bluuebunny/crossref_metadata_2025 huggingface dataset:
Online Education Improves Clinicians’ Knowledge and Competence Related to Advances in Cervical Cancer Screening [A44]
Authors: Thorpe Sara , Bahra Sukhbir
Published: June 2022

INTRODUCTION:

Women who test positive on primary screening tests for human papillomavirus (HPV) infection are triaged with Pap to determine whether a colposcopy is needed. The diagnostic variability of Paps may lead to missed diagnosis. Clinicians would benefit from education that will provide expert guidance on best-practice triage strategies for women who test HPV-positive.

METHODS:

The educational initiative consisted of an online video-based continuing medical education (CME) discussion among three experts, with synchronized slides. Intervention included pre/post study assessment, and McNemar tests (P< .05 level) determined statistical significance. Learners who improved (answered ≥1 questions correctly pre-education than post) were identified. Data are reported from 1/11/2021-10/17/2021.

RESULTS:

The analysis set consisted of obstetrician-gynecologists (ob-gyns) (n=1,086) and primary care providers (PCPs) (n=296). Pre- vs. post-education decisions demonstrated significant improvement (P<.001) in knowledge and competence related to the following for HPV positive women (pre% vs. post%): Knowledge regarding the limitations of traditional cytology methods: 20% of ob-gyns improved (36% pre, 48% post, P<.001); 21% of PCPs improved (28% pre, 41% post, P<.001). Knowledge regarding newer methodologies to triage women with abnormal screening results: 41% of ob-gyns improved (31% pre, 67% post, P<.001); 33% of PCPs improved (24% pre, 49%,P<.001). Competence related to follow-up care: 21% of ob-gyns (16% pre, 30% post, P<.001); 11% of PCPs improved (18% pre, 24% post; P<.05).

CONCLUSION:

The intervention demonstrates improvements and highlights the role of online video-based CME discussion in improving knowledge and competence related to clinicians’ ability to triage women who are HPV positive or have an abnormal Pap test. Additional gaps were identified for future education.
Linguistic Differences in Letters of Recommendation for Maternal Fetal Medicine Fellowship Applicants [A49]
Authors: Rosenthal Elise , Tappy Erryn , Pan Evelyn T. , Brown L. Steven , Wang Angela , Florian-Rodriguez Maria
Published: June 2022

INTRODUCTION:

Multiple medical specialties have previously reported on gender bias in letters of recommendation (LORs). We aimed to determine if linguistic differences exist in LORs for male and female applicants to a maternal fetal medicine (MFM) fellowship at an academic institution.

METHODS:

This was an institutional review board (IRB)-approved retrospective single-site cohort study conducted from 2019-2021. Data collected included applicant’s age, race, self-reported gender, geographic region of residency, Step 1 and 2 scores, scholarly and volunteer activities, and number of LORs. The Linguistic Inquiry and Word Count (LIWC) software, a validated text analysis program, was used to characterize LORs’ linguistic content. Multivariable analysis was used to compare letter characteristics to applicant demographics.

RESULTS:

A total of 212 applications were reviewed, including 808 LORs. Women comprised 76.9% of applicants and men 23.1%. Most applicants identified as non-Hispanic White (52.8%). Men were more likely to be international medical graduates (20% vs. 6%, P=<.01), and women reported more volunteer activities (7.1 ± 5.1 vs. 5.5 ± 4.3, P=.04). There were no significant differences in Step scores, number of research projects, or number of LORs. Multivariable analysis controlling for applicant race, Step 1 score, and gender of the letter writer revealed that letters written for males contained significantly more references to the word category cognitive processes (7.4 ± 0.2 vs. 7.1 ± 0.1, P=.046), specifically in reference to the subcategories of certainty and differentiation.

CONCLUSION:

We identified linguistic differences in LORs written for MFM applicants, suggesting potential bias in the style of writing for male and female physicians applying to this field.
Race.Culture.OBGYN: Creating a Database of Diversity, Equity, and Inclusion Resources for Obstetrics and Gynecology Residency Programs [A60]
Authors: Venkatesh Anusha , Udutha Anirudh , Dickinson Micaela , Gandy Asia , Darivemula Shilpa M.
Published: June 2022

INTRODUCTION:

Multiple studies repeatedly demonstrate that people of color suffer poorer obstetrical and gynecological outcomes in the United States. To improve physician awareness on these inequities, the American College of Obstetricians and Gynecologists released a Committee Opinion on Race and Ethnic Disparities recommending that all obstetrics and gynecology residency programs address inherent bias and systemic racism. However, competing resident educational requirements leaves limited time for a diverse diversity, equity, and inclusion (DEI) education beyond the occasional lecture. The Race.Culture.OBGYN initiative seeks to increase the frequency and quality of GME level DEI education by making it applicable to already existing didactics and clinical duties.

METHODS:

The Race.Culture.OBGYN initiative has curated a wide variety of resources for specific clinical conditions in every subspecialty in obstetrics and gynecology. The resources are curated on an open access website to allow graduate medical education (GME) programs to incorporate DEI knowledge into specific didactic lectures with ease. Our hypothesis is that residents will feel more comfortable applying DEI education to daily clinical encounters. A national survey of the current statuses of DEI education at residency programs and an evaluation of the resources on the website will be collected.

RESULTS:

The Race.Culture.OBGYN project has curated resources and has now expanded into creating a podcast series to elevate voices of resident physicians doing DEI work locally. Survey results are pending.

CONCLUSION:

By creating a single hub of condition-based resources, this project reminds us the issues are more pervasive, present in all aspects of clinical care. Through this, the initiative hopes to transform DEI education for obstetrics and gynecology residents.
Efficacy and Safety of Elagolix 150 mg QD in Women With Uterine Fibroids and Heavy Menstrual Bleeding [A87]
Authors: Kroll Robin , Poindexter Alfred , Ng Juki , Li Hong , Snabes Michael
Published: June 2022

INTRODUCTION:

Elagolix is an oral GnRH antagonist approved in combination with hormonal add back therapy (elagolix 300 mg BID+estradiol/norethindrone acetate QD) for the treatment of heavy menstrual bleeding (HMB) associated with uterine fibroids (UF) for up to 24 months (M). However, estradiol and/or norethindrone acetate may be contraindicated in some patients with UF and HMB.

METHODS:

This phase 4, randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of elagolix 150 mg QD for UF-associated HMB. Premenopausal women with UF and HMB were randomized 2:1 to elagolix 150 mg QD or placebo for 6M. Assessments included the proportion of patients with menstrual blood loss (MBL) volume less than 80mL at the final month (FM) and greater than or equal to 50% reduction in MBL volume from baseline to FM, and evaluating adverse events (AEs).

RESULTS:

Eighty-two patients were randomized (54 elagolix, 28 placebo). Elagolix 150 mg QD reduced MBL volume to less than 80mL and by greater than or equal to 50% from baseline in a clinically meaningful and statistically significantly larger proportion of patients versus placebo at FM (49.4% versus 23.3%, respectively; difference of 26.1%; P< .05). The most common AEs were headache and hot flush (13.0% and 11.1%, respectively, with elagolix; both 3.6% placebo). The safety profile was consistent with previously established elagolix 150 mg monotherapy safety.

CONCLUSION:

Elagolix 150 mg QD alone significantly reduced HMB in patients with UF after 6M of treatment with no new safety signals and may be an effective therapeutic option for patients with contraindications to estradiol and/or norethindrone acetate.
Assessment of Immune Profiles in Patients With Endometriosis and Associated Patient Outcomes [A88]
Authors: Loret de Mola J. Ricardo , Osorio Erika Gonzalez , Groesch Kathleen , Wilson Teresa , Delfino Kristin , Braundmeier-Fleming Andrea
Published: June 2022

INTRODUCTION:

Endometriosis is associated with inflammation. We characterized systemic immune populations in patients with endometriosis and identified associations between immune status and therapies (surgical intervention and/or hormonal therapy, HT) on clinical outcomes.

METHODS:

Peripheral blood was collected on the day of surgery (DOS) and ∼1-3 weeks post-surgical intervention (PSI) from consented subjects (IRB approval #14-220). Thirty-three cases (surgically confirmed endometriosis) and nine controls underwent laparoscopy with obstetrics and gynecology faculty at Southern Illinois University School of Medicine. Peripheral tolerant regulatory T-cells (Tregs) and inflammatory T-helper 17 (Th17) cells were identified via flow cytometry. Outcomes (recurrence of pain) were assessed through review of electronic health records. Categorical variables were compared by the Fisher exact test; continuous variables were compared with the Student t-test or nonparametric equivalent. Predictors of pain recurrence were assessed using Cox proportional hazards regression analyses.

RESULTS:

Compared to controls, patients with endometriosis had greater inflammation PSI (P=0.016). Patients with endometriosis who used HT had reduced inflammation compared to patients without HT (1.280 vs. 2.834, respectively; P=.028). In patients with endometriosis, risk of pain recurrence increased with greater inflammation at DOS (P =.003). Additionally, reduction of inflammation at PSI did not result in decreased risk of pain recurrence (P=.034).

CONCLUSION:

Neither surgical intervention nor HT reduced inflammation alone; yet, when used in conjunction, they reduced inflammation in endometriosis patients. Reduction of inflammation following surgical intervention was not effective at reducing the risk of pain recurrence. Thus, while interventional strategies do affect inflammatory status, inflammatory status does not predict clinical outcomes.
Lymph Node Dissection for Uterine Cancer is Associated With a Higher Incidence of Venous Thromboembolism [A112]
Authors: LeBental Alexandra
Published: June 2022

INTRODUCTION:

The objective of this study was to examine whether lymphadenectomy was associated with development of postoperative venous thromboembolic events (VTE), and ultimately to identify an area for primary prevention of VTE in patients with endometrial cancer undergoing surgical management.

METHODS:

Patients with endometrial cancer who underwent minimally invasive hysterectomy recorded in the American College of Surgeons National Surgical Quality Improvement (NSQIP) database between 2014 and 2017 were identified. Primary exposure was performance of lymphadenectomy. The primary outcome was VTE, including both deep vein thrombosis (DVT) and pulmonary embolism (PE). Associations were examined with bivariable tests and multivariable regression. Effect modification was performed using logistic regression.

RESULTS:

A total of 19,162 women with endometrial cancer who underwent minimally invasive hysterectomy between 2014 and 2017 were identified. Of these, 10,523 underwent lymphadenectomy and 8,639 did not. The odds of DVT with lymphadenectomy versus without lymphadenectomy were 2.59 (1.329-5.046). When adjusted for body mass index (BMI), cancer stage, operative time, and smoking status this remained significant at 2.473 (1.265-4.835). The odds of PE after minimally invasive surgery including lymphadenectomy versus without lymphadenectomy was 2.054 (1.281-3.464). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 1.928 (1.140-3.263).

CONCLUSION:

Lymphadenectomy is associated with increased risk of VTE in patients undergoing minimally invasive surgery for endometrial cancer. Based on this study, the number needed to treat to prevent PE is 333, and the number needed to treat for DVT is 200. The morbidity associated with VTE in patients undergoing minimally invasive surgery for endometrial cancer might be mitigated by prophylactic anticoagulation.
Get It Off Your Chest: A Narrative Review of Breast Ulcers
Authors: Shavit Eran , Alavi Afsaneh
Published: June 2022

Cutaneous breast ulcers are uncommon but important encounters in clinical practice. Myriad causes may introduce ulcers in the breast tissue. Women are more prone to breast ulcers than men because of having heavier breast fatty tissue. Thorough medical history may easily reveal the underlying etiology; however, a tissue biopsy is often required to rule out other potential causes. The clinical presentation varies based on the underlying etiology, but some clues include surgical scars for postoperative wound dehiscence or well-defined violaceous borders with undermined ulcer base in pyoderma gangrenosum. In this article, the authors divide breast cancers into two major groups: with and without underlying mass. Depending on the underlying etiology, treatment may involve topical medications; optimal wound care; systemic medications such as antibiotics, immunosuppressive medications, or biologics; surgery; or a combination of all of the above. This article aims to shed light on a less frequent anatomic location of ulcers and provide advice to clinicians to facilitate accurate diagnosis and treatment.

GENERAL PURPOSE

To provide comprehensive information about breast ulcers to facilitate accurate diagnosis and treatment of these lesions.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Differentiate common wound complications after mastectomy.

2. Identify the clinical manifestations of various types of breast ulcers.

3. Explain appropriate pharmacologic and nonpharmacologic treatment options for various types of breast ulcers.
“Turning The Tables”: A Technical Tip to Overcome Anatomic Constraints While Distal Locking During Femur Intramedullary Nailing
Authors: Mittal Samarth , Trikha Tanya , Karpe Aashraya , Vatsya Pulak , Trikha Vivek
Published: June 2022

Introduction:

Interlocking nailing for femoral shaft fractures is one of the most common surgeries by orthopedic traumatologists. With the advent of cephalon-medullary nailing, a center-center position of the head screw has become mandatory. With retroversion or reduced anteversion of neck, a center placement needs internal rotation of the nail. This makes distal locking problematic, as now making a perfect circle is difficult due to the physical constraints of C-arm rotation.

Objective:

To describe a novel technique to overcome the anatomic constraints and get a perfect circle for quick distal locking.

Material and Methods:

We used a novel technique in our routine femur nailing cases. Here, in cases with reduced anteversion of the neck, distal locking was tenuous due to difficulty in making a perfect circle. Thus, we have used a new technique called “Turning the table” where we externally rotate the table, which allows us to get a perfect circle for locking in almost a single exposure.

Results:

This is a useful technique in cases where getting a perfect circle is difficult due to anatomic constraints and variations and can help in getting a perfect circle with limited radiation exposure.
Persistent vascular dysfunction following an acute nonpharmacological reduction in blood pressure in hypertensive patients
Authors: Fermoyle Caitlin C. , Broxterman Ryan M. , La Salle D. Taylor , Ratchford Stephen M. , Hopkins Paul N. , Richardson Russell S. , Trinity Joel D.
Published: June 2022

Background:

Vascular dysfunction, an independent risk factor for cardiovascular disease, often persists in patients with hypertension, despite improvements in blood pressure control induced by antihypertensive medications.

Methods:

As some of these medications may directly affect vascular function, this study sought to comprehensively examine the impact of reducing blood pressure, by a nonpharmacological approach (5 days of sodium restriction), on vascular function in 22 hypertensive individuals (14 men/8 women, 50 ± 10 years). Following a 2-week withdrawal of antihypertensive medications, two 5-day dietary phases, liberal sodium (liberal sodium, 200 mmol/day) followed by restricted sodium (restricted sodium, 10 mmol/day), were completed. Resting blood pressure was assessed and vascular function, at both the conduit and microvascular levels, was evaluated by brachial artery flow-mediated dilation (FMD), reactive hyperemia, progressive handgrip exercise, and passive leg movement (PLM).

Results:

Despite a sodium restriction-induced fall in blood pressure (liberal sodium: 141 ± 14/85 ± 9; restricted sodium 124 ± 12/79 ± 9 mmHg, P < 0.01 for both SBP and DBP), FMD (liberal sodium: 4.6 ± 1.8%; restricted sodium: 5.1 ± 2.1%, P = 0.27), and reactive hyperemia (liberal sodium: 548 ± 201; restricted sodium: 615 ± 206 ml, P = 0.08) were not altered. Similarly, brachial artery vasodilation during handgrip exercise was not different between conditions (liberal sodium: Δ0.36 ± 0.19 mm; restricted sodium: Δ0.42 ± 0.18 mm, P = 0.16). Lastly, PLM-induced changes in peak blood flow (liberal sodium: 5.3 ± 2.5; restricted sodium: 5.8 ± 3.6 ml/min per mmHg, P = 0.30) and the total vasodilatory response [liberal sodium: 2 (0.9–2.5) vs. restricted sodium: 1.7 (1.1–2.6) ml/min per mmHg; P = 0.5] were also not different between conditions.

Conclusion:

Thus vascular dysfunction, at both the conduit and microvascular levels, persists in patients with hypertension even when blood pressure is acutely reduced by a nonpharmacological approach.
Lifestyle modification and cognitive function among individuals with resistant hypertension: cognitive outcomes from the TRIUMPH trial
Authors: Smith Patrick J. , Sherwood Andrew , Hinderliter Alan L. , Mabe Stephanie , Watkins Lana L. , Craighead Linda , Ingle Krista , Tyson Crystal , Avorgbedor Forgive , Lin Pao-Hwa , Kraus William E. , Liao Lawrence , Blumenthal James A.
Published: June 2022

Background:

Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia. Lifestyle modification has been suggested to improve cognitive function through its salutary effects on vascular function.

Methods:

Participants included 140 patients with resistant hypertension participating in the TRIUMPH trial. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA). Participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. Biomarkers of vascular [flow mediated dilation of the brachial artery (FMD)], microvascular, and cerebrovascular function were also collected, in addition to weight, fitness, and ambulatory blood pressure.

Results:

Participants averaged 63 years of age, 48% women, 59% black, and obese [mean BMI = 36 kg/m2 (SD = 4)]. Cognitive performance improved across the entire cohort during the 4-month trial [t-scores pretreatment = 48.9 (48, 50) vs. posttreatment = 50.0 (49, 51), P < 0.001]. Postintervention Executive Function/Learning composite performance was higher for participants in C-LIFE compared to SEPA (d = 0.37, P = 0.039). C-LIFE intervention effects on Memory and Processing Speed were moderated by sex and baseline stroke risk, respectively (P = 0.026 and P = 0.043 for interactions), such that males and participants with greater stroke risk showed the greatest cognitive changes. FMD [C-LIFE: +0.3% (−0.3, 1.0) vs. SEPA: −1.4% (−2.5, −0.3), P = 0.022], and microvascular function [C-LIFE: 97 (65, 130) vs. SEPA: 025 (−75, 23), P < 0.001] were improved in C-LIFE compared with SEPA, whereas cerebrovascular reactivity was not [C-LIFE: −0.2 (−0.4, 0) vs. SEPA: 0.1 (−0.2, 0.4), P = 0.197). Mediation analyses suggested that increased executive function/learning was associated with reduced ambulatory SBP levels secondary to weight loss [indirect effect: B = 0.25 (0.03, 0.71)].

Conclusion:

Lifestyle modification individuals with resistant hypertension improves cognition, which appeared to be associated with reduced ambulatory SBP changes through weight loss. Cognitive improvements were accompanied by parallel improvements in endothelial and microvascular function.
CHOROIDAL AMYLOID DEPOSITION
Authors: Mano Fukutaro , Yonekawa Yoshihiro , Kakihara Shinji , Fortun Jorge , Borrelli Enrico , Bandello Francesco , Murata Toshinori , Kusaka Shunji , Dispenzieri Angela , Pulido Jose S.
Published: June 2022

Purpose:

To characterize choroidal amyloid angiopathy (CAA) using late-phase indocyanine green angiography (ICGA).

Methods:

This was a multicenter retrospective observational case series on patients with transthyretin (ATTR) and AL amyloidosis who underwent ICGA. The timing of hyperfluorescence and longitudinal changes were analyzed.

Results:

Thirty-two patients (27 with ATTR and 5 with AL) with mean age of 58.9 ± 17.4 years were included. Hyperfluorescent spots in the very late phases of ICGA, corresponding to CAA, were observed in 49 of 55 eyes (89%). The median time to maximal staining was 672 (95% confidence interval, 644–752) seconds, which was significantly later than the initial staining (503 [95% confidence interval, 447–521], P < 0.0001; Wilcoxon signed rank test). In seven patients with ATTR amyloidosis who underwent follow-up of ICGA, the CAA was stable in two patients and improved in five patients during treatment. However, 3 patients (43%) had worsening vitreous opacities in both eyes, and 4 patients (57%) developed secondary open-angle glaucoma.

Conclusion:

Most patients with amyloidosis were found to have CAA on ICGA. Up to 12.5 minutes is required for maximal ICG staining. Choroidal amyloid angiopathy improved in most patients with systemic treatment and may serve as a marker of systemic disease status.
Clinical Profile and Treatment Outcomes of Patients With Acremonium Species Positive Keratitis Managed in a Tertiary Eye Care Center
Authors: Maharana Prafulla K. , Saluja Gunjan , Nair Sridevi , Vijay Rahul P. , Nagpal Ritu , Hussain Nishat , Sinha Rajesh , Agarwal Tushar , Sharma Namrata , Titiyal Jeewan S.
Published: June 2022

Purpose:

To report the clinical profile and treatment outcomes of patients with culture-positive Acremonium keratitis.

Methods:

This is a retrospective observational study. Medical records of all patients treated in a tertiary eye hospital for culture positive infective keratitis from March 2016 to February 2021 were screened, of which those positive for Acremonium species on fungal culture were reviewed. Demographic details, clinical presentation, clinical course, treatment given, total follow-up duration, time taken for ulcer to heal, scar size, and final visual acuity in the last follow-up were recorded.

Results:

Fifty three cases of fungal keratitis caused by Acremonium species were identified, 22 females and 31 males, with average age of 46.39±18.64 years. The mean duration of symptoms being 54.47±50 days. Only five patients had a history of trauma with vegetative matter. Clinical presentation of patients showed a large number of variations, with 2 patients presenting as peripheral ulcerative keratitis and 1 with epithelial plaque. The mean visual acuity of patients at presentation was 2.43±0.46 logMAR units. Thirty-three of 53 patients presented with perforated corneal ulcer and underwent penetrating keratoplasty; 20 patients were medically managed on topical voriconazole 1%, natamycin 5%, and oral voriconazole. The mean duration of healing of epithelial defect was 95±60.62 days (range 60–165 days).

Conclusion:

Acremonium keratitis has a long and indolent course. A prolonged combination therapy of natamycin and voriconazole seems to be effective in the management. A delay in the diagnosis of Acremonium keratitis often leads to clinical worsening requiring keratoplasty.
Invasive Group B Streptococcal Disease In Childhood
Authors: Edwards Morven S. , Rench Marcia A. , Baker Carol J.
Published: June 2022

Invasive group B streptococcal disease in childhood is uncommon and occupies a unique clinical niche. We present 10 children, 1–17 years of age, with invasive group B streptococcal disease from 2010 to 2020. Seven had conditions predisposing to infection and 3 had no identifiable risk factors. With appropriate consideration of pathogenesis, source control, and treatment, all children recovered.
Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated With Varicella Infection in Children
Authors: Li Wen , Teng Shu , Zhao Shi-Yong , Qi Zheng-Hong
Published: June 2022

A 9-year-old girl with remarkable hyponatremia was diagnosed with SIADH that was likely secondary to varicella. Under appropriate treatment, her serum sodium returned to the normal level. There was no evidence of hyponatremia at a 3-month follow-up. We propose that medical professionals need to consider the existence of that SIADH when treating patients with varicella who present with severe hyponatremia.
Dermal Melanocytosis
Authors: Gomez Jason , Admani Shehla
Published: June 2022

Dermal melanocytosis includes a spectrum of benign diseases, including congenital dermal melanocytosis, nevus of Ota, and nevus of Ito. Congenital dermal melanocytosis is blue–gray pigmentation typically on the lumbar or sacral regions. Affected areas outside the lumbar or sacral region are less likely to fade with time. Nevus of Ota is usually a unilateral blue–gray pigmentation change of the face in the distribution of the first and second divisions of the trigeminal nerve. It persists lifelong and can be complicated by ocular melanoma. Nevus of Ito is similar to Nevus of Ota in that it persists lifelong but differs in its location. Nevus of Ito primarily affects the supraclavicular, deltoid, or scapular regions. In select cases, dermal melanocytosis can be treated with cosmetic cover-ups and lasers that target melanin.
A Mixed-Methods Study of Risk Factors and Experiences of Health Care Workers Tested for the Novel Coronavirus in Canada
Authors: Okpani Arnold Ikedichi , Barker Stephen , Lockhart Karen , Grant Jennifer , Delgado-Ron Jorge Andrés , Zungu Muzimkhulu , Naicker Nisha , Ehrlich Rodney , Yassi Annalee
Published: June 2022

Objective

The aims of this study were to investigate occupational and non–work-related risk factors of coronavirus disease 2019 among health care workers (HCWs) in Vancouver Coastal Health, British Columbia, Canada, and to examine how HCWs described their experiences.

Methods

This was a matched case-control study using data from online and phone questionnaires with optional open-ended questions completed by HCWs who sought severe acute respiratory syndrome coronavirus 2 testing between March 2020 and March 2021. Conditional logistic regression and thematic analysis were utilized.

Results

Providing direct care to coronavirus disease 2019 patients during the intermediate cohort period (adjusted odds ratio, 1.90; 95% confidence interval, 1.04 to 3.46) and community exposure to a known case in the late cohort period (adjusted odds ratio, 3.595%; confidence interval, 1.86 to 6.83) were associated with higher infection odds. Suboptimal communication, mental stress, and situations perceived as unsafe were common sources of dissatisfaction.

Conclusions

Varying levels of risk between occupational groups call for wider targeting of infection prevention measures. Strategies for mitigating community exposure and supporting HCW resilience are required.
Revisiting the relationship between (Pro)Renin receptor and the intrarenal RAS: focus on the soluble receptor
Authors: Yang Tianxin
Published: June 2022

Purpose of review

The (pro)renin receptor (PRR), also termed as ATPase H+ transporting accessory protein 2 (ATP6AP2), was originally cloned as a specific receptor for prorenin and renin [together called (pro)renin]. Given the wide tissue distribution of PRR, PRR was further postulated to act as a regulator of tissue renin. However, assigning a physiological role of PRR within the renin-angiotensin system (RAS) has been challenging largely due to its pleotropic functions in regulation of embryogenesis, autophagy, and H+ transport. The current review will summarize recent advances in understanding the roles of sPPR within the intrarenal RAS as well as those outside this local system.

Recent findings

Site-1 protease (S1P) is a predominant source of sPPR at least in the kidney. So far most of the known physiological functions of PRR including renal handling of electrolytes and fluid and blood pressure are mediated by sPRR. In particular, sPRR serves as a positive regulator of collecting duct renin to activate the intrarenal RAS during water deprivation or angiotensin-II (AngII) infusion. However, PRR/sPRR can act in renin-independent manner under other circumstances.

S1P-derived sPRR has emerged as a key regulator of kidney function and blood pressure and its relationship with the intrarenal RAS depends on the physiological context.
Enhanced Federal Collaborations in Implementation Science and Research of HIV Prevention and Treatment
Authors: Purcell David W. , Namkung Lee Ann , Dempsey Antigone , Gordon Christopher
Published: June 2022

Over the past decade, national initiatives in the United States (U.S.) have focused HIV prevention and care programs and research to optimize the delivery of HIV prevention and treatment through implementation research. Although existing biomedical and behavioral prevention tools could end HIV in the U.S., the implementation of these tools has been uneven because of many factors, including organizational capacity, insufficient uptake by key populations, lack of success with prioritizing by geography or population growth, and inadequate scaling. To address these challenges, the federal government has funded programs, research, and evaluation projects aimed at improving health outcomes among people with HIV and people vulnerable to HIV acquisition. Increasingly, several special federal efforts are being conducted under the umbrella of “implementation science and research” that are essential components to scaling up evidence-based HIV prevention and treatment interventions in the U.S. This paper describes federal collaborations that have supported this increased focus on implementation from the perspective of 3 agencies in the U.S. Department of Health and Human Services; the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration. These federal collaborations have resulted in improved communication and coordination of efforts in the shaping and alignment of priorities in research and service delivery, increased implementation research conducted in real-world community and clinical settings and provided a feedback loop to expedite action in response to emerging evidence from such projects.
Acceptability and Appropriateness of Digital PrEP Interventions for Black and Latina Cisgender Women: Perspectives From Service Providers in Los Angeles County
Authors: Üsküp Dilara K. , Nieto Omar , Rosenberg-Carlson Elena , Lee Sung-Jae , Milburn Norweeta G. , Brooks Ronald A.
Published: June 2022

Background:

Black and Latina cisgender women (BLCW) experience disproportionately high rates of HIV infection compared with White women. BLCW also experience disparities in uptake of pre-exposure prophylaxis (PrEP), a highly effective HIV prevention strategy. Digital technology interventions may help to improve PrEP accessibility among BLCW and address barriers to receiving PrEP services in clinical settings.

Methods:

We conducted a formative implementation research project with service providers to explore the use of digital technology interventions to improve PrEP care continuum outcomes among priority populations in Los Angeles County. A thematic analysis approach was then used to assess the perceived acceptability and appropriateness of digital PrEP interventions for BLCW.

Results:

Of the five technology products presented, service providers viewed the stand-alone telemedicine platforms as the most acceptable intervention type for BLCW. Service providers also noted perceived benefits and barriers that BLCW may experience in using stand-alone telemedicine platforms, and offered recommendations for tailoring the products to meet the individual needs of BLCW.

Conclusions:

Digital PrEP interventions may help address barriers BLCW experience in accessing PrEP in clinical settings. We offer suggestions of implementation strategies to optimize the use of digital PrEP interventions among BLCW.
Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White–Funded Clinics in Chicago
Authors: Stump Tammy K. , Ethier Kristen , Hirschhorn Lisa R. , Dakin Andrea , Bouacha Nora , Freeman Angela , Bannon Jacqueline , Gómez Walter , Moskowitz Judith T. , Bouris Alida
Published: June 2022

Background:

To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation.

Setting:

Sixteen Chicagoland area Ryan White Medical Case Management sites.

Methods:

We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis.

Results:

On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80–3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71–3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09–3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation.

Conclusions:

Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).
The Setting-Intervention Fit of Nine Evidence-Based Interventions for Substance Use Disorders Within HIV Service Organizations Across the United States: Results of a National Stakeholder-Engaged Real-Time Delphi Study
Authors: Garner Bryan R. , Knudsen Hannah K. , Zulkiewicz Brittany A. , Tueller Stephen J. , Gotham Heather J. , Martin Erika G. , Donohoe Tom , Toro Alyssa K. , Loyd Katie , Gordon Theodore
Published: June 2022

Background:

Given substance use disorders (SUDs) among people with HIV are highly prevalent, integrating SUD services within HIV service settings is needed to help end the HIV epidemic. In this study, we assessed the setting-intervention fit (SIF) of 9 evidence-based SUD interventions: acamprosate, disulfiram, oral naltrexone, injectable naltrexone, oral buprenorphine, injectable buprenorphine, contingency management, motivational interviewing, and cognitive behavioral therapy (CBT).

Setting:

Clinical and nonclinical HIV service organizations (HSOs) in the United States.

Methods:

In May 2020, a stakeholder-engaged real-time Delphi was completed with 202 HSOs. HSO respondents rated the extent to which each SUD intervention was fundable, implementable, retainable, sustainable, scalable, and timely for their HSO, and these 6 items were summed into an SIF score (possible range of 0–18).

Results:

Motivational interviewing had the highest average SIF score (11.42), with SIF scores above the midpoint (9.5) for clinical (11.51) and nonclinical HSOs (11.36). For nonclinical HSOs, none of the other interventions were above the midpoint. For clinical HSOs, the average SIF scores were above the midpoint for CBT (10.97) and oral buprenorphine (9.51). Multivariate regression analyses, which controlled for characteristics of the HSO respondent, revealed geographic region of the United States and whether the HSO currently offered any substance use services as 2 of the best predictors of SIF scores.

Conclusions:

Notwithstanding the need to improve the SIF for the other evidence-based SUD interventions, motivational interviewing, CBT, and oral buprenorphine are currently the evidence-based SUD interventions with greatest perceived fit for integration within HSOs in the United States.
A Comparison of Handheld Doppler and Indocyanine Green Angiography for Perforator Localization
Authors: Han Tinglu , Khavanin Nima , Zhu Shan , Zang Mengqing , Chen Bo , Li Shanshan , Wu Jinlin , Liu Yuanbo
Published: June 2022

Background

The preoperative identification of perforators is critical to the success of perforator flaps. Several technologies, including handheld Doppler (HHD) and indocyanine green angiography (ICGA), facilitate this process; however, each technology comes with unique downsides. This study directly compares the performance of HHD and ICGA in preoperative perforator identification and measures the effects of flap thickness and body mass index (BMI) on perforator localization.

Method

Data from preoperative HHD and ICGA assessments were compared with the criterion standard of intraoperative perforator localization. Sensitivity, specificity, accuracy, and positive predictive values were calculated for both and correlated with flap thickness and BMI.

Results

Thirty flaps were transferred in 30 patients across 15 different donor sites. Indocyanine green angiography had higher sensitivity, accuracy, and positive predictive value (79.2%, 74.2%, and 87.5%, respectively) than HHD (55.6%, 46.6%, and 69.4%, respectively). Perforators detected by ICGA were used as flap pedicles in 21 cases compared with 13 with HHD. There were no correlations between HHD or ICGA performance and patient BMI (both P > 0.05). Increasing flap thickness was negatively correlated with the accuracy of ICGA (P = 0.001) but not HHD (P > 0.05).

Conclusions

Indocyanine green angiography was more sensitive, specific, and accurate than HHD in identifying perforators across various donor sites; however, its performance suffered in thicker flaps, whereas HHD did not. Patient BMI was not correlated with the performance of either technology. Additional research can further delineate the interrelationships of flap thickness and technologies for perforator localization.
Treatment Strategies for Acute Seymour Fractures in Children and Adolescents
Authors: Cha Soo Min , Lin Yu-Te
Published: June 2022

Purpose

We aimed to suggest treatment strategies for Seymour fractures (SFs) with varying clinical manifestations, based on the retrospective outcomes of patients seen at our institute.

Methods

Between March 2000 and December 2019, a total of 26 SF patients were categorized into 3 groups: acute typical SF (category 1; open fracture/exposed germinal matrix and physis), acute injuries but delayed presentation (category 2; presented to our institute more than 24 hours after the injury with misdiagnosis as simple nail injuries), and direct crush injuries (category 3; the most severe injury type, characterized by nail loss, nail bed lacerations, or maceration of the germinal matrix). In category 1, reduction was maintained using K-wire fixation without nail plate sutures. In 2, massive irrigation/debridement was followed by reduction and nail plate suturing without K-wire fixation. Finally, in 3, nail bed repair, reinsertion of the extracted nail plate after creating a penetration hole for drainage, K-wire fixation, and nail plate suturing were sequentially performed.

Results

The mean age of the patients was 8.92 years. At the final follow-up, the mean dorsal angulation was 1.73 degrees, and the length ratio was 97.88%; no significant differences were observed compared with the contralateral normal side (P = 0.498 and P = 0.341, respectively). The final visual analog scale pain score; the Disabilities of the Arm, Shoulder, and Hand score; and the active range of motion ratio were 0.50, 1.52, and 96.92%, respectively. There were no significant complications requiring revision surgery. Although the overall outcomes were satisfactory, category 3 patients had slightly worse visual analog scale pain scores; Disabilities of the Arm, Shoulder, and Hand scores; and range of motion compared with those in the other categories (P = 0.003, P = 0.002, and P < 0.001, respectively).

Conclusions

Satisfactory clinical outcomes were obtained by applying different surgical treatments to the different SF categories. We have suggested appropriate treatment strategies for acute SF varying in severity.
Gliomas of the Optic Nerve: A SEER-Based Epidemiologic Study
Authors: Dihowm Fatma , Alvarado Luis A. , Margo Curtis E.
Published: June 2022

Background:

To determine whether patients with biopsy-confirmed optic nerve glioma differ in clinical features and outcomes from those diagnosed by neuroradiologic imaging alone.

Methods:

Retrospective comparative analysis. Pilocytic astrocytomas (PAs) and gliomas of the optic nerve were identified through ICD-O codes in the Surveillance, Epidemiology, and End Results (SEER) cancer registry from 1975 through 2017. Demographics, clinical features, and outcomes were compared according to the method of diagnosis (biopsy-confirmed and radiologic only) and by age (birth through 19 years and 20 years of age and older). Differences in proportions were tested with the chi-square test. Associations with tumor-related death were evaluated with logistic regression. Statistical significance: α < 0.01.

Results:

Over 42 years, 313 PAs and 720 gliomas of the optic nerve were identified. The young age distributions were similar between the 2 groups. PAs were biopsied more often than gliomas (54% vs 13.2% [P < 0.001]). Tumor-attributable death occurred more often among PAs and gliomas that were biopsied than those that were not (7.1% vs 0.7% [P < 0.01]; 7.4% vs 1.1% [P < 0.01], respectively). Roughly 15% of both PAs and gliomas were diagnosed in persons 20 years and older.

Conclusions:

Biopsy-confirmed cases of PA and glioma of the optic nerve were associated with more therapeutic interventions and worse outcomes compared with patients who were diagnosed radiologically. Clinical variables relevant to clinical decision-making not captured by SEER likely explain the inability to meaningfully interpret outcome from the registry database. Cancer registries should avoid coding specific histopathologic diagnoses when tissue is not obtained.
Postpartum Depression in Surgeons and Workplace Support for Obstetric and Neonatal Complication: Results of a National Study of US Surgeons
Authors: Castillo-Angeles Manuel , Atkinson Rachel B , Easter Sarah Rae , Gosain Ankush , Hu Yue-Yung , Cooper Zara , Kim Eugene S , Fromson John A , Rangel Erika L
Published: June 2022

BACKGROUND:

Postpartum depression has well-established long-term adverse effects on maternal and infant health. Surgeons with rigorous operative schedules are at higher risk of obstetric complications, but they rarely reduce their workload during pregnancy. We evaluated whether lack of workplace support for work reductions during difficult pregnancies or after neonatal complications is associated with surgeon postpartum depression.

STUDY DESIGN:

An electronic survey was sent to practicing and resident surgeons of both sexes in the US. Female surgeons who had at least one live birth were included. Lack of workplace support was defined as: (1) disagreeing that colleagues/leadership were supportive of obstetric-mandated bedrest or time off to care for an infant in the neonatal intensive care unit; (2) feeling unable to reduce clinical duties during pregnancy despite health concerns or to care for an infant in the neonatal intensive care unit. Multivariate logistic regression was used to determine the association of lack of workplace support with postpartum depression.

RESULTS:

Six hundred ninety-two surgeons were included. The 441 (63.7%) respondents who perceived a lack of workplace support had a higher risk of postpartum depression than those who did not perceive a lack of workplace support (odds ratio 2.21, 95% CI 1.09 to 4.46), controlling for age, race, career stage, and pregnancy/neonatal complications. Of the surgeons with obstetric-related work restrictions, 22.6% experienced loss of income and 38.5% reported >$50,000 loss.

CONCLUSION:

Lack of workplace support for surgeons with obstetric or neonatal health concerns is associated with a higher risk of postpartum depression. Institutional policies must address the needs of surgeons facing difficult pregnancies to improve mental health outcomes and promote career longevity.
Multidisciplinary Project to Prevent Postoperative Urinary Tract Infection
Authors: Wilson Spencer B , Shaikh Shamsh P , Rosenkranz Pam , Rush Ingrid , Kandadai Padma , Wang David S , McAneny David
Published: June 2022

BACKGROUND:

Postoperative urinary tract infections (UTIs) are associated with increased lengths of stay, inpatient costs, and mortality. Review of institutional data from the American College of Surgeons (ACS) NSQIP revealed opportunities to improve practices with respect to urinary catheter (Foley) insertion, catheter care, adherence to diagnosis and prevention protocols, and ACS NSQIP reporting.

STUDY DESIGN:

A multidisciplinary quality improvement team convened and implemented interventions based on a literature review and analysis of institutional drivers of postoperative UTI. The team educated the ACS NSQIP surgical clinical reviewers and clinical teams about UTI diagnostic criteria and prevention, trained staff in proper catheterization technique, and provided performance feedback. The team also developed kits with supplies and instructions for patients who were discharged home with catheters, along with an instructional video. The investigators evaluated project effectiveness by comparing pre- and postintervention process measures and rates of postoperative UTI.

RESULTS:

After interventions, compliance rates improved for hand hygiene (62% to 83%, p = 0.04), precleansing of the periurethral area (66% to 97%, p = 0.001), and catheter positioning (41% to 93%, p < 0.001), and the composite performance (10% to 73%, p < 0.001). Surgery residents’ scores on a UTI knowledge assessment improved from 71% to 81% (p = 0.005). The majority of residents and staff strongly agreed that the training sessions would change their practice (57% and 69%, respectively). The unadjusted rate of postoperative UTIs at our institution decreased from 1.55% to 0.69% (p = 0.016), corresponding to an improvement in the ACS NSQIP odds ratio from 1.51 to 0.86.

CONCLUSIONS:

A series of interventions, including provider training, patient education, and audits of practice with performance feedback, are associated with improvements in both practice and the incidence of postoperative UTI.