff had significantly lower antibodies titers against WT as cross-reactive antibodies against the Alpha, Beta and Delta variants than students (allP< 0.01). In participants with sufficient sera, only 2.3% (1/43) students and 17.2% (5/29) staff had cross-reactive antibodies against the Omicron variant; they also had higher antibody titers against WT (3042.5; 95% confidence interval: 769.0–12,036.2) than those who did not have cross-reactive antibodies against the Omicron variant (680.7; 534.2–867.4).

Conclusions:

We found very high rates of antibody persistence after primary infection with WT in students and staff. Infection with WT induced cross-reactive antibodies against Alpha, Beta and Delta variants, but not Omicron. Primary infection with WT may not be cross-protective against the Omicron variant.
Comparison of Clinical Characteristics of Children Infected With Coronavirus Disease 2019 Between Omicron Variant BA.5 and BA.1/BA.2 in Japan
Authors: Ikuse Tatsuki , Aizawa Yuta , Yamanaka Takayuki , Hasegawa Satoshi , Hayashi Takanori , Kon Miyako , Tamura Tsutomu , Saitoh Akihiko
Published: March 2023

Background:

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants has dramatically altered the clinical profile of pediatric coronavirus disease 2019 (COVID-19). In Japan, we experienced a pandemic of omicron subvariant BA.1/BA.2 from January through June 2022. However, after the emergence of BA.5 in early July 2022, the number of children hospitalized with COVID-19 increased dramatically in Japan.

Methods:

We collected data on monthly numbers of cases and clinical characteristics of hospitalized children with COVID-19 in 13 hospitals, the total number of pediatric COVID-19 cases, and COVID-19 vaccination rates in Niigata, Japan, for the period from January 2020 through August 2022. We compared clinical presentation during the periods of BA.1/BA.2 predominance (January–June 2022) and BA.5 predominance (July–August 2022) and estimated vaccine effectiveness (VE) against hospitalization during the BA.5-predominant period.

Results:

Between January 1, 2020, and August 31, 2022, 49,387 children (19,085 children/100,000 population) were newly diagnosed as having COVID-19, and 393 were hospitalized for COVID-19. Hospitalization for febrile seizure, especially complex seizure, was significantly higher during BA.5 predominance than during BA.1/BA.2 predominance (27.9% vs. 7.0%, P < 0.01). VE against hospitalization during BA.5 predominance was estimated to be 75% (95% confidence interval, 48%–88%, P < 0.01).

Conclusions:

The emergence of BA.5 significantly affected children in Japan; the number with complex febrile seizure who required hospitalization was higher than during BA.1/BA.2 predominance. The COVID-19 vaccination rate in children must be increased to prevent hospitalization for COVID-19 and to prepare for current and future variant outbreaks.
Leveraging Telehealth to Address Sexual Assault Nurse Examiner Access Disparities in Rural Communities
Authors: Miyamoto Sheridan , Downing Nancy R.
Published: March 2023

Background

There are persistent gaps in access to sexual assault nurse examiners (SANEs) in rural and underserved areas, yielding health and legal disparities for survivors. These inequities prompted federal investment in novel telehealth programs to improve SANE access.

Purpose

The aim of this study was to examine program case studies from two sexual abuse/assault (SA) telehealth centers, illuminating successes, challenges, and lessons learned.

Methods

Two state SA telehealth program directors used a collective instrumental case study approach to understand telehealth SANE (teleSANE) program challenges/lessons learned, outcomes, and recommendations for the field. Cross-program commonalities and differences were examined, pooling experiences to derive recommendations to sustain telehealth to increase SA health equity.

Results

Collectively, the two programs have served 18 remote sites and provided 335 consultations. Both programs provide access to 24/7 teleSANE consultation, quality assurance, and mentoring. Unique to each program were engagement of hospital leadership in advisory boards, use of telehealth technology, training programs, and fiscal sustainability. Both programs identified flexibility, offering a tailored implementation approach, regular site support and communication, and teleSANE mentoring aligned with the Quality Caring Model as essential to success. Critical needs identified to sustain programs included (a) multilevel community and hospital buy-in, (b) sustainable funding specific to local institution needs, and (c) robust processes to oversee clinical and technology support.

Conclusions

Cross-program similarities and differences show the impact telehealth can have on equitable SA care. Program evaluation showed common challenges, lessons learned, and recommendations to advance equitable SA care access in underresourced communities.
Risk Factors for Severe COVID-19 Among Health Care Workers
Authors: O'Connor Lauren F. , Madden Gregory R. , Stone Derrick , Classen David C. , Eby Joshua C.
Published: March 2023

Objective:Evaluate potential risk factors for severe coronavirus disease 2019 (COVID-19) among health care workers (HCWs) at the University of Virginia Medical Center in Charlottesville, Virginia.Methods:We conducted a retrospective manual chart review of data from HCWs who were diagnosed with COVID-19 from March 2020 to March 2021. Using data from patient medical histories, we ascertained risk factors for COVID-19–related emergency department encounter, hospitalization, or death.Results:We had 634 patients in total, and 9.8% had a severe COVID-19–related outcome. A history of deep vein thrombosis/pulmonary embolism/stroke (odds ratio, 19.6; 95% confidence interval, 5.11 to 94.7), as well as asthma, chronic lung disease, diabetes, or current immunocompromised status, was associated with increased adjusted odds of COVID-19–related emergency department encounter/hospitalization/death.Conclusions:A preexisting history of deep vein thrombosis/pulmonary embolism/stroke is a novel risk factor for poor COVID-19 outcomes among a cohort of HCWs.
Parathyroidectomy for primary hyperparathyroidism: effect on quality of life after 3 years – a prospective cohort study
Authors: Frey Samuel , Perrot Bastien , Caillard Cécile , Le Bras Maëlle , Gérard Maxime , Blanchard Claire , Cariou Bertrand , Wargny Matthieu , Mirallié Eric
Published: March 2023

Background:

The impact of parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) on long-term quality of life (QoL) remains controversial. The study evaluated QoL changes 1 and 3 years after PTX.

Materials and Methods:

Patients undergoing PTX for PHPT between 2016 and 2022 (n=329) were enrolled in this monocentric, prospective cohort study. QoL was evaluated using the SF-36 questionnaire before, 1 year, and 3 years after PTX and compared with an age-matched and sex-matched French reference population. Only patients with 1-year and 3-year follow-up and complete evaluation (serum calcium, phosphorus, parathyroid hormone) were included.

Results:

A total of 159 patients were included (mean age: 62.6±12.7 years, 79.2% females). Mean serum calcium (2.66±0.20 mmol/l) and median parathyroid hormone (96.4 [76.9−126.4] pg/ml) levels improved significantly after PTX. Before surgery, PHPT patients had impaired physical (44.6±8.9 vs. 47.6±6.8 in the reference population, P<0.001) and mental (42.3±10.9 vs. 48.9±6.8, P<0.001) component scores. The mean physical component score increased significantly at 1 and 3 years and was no longer different from the reference population (ratio: 0.94±0.15 preoperatively vs. 0.99±0.15 at 3 years, P<0.01). The mean mental component score increased significantly at 1 and 3 years, but remained significantly lower than the reference population. Before surgery, a lower physical component score and younger age were significantly associated with a 3-year physical component score increase on multiple linear regression analysis.

Conclusion:

A significant improvement in QoL is associated with PTX for PHPT at 1 year and is sustained for at least 3 years after surgery.
Effectiveness of artificial intelligence-assisted colonoscopy in early diagnosis of colorectal cancer: a systematic review
Authors: Mehta Aashna , Kumar Harendra , Yazji Katia , Wireko Andrew A. , Sivanandan Nagarajan Jai , Ghosh Bikona , Nahas Ahmad , Morales Ojeda Luis , Anand Ayush , Sharath Medha , Huang Helen , Garg Tulika , Isik Arda
Published: March 2023

Introduction:

As artificial intelligence (AI)-assisted diagnosis gained immense popularity, it is imperative to consider its utility and efficiency in the early diagnosis of colorectal cancer (CRC), responsible for over 1.8 million cases and 881 000 deaths globally, as reported in 2018. Improved adenoma detection rate, as well as better characterizations of polyps, are significant advantages of AI-assisted colonoscopy (AIC). This systematic review (SR) investigates the effectiveness of AIC in the early diagnosis of CRC as compared to conventional colonoscopy.

Materials and Methods:

Electronic databases such as PubMed/Medline, SCOPUS, and Web of Science were reviewed for original studies (randomized controlled trials, observational studies), SRs, and meta-analysis between 2017 and 2022 utilizing Medical Subject Headings terminology in a broad search strategy. All searches were performed and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and were conducted from November 2022. A data extraction form based on the Cochrane Consumers and Communication Review group’s extraction template for quality assessment and evidence synthesis was used for data extraction. All included studies considered for bias and ethical criteria and provided valuable evidence to answer the research question.

Results:

The database search identified 218 studies, including 87 from PubMed, 60 from SCOPUS, and 71 from Web of Science databases. The retrieved studies from the databases were imported to Rayyan software and a duplicate article check was performed, all duplicate articles were removed after careful evaluation of the data. The abstract and full-text screening was performed in accordance with the following eligibility criteria: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for observational studies; Preferred Reporting Items for Systematic Reviews and Meta-Analysis for review articles, ENTREQ for narrative studies; and modified JADAD for randomized controlled trials. This yielded 15 studies that met the requirements for this SR and were finally included in the review.

Conclusion:

AIC is a safe, highly effective screening tool that can increase the detection rate of adenomas, and polyps resulting in an early diagnosis of CRC in adults when compared to conventional colonoscopy. The results of this SR prompt further large-scale research to investigate the effectiveness in accordance with sex, race, and socioeconomic status, as well as its influence on prognosis and survival rate.
Impact of Task-Fit Misalignment and the Director of Clinical Education: A Grounded Theory Study
Authors: McCallum Christine , Murray Leigh , Engelhard Chalee , Doren Sarah
Published: March 2023

Introduction.

The roles and responsibilities of the director of clinical education (DCE) are of interest in the academic physical therapist (PT) community. This study explored the impact of professional and positional task characteristics of the DCE position on task-fit misalignment within PT education programs. Task-fit explores how the tasks of a particular job align with the appropriately trained person who holds the position.

Review of the Literature.

A recently published DCE Matrix highlights 2 extremes of misalignment and nonoptimal task-fit between the position and the person. Misalignment was investigated rather than alignment because negative connotations often have greater impact on behavior, decision making, and relationships. The impact of misalignment is unknown.

Subjects.

Program directors and DCEs among ACAPT member PT programs were surveyed.

Methods.

A qualitative grounded theory design was used. Two rounds of surveys with focused questions about the impact of task-fit misalignment. Qualitative content data analysis through a constant comparative process was followed. Respondent descriptive statistics were collected.

Results.

Three realms of impact were identified when misalignment of positional and professional characteristics exists. The realms include the 1) individual person holding the position; 2) academic program; or 3) physical therapy profession. There is a high level of agreement that task-fit misalignment affects each realm; variability exists about its prevalence.

Discussion.

There seems to be an interconnectedness of impact among the person, the program, and the profession when misalignment exists between the fit of the DCE to the job or the work environment to the DCE. Findings indicate job crafting may be necessary to evolve the nature of the DCE work toward higher director-level tasks. This is the first study of its kind to explore the impact intersection of person-job fit and task-fit and the impact on a DCE's responsibilities. Nonrespondent or attrition bias may have limited sample size.
The prevalence of childhood asthma: interpreting falling rates in the context of shifting measurement and the COVID-19 pandemic
Authors: Frey Sean M. , Rowe Regina K. , Halterman Jill S.
Published: March 2023

Purpose of review

The estimated prevalence of childhood asthma in the United States, as measured by the National Health Information Survey (NHIS), has decreased by 30% since 2017. This review provides context for observed changes in asthma rates by describing recent shifts in NHIS data collection and analysis, and considers whether the COVID-19 pandemic might impact asthma prevalence in years to come.

Recent findings

The NHIS underwent a planned redesign in 2019 with updated sampling weights to better match the U.S. population. In early 2020, the COVID-19 pandemic resulted in unplanned modifications to NHIS implementation, which may have included fewer children from populations at a heightened risk for asthma. Decreasing prevalence estimates in recent years are likely at least in part due to these survey changes rather than true epidemiologic shift. However, pandemic-related changes to risk factors for childhood asthma (including exposure to rhinovirus infections and allergic sensitization) may also influence prevalence in the future.

Recent changes in estimated rates of childhood asthma in the USA are likely driven by changes to survey methods and implementation, both before and during the COVID-19 pandemic. Additional years of data are needed to determine whether a true shift in disease prevalence is occurring.
Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis
Authors: Gorbounova Irina , Tham See Wan , Abu-El-Haija Maisam , Palermo Tonya M.
Published: March 2023

Background:

Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid administration, and test the associations between opioid administration and hospital length of stay (LOS).

Methods:

This is a retrospective cohort study of pediatric AP hospitalizations in a single institution from 2010 to 2020. Opioid administration was calculated for the first 48 hours of admission (morphine milligram equivalent; MME48). Data on multimodal analgesia [defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)] during hospitalization was captured.

Results:

The sample included 224 patients, mean age 12.0 years (standard deviation = 4.9) and 58.9% female. Median LOS was 4 days (interquartile range 2–9). Most patients (71.4%) were prescribed opioids, 77.7% acetaminophen, 40.2% NSAIDs, and 37.5% multimodal analgesia. Opioid administration decreased over the study period; in contrast, there was an increase in multimodal analgesia administration. Opioid administration did not differ by sex, age, biliary versus non-biliary etiology, or race/ethnicity. In a multivariate regression model, lower albumin values (P < 0.01) and younger age (P < 0.05) were significant predictors of increased LOS, while MME48 was not associated with increased LOS.

Conclusions:

Opioids were commonly administered; only 37.5% of children were administered multimodal analgesia during their hospitalization for AP. Opioid administration was not associated with increased LOS. Prospective studies are needed to determine optimal pain management for pediatric AP.
A novel application of the World Health Organization Community-Based Rehabilitation matrix to understand services’ contributions to community participation for persons with traumatic spinal cord injury: A mixed methods study
Authors: Raha Srijan S. , Yip Silas , Ho Chester , Olayinka Olaleye , Peláez-Ballestas Ingris , Rame-Montiel Ana K. , MacIsaac Rob , Henderson Rita , Burns Katharina Kovacs , Bakal Jeffrey , Charbonneau Rebecca , Kamran Rija , Loyola-Sanchez Adalberto
Published: March 2023

Purpose

To utilize the World Health Organization (WHO) Community-Based Rehabilitation (CBR) matrix for understanding services’ contributions to foster community participation for people with traumatic spinal cord injury (tSCI).

Methods

Convergent mixed-methods design with a quantitative arm describing the frequency with which services contributed to 22 of the CBR-matrix elements, and a qualitative arm involving document reviews and stakeholder interviews. Results were integrated following Onwuegbuzie and Teddlie’s method (ie quan + QUAL).

Results

20 of the 22 (91%) of the WHO-CBR elements were addressed by tSCI services. Five types of services were identified. Integrated results showed that the strengths of tSCI services were: 1) comprehensiveness; 2) essential medical services publicly funded; 3) numerous social protections available; and 4) highly active community-based organizations. Identified opportunities to improve these services were: 1) increase specificity for tSCI, and 2) increase communication and integration among services.

Conclusion

Services available for people with tSCI in the province studied address most of the elements of the WHO-CBR matrix. However, lack of cohesion between services could create gaps that hinder community participation. Addressing these gaps could improve the quality of life and outcomes of people with tSCI.
Peripheral Nerve Stimulation for the Treatment of Post-Amputation Pain: A Systematic Review
Authors: Smith Brandon J. , Twohey Eric E. , Dean Kaylie P. , D’Souza Ryan S.
Published: March 2023

Despite numerous first-line treatment interventions, adequately managing a patient’s post-amputation pain (PAP) can be difficult. Peripheral nerve stimulation (PNS) has emerged as a safe neuromodulatory intervention that can be utilized for many etiologies of chronic pain. We performed a systemic review to appraise the evidence of PNS use for improvement in PAP. This was performed in Ovid, Cochrane databases, OVID, Scopus, Web of Science Core Collection, and PubMed. The primary outcome was improvement in PAP after use of PNS. Secondary outcomes included improvements in functional status, opioid usage, and mood. Data extraction and risk of bias assessments were performed independently in a blinded manner. Of the 989 studies identified, thirteen studies were included consisting of three randomized control trials, seven observational studies, and three case series. While large heterogeneity limited definitive conclusions, the included studies generally demonstrated favorable outcomes regarding pain reduction. Each included study that used an objective pain scale demonstrated clinically significant pain improvements. Per the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria, there is very low-quality GRADE evidence supporting that PNS is associated with improvements in pain intensity for PAP. Future prospective, comparative, and well-powered studies assessing the use of PNS for PAP are warranted.
Developing the Key Driver Diagram by Analyzing Home Central Line Caregiver Proficiency Factors
Authors: Wong Chris I. , Henrich Natalie , Barysauskas Constance M. , Conway Margaret , Desrochers Marie D. , Mahan Riley M. , Billett Amy L.
Published: March 2023

Introduction:

Caregivers of pediatric oncology and stem cell transplant patients often care for central lines (CLs) at home. Methods to achieve caregiver CL care proficiency, and interventions designed with caregiver input are lacking.

Methods:

Caregivers of pediatric oncology and stem cell transplant patients patients with an external CL or removed within 2 weeks were eligible for a survey assessing knowledge, the value of training strategies, and comfort. We mapped responses (n = 79) and acceptability/challenges of introducing a pilot caregiver CL teach-back clinic program onto the capability, opportunity, motivation behavioral (COM-B) model of change to identify drivers of caregiver CL care proficiency. A working group, including caregivers, refined and approved a final driver diagram.

Results:

Survey: Ninety-four percent of caregivers answered knowledge questions correctly (capability); 95% considered hands-on training helpful (opportunity); 53% were not very comfortable with CL care (motivation). Teach-back: Seventy-nine percent of caregivers were interested in a teach-back as additional training; 38% participated (opportunity); 20% refused participation due to being overwhelmed/not having time (motivation). Thirty-three percent of participants had a CL proficiency assessment (capability). Drivers of home caregiver CL care proficiency included: support for the caregiver’s physical capability to perform CL care; enabling the CL care nurse trainer role; facilitating and increasing training opportunities, and engaging caregivers early and continuously to motivate proficiency development appropriately.

Conclusions:

An approach centered on caregivers as main stakeholders can identify drivers to co-design an intervention for improved home CL care delivery. A standardized process to train and evaluate caregivers with multiple hands-on opportunities might be beneficial.
“Development of Three-Dimensional Breast Scan and Measurement Application Using Laser Imaging Detection and Ranging (LiDAR) Sensor on iPhone”
Authors: Han Woo Yeon , Lee Seok Joon , Chang Hsien Pin , Heo Jin , Eom Jin Sup , Kim Eun Key , Han Hyun Ho
Published: March 2023

Laser imaging detection and ranging (LiDAR) is a modern three-dimensional (3D) technology that utilizes time-of-flight method using the round-trip time of an infrared laser beam to accurately detect the presence and features of objects. Notably, The iPhone XII Pro (Apple, Inc., Cupertino, Calif.) is the first smart mobile device with built-in LiDAR sensors in 2020. Our team developed the software application based on iOS devices with built-in LiDAR sensors for 3D breast scanning and automatically analyzing the breast geometric measurement. Breast geometry, including mid-clavicle-to-nipple distance, sternal notch-to-nipple distance, nipple-to-inframammary fold (IMF) distance, distance between nipples and body circumference on nipple and IMF level were measured using the software application and tapeline. The relative technical error of measurement (rTEM) value was used to calculate the error ratios between the measurements acquired by the software application and those of the tapeline. Good rTEM values ranging from 2.99 to 5.19% were found in the mid clavicle-to-nipple distance, sternal notch-to-nipple distance, distance between nipples, nipple level circumference and IMF level circumference. However, there was a poor rTEM value over 10% in the nipple-to-IMF distance. The proposed software application using current iOS devices with built-in LiDAR sensors can provide an ideal 3D scanning system which has low-cost burden, good accuracy, portability and ease-to-use.
Operative Autonomy in a Gender Balanced Cohort of Surgical Trainees
Authors: Parr Justin M , van der Werf Bert , Locke Michelle
Published: March 2023

Background:

Gender inequity continues to be a major focus of improvements within surgical education. Female trainees are fewer in number and suffer reduced quality of surgical training. Prior studies have demonstrated that surgical autonomy for female trainees in a range of surgical disciplines is less than that of male trainees. As a unique example amongst Australasian specialty training boards, The New Zealand Board of Plastic and Reconstructive Surgery has boasted a gender balanced cohort of surgical trainees since 2013. We sought to examine the effect of gender on surgical autonomy in a cohort of trainees where gender balance has been achieved.

Methods:

A retrospective cohort study was undertaken. Anonymised logbook data for New Zealand plastic surgery trainees was analysed, for the study period, comprising rotations from December 2013 to June 2020. Self-reported levels of trainee supervision were compared against gender. Outcomes were tested using multivariate analysis

Results:

38 trainees were included in the study (58% Female), with a total of 81,178 cases recorded over the 6.5-year study period. No overall statistically significant difference in surgical autonomy was identified when analysed by gender. Male and female trainees showed similar trends of increasing surgical autonomy throughout the course of surgical training.

Conclusions and Relevance:

In a cohort of surgical trainees which has reached gender balance, the negative impact of gender on surgical autonomy was not identified. These findings suggest that where women make up an equal proportion of trainees, the implicit gender bias within surgical training may be ameliorated.
Urgent Care Centers and what you need to know
Authors: Pennington Gary A.
Published: March 2023

Interpretation and adaption to the healthcare environment has become a daily activity to the practice of medicine. The only constant in health care is patient demand for affordability, convenience and timeliness. The evolution of urgent care center has been based on their ability to adapt in the face of changes and answer the demand of patients to become a viable entry point into the healthcare system. I will discuss the history of urgent cares, the types of urgent cares and our experience in establishing our own urgent care.
Depression Treatment Initiation Among Patients With Versus Without Chronic Pain
Authors: Owen-Smith Ashli A. , McDonald Bennett , Sesay Musu M. , Simon Gregory E. , McCracken Courtney E.
Published: March 2023

Objective

The purpose of this study was to examine the extent to which the presence of chronic noncancer pain (CNCP) impacts the likelihood that patients with diagnoses of depression will initiate depression treatment compared with those without CNCP.

Methods

We performed a retrospective cohort study of Kaiser Permanente of Georgia members older than 18 years who received a diagnosis of depression. Demographics and medical history were extracted from the electronic health record database. Members were further classified by the presence or absence of a CNCP diagnosis. Outcomes of interest were treated as time dependent and included (1) time to fulfillment of a new antidepressant medication and (2) time to a follow-up mental health encounter. Outcomes were compared between members with and without a CNCP diagnosis using Kaplan-Meier survival curves and Cox proportional hazard regression models.

Results

During the study period, 22,996 members met the inclusion criteria and 27.4% had a diagnosis of CNCP. In the matched sample, there was no difference in the time to a new antidepressant fill among members with and without CNCP (hazard ratio = 0.96; 95% confidence interval = 0.90–1.02; p = .18). In contrast, members with CNCP were significantly less likely to have a new mental health encounter after diagnosis (hazard ratio = 0.87; 95% confidence interval = 0.81–0.94; p < .001).

Conclusions

Patients with CNCP were significantly less likely to have a new mental health encounter after a depression diagnosis compared with patients without CNCP. Additional outreach and consideration may be needed to improve initiation of depression treatment for newly diagnosed patients with comorbid depression and CNCP.
Assessment of Cranial Sexual Dimorphism Using 3D Reconstruction: Implications for Gender-Affirming Surgery
Authors: Goli Rachna , Lasky Sasha , Ray Edward , Chen Henry
Published: March 2023

Background:

As more centers offer gender-affirming procedures, dissemination of best practices is critical to ensuring quality care. This study is the first to use advanced 3-dimensional visualization software to characterize cranial differences between natal males and females, as they relate to planning for facial gender-affirming operations.

Materials and Methods:

A retrospective analysis was conducted on randomly selected patients with facial computed tomography imaging performed at a single institution between February 2020 and July 2021. Patients with acquired bony deformity on computed tomography or documented history of hormone replacement therapy were excluded. The images were retrieved and analyzed using advanced 3-dimensional visualization software (Vitrea). Independent sample t tests were performed to analyze variation in typically sexually dimorphic facial features between natal males and females.

Results:

We identified 50 patients (25 natal males and 25 natal females) who met the inclusion criteria. Ages ranged from 19 to 91. Natal males were found to have significantly greater frontosellar distances (difference between means, SEM: 2.7±1.2; P=0.03) and mandible volumes (difference between means, SEM: 14.0±4.2; P=0.002) than natal females. Statistical analysis revealed no significant differences in gonial angle, chin width, nasofrontal angle, or nasolabial angle between natal males and females.

Conclusion:

In this diverse sample of natal males and females, statistical analysis revealed that the sexually dimorphic facial characteristics most relevant to the planning of facial gender-affirming surgery are frontosellar distance and mandible volume. When planning facial gender-affirming surgery, we recommend that these characteristics be considered to achieve optimum results.
Health-Related Quality of Life in Osteoporosis Patients with and without Fractures in Tehran, Iran
Authors: Rajabi Marziyeh , Ostovar Afshin , Sari Ali Akbari , Sajjadi-Jazi Sayed Mahmoud , Mousavi Abdoreza , Larijani Bagher , Fahimfar Noushin , Daroudi Rajabali
Published: March 2023

Background: This study aimed to measure the health-related quality of life (HRQOL) of patients with osteoporosis with and without fractures in Tehran, the capital city of Iran.Methods: We surveyed a sample of 478 patients with osteoporosis aged over 50 years. Participants with fractures included patients referred to hospitals due to osteoporotic fractures which were alive 6 months after the fracture. Participants without fractures were randomly selected from patients with a definite diagnosis of osteoporosis admitted to 3 outpatient clinics in Tehran. Data were collected using the EuroQol 5-dimensional 5-level questionnaire. Statistical differences between patients with and without fracture were tested with Pearson’s χ2 test, Student’s t-test, and the Mann–Whitney U-test. The association between HRQOL and other variables was evaluated using a multiple linear regression model.Results: The patients’ mean age±standard deviation was 67.3±11.9 years, and 74.1% were women. One hundred and seventeen (23%) patients had hip fractures, 56 (11%) had vertebral fractures, 127 (25%) had forearm fractures, and 178 (40%) had no fractures. The median (interquartile range) values of HRQOL scores of those with hip, vertebral, and forearm fractures and those with no history of fracture were 0.53 (0.22), 0.60 (0.28), 0.64 (0.26), and 0.64 (0.27), respectively. The multiple regression model revealed a significant relationship between the HRQOL scores and sex, marital status, employment status, presence of any chronic illness in addition to osteoporosis, and type of fracture.Conclusions: Osteoporosis and its related fractures can reduce the HRQOL.
Sphenoid Bone Determines the Curvature of the Cranial Vault in Postnatal Skull Development in C57BL/6 Mice
Authors: Adasooriya Dinuka , Kyeong Minjae , Cho Sung-Won
Published: March 2023

Background: The skull is a complex structure formed by the craniofacial bones’ elaborate organization. The growth pattern in each craniofacial bone of the postnatal skull has been presented in wild-type mice. However, the skull’s growth pattern, determined by the craniofacial bones’ coordinated growth, is unfamiliar. This study aimed to examine the overall morphological change in the mid-sagittal plane of the postnatal mice’s skulls and interaction between the craniofacial bones.Methods: Geometric morphometric principal component analysis was performed in the mid-sagittal plane of 31 wild-type mice’s skulls from postnatal days 28 to 98. The relationship between the cranial base and cranial vault was investigated by comparing skulls with early fusion and non-fusion of intersphenoid synchondrosis (ISS).Results: The cranial vault flattening and sphenoid bone length increased with age. The cranial vault curvature and sphenoid base length showed a positive correlation that was confirmed by comparing the skulls with early fusion and non-fusion of ISS. The sphenoid bone length and cranial vault angle significantly decreased in the skulls with early fusion of ISS compared to non-fusion skulls.Conclusions: It is suggested that the cranial vault flattening is sphenoid bone length-induced but cranial vault length-independent during postnatal mice skull development.
Modelling the displacement and coexistence of clonal lineages ofPhytophthora infestansthrough revisiting past outbreaks
Authors: Huang Chih-Chiang , Liew Edward C.Y. , Wan Justin S. H.
Published: March 2023

The continuous changes in the lineage proportions of populations in the clonal plant pathogenPhytophthora infestanson potato and tomato crops have been perplexing to researchers and disease managers. Sudden outbreaks of newly emergent genotypes are often associated with these rapid composition changes. Modelling can predict the persistence and displacement of pathogen genotypes with differential fitness among hosts. Building upon previous models, we combined analytical and simulation methods to model the outcome of interactions between competing lineages on multiple hosts. Model inputs include pathogenesis parameters, and the outputs are fitness and lineage proportions within each host. Analytical solutions yielding complete displacement, partial coexistence-displacement, and complete coexistence were described. In a retrospective study, the lesion growth rate and sporulation density ofP. infestanslineages on potato and tomato from pathogenicity trials were used as inputs. Output lineage frequencies were compared with historical epidemiological situations to check model accuracy. The results showed that pathogenesis traits measured from empirical trials could simulate lineage constituents on potato and tomato, and estimate genotypic fitness with reasonable accuracy. The model also showed promise in predicting ongoing lineage displacements in the subsequent year or few years, even when the displaced lineage was still highly prevalent during the time of isolation. However, large uncertainties remain at temporal-spatial scales owing to complex meta-population dynamics in some regions and adaptation to local environmental factors. This simulation model provides a new tool for forecasting pathogen compositions, and can be used to identify potentially problematic genotypes based on pathogen life-history traits.
Pulmonary sequelae at six months in children with SARS-CoV-2 infection:A Single-Centre Study
Authors: Sharanya Pothireddy , Mishra Devendra , Agarwal Anurag , Keerthana D
Published: March 2023

Objective

Pulmonary sequelae post SARS - CoV-2 infection have been reported in adults; however, there is scant literature regarding pulmonary dysfunction following SARS-CoV-2 infection in children. We studied the long term pulmonary sequelae in children who had SARS-CoV-2 infection.

Methods

This single center descriptive study conducted in a public sector tertiary care hospital in Northern India, from June, 2020 to October, 2021. We enrolled children aged 7-18 years admitted with SARS-CoV-2 infection and followed them up for 6 months. A detailed interval history was taken and pulmonary function tests were performed after 6 months, using a spirometer. A convenience sample of 40 children was enrolled. There were 21 males and the median (IQR) age was 13 (10.75, 17) years.

Results

Thirty percent of children (n=12) had pulmonary function abnormalities, which was of restrictive pattern in all. Children who were underweight had higher odds of developing pulmonary dysfunction following SARS-CoV-2 infection [OR (95% CI) 5.13 (1.19, 22.11);P=0.028]. There were no significant association with age, sex, severity of initial infection and oxygen requirement during the initial infection. Three children had persistence of dyspnea during follow up.

Conclusion

This study is the one of the first Indian studies regarding the pulmonary sequelae in children. A possibility of long term sequelae should be considered in children with history of SARS-CoV-2, presenting with suggestive complaints.
Are There Sex Differences in Thrombectomy Utilisation in Treatment of Acute Ischaemic Stroke? A Systematic Review and meta-analysis
Authors: Baker Serena , Micallef Clayton , Mead Gillian
Published: March 2023

Objectives

Mechanical thrombectomy (MT) is a highly effective treatment for acute ischaemic stroke (AIS). Our aim was to determine whether there are differences in access to thrombectomy between men and women; this is an important question because a previous meta-analysis had shown that women were less likely than men to receive intravenous thrombolysis for AIS.

Materials

This was a systematic review and meta-analysis.

Methods

Medical databases (Embase, Medline and APA Web of Science) were searched for eligible studies from 01/01/2010-30/09/2021. Two independent authors screened titles and abstracts and scrutinised full texts. Eligible studies were hospital-based, registry-based, or administrative data studies reporting sex-specific data on patients treated with thrombectomy for AIS, in representative populations of patients with AIS. Studies including only posterior circulation strokes were excluded. Summary unadjusted odds ratios were calculated to compare MT utilisation in men and women.

Results

1,379 citations were retrieved, 76 underwent full review and 16 were included in the meta-analysis, which comprised 5,281,009 stroke cases (47.2% women, 52.8% men). The summary unadjusted OR for sex differences in thrombectomy use was 0.931 (95% CI 0.834-1.040, p=0.206), indicating women had lower odds of receiving MT though confidence intervals overlapped one. There was statistically significant heterogeneity between studies (Q=1043.13 p<0.0001, I2=98.56%).

Conclusion

We found no clear evidence that women were less likely to receive thrombectomy then men. Future studies should continue to report sex-specific data to ensure that there is equity of access to thrombectomy irrespective of sex.