bluuebunny/crossref_metadata_2025 huggingface dataset:
Integration of Person-Centered Narratives Into the Electronic Health Record
Authors: Coats Heather , Shive Nadia , Doorenbos Ardith Z. , Schmiege Sarah J.
Published: August 2020

Background

Incorporating a patient’s personal narrative into the electronic health record is an opportunity to more fully integrate the patient’s values and beliefs into care, thus creating opportunities to deliver high-quality/high-value, person-centered care.

Objectives

The aim of the study was to present a study protocol of a narrative intervention to (a) compare the effects of the narrative intervention to usual care on primary outcome of person’s (patient) perceptions of quality of communication, (b) compare the effects of the narrative intervention on secondary outcomes of biopsychosocial well-being, and (c) examine the feasibility and acceptability of the narrative intervention from the perspective of both persons: the patient and the acute care bedside nurse.

Methods

A randomized control trial is being conducted with a targeted enrollment of 80 patient participants and 80 nurse participants. The patient participants include individuals who are admitted to the acute care hospital for either heart failure or end-stage renal disease. An acute care beside nurse who has cared for the patient participant is also enrolled. Through a 1:1 random allocation scheme, stratified by illness, we will enroll 40 in the narrative intervention group and 40 in the usual care group. Patient participants will be assessed for patient-reported outcomes of patient’s perception of quality of communication and biopsychosocial well-being.

Results

The study began in October 2019; 53 potential patient participants have been approached, 21 have enrolled, and 20 have completed the data collection process.

Discussion

The testing and integration of a person-centered narrative into the electronic health record is a novel approach to provide opportunities for improvement in communication between patients and nurses. The results from this study will provide important preliminary knowledge to inform future randomized clinical trials of narrative interventions leading to advances in how to best provide high-value, high-quality, person-centered care for persons living with serious illness.
Technology Utilization in Fall Prevention
Authors: Oh-Park Mooyeon , Doan Thao , Dohle Carolin , Vermiglio-Kohn Valerie , Abdou Andrew
Published: August 2020

Falls, defined as unplanned descents to the floor with or without injury to an individual, remain to be one of the most challenging health conditions. Fall rate is a key quality metric of acute care hospitals, rehabilitation settings, and long-term care facilities. Fall prevention policies with proper implementation have been the focus of surveys by regulatory bodies, including The Joint Commission and the Centers for Medicare and Medicaid Services, for all healthcare settings. Since October 2008, the Centers for Medicare and Medicaid Services has stopped reimbursing hospitals for the costs related to patient falls, shifting the accountability for fall prevention to the healthcare providers. Research shows that almost one-third of falls can be prevented and extensive fall prevention interventions exist. Recently, technology-based applications have been introduced in healthcare to obtain superior patient care outcomes and experience via efficiency, access, and reliability. Several areas in fall prevention deploy technology, including predictive and prescriptive analytics using big data, video monitoring and alarm technology, wearable sensors, exergame and virtual reality, robotics in home environment assessment, and personal coaching. This review discusses an overview of these technology-based applications in various settings, focusing on the outcomes of fall reductions, cost, and other benefits.
Medical Error Disclosure: Developing Evidence-Based Guidelines for Chinese Hospitals
Authors: Gu Xiuzhu , Deng Mingming
Published: August 2020

Objectives

This study aims to investigate Chinese individuals’ expectations regarding the disclosure of errors that vary in level of harm severity and to develop guidelines for error disclosure.

Methods

A total of 947 valid responses were collected from a questionnaire survey in 2019, and 220 respondents or their family members had experienced medical errors. The respondents were required to indicate their preferences regarding the disclosure of errors that entail moderate and severe harm. Based on their responses and interviews conducted with several patient safety managers, guidelines for medical error disclosure were developed.

Results

Similar preferences were reported for the disclosure of errors that entail moderate and severe harm. They expected a formal disclosure. Furthermore, they wished to be informed about the error through face-to-face communication in a meeting room immediately after error detection. Moreover, they wanted to be provided with all details about the incident. The health care provider who was involved in the incident, the leader of his/her department/team, the patient safety manager, and top management member were expected to attend the meeting. However, there was a significant difference in who was expected to disclose errors that entail moderate (i.e., the health care provider involved in the incident) and severe (i.e., the leader, top management member) harm.

Conclusions

Medical error disclosure is not commonly practiced in Chinese hospitals. Therefore, the proposed guidelines could be the first step toward disclosure supporting. In addition, the present findings underscore the importance of cultural sensitivity and error severity in international error disclosure research and practice.
High Prevalence of Right Ventricular/Left Ventricular Ratio ≥1 Among Patients Undergoing Computed Tomography Pulmonary Angiography
Authors: Hadad Yitzhac , Iluz Moshe , Ziv-Baran Tomer , Shalmon Tamar , Rozenbaum Zach , Berliner Shlomo , Aviram Galit
Published: August 2020

Aim:

Increased ratio between the right and left ventricular (RV/LV) diameters ≥1 is considered an important imaging marker for risk stratification among patients diagnosed with acute pulmonary embolism (PE). Our goal was to assess the prevalence of RV/LV≥1 among consecutive patients undergoing computed tomography pulmonary angiography, and to compare the prevalence of RV/LV≥1 between patients with and without PE.

Methods:

Retrospective analysis of consecutive patients who underwent computed tomography pulmonary angiography due to clinical suspicion of PE between January 1, 2014 and December 31, 2014. The axial RV/LV diameters were measured. The prevalence of RV/LV ≥1 was compared between patients with and without PE and among PE patients, between those with central versus peripheral PE.

Results:

The final cohort included 862 patients. A total of 142 (16.5%) had PE. RV/LV ≥1 was found in 553 (64.1%) of all patients, of them in 453 (63%) patients without PE and in 100 (70.4%) patients with PE (P=0.117). On multivariate analysis, PE was not significantly associated with RV/LV ≥1 (odds ratio [OR]: 1.4; 95% confidence interval [CI]: 0.9-2.1; P=0.102). There was no significant difference in the prevalence of RV/LV ≥1 among patients with central versus peripheral PE distribution (79.5% vs. 67%, P=0.101). Older age (OR: 1.03; 95% CI: 1.02-1.04; P<0.001) and male gender (OR: 1.51; 95% CI: 1.11-2.03; P=0.008), among all patients, were significantly associated with RV/LV diameter ≥1.

Conclusion:

As RV/LV ≥1 is highly prevalent (64.1%), without a significant difference between those with and without PE, an RV/LV ≥1 might not represent the cardiac response to the acute PE event, but rather the patient’s baseline condition.
The Effect of Arterial Disease Level on Outcomes of Supervised Exercise Therapy for Intermittent Claudication
Authors: van den Houten Marijn M. L. , Jansen Sandra , van der Laan Lijckle , Vriens Patrick W. H. E. , Willigendael Edith M. , Koelemay Mark J. W. , Scheltinga Marc R. M. , Teijink Joep A. W. ,   on behalf of the ELECT Study Group
Published: August 2020

Objective:

To assess whether level of arterial obstruction determines the effectiveness of SET in patients with IC.

Background Data:

Guidelines advocate SET before invasive treatment for IC, but early revascularization remains widespread, especially in patients with aortoiliac disease.

Methods:

Patients were recruited from 10 Dutch centers between October 2017 and October 2018. Participants received SET first, followed by endovascular or open revascularization in case of insufficient effect. They were grouped according to level of stenosis (aortoiliac, femoropopliteal, multilevel, or rest group with no significant stenosis). Changes from baseline walking performance (maximal and functional walking distance on a treadmill test, 6-minute walk test) and vascular quality of life questionnaire-6 at 3 and 6 months were compared, after multivariate adjustment for possible confounders. Freedom from revascularization was estimated with Kaplan-Meier analysis.

Results:

Some 267 patients were eligible for analysis (aortoiliac n = 70, 26%; femoropopliteal n = 115, 43%; multilevel n = 69, 26%; rest n = 13, 5%). No between group differences in walking performance or vascular quality of life questionnaire-6 were found. Mean improvement in maximal walking distance after 6 months was 439 m [99% confidence interval (CI) 297–581], 466 m (99% CI 359–574), 353 m (99% CI 210–496), and 403 m (99% CI 58–749), respectively (P = 0.40). Freedom from intervention was 73.9% for aortoiliac disease and 88.6% for femoropopliteal disease (hazard ratio 2.46, 99% CI 0.96 – 6.30, P = 0.013).

Conclusions:

Short-term effectiveness of SET for IC is not determined by the location of stenosis. Although aortoiliac disease patients improved walking performance and health-related quality of life similarly compared to other arterial disease level groups, they underwent revascularization more often.
Surgical Outcome Results From SWOG S1505
Authors: Ahmad Syed A. , Duong Mai , Sohal Davendra P. S. , Gandhi Namita S. , Beg Muhammad Shaalan , Wang-Gillam Andrea , Wade James L. , Chiorean Elena Gabriela , Guthrie Katherine A. , Lowy Andrew M. , Philip Philip A. , Hochster Howard S.
Published: August 2020

Objective:

The optimal neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDA) and the impact on surgical outcomes remains unclear.

Methods:

S1505 (NCT02562716) was a randomized phase II study of perioperative chemotherapy with mFOLFIRINOX (Arm 1) or gemcitabine/nab-paclitaxel (Arm 2). Measured parameters included resection rate, margin positivity, pathologic response, and toxicity.

Results:

Between 2015 and 2018, 147 patients were randomized. Of these, 44 (30%) were deemed ineligible (43 by central review). Of the 103 eligible patients, 77 (76%) completed preoperative therapy and underwent surgery; reasons patients did not undergo surgery included toxicity related to preoperative therapy (n = 9), progression (n = 9), or other (n = 7). Of the 77, 73 (95%) underwent successful resection; 21 (29%) required vascular reconstruction, 62 (85%) had negative (R0) margins, and 24 (33%) had a complete or major pathologic response to therapy. The grade 3–5 postoperative complication rate was 16%. Of the 73 patients completing surgery, 57 (78%) started and 46 (63%) completed postoperative therapy. This study represents the first prospective trial evaluating modern systemic therapy delivered in a neoadjuvant/perioperative format for resectable PDA.

Conclusions:

We have demonstrated: (1) Based on the high percentage of enrolled, but ineligible patients, it is clear that adherence to strict definitions of resectable PDA is challenging; (2) Patients can tolerate modern systemic therapy and undergo successful surgical resection without prohibitive perioperative complications; (3) Completion of adjuvant therapy in the perioperative format is difficult; (4) Major pathologic response rate of 33% is encouraging.
Significance of Lymph Node Resection After Neoadjuvant Therapy in Pancreatic, Gastric, and Rectal Cancers
Authors: Arrington Amanda K. , O’Grady Catherine , Schaefer Kenzie , Khreiss Mohammad , Riall Taylor S.
Published: August 2020

Objective:

Gastrointestinal cancers are increasingly being treated with NAT before surgical resection. Currently, quality metrics are linked to the number of LNs resected to determine subsequent treatment and prognosis. We hypothesize that NAT decreases LN metastasis, downstages patients, and decreases overall lymph node yields (LNY) compared to initial surgical resection. With increasing use of NAT, this brings into question the validity of quality metrics.

Methods:

Gastric (stage II/III), pancreatic (stage I/II/III), and rectal cancers (stage II/III) (2010–2015) treated with surgery with/without NAT were identified in National Cancer Database. We evaluated total LNY and LN metastasis with/without NAT and clinical and pathological stage to evaluate rates of downstaging.

Results: :

A total of 7934 gastric, 15,908 pancreatic, and 21,354 rectal cancer patients were included of which 61.1%, 21.2%, and 85.7% received NAT, respectively. NAT patients were more likely to be downstaged (39.9% vs 11.1% gastric P
< 0.001, 30.6% vs 3.2% pancreatic P
< 0.001, 52.0% vs 16.3% rectal P
< 0.001), have lower LNYs (18.8 vs 19.1 gastric P = 0.239, 18.4 vs 17.5 pancreatic P
< 0.001, 15.7 vs 20.0 rectal P
< 0.001) and have N0 pathologic disease (43.6% vs 26.7% gastric P
< 0.001, 51.1% vs 30.9% pancreatic P
< 0.001, 65.9% vs 49.4% rectal P
< 0.001) when compared to initial surgical resection.

Conclusion:

NAT for gastrointestinal cancers results in overall lower LN yields, lower LN metastases, and significant downstaging of tumors. As all patients undergoing NAT receive multimodality therapy, LN yield recommendations may not be true quality metric changing.
The Increasing Financial Burden of Outpatient Elective Surgery for the Privately Insured
Authors: Billig Jessica I. , Lan Wen-Ching , Chung Kevin C. , Kuo Chang-Fu , Sears Erika D.
Published: August 2020

Objective:

To examine temporal trends of OOP expenses, total payments, facility fees, and professional fees for outpatient surgery.

Summary Background Data:

Approximately 48 million outpatient surgeries are performed annually with a limited financial understanding of these procedures. High OOP expenses may influence treatment decisions, delay care, and cause financial burden for patients.

Methods:

We conducted a retrospective cohort study of patients with employer-sponsored insurance undergoing common outpatient surgical procedures (cholecystectomy, cataract surgery, meniscectomy, muscle/tendon procedures, and joint procedures) from 2011 to 2017. Total payments for surgical encounters paid by the insurer/employer and patient OOP expenses were calculated. We used multivariable linear regression to predict total payments and OOP expenses, with costs adjusted to the 2017 US dollar.

Results:

We evaluated 5,261,295 outpatient surgeries (2011–2017). Total payments increased by 29%, with a 53% increase in facility fees and no change in professional fees. OOP expenses grew by 50%. After controlling for procedure type, procedures performed in ambulatory surgery centers conferred an additional $2019 in predicted total payments (95%CI:$2002–$2036) and $324 in OOP expenses (95%CI:$319–$328) compared to predicted cost for office-based procedures. Hospital-based procedures cost an additional $2649 in predicted total payments (95%CI:$2632–$2667) and $302 in predicted OOP expenses (95%CI:$297–$306) compared to office procedures.

Conclusion:

Increases in outpatient surgery total payments were driven primarily by facility fees and OOP expenses. OOP expenses are rising faster than total payments, highlighting the transition of costs to patients. Healthcare cost reduction policies should consider the largest areas of spending growth such as facility fees and OOP expenses to minimize the financial burden placed on patients.
Should Radiation Exposure be an Issue of Concern in Children With Multiple Trauma?
Authors: Howard Anthony , West Robert M. , Iball Gareth , Panteli Michalis , Baskshi Mantaran Singh , Pandit Hemant , Giannoudis Peter V.
Published: August 2020

Objective:

The aims of this study were 3-fold: first, establish the level of radiation exposure experienced by the pediatric trauma patients; second, model the level of risk of developing fatal carcinogenesis; and third, test whether pattern of injury was predictive of the level of exposure.

Summary Background Data:

There are certain conditions that cause children to be exposed to increased radiation, that is, scoliosis, where level of radiation exposure is known. The extent that children are exposed to radiation in the context of multiple traumas remains unclear.

Methods:

Patients below the age of 16 years and with an Injury Severity Score (ISS) ≥10, treated by a Major Trauma Center for the period January 2008 to December 2018 were identified. The following data were extracted for the year following the patient's injury: number, doses, and type of radiological examination.

The sex and age of the patient was taken into account in the calculation of the risk of developing a carcinogenesis.

Results:

The median radiation dose of the 425 patients identified in the 12 months following injury, through both CT and radiographs, was 24.3 mSv. Modeling the predictive value of pattern of injury and other relevant clinical values, ISS was proportionately predictive of cumulative dose received.

Conclusion:

A proportion of younger polytrauma patients were exposed to high levels of radiation that in turn mean an increased risk of carcinogenesis. However, the ISS, age, injury pattern, and length of hospital stay are predictive of both risks, enabling monitoring and patient advisement of the risks.
Lung Transplantation After Ex Vivo Lung Perfusion Early Outcomes From a US National Registry
Authors: Jawitz Oliver K. , Raman Vignesh , Becerra David , Doberne Julie , Choi Ashley Y. , Halpern Samantha E. , Klapper Jacob A. , Hartwig Matthew G.
Published: August 2020

Objective:

The objective of this study was to examine early lung transplant outcomes following EVLP using a large national transplant registry.

Summary of Background Data:

Lung transplantation in the United States continues to be constrained by a limited supply of donor organs. EVLP has the potential to significantly increase the available pool of donor lung allografts through the reconditioning of “marginal” organs.

Methods:

The united network for organ sharing registry was queried for all adults (age ≥18) who underwent first-time lung transplantation between March 2018 (when united network for organ sharing began collecting confirmed donor EVLP status) and June 2019. Transplants were stratified by EVLP use. The primary outcome was short-term survival and secondary outcomes included acute rejection before discharge and need for extracorpo-real membrane oxygenation support post-transplant.

Results:

A total of 3334 recipients met inclusion criteria including 155 (5%) and 3179 (95%) who did and did not receive allografts that had undergone EVLP, respectively. On unadjusted descriptive analysis, EVLP and non-EVLP cohorts had similar 180-day survival (92% vs 92%, P = 0.9). EVLP use was associated with a similar rate of acute rejection (13% vs 9%, P = 0.08) but increased rate of early extracorporeal membrane oxygenation use (12% vs 7%, P = 0.04). After adjustment, EVLP use was not associated with significantly increased mortality (adjusted hazard ratio 0.99, 95% confidence interval 0.62–1.58) or acute rejection (adjusted odds ratio 0.89, 95% confidence interval 0.40–1.97) compared to non-EVLP use.

Conclusions:

In the largest national series of EVLP lung transplant recipients, EVLP is associated with early recipient outcomes comparable to that of non-EVLP recipients with similar baseline characteristics. Longer term follow-up data is needed to further assess the impact of EVLP on post-lung transplant outcomes.
A New Surgical Technique Variant of Partial ALPPS (Tourniquet Partial-ALPPS)
Authors: Robles-Campos Ricardo , Brusadín Roberto , López-López Víctor , López-Conesa Asunción , Navarro-Barrios Álvaro , Gómez-Valles Paula , Caballero-Illanes Albert , Cayuela-Fuentes Valentín , Parrilla-Paricio Pascual
Published: August 2020

Objective:

We present a new variant of partial-ALPPS (p-ALPPS) “Tourniquet partial-ALPPS (Tp-ALPPS)”, with the aim of reducing aggressiveness during stage 1.

Summary Background Data:

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) results in liver regeneration in only 9 days. Due to its high initial morbidity and mortality, less aggressive variants were designed.

Methods:

A new surgical variant of ALPPS was designed consisting in introducing a Kelly forceps from the base of the liver, crossing the liver parenchyma through an avascular area. A 3-mm Vicryl (V152; Ethicon, Somerville, New Jersey, USA) tape is passed, and the tourniquet is then knotted. Six patients operated on by this new Tp-ALPPS surgical technique were compared to 6 patients operated on by Tourniquet ALPPS (T-ALPPS).

Results:

There were no differences in volume increase at 10 days. During stage 1, blood losses and transfusion rates tended to be lower in the Tp-ALPPS group, without statistical differences. Surgical time was shorter in the Tp-ALPPS group than in T-ALPPS (90 min versus 135 min) (p < 0.023). In stage 2, blood losses and transfusion were similar in both groups, but surgical time tended to be higher in the Tp-ALPPS group, which could be related to the surgical technique performed. There were no differences in morbidity and mortality.

Conclusions:

Tp-ALPPS achieved a similar increase in volume as T-ALPPS but with a shorter stage 1 surgical and similar morbidity and mortality.
Prolonged In-hospital Time to Appendectomy is Associated With Increased Complicated Appendicitis in Children
Authors: Kovler Mark L. , Pedroso Felipe E. , Etchill Eric W. , Vacek Jonathan , Bouchard Megan E. , Many Benjamin T. , Raval Mehul V. , Goldstein Seth D.
Published: August 2020

Objective:

To examine the association between prolonged in-hospital time to appendectomy (TTA) and the risk of complicated appendicitis.

Summary Background Data:

Historically, acute appendicitis was treated with emergency appendectomy. More recently, practice patterns have shifted to urgent appendectomy, with acceptable in-hospital delays of up to 24 hours. However, the consequences of prolonged TTA remain poorly understood. Herein, we present the largest individual analysis to date of outcomes associated with prolonged in-hospital delay before appendectomy in children.

Methods:

Data from patients who underwent appendectomy within 24 hours of hospital presentation were obtained from the American College of Surgeons Pediatric National Surgical Quality Improvement Program Procedure Targeted Appendectomy database from 2016 to 2018. Appendectomy within 16 hours of presentation was considered early, whereas those between 16 to 24 hours were defined as late. The primary outcome was operative findings of complicated appendicitis. Secondary outcomes included 30-day complications and resource utilization.

Results:

This study consisted of 18,927 patients, with 20.6% undergoing late appendectomy. The rate of complicated appendicitis was significantly higher in the late group (Early: 26.3%, Late: 30.3%, P < 0.05). Additionally, the late group had longer operative times, increased need for postoperative percutaneous drainage, antibiotics at discharge, parenteral nutrition, and an extended hospital length of stay (P < 0.05). On multivariate analysis, late appendectomy remained a predictor of complicated disease (odds ratio 1.17 [95% confidence interval, 1.08–1.27]).

Conclusions:

A significant proportion of pediatric patients with acute appendicitis experience prolonged in-hospital delays before appendectomy, which are associated with modestly increased rates of complicated appendicitis. Although this does not indicate appendectomy needs to be done emergently, prolonged in-hospital TTA should be avoided whenever possible.
Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients
Authors: Granek Leeat , Nakash Ora
Published: August 2020

Purpose of review

The aim of this study was to summarize the literature on prevalence and risk factors for suicidality in cancer patients and to document the research on oncology healthcare professionals’ strategies in identifying this risk.

Recent findings

Cancer patients exhibit increased risk of suicidality compared with the general population. Various risk factors have been identified including sociodemographic factors such as poverty, being male and elderly as well as disease-related attributes such as cancer type and stage. The literature on how healthcare professionals identify suicide risk is sparse. Ten articles were found that focused on two main themes. These included information on systematic strategies in identifying suicide risk and factors that affect healthcare professionals’ ability to identify risk in their patients.

Although there is an immense amount of literature documenting the problem of suicidality among patients, the research on how healthcare professionals identify and respond to these indications in patients is nearly nonexistent. Cancer centres should implement standardized and systematic screening of cancer patients for suicidality and research on this patient population should collect and report these data. Ongoing training and education for healthcare professionals who work in the oncology setting on how to identify and respond to suicide risk among cancer patients is urgently needed.
Morphine for the symptomatic reduction of chronic breathlessness: the case for controlled release
Authors: Currow David C. , Kochovska Slavica , Ferreira Diana , Johnson Miriam
Published: August 2020

Purpose of review

Clinicians who seek to reduce the symptomatic burden of chronic breathlessness by initiating regular low-dose morphine has the choice of immediate or sustained-release formulations – which will be better for this often frail population, and which has the more robust evidence to inform its prescription? Both formulations can be used.

Recent findings

For chronic breathlessness, three factors consistently favour the use of regular, low-dose, sustained-release morphine over immediate-release formulations:

As the evidence base expands for the symptomatic reduction of chronic breathlessness, pharmacological interventions will play a part. Using the best available evidence underpins patient-centred approaches that seek to predictably maximize the net effect.

As such, the weight of evidence in patient-centred clinical care favours the use of regular, low-dose sustained-release morphine for the symptomatic reduction of chronic breathlessness.
Thrombolysis for Central Retinal Artery Occlusion in 2020: Time Is Vision!
Authors: Dumitrascu Oana M. , Newman Nancy J. , Biousse Valérie
Published: August 2020

Background:

Acute nonarteritic central retinal artery occlusion (CRAO) is an eye stroke with poor visual prognosis and no proven effective therapies. Given advances in acute stroke care, thrombolysis in CRAO merits critical re-examination. We review the evidence for intravenous (IV) and intra-arterial (IA) tissue plasminogen activator (tPA) in CRAO management.

Evidence Acquisition:

MEDLINE, Scopus, and Cochrane online databases were systematically searched from 1960 to present, for reports of acute IV or IA therapy with alteplase or tenecteplase in nonarteritic CRAO patients. English language case reports, case series, interventional studies, or randomized controlled trials were included. The study type, age and number of subjects, the regimen administered, the time since symptoms' onset, visual outcome, and safety reports were noted.

Results:

Use of IV thrombolysis with alteplase was reported in 7 articles encompassing 111 patients, with 54% of them receiving IV tPA within 4.5 hours of symptom onset, and none developing symptomatic intracranial or ocular hemorrhage. Six studies described IA alteplase administration, with only 18 of a total of 134 patients (13.4%) treated within the first 6 hours after visual loss. The reported adverse events were minimal. Visual outcomes post-IV and IA thrombolysis were heterogeneously reported; however, most studies demonstrated benefit of the respective reperfusion therapies when administered very early. We found no reports of tenecteplase administration in CRAO.

Conclusions:

In 2020, nonarteritic CRAO patients should theoretically receive the same thrombolytic therapies, in the same time window, as patients with acute cerebral ischemia. Eye stroke and teleeye stroke code encounters must include an expert ophthalmologic evaluation to confirm the correct diagnosis and to evaluate for ocular signs that may help guide IV tPA administration or IA management. Future research should focus on developing feasible retinal penumbra imaging studies that, similar to cerebral tissue viability or perfusion imaging, can be incorporated into the thrombolysis decision-making algorithm.
Clinical Utility of a Highly Sensitive Lateral Flow Immunoassay as determined by Titer Analysis for the Detection of anti-SARS-CoV-2 Antibodies at the Point-of-Care
Authors: Haymond Amanda , Mueller Claudius , Steinberg Hannah , Hodge K. Alex , Lehman Caitlin , Lin Shih-Chao , Collini Lucia , Branscome Heather , Nguyen Tuong Vi , Rucker Sally , Panny Lauren , Flor Rafaela , Guirgus Raouf , Hoefer Richard , Lorenzin Giovanni , Petricoin Emanuel , Kashanchi Fatah , Kehn-Hall Kylene , Lanzafame Paolo , Liotta Lance , Luchini Alessandra
Published: August 2020

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), became a pandemic in early 2020. Lateral flow immunoassays for antibody testing have been viewed as a cheap and rapidly deployable method for determining previous infection with SARS-CoV-2; however, these assays have shown unacceptably low sensitivity. We report on nine lateral flow immunoassays currently available and compare their titer sensitivity in serum to a best-practice enzyme-linked immunosorbent assay (ELISA) and viral neutralization assay. For a small group of PCR-positive, we found two lateral flow immunoassay devices with titer sensitivity roughly equal to the ELISA; these devices were positive for all PCR-positive patients harboring SARS-CoV-2 neutralizing antibodies. One of these devices was deployed in Northern Italy to test its sensitivity and specificity in a real-world clinical setting. Using the device with fingerstick blood on a cohort of 27 hospitalized PCR-positive patients and seven hospitalized controls, ROC curve analysis gave AUC values of 0.7646 for IgG. For comparison, this assay was also tested with saliva from the same patient population and showed reduced discrimination between cases and controls with AUC values of 0.6841 for IgG. Furthermore, during viral neutralization testing, one patient was discovered to harbor autoantibodies to ACE2, with implications for how immune responses are profiled. We show here through a proof-of-concept study that these lateral flow devices can be as analytically sensitive as ELISAs and adopted into hospital protocols; however, additional improvements to these devices remain necessary before their clinical deployment.
Self-rated smell ability enables highly specific predictors of COVID-19 status: a case control study in Israel
Authors: Karni Noam , Klein Hadar , Asseo Kim , Benjamini Yuval , Israel Sarah , Nimri Musa , Olstein Keren , Nir-Paz Ran , Hershko Alon , Muszkat Mordechai , Niv Masha Y.
Published: August 2020

Background

Clinical diagnosis of COVID-19 poses an enormous challenge to early detection and prevention of COVID-19, which is of crucial importance for pandemic containment. Cases of COVID-19 may be hard to distinguish clinically from other acute viral diseases, resulting in an overwhelming load of laboratory screening. Sudden onset of taste and smell loss emerge as hallmark of COVID-19. The optimal ways for including these symptoms in the screening of suspected COVID-19 patients should now be established.

Methods

We performed a case-control study on patients that were PCR-tested for COVID-19 (112 positive and 112 negative participants), recruited during the first wave (March 2020 – May 2020) of COVID-19 pandemic in Israel. Patients were interviewed by phone regarding their symptoms and medical history and were asked to rate their olfactory and gustatory ability before and during their illness on a 1-10 scale. Prevalence and degrees of symptoms were calculated, and odds ratios were estimated. Symptoms-based logistic-regression classifiers were constructed and evaluated on a hold-out set.

Results

Changes in smell and taste occurred in 68% (95% CI 60%-76%) and 72% (64%-80%), of positive patients, with 24 (11-53 range) and 12 (6-23) respective odds ratios. The ability to smell was decreased by 0.5±1.5 in negatives, and by 4.5±3.6 in positives, and to taste by 0.4±1.5 and 4.9±3.8, respectively (mean ± SD). A penalized logistic regression classifier based on 5 symptoms (degree of smell change, muscle ache, lack of appetite, fever, and a negatively contributing sore throat), has 66% sensitivity, 97% specificity and an area under the ROC curve of 0.83 (AUC) on a hold-out set. A classifier based on degree of smell change only is almost as good, with 66% sensitivity, 97% specificity and 0.81 AUC. Under the assumption of 8% positives among those tested, the predictive positive value (PPV) of this classifier is 0.68 and negative predictive value (NPV) is 0.97.

Conclusions

Self-reported quantitative olfactory changes, either alone or combined with other symptoms, provide a specific and powerful tool for clinical diagnosis of COVID-19. The applicability of this tool for prioritizing COVID-19 laboratory testing is facilitated by a simple calculator presented here.
Access to HIV-prevention in female sex workers in Ukraine between 2009 and 2017: coverage, barriers and facilitators
Authors: Blumer Natasha , Pfadenhauer Lisa M. , Burns Jacob
Published: August 2020

The provision of comprehensive prevention services is vital for reducing the high burden of HIV amongst Ukrainian female sex workers (FSWs). To identify barriers and facilitators that influence access to HIV prevention amongst this population between 2009 and 2017, we developed a literature-informed conceptual framework and conducted a document analysis to identify the components of the Ukrainian prevention package (PP). Using the Integrated Bio Behavioural Surveillance Surveys, we then conducted descriptive analyses to explore PP coverage from 2009 to 2017 and the influence of factors, identified by our conceptual framework. After increasing over four years, a drop in PP coverage was observed from 2013 onwards. Being a client of a non-governmental organisation, street and highway solicitation, non-condom use, and knowledge of HIV may influence access to HIV prevention in the Ukrainian context. Future interventions should consider barriers and facilitators to HIV prevention and the multiple structural levels on which they operate.
Links between gut microbiome composition and fatty liver disease in a large population sample
Authors: Ruuskanen Matti O. , Åberg Fredrik , Männistö Ville , Havulinna Aki S. , Méric Guillaume , Liu Yang , Loomba Rohit , Vázquez-Baeza Yoshiki , Tripathi Anupriya , Valsta Liisa M. , Inouye Michael , Jousilahti Pekka , Salomaa Veikko , Jain Mohit , Knight Rob , Lahti Leo , Niiranen Teemu J.
Published: August 2020

Fatty liver disease is the most common liver disease in the world. It is characterized by a buildup of excess fat in the liver that can lead to cirrhosis and liver failure. The link between fatty liver disease and gut microbiome has been known for at least 80 years. However, this association remains mostly unstudied in the general population because of underdiagnosis and small sample sizes. To address this knowledge gap, we studied the link between the Fatty Liver Index (FLI), a well-established proxy for fatty liver disease, and gut microbiome composition in a representative, ethnically homogeneous population sample in Finland. We based our models on biometric covariates and gut microbiome compositions from shallow metagenome sequencing. Our classification models could discriminate between individuals with a high FLI (≥ 60, indicates likely liver steatosis) and low FLI (< 60) in our validation set, consisting of 30% of the data not used in model training, with an average AUC of 0.75. In addition to age and sex, our models included differences in 11 microbial groups from classClostridia, mostly belonging to ordersLachnospiralesandOscillospirales. Pathway analysis of representative genomes of the FLI-associated taxa in (NCBI)Clostridiumsubclusters IV and XIVa indicated the presence ofe.g., ethanol fermentation pathways. Through modeling the fatty liver index, our results provide with high resolution associations between gut microbiota composition and fatty liver in a large representative population cohort and support the role of endogenous ethanol producers in the development of fatty liver.
Comparative effects of viral transport medium heat inactivation upon downstream SARS-CoV-2 detection in patient samples
Authors: Thompson Jamie L , Velasco Angela Downie Ruiz , Cardall Alice , Tarbox Rebecca , Richardson Jaineeta , Clarke Gemma , Lister Michelle , Howson-Wells Hannah C , Fleming Vicki M , Khakh Manjinder , Sloan Tim , Duckworth Nichola , Walsh Sarah , Denning Chris , McClure C. Patrick , Benest Andrew V , Seedhouse Claire H
Published: August 2020

The COVID-19 pandemic, which began in 2020 is testing economic resilience and surge capacity of healthcare providers worldwide. At time of writing, positive detection of the SARS-CoV-2 virus remains the only method for diagnosing COVID-19 infection. Rapid upscaling of national SARS-CoV-2 genome testing presented challenges: 1) Unpredictable supply chains of reagents and kits for virus inactivation, RNA extraction and PCR-detection of viral genomes 2) Rapid time to result of <24 hours is required in order to facilitate timely infection control measures. We evaluated whether alternative commercially available kits provided sensitivity and accuracy of SARS-CoV-2 genome detection comparable to those used by regional National Healthcare Services (NHS), and asked if detection was altered by heat inactivation, an approach for rapid one-step viral inactivation and RNA extraction without chemicals or kits. Using purified RNA, we found the CerTest VIASURE kit to be comparable to Altona RealStar system currently in use, and further showed that both diagnostic kits performed similarly in the BioRad CFX96 and Roche LightCycler 480 II machines. Additionally, both kits were comparable to a third alternative using a combination of Quantabio qScript 1-step qRT-PCR mix and CDC-accredited N1 and N2 primer/probes when looking specifically at borderline samples. Importantly, when using the kits in an extraction-free protocol, following heat inactivation, we saw differing results, with the combined Quantabio-CDC assay showing superior accuracy and sensitivity. In particular, detection using the CDC N2 probe following the extraction-free protocol was highly correlated to results generated with the same probe following RNA extraction and reported clinically (n=127; R2=0.9259). Our results demonstrate that sample treatment can greatly affect the downstream performance of SARS-CoV-2 diagnostic kits, with varying impact depending on the kit. We also showed that one-step heat inactivation methods could reduce time from swab receipt to outcome of test result. Combined, these findings present alternatives to the protocols in use and can serve to alleviate any arising supply chain issues at different points in the workflow, whilst accelerating testing, and reducing cost and environmental impact.
A prospective study to identify rates of SARS-CoV-2 virus in the peritoneum and lower genital tract of patients having surgery
Authors: Jones Dominique , Faluyi David , Hamilton Sarah , Stylianides Nicholas , Ma Ken , Duff Sarah , Machin Nicholas , Edmondson Richard J
Published: August 2020

Introduction

The risks to surgeons of carrying out aerosol generating procedures during the COVID pandemic are unknown. To start to define these risks, in a systematic manner, we investigated the presence of SARS-CoV-2 virus in the abdominal fluid and lower genital tract of patients undergoing surgery.

Methods

We carried out a prospective cross sectional observational study of 113 patients undergoing abdominal surgery or instrumentation of the lower genital tract. We took COVID swabs from the peritoneal cavity and from the vagina from all eligible patients. Results were stratified by pre operative COVID status.

Results

In patients who were presumed COVID negative at the time of surgery SARS-CoV-2 virus RNA was detected in 0/102 peritoneal samples and 0/98 vaginal samples. Peritoneal and vaginal swabs were also negative in one patient who had a positive nasopharyngeal swab immediately prior to surgery.

Conclusions

The presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic surgery at a time when COVID19 is endemic in the population.
The relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals: A rapid scoping review
Authors: Mc Evoy David , McAloon Conor G. , Collins Áine B. , Hunt Kevin , Butler Francis , Byrne Andrew W. , Casey Miriam , Barber Ann , Griffin John , Lane Elizabeth Ann , Wall Patrick , More Simon J.
Published: August 2020

Objectives

The aim of this study was to conduct a scoping review of estimates of the relative infectiousness of asymptomatic persons infected with SARS-CoV-2 compared with symptomatic individuals.

Design

Rapid scoping review of literature available until 8thApril 2020.

Setting

International studies on the infectiousness of individuals infected with SARS-CoV-2

Participants

Studies were selected for inclusion if they defined asymptomatics as a separate cohort distinct from pre-symptomatics and if they provided a quantitative measure of the infectiousness of asymptomatics relative to symptomatics.

Primary outcome measures

The relative number of secondary cases produced by an average primary case, the relative probability of transmitting infection upon contact, and the degree of viral shedding.

Results

Very few studies reported estimates of relative infectiousness of asymptomatic compared with symptomatic individuals. Significant differences exist in the definition of infectiousness. Viral shedding studies in general show no difference in shedding levels between symptomatic and asymptomatic individuals but are likely to be impacted by insufficient statistical power. Two contact tracing studies provided estimates of 0.7 and 1.0, but differences in approach and definition preclude comparison across the two studies. Finally, two modelling studies suggest a relative infectiousness of around 0.5 but one of these was more reflective of the infectiousness of undocumented rather than asymptomatic cases. Importantly, one contact tracing study showing a very low level of infectiousness of asymptomatic was not included in the analysis at this point due difficulties interpreting the reported findings.

Conclusions

The present study highlights the need for additional studies in this area as a matter of urgency. For the purpose of epidemiological modelling, we cautiously suggest that at present, asymptomatics could be considered to have a degree of infectiousness which is about 0.40-0.70 that of symptomatics. However, it must be stressed that this suggestion comes from a very low evidence base and that estimates exist that are close to zero and close to 1.

ARTICLE SUMMARY

Strengths and limitations of this study

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Differences in the definition of infectiousness and a low number of studies estimating this parameter negate the potential to provide a pooled quantitative estimate or relative infectiousness.

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The present study highlights the need for additional studies in this area as a matter of urgency.

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Several of the studies reviewed are in pre-print stage and are not peer-reviewed.
Clinical manifestations of patients with Coronavirus Disease 2019 (COVID-19) attending at hospitals in Bangladesh
Authors: Morshed Md. Shahed , Mosabbir Abdullah Al , Chowdhury Prodipta , Ashadullah Sheikh Mohammad , Hossain Mohammad Sorowar
Published: August 2020

Bangladesh is in the rising phase of the ongoing pandemic of the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The scientific literature on clinical manifestations of COVID-19 patients from Bangladesh is scarce. This study aimed to report the sociodemographic and clinical characteristics of patients with COVID-19 in Bangladesh. We conducted a cross-sectional study at three dedicated COVID-19 hospitals. The severity of the COVID-19 cases was assessed based on the WHO interim guidance. Data were collected only from non-critical COVID-19 patients as critical patients required immediate intensive care admission making them unable to respond to the questions. A total of 103 RT-PCR confirmed non-critical COVID-19 patients were enrolled. Most of the patients (71.8%) were male. Mild, moderate and severe illness were assessed in 74.76%, 9.71% and 15.53% of patients respectively. Nearly 52.4% of patients had a co-morbidity, with hypertension being the most common (34%), followed by diabetes mellitus (21.4%) and ischemic heart disease (9.7%). Fever (78.6%), weakness (68%) and cough (44.7%) were the most common clinical manifestations. Other common symptoms included loss of appetite (37.9%), difficulty in breathing (37.9%), altered sensation of taste or smell (35.0%), headache (32%) and body ache (32%). The median time from onset of symptom to attending hospitals was 7 days (IQR 4-10). This study will help both the clinicians and epidemiologists to understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.