bluuebunny/crossref_metadata_2025 huggingface dataset:
The Acoustic Change Complex Compared to Hearing Performance in Unilaterally and Bilaterally Deaf Cochlear Implant Users
Authors: van Heteren Jan A. A. , Vonck Bernard M. D. , Stokroos Robert J. , Versnel Huib , Lammers Marc J. W.
Published: June 2022

Objectives:

Clinical measures evaluating hearing performance in cochlear implant (CI) users depend on attention and linguistic skills, which limits the evaluation of auditory perception in some patients. The acoustic change complex (ACC), a cortical auditory evoked potential to a sound change, might yield useful objective measures to assess hearing performance and could provide insight in cortical auditory processing. The aim of this study is to examine the ACC in response to frequency changes as an objective measure for hearing performance in CI users.

Design:

Thirteen bilaterally deaf and six single-sided deaf subjects were included, all having used a unilateral CI for at least 1 year. Speech perception was tested with a consonant-vowel-consonant test (+10 dB signal-to-noise ratio) and a digits-in-noise test. Frequency discrimination thresholds were measured at two reference frequencies, using a 3-interval, 2-alternative forced-choice, adaptive staircase procedure. The two reference frequencies were selected using each participant’s frequency allocation table and were centered in the frequency band of an electrode that included 500 or 2000 Hz, corresponding to the apical electrode or the middle electrode, respectively. The ACC was evoked with pure tones of the same two reference frequencies with varying frequency increases: within the frequency band of the middle or the apical electrode (+0.25 electrode step), and steps to the center frequency of the first (+1), second (+2), and third (+3) adjacent electrodes.

Results:

Reproducible ACCs were recorded in 17 out of 19 subjects. Most successful recordings were obtained with the largest frequency change (+3 electrode step). Larger frequency changes resulted in shorter N1 latencies and larger N1-P2 amplitudes. In both unilaterally and bilaterally deaf subjects, the N1 latency and N1-P2 amplitude of the CI ears correlated to speech perception as well as frequency discrimination, that is, short latencies and large amplitudes were indicative of better speech perception and better frequency discrimination. No significant differences in ACC latencies or amplitudes were found between the CI ears of the unilaterally and bilaterally deaf subjects, but the CI ears of the unilaterally deaf subjects showed substantially longer latencies and smaller amplitudes than their contralateral normal-hearing ears.

Conclusions:

The ACC latency and amplitude evoked by tone frequency changes correlate well to frequency discrimination and speech perception capabilities of CI users. For patients unable to reliably perform behavioral tasks, the ACC could be of added value in assessing hearing performance.
History of Prior Lumbar Surgery Does Not Impact Mental Health Outcomes Following Anterior Cervical Discectomy and Fusion
Authors: Geoghegan Cara E. , Jadczak Caroline N. , Jacob Kevin C. , Patel Madhav R. , Cha Elliot D.K. , Lynch Conor P. , Mohan Shruthi , Singh Kern
Published: June 2022

Study Design:

This was a retrospective cohort study.

Objective:

The objective of this study was to evaluate the impact of undergoing a prior lumbar procedure on mental health outcomes following anterior cervical discectomy and fusion.

Summary of Background Data:

Revision and reoperations are perceived as risk factors for worse mental health outcomes.

Methods:

A retrospective review of a surgical database was performed for cervical and lumbar procedures. The mental health measures used were: Short Form 12-Item Mental Composite Score (SF-12 MCS) and Patient Health Questionnaire 9 (PHQ-9). Secondary outcomes of interest were Visual Analogue Scale for neck and arm pain, Neck Disability Index, and Short Form 12-Item Physical Composite Score (SF-12 PCS). All outcomes were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Minimum clinically important difference (MCID) was calculated using established values. Patients were grouped based on the surgical history of an elective lumbar spine procedure and propensity-matched. Differences in postoperative outcome scores and MCID achievement were evaluated using linear and logistic regression respectively.

Results:

A total of 74 patients were included in this study. Mental health outcomes did not demonstrate significant differences between groups for SF-12 MCS and PHQ-9 for all time points except at 6 weeks for PHQ-9 (P=0.038). MCID achievement was not significantly impacted by surgical history for all outcome measures at all postoperative time points (all P>0.050). The majority of patients achieved an MCID by the 1-year time point for all outcomes for patients without a prior lumbar surgery except for Visual Analogue Scale arm and SF-12 PCS, while those with a surgical history achieved an MCID for all outcomes except SF-12 PCS and PHQ-9.

Conclusions:

Anterior cervical discectomy and fusion patients with a past history of lumbar surgery demonstrated significant improvements in depression, neck and arm pain, disability, and physical function as those without a past lumbar surgical history. Prior surgery also did not impact MCID achievement for all outcomes.
An Exploratory Study of Neoadjuvant Cetuximab Followed by Cetuximab and Chemoradiotherapy in Women With Newly Diagnosed Locally Advanced Cervical Cancer
Authors: Fracasso Paula M. , Duska Linda R. , Thaker Premal H. , Gao Feng , Zoberi Imran , Dehdashti Farrokh , Siegel Barry A. , Uliel Livnat , Menias Christine O. , Rehm Patrice K. , Goodner Sherry A. , Creekmore Allison N. , Lothamer Heather L. , Rader Janet S.
Published: June 2022

Objectives:

This study explored the feasibility of cetuximab with chemoradiation in women with cervical carcinoma and evaluated fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) to assess early response to cetuximab (NCT00292955).

Patients and Methods:

Eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB invasive carcinoma of the uterine cervix were treated on 1 of 3 dose levels (DL). DL1 consisted of neoadjuvant cetuximab, then concurrent radiotherapy with cetuximab 250 mg/m2/cisplatin 40 mg/m2, followed by weekly cetuximab. DL2 consisted of radiotherapy with cetuximab 200 mg/m2 and cisplatin 30 mg/m2. DL3 consisted of radiotherapy with cetuximab 250 mg/m2 and cisplatin 30 mg/m2. Patients underwent 18F-FDG-PET/CT before treatment, after neoadjuvant cetuximab, and at the end of treatment.

Results:

Of the 21 patients enrolled, 9, 3, and 9 were treated in DL1, DL2, and DL3, respectively. DL1 required dose reductions due to gastrointestinal toxicities. DL2 and 3 were tolerated with 1 dose-limiting toxicity (grade 4 renal failure) at DL3. Following 3 weekly treatments of neoadjuvant cetuximab in DL1, 7 patients had maximum standardized uptake value changes on 18F-FDG-PET/CT consistent with response to cetuximab. Of the 12 patients with locally advanced disease, eleven evaluable patients had no evidence of disease on 18F-FDG-PET/CT at treatment end. Five-year progression-free survival and overall survival rates for all patients were 57.5% and 58.5%, respectively.

Conclusions:

Cetuximab with cisplatin 30 mg/m2 and radiotherapy was tolerated. 18F-FDG-PET/CT demonstrated early evidence of response to neoadjuvant cetuximab. With advances in precision oncology and the recent approval of pembrolizumab in metastatic cervical cancer, dual-target inhibition with an epidermal growth factor receptor inhibitor may be a promising treatment in the future.
Novel Colorectal Endoscopic Submucosal Dissection With Double-Endoscope and Snare-Based Traction
Authors: Chou Chu-Kuang , Tsai Kun-Feng , Tseng Cheng-Hao , Lee Ching-Tai , Yang Kuo-Hsin , Chang Min-Chi , Hsu Chao-Wen
Published: June 2022

BACKGROUND:

Colorectal endoscopic submucosal dissection is technically demanding, and the traction offered by gravity, cap, or clip-with-line during conventional endoscopic submucosal dissection remains unsatisfactory. Robotic systems are still under development and are expensive. We proposed double-scope endoscopic submucosal dissection with strong and adjustable traction offered by snaring the lesion with additional scope.

OBJECTIVE:

This study aimed to test the novel double-scope endoscopic submucosal dissection with snare-based traction.

DESIGN:

This was a retrospective study that reviewed double-scope endoscopic submucosal dissection compared with matched conventional endoscopic submucosal dissection, and size, location, morphology, and pathology between groups were compared.

SETTINGS:

This study was conducted in a referral endoscopy center in a local hospital.

PATIENTS:

This study included patients with colorectal lesions receiving double-scope endoscopic submucosal dissection and matched conventional endoscopic submucosal dissection.

MAIN OUTCOME MEASURES:

The pathological completeness, procedure time, and complications were analyzed.

RESULTS:

Fifteen double-scope endoscopic submucosal dissection procedures, with 11 lesions located in the proximal colon with a median size of 40 mm, were performed. The median procedure time of double-scope endoscopic submucosal dissection was 32.45 (interquartile range, 16.03–38.20) minutes. The time required for second scope insertion was 2.57 (interquartile range, 0.95–6.75) minutes; for snaring, 3.03 (interquartile range, 2.12–6.62) minutes; and for actual endoscopic submucosal dissection, 28.23 (interquartile range, 7.90–37.00) minutes. All lesions were resected completely. No major complication was encountered. The procedure time was significantly shorter than that of 14 matched conventional endoscopic submucosal dissections (54.61 [interquartile range, 33.11–97.25] min; p = 0.021).

LIMITATIONS:

This was a single-center, single-operator, retrospective case-controlled study with limited cases.

CONCLUSIONS:

This study confirmed the feasibility of double-scope endoscopic submucosal dissection with snare-based traction to shorten procedure time and to simplify endoscopic submucosal dissection. Additional trials are required.
Prediction of intraoperative hypotension from the linear extrapolation of mean arterial pressure
Authors: Jacquet-Lagrèze Matthias , Larue Antoine , Guilherme Enrique , Schweizer Rémi , Portran Philippe , Ruste Martin , Gazon Mathieu , Aubrun Frédéric , Fellahi Jean-Luc
Published: June 2022

BACKGROUND

Hypotension prediction index (HPI) software is a proprietary machine learning-based algorithm used to predict intraoperative hypotension (IOH). HPI has shown superiority in predicting IOH when compared to the predictive value of changes in mean arterial pressure (ΔMAP) alone. However, the predictive value of ΔMAP alone, with no reference to the absolute level of MAP, is counterintuitive and poor at predicting IOH. A simple linear extrapolation of mean arterial pressure (LepMAP) is closer to the clinical approach.

OBJECTIVES

Our primary objective was to investigate whether LepMAP better predicts IOH than ΔMAP alone.

DESIGN

Retrospective diagnostic accuracy study.

SETTING

Two tertiary University Hospitals between May 2019 and December 2019.

PATIENTS

A total of 83 adult patients undergoing high risk non-cardiac surgery.

DATA SOURCES

Arterial pressure data were automatically extracted from the anaesthesia data collection software (one value per minute). IOH was defined as MAP < 65 mmHg.

ANALYSIS

Correlations for repeated measurements and the area under the curve (AUC) from receiver operating characteristics (ROC) were determined for the ability of LepMAP and ΔMAP to predict IOH at 1, 2 and 5 min before its occurrence (A-analysis, using the whole dataset). Data were also analysed after exclusion of MAP values between 65 and 75 mmHg (B-analysis).

RESULTS

A total of 24 318 segments of ten minutes duration were analysed. In the A-analysis, ROC AUCs to predict IOH at 1, 2 and 5 min before its occurrence by LepMAP were 0.87 (95% confidence interval, CI, 0.86 to 0.88), 0.81 (95% CI, 0.79 to 0.83) and 0.69 (95% CI, 0.66 to 0.71) and for ΔMAP alone 0.59 (95% CI, 0.57 to 0.62), 0.61 (95% CI, 0.59 to 0.64), 0.57 (95% CI, 0.54 to 0.69), respectively. In the B analysis for LepMAP these were 0.97 (95% CI, 0.9 to 0.98), 0.93 (95% CI, 0.92 to 0.95) and 0.86 (95% CI, 0.84 to 0.88), respectively, and for ΔMAP alone 0.59 (95% CI, 0.53 to 0.58), 0.56 (95% CI, 0.54 to 0.59), 0.54 (95% CI, 0.51 to 0.57), respectively. LepMAP ROC AUCs were significantly higher than ΔMAP ROC AUCs in all cases.

CONCLUSIONS

LepMAP provides reliable real-time and continuous prediction of IOH 1 and 2 min before its occurrence. LepMAP offers better discrimination than ΔMAP at 1, 2 and 5 min before its occurrence. Future studies evaluating machine learning algorithms to predict IOH should be compared with LepMAP rather than ΔMAP.
The selective 5-HT1A receptor agonist, NLX-112, overcomes tetrabenazine-induced catalepsy and depression-like behavior in the rat
Authors: Jastrzębska-Więsek Magdalena , Wesołowska Anna , Kołaczkowski Marcin , Varney Mark A. , Newman-Tancredi Adrian , Depoortere RonanY.
Published: June 2022

Tetrabenazine, a preferential inhibitor of the vesicular monoamine transporter type 2, depletes the brain monoamines dopamine, serotonin and norepinephrine. Tetrabenazine and deutetrabenazine (Austedo ®) are used to treat chorea associated with Huntington’s disease. However, both compounds are known to aggravate Parkinsonism and depression observed in Huntington’s disease patients. NLX-112 (a.k.a. befiradol/F13640) is a highly selective, potent and efficacious serotonin 5-HT1A agonist. In animal models, it has robust efficacy in combating other iatrogenic motor disorders such as L-DOPA-induced dyskinesia and has marked antidepressant-like activity in rodent tests. In the present study, we investigated, in rats, the efficacy of NLX-112 to counteract tetrabenazine-induced catalepsy (a model of Parkinsonism) and tetrabenazine-induced potentiation of immobility in the forced swim test (FST, a model to detect antidepressant-like activity). The prototypical 5-HT1A agonist, (±)8-OH-DPAT, and the 5-HT1A partial agonist/dopamine D2 receptor blocker, buspirone, were used as comparators. Both NLX-112 and (±)8-OH-DPAT (0.16–2.5 mg/kg p.o. or s.c., respectively) abolished catalepsy induced by tetrabenazine (2 mg/kg i.p.). In comparison, buspirone (0.63–5.0 mg/kg p.o.) was ineffective and even tended to potentiate tetrabenazine-induced catalepsy at 0.63 mg/kg. In the FST, NLX-112 and (±)8-OH-DPAT (0.63 mg/kg) strongly reduced immobility when administered alone but also significantly opposed potentiation of immobility induced by tetrabenazine (1.5 mg/kg i.p.). Buspirone (0.63 and 2.5 mg/kg p.o.) had no effect by itself or against tetrabenazine. These results strongly suggest that selective and highly efficacious 5-HT1A agonists, such as NLX-112, may be useful in combating tetrabenazine-induced Parkinsonism and/or depression in Huntington’s disease patients.
Genome-wide DNA methylation profile of peripheral blood lymphocytes from subjects with nonsteroidal anti-inflammatory drug-induced respiratory diseases
Authors: Lee Jong-Uk , Soo Chang Hun , Kyung Kim Min , Park Seung-lee , Kim Jung Hyun , Park Jong-Sook , Park Choon-Sik
Published: June 2022

Background

Significant changes in CpG methylation have been identified in nasal polyps, which are the main targets of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (NERD); however, these polyps are composed of various cellular components. In the present study, whole-genome CpG methylation in peripheral blood lymphocytes (PBLs) was analyzed to define the epigenetic changes in lymphocytes, which are the primary immune cells involved in NERD.

Materials and methods

Genomic DNA from peripheral blood mononuclear cells from 27 NERD and 24 aspirin-tolerant asthma (ATA) was subjected to bisulfate conversion and a methylation array. Quantitative CpG methylation, the β-values as a quantitative measure of DNA methylation, in lymphocytes were calculated after adjustments for cellular composition.

Results

Fifty-six hypermethylated and three hypomethylated differentially methylated CpGs (DMCs) in PBLs in the NERD compared with ATA. The top 10 CpG loci predicted the methylation risk score, with a positive predictive value of 91.3%, a negative predictive value of 81.5% and an accuracy of 84.3%. As demonstrated in the nasal polyps, 30 DMCs were predicted to bind to the following 10 transcription factors, ranked in descending order: AP-2alphaA, TFII-1, STAT4, FOXP3, GR, c-Est-1, E2F-1, XBP1, ENKTF-1 and NF-1. Gene ontology analysis identified 13 categories such as regulation of T-helper 17 cell differentiation, including SMAD7 and NFKBIZ. PBLs in NERD contained no DMCs in genes associated with the prostaglandin and leukotriene pathways, which were found in ATA.

Conclusion

PBLs in NERD form a unique pattern of DNA CpG methylation, and the combined analysis may provide predictive values for NERD.
Paliperidone Extended Release Versus Olanzapine in Treatment-Resistant Schizophrenia
Authors: Wang Dandan , Wei Ning , Hu Fangzhen , Li Jianhua , Wang Yucheng , Qian Zhiwei , Yang Miao , Yao Mingrong , Xia Yong , Yu Hong , Tu Wenzhen , Ye Minjie , Qian Cheng , Hu Jianbo , Chen Jingkai , Hu Chanchan , Huang Manli , Xu Yi , Hu Shaohua
Published: June 2022

Purpose

Paliperidone is an atypical antipsychotic as effective as other atypical antipsychotics for schizophrenia. However, few studies have explored the efficacy of paliperidone for treatment-resistant schizophrenia. This study aimed to compare the efficacy and safety of paliperidone extended release (ER) versus olanzapine in schizophrenia patients with either poor treatment response or intolerable adverse effects due to standardized antipsychotic therapy.

Methods

This 12-week randomized, double-blind, multicenter study compared the treatment efficacy on psychotic symptoms, cognitive functions, and tolerance between paliperidone ER (6–15 mg/d, n = 45) and olanzapine (10–30 mg/d, n = 41) in treatment-resistant or treatment-intolerant patients with schizophrenia. The severity of psychotic symptoms was evaluated by the Positive and Negative Syndrome Scale and the Clinical Global Impression Severity of Illness Scale. The cognitive functions were assessed by the MATRICS Consensus Cognitive Battery. In addition, the metabolic impacts were evaluated by weight gain and waist circumference.

Results

Patients with either paliperidone ER or olanzapine treatment showed apparent improvement in psychotic symptoms, without significant intergroup difference. Twelve-week paliperidone ER or olanzapine treatment did not improve the cognitive functions. Both paliperidone ER and olanzapine treatment caused significant increase in weight and waist circumference, and olanzapine had a greater impact on waist circumference than paliperidone ER. In addition, both drugs were well tolerated.

Conclusions

Paliperidone ER could be a safe alternative for treatment-resistant schizophrenia.
Assessing the Role of Operative Intervention in Elderly Patients With Nonfunctional Pancreatic Neuroendocrine Neoplasms
Authors: Hue Jonathan J. , Sugumar Kavin , Mohamed Amr , Selfridge J. Eva , Bajor David , Hardacre Jeffrey M. , Ammori John B. , Rothermel Luke D. , Winter Jordan M. , Ocuin Lee M.
Published: June 2022

Objectives

Resection of locoregional pancreatic neuroendocrine neoplasms (PanNENs) is typically recommended, but there is a paucity of data on the management of elderly patients.

Methods

The National Cancer Database (2004–2016) was queried for patients 80 years or older with localized PanNENs. Patients were grouped as nonoperative or operative management. Postoperative outcomes and survival were compared.

Results

In total, 591 patients were included: 202 underwent resection, and 389 did not. Increasing age and pancreatic head tumors were associated with lower likelihood of resection. The overall 90-day mortality rate was 6.4%, which was higher for pancreatoduodenectomy than distal pancreatectomy (13.6% vs 5.1%, respectively). Operatively managed patients had longer median survival (80.8 vs 45.0 months, P < 0.001), and this association was independent of tumor location. On multivariable Cox regression, resection remained associated with longer survival (hazard ratio, 0.69; 95% confidence interval, 0.50–0.95). Among operatively managed patients, age and tumor location were not associated with survival; however, greater comorbidity and high-risk tumor-specific features were associated with worse survival.

Conclusions

Resection of nonfunctional PanNENs in elderly patients is associated with improved survival compared with nonoperative management. Resection could be considered in appropriate operative candidates, regardless of tumor location, but the perioperative mortality rate must be considered.
Splanchnic Vein Thrombosis
Authors: Mandal Meenakshi , Rana Surinder Singh , Kang Mandeep , Chakrabarti Arunaloke , Gupta Vikas , Kumar-M Praveen , Gupta Rajesh
Published: June 2022

Objective

Infected pancreatic necrosis (IPN) is associated with poor outcomes. The present study looked at incidence of infection and predictors, if any, in these collections.

Methods

This prospective observational study was done between July 2019 and October 2020. Symptomatic patients of acute necrotic collections and walled-off necrosis of pancreas requiring drainage were included. Necrotic fluid and blood were analyzed for growth of organisms.

Results

Sixty-two patients were included. The mean age was 36.8 years (standard deviation, 11.5 years). Male-female ratio was 4:1. Alcohol was the most common etiology. Infection was noted in 44 of the 62 patients (70.9%) and bacteremia noted in 23 of the 62 patients (37%). Escherichia coli was the most common organism in necrotic collections and Staphylococcus was the most common organism isolated from blood culture. The patients with Modified Computed Tomography–Severity Index of 8 of higher (P < 0.001) had significant association with IPN but not with bacteremia. However, splanchnic vein thrombosis (P = 0.022) was significantly associated with development of IPN as well as bacteremia on both univariate and multivariate analysis.

Conclusions

Escherichia coli and Staphylococcus were the most common organisms grown from necrotic collections and blood respectively. Presence of splanchnic vein thrombosis was a significant factor for development of IPN and bacteremia on univariate as well as multivariate analysis.
Class III β-Tubulin Expression Is of Value in Selecting nab-Paclitaxel and Gemcitabine as First-Line Therapy in Unresectable Pancreatic Cancer
Authors: Kato Akihisa , Naitoh Itaru , Naiki-Ito Aya , Hayashi Kazuki , Okumura Fumihiro , Fujita Yasuaki , Sano Hitoshi , Nishi Yuji , Miyabe Katsuyuki , Inoue Tadahisa , Hirano Atsuyuki , Takada Hiroki , Yoshida Michihiro , Hori Yasuki , Natsume Makoto , Kato Hiroyuki , Takahashi Satoru , Kataoka Hiromi
Published: June 2022

Objectives

Nab-paclitaxel and gemcitabine (GnP) or FOLFIRINOX (a combination of leucovorin, fluorouracil, irinotecan, and oxaliplatin [FFX]) is currently recognized as the standard first-line regimen for unresectable pancreatic ductal adenocarcinoma (PDAC). Class III β-tubulin (TUBB3) has the potential to predict resistance to taxane in various tumors; therefore, this study aimed to clarify whether TUBB3 is a predictive marker for GnP response.

Methods

We retrospectively reviewed 113 patients with PDAC who received GnP or FFX as first-line chemotherapy and examined immunohistochemically the TUBB3 expression in specimens obtained by endoscopic ultrasound-guided fine-needle aspiration.

Results

High TUBB3 expression was associated with a significantly lower disease control rate (P = 0.017) and shorter progression-free survival (PFS) (P = 0.019), and multivariate analysis revealed that TUBB3 expression was an independent variable for PFS in the GnP first-line group (P = 0.045). In addition, in the FFX first-line group, TUBB3 expression was not correlated with PFS or overall survival (OS). In all 113 patients, TUBB3 expression was not also associated with OS.

Conclusions

Class III β-tubulin might be a predictive factor for the response of GnP, but not a prognostic factor for OS, helping the selection of an optimized first-line chemotherapy regimen for unresectable PDAC.
Preclinical Pediatric Care by Emergency Physicians
Authors: Vetschera Anna , Beliveau Vincent , Esswein Katharina , Linzmeier Klaus , Gozzi Roland , Hohlrieder Matthias , Simma Burkhard
Published: June 2022

Objectives

Fewer than 10% of emergency medical system (EMS) calls concern children and adolescents younger than 18 years. Studies have shown that the preclinical care of children differs from that of adults regarding assessment, interventions, and monitoring. The aims of this study were to describe the preclinical care and emergency transport of pediatric patients in Vorarlberg, Austria and to compare trauma and nontrauma cases.

Methods

This is a population-based study, analyzing medical records of EMS calls to children and adolescents. We received all patient records of EMS calls to children and adolescents younger than 18 years (n = 4390 in total) from the 2 local EMS providers, the Red Cross Vorarlberg and the Austrian Mountain Rescue Service (Christophorus 8 and Gallus 1) covering a study period of 7 years, from 2013 to 2019. The record data were extracted by automation with an in-house program and subsequently anonymized. Statistical analyses were performed with SPSS Statistics.

Results

During the study period, 7.9% of all EMS calls concerned children and adolescents younger than 18 years. For our study, 3761 records were analyzed and 1270 trauma cases (33.8%) were identified. The most common injuries were injuries of the extremities and traumatic brain injury. The frequency of National Advisory Committee of Aeronautics Scores of 4 or higher was 17.7%, similar for all age groups and for trauma as well as nontrauma patients. Mean Glasgow Coma Scale scores were higher in the trauma group than in the nontrauma group (14.2 vs 11.2). In 62.9% of all patients, 1 or more vital parameters were documented. A majority of these values was in the pathologic range for the respective age group. The rate of pulsoxymetry monitoring during transport was low (42.1% in trauma and 30.3% in nontrauma patients) and decreased significantly with patient age. Moreover, while the placing of intravenous lines and monitoring during transport were significantly more frequent in trauma patients, the administration of medication or oxygen was significantly more frequent in nontrauma patients.

Conclusions

The pediatric population lacks assessments and monitoring in preclinical care, especially the youngest children and nontrauma patients, although emergency severity scores are similar.
Improving Adherence to AAP Acute Otitis Media Guidelines in an Academic Pediatrics Practice through a Quality Improvement Project
Authors: Wolf Ryan M. , Langford Kyle T. , Patterson Barron L.
Published: June 2022

Introduction:

Acute otitis media (AOM) is the most common reason for antibiotic use in children. The American Academy of Pediatrics (AAP) published its latest AOM guidelines in 2013. A safety-net antibiotic prescription (SNAP) is recommended for some patients based on age, severity, and duration of symptoms. At baseline, 78% of patients diagnosed with AOM in our general pediatrics practice met AAP guidelines, and 20% of eligible patients received a SNAP according to guidelines. We aimed to increase adherence to AAP AOM guidelines in an academic general pediatrics clinic from 78% to 90% by January 2020.

Methods:

A quality improvement team determined key drivers and developed interventions. Patients included were 6 months to 12 years old with AOM. Encounters were reviewed for adherence to AAP AOM guidelines. During the project, interventions included an ear pain note template, which generated guideline-based recommendations, note template education in clinic orientation sessions, a didactic session on AOM management, and reminders on workstations. Data were analyzed using P-charts.

Results:

Percent of AOM encounters (n = 1266) adhering to AAP AOM guidelines increased from 78% to 92%. We also reviewed two process measures. First, the use of the ear pain note template increased from 0% to 44%. Second, the percent of AOM encounters where an eligible patient received a SNAP increased from 21% to 78% (encounters n = 421).

Conclusion:

We demonstrate increased adherence to AAP AOM guidelines, including improved use of SNAPs after introducing a note template with clinical decision support and provider educational sessions.
Therapeutic Hypothermia on Transport: The Quest for Efficiency: Results of a Quality Improvement Project
Authors: Redpath Stephanie , Moore Heather , Sucha Ewa , Agarwal Amisha , Barrowman Nicholas , Lemyre Brigitte , St. Germain Louise
Published: June 2022

Introduction:

Therapeutic hypothermia (TH) within 6 hours after birth is known to improve both survival and neurodevelopmental outcomes in neonates with hypoxic ischemic encephalopathy (HIE). Meeting this recommended target temperature for neonates who require transport for TH treatment can be complex for various reasons. This study aimed to reduce the time from birth to the initiation of TH and target temperature, thereby increasing the proportion of transported neonates reaching target temperature within 6 hours to >50%.

Methods:

We evaluated the effect of three quality improvement interventions, including revised transport team processes, outreach education/resources, and the use of a servo-controlled cooling device on land transports. We compared key outcome TH metrics for cohorts before and after implementation.

Results:

The study team compared baseline data for 77 to 102 neonates born between 2009 and April 2015 (preintervention) and September 2015 and September 2020 (postintervention(s)). We observed reductions in both the time from birth to the initiation of passive cooling (38%) and time to reach target TH temperature (23%), with an increase in the proportion of neonates reaching target temperature by 6 hours of age from 50% to 71%.

Conclusions:

We used quality improvement methodology to identify key areas for intervention(s) and improvement. Targeted interventions have successfully and consistently improved the timing and delivery of TH to neonates with hypoxic ischemic encephalopathy within the transport environment, with a 20% increase in neonates reaching target temperature by 6 hours of age.
Reducing Wait Time in a High-volume Pediatric Neuro-oncology Clinic by Optimizing Process Flow: A Quality Improvement Project
Authors: Vinitsky Anna , David Barbara , Michalik Layna , Ramirez Nicole , Risinger Adam , Burlison Jonathan D. , Zanders Jacky , Mans Bridget , Heady Katie , Holdiness Joni , Qaddoumi Ibrahim , Robinson Giles W. , Moreira Daniel , Upadhyaya Santhosh A. , Gajjar Amar
Published: June 2022

Introduction:

Hospital wait time (WT) influences healthcare quality and patient satisfaction. Long WTs are distressful for patients and considered substandard healthcare delivery. Pediatric hematology/oncology patients with complex medical conditions frequently need multiple appointments in a day, making their scheduling very challenging. Here, we report a quality improvement (QI) project aimed to decrease the percentage of patients waiting >30 minutes before room placement in the neuro-oncology clinic.

Methods:

We measured WT from when the patient reported to the clinic (or, for those arriving early, from scheduled appointment) to when the patient got an exam room. We collected data by random sampling and collected baseline data over the initial 4 weeks; generated process mapping and Pareto charts to identify reasons for delayed patient placement in rooms; and used iterative Plan-Do-Study-Act (PDSA) cycles to test interventions. We used Run charts and Shewhart charts for data analysis.

Results:

Our baseline data analyses showed provider and room availability as critical reasons for delayed room placement (38.4% and 30%, respectively). We also completed related PDSA improvement cycles. The median percent of patients waiting >30 minutes decreased from 21% to 13%. The median average waiting time decreased from 21 to 11 minutes.

Conclusion:

Using structured QI methodology, we decreased the percent of patients waiting >30 minutes before room placement and overall WTs. We developed a strategy for continuous improvement and future interventions. Furthermore, our results suggest that QI projects, which account for the complexity of hospital systems, can improve patient flow throughout the hospital.
Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU
Authors: Flaherty Brian F. , Hummel Kevin , Vijayarajah Senthuran , White Benjamin R. , Outsen Shad , Larsen Gitte Y.
Published: June 2022

Introduction:

The success of quality improvement (QI) projects depends on many factors, with communication and knowledge of project-specific practice change being fundamental. This project aimed to improve the knowledge of active safety and QI projects.

Methods:

Two interventions were trialed to improve knowledge: paired email and meeting announcements followed by a daily huddle to review ongoing projects. Knowledge, measured as the ability to recall a project and its practice change, was the primary outcome. The frequency and duration of the Huddle were process and balancing measures, respectively.

Results:

Seven days after a meeting/email announcement, 3 of 13 (23%) faculty and fellows recalled the announced practice change. Investigators then tested the effects of the Huddle by assessing practitioners’ knowledge of safety and QI project-related practice changes on the first and last day of a service week. The average percentage of items recalled increased from the beginning to end of a service week by 33% [46% to 79%, 95% confidence interval (CI) 12–53] for faculty and 27% (51% to 77%, 95% CI 13–40) for fellows. The Huddle occurred in four of seven (interquartile range 2–5) days/wk with a mean duration of 4.5 (SD 2) minutes. Follow-up assessment 2 years after Huddle implementation demonstrate sustained increase in item recall [faculty +36% (95% CI +13% to 40%); fellows +35% (95% CI +23% to 47%)].

Conclusions:

A daily huddle to discuss safety and QI project-related practice change is an effective and time-efficient communication method to increase knowledge of active projects.
Improving Blood Product Transfusion Premedication Plan Documentation: A Single-institution Quality Improvement Effort
Authors: Sitthi-amorn Jitsuda , Denton Emily , Harper Erin , Carias Delia , Hashmi Saman , Bami Sakshi , Ast Allison , Landry Taylor , Pettit Kenneth L. , Gorantla Shilpa , Vinitsky Anna , Zheng Yan , Johnson Liza-Marie
Published: June 2022

Introduction:

Premedication with acetaminophen and/or diphenhydramine to prevent febrile nonhemolytic transfusion reactions and minor allergic transfusion reactions is a common practice based on historical recommendations. However, recent small randomized-controlled trials showed no benefit of premedication. This inconsistency leads to practice variability, which results in the inefficiency of our institution’s blood product ordering process. This project aimed to improve the number of transfusion encounters with premedication plan documentation from a baseline of 19% to 80% in 12 months.

Methods:

A multidisciplinary quality improvement (QI) team used QI tools to design interventions to improve the efficiency of the ordering process for blood products. Measures were tracked monthly and analyzed using statistical process control.

Results:

From September 2018 to January 2021, 5,351 blood product transfusion visits were scheduled. At baseline, 34% of patients received premedication, and 19% had premedication plans documented. Interventions included a passive computerized provider order entry alert, clinical care pathway development, and clinician education. Postimplementation, the average number of encounters with a premedication plan increased from 19% to 87%, whereas encounters receiving premedication decreased from 34% to 25%. There was no change in the average number of transfusion reactions (1.8 per 100 transfusions).

Conclusions:

Using QI methods, our team successfully standardized the blood product premedication plan documentation despite unclear best practices regarding blood product transfusion premedication. The team added premedication plan documentation training to new employee orientation for sustainability.
A Safety Analysis of Programmed Death 1 Pathway Inhibitors in Patients With Solid Tumor Malignancies and Preexisting Autoimmune Disease
Authors: Higgins Jordyn Paige , Trinh Anh Viet , Watson Marley L. , Beardslee Tyler , Goyal Subir , Kudchadkar Ragini , Pakkala Suchita , Waltuck Jonathan , Momary Kathryn , Byers Kristina F.
Published: June 2022

Objective

The aim of this study was to characterize the safety of programmed death 1 inhibitors in patients with preexisting autoimmune disease.

Methods

A medical records review study was conducted on adults with solid tumor malignancies who received ≥1 dose of pembrolizumab or nivolumab at Emory Healthcare from September 4, 2014 until December 31, 2019. All autoimmune patients were included (n = 77), whereas the nonautoimmune patients were randomized and the first 156 patients were included in a 2:1 ratio to autoimmune patients. The primary objective was the comparison of incidence of immune-related adverse events (irAEs) between patients with preexisting autoimmune disease and those without. Secondary objectives included irAE characterization, irAE treatment, and survival analyses.

Results

Preexisting autoimmune disease was controlled in all of the autoimmune patients before immunotherapy initiation. The rate of irAE was 32.7% in the nonautoimmune group and 42.9% in the autoimmune group (odds ratio, 0.65; 95% confidence interval, 0.37–1.14; p = 0.130). In the patient population diagnosed with a rheumatologic autoimmune disease, 23.81% of irAEs were considered to be a flare of their preexisting autoimmune disease. Less patients in the autoimmune group experienced a grade ≥3 irAE (21.21% vs 37.25%, p = 0.379) and received systemic corticosteroids (54.55% vs 67.35%, p = 0.241) for the treatment of the irAE.

Conclusions

These results suggest that pembrolizumab and nivolumab can be safely administered in patients with controlled preexisting autoimmune diseases without a significant increase in irAE compared with patients without autoimmune diseases. Inclusion of patients with preexisting autoimmune diseases in prospective clinical trials is warranted.
Immune Checkpoint Inhibitor–Associated Myositis
Authors: Saygin Didem , Ghosh Nilasha , Reid Pankti
Published: June 2022

Research on the relationship between inflammatory myopathy and malignancy has grown considerably within the last century. Now, the burgeoning field of inflammatory myopathy has yet another player in the mix: immune checkpoint inhibitor–associated myositis (ICI myositis). Immune checkpoint inhibitor–associated myositis is indicated by clinical diagnosis of inflammatory myopathy after initiation of immune checkpoint inhibitor for cancer management. Current literature reflects low prevalence but high mortality associated with ICI myositis, especially when involving myasthenia gravis and myocarditis. Immune checkpoint inhibitor–associated myositis tends to have muscle pain along with weakness, infrequent presentation with dermatitis, or interstitial lung disease and is typically seronegative with scattered, endomysial inflammatory infiltrates on biopsy. The differential diagnosis of ICI myositis includes myasthenia gravis and other neurological immune-related adverse events. Therapeutic approach involves high doses of corticosteroids with a choice of steroid-sparing immunomodulating agent(s) that is primarily driven by expert opinion due to lack of robust research to support one agent over another. There is wide variation in the inclusion criteria for ICI myositis used in previous studies. We review previously used inclusion criteria and suggest an expertise-based classification criterion to provide a standardized definition and allow comparability between studies. There is a critical need for prospective translational and clinical studies that elucidate the pathophysiology of ICI myositis in order to improve evaluation and management of these patients.
Predictors of Remission and Low Disease Activity in Rheumatoid Arthritis Patients
Authors: Gamboa-Cárdenas Rocío-V. , Ugarte-Gil Manuel-F. , Pimentel-Quiroz Víctor , Reátegui -Sokolova Cristina , Rodríguez-Bellido Zoila , Zevallos-Miranda Francisco , Medina-Chinchón Mariela , Alfaro-Lozano José , Noriega-Zapata Erika , Cucho-Venegas J. Mariano , Perich-Campos Risto , Pastor-Asurza César , Alarcón Graciela S.
Published: June 2022

Background

Clinical remission is the goal in rheumatoid arthritis (RA) management; however, this can be difficult to achieve in several parts of the world. Our objective was to determine predictors of remission and remission/low disease activity (LDA) in RA.

Methods

A longitudinal real-setting RA cohort was followed up (January 2016–2020). Predictors examined were sex, age at diagnosis, disease duration, socioeconomic status, tobacco use, rheumatoid factor titer, comorbidities (Charlson index), Simple Disease Activity Index (SDAI) score, disability (Multidimensional Disease Health Assessment Questionnaire), health-related quality of life (Short Form-36 questionnaire), glucocorticoid dose, biological/target synthetic disease-modifying antirheumatic drugs, and conventional DMARD (c-DMARD) use. Univariable and multivariable generalized estimating equation models were done to determine predictors of remission (at a given visit) and sustained remission (2 consecutives visits), using the SDAI definition (0 or <3.3). Similarly, remission/LDA (SDAI <11) predictors were examined.

Results

Five hundred thirty RA patients included the following: 160 patients (30.2%) achieved remission in at least 1 visit, and 126 patients (23.77%) achieved sustained remission. On the multivariable analysis glucocorticoid dose (odds ratio [OR], 1.060; 95% confidence interval [CI], 1.027–1.094; p = 0.004) and current (OR, 2.293; 95% CI, 1.811–2.903; p < 0.001) or past (OR, 1.383; 95% CI, 1.127–1.698; p = 0.002) use of c-DMARDs predicted remission/LDA in at least 1 visit, whereas the SDAI (OR, 0.951; 95% CI, 0.942–0.959; p < 0.001), Multidimensional Disease Health Assessment Questionnaire (OR, 0.648; 95% CI, 0.549–0.764; p < 0.001), and age at diagnosis (OR, 0.994; 95% CI, 0.990–0.998; p = 0.004) were negative predictors. As to sustained remission/LDA, current (OR, 2.012; 95% CI, 1.458–2.776: p < 0.001) or past (OR, 1.517; 95% CI, 1.155–1.993; p = 0.003) use of c-DMARDs, having a better Short Form-36 questionnaire physical component summary (OR, 1.022; 95% CI, 1.014–1.029; p < 0.001), and older age at diagnosis (OR, 1.013; 95% CI, 1.003–1.022; p = 0.008) predicted it, whereas SDAI (OR, 0.949; 95% CI, 0.933–0.965; p < 0.001) and medium low/low socioeconomic status (OR, 0.674; 95% CI, 0.500–0.909; p = 0.010) were negative predictors.

Conclusion

During follow-up of this real-world RA cohort, c-DMARD use predicted remission and remission/LDA. In contrast, disease activity was a negative predictor.
Potential Pitfall in the Interpretation of Ganglioneuronal Uptake of 18F-PSMA-1007 PET/CT Scans Performed With a High Spatial Resolution Digital PET Scanner
Authors: Kisiel Nadya , Thomas Paul
Published: June 2022

A 69-year-old man with biochemical recurrence of prostate cancer after radical prostatectomy 5 years previously and subsequent salvage radiotherapy to the prostate bed and pelvic nodes underwent PET/CT on a Siemens mCT Flow PET and a second PET/CT 10 months later on a Siemens Vision 600 Digital PET. In addition to a suspicious left hilar lymph node, the new high-resolution PET showed increased visualization and avidity of physiologic uptake in paraspinal and presacral sympathetic ganglia. Caution should be undertaken when interpreting PET/CTs performed on high-resolution digital scanners to avoid mistaking ganglia uptake for metastatic disease.
Virtual Reality Training in Disaster Medicine
Authors: Brown Natasha , Margus Colton , Hart Alexander , Sarin Ritu , Hertelendy Attila , Ciottone Gregory
Published: June 2022

Summary Statement

Disaster medicine (DM) training aims to recreate stressful, mass casualty scenarios faced by medical professionals in the field with high fidelity. Virtual (VR) and augmented reality (AR) are well suited to disaster training as it can provide a safe, socially distant simulation with a high degree of realism. The purpose of this literature review was to summarize the current use of VR or AR for simulation training of healthcare providers in DM education. A systematic review of peer-reviewed articles was performed from January 1, 2000, to November 21, 2020, on PubMed, Embase, and OVID. Exclusion criteria included non-English articles, computer-generated models without human participants, or articles not relating to DM, VR or AR. Thirty-two articles were included. Triage accuracy was evaluated in 17 studies. Participants reported improved confidence and positive satisfaction after the simulations. The studies suggest VR or AR can be considered for disaster training in addition to other, more traditional simulation methods. More research is needed to create a standardized educational model to incorporate VR and AR into DM training and to understand the relationship between disaster simulation and improved patient care.
Development and validation of a Bayesian belief network predicting the probability of blood transfusion after pediatric injury
Authors: Sullivan Travis M. , Milestone Zachary P. , Tempel Peyton E. , Gao Sarah , Burd Randall S.
Published: June 2022

BACKGROUND

Early recognition and intervention of hemorrhage are associated with decreased morbidity in children. Triage models have been developed to aid in the recognition of hemorrhagic shock after injury but require complete data and have limited accuracy. To address these limitations, we developed a Bayesian belief network, a machine learning model that represents the joint probability distribution for a set of observed or unobserved independent variables, to predict blood transfusion after injury in children and adolescents.

METHODS

We abstracted patient, injury, and resuscitation characteristics of injured children and adolescents (age 1 to 18 years) from the 2017 to 2019 Trauma Quality Improvement Project database. We trained a Bayesian belief network to predict blood transfusion within 4 hours after arrival to the hospital following injury using data from 2017 and recalibrated the model using data from 2018. We validated our model on a subset of patients from the 2019 Trauma Quality Improvement Project. We evaluated model performance using the area under the receiver operating characteristic curve and calibration curves and compared performance with pediatric age-adjusted shock index (SIPA) and reverse shock index with Glasgow Coma Scale (rSIG) using sensitivity, specificity, accuracy, and Matthew's correlation coefficient (MCC).

RESULTS

The final model included 14 predictor variables and had excellent discrimination and calibration. The model achieved an area under the receiver operating characteristic curve of 0.92 using emergency department data. When used as a binary predictor at an optimal threshold probability, the model had similar sensitivity, specificity, accuracy, and MCC compared with SIPA when only age, systolic blood pressure, and heart rate were observed. With the addition of the Glasgow Coma Scale score, the model has a higher accuracy and MCC than SIPA and rSIG.

CONCLUSION

A Bayesian belief network predicted blood transfusion after injury in children and adolescents better than SIPA and rSIG. This probabilistic model may allow clinicians to stratify hemorrhagic control interventions based upon risk.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III.