bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical Inactivity as an Early Sign of Frailty in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia
Authors: Chua Ling L. , Azanan Mohamad S. , Oh Lixian , Ariffin Hany
Published: February 2023

Young adult survivors of childhood leukemia have been reported with increased likelihood of age-related comorbidities compared with the general population. We compared the prevalence of frailty in young adult survivors of childhood acute lymphoblastic leukemia (n=58, median age=23 y, median survival time=18 y) with age-matched and sex-matched controls without history of cancer. Frailty phenotypes were determined using Fried frailty model. Association between frailty status and cardiometabolic conditions, systemic inflammation, and T-cell immunophenotype changes were also examined. Frailty and prefrailty were more common among survivors compared with controls (58.6% vs. 34.5%, P=0.019). Physical inactivity (39.7%) was the most frequently observed frailty criterion among the survivors. Prevalence of cardiometabolic conditions was comparable between the robust and frail/prefrail survivors. Robust survivors had a higher level of T-cell activation than the prefrail/frail survivors (P<0.05), but no significant difference was observed for systemic inflammatory markers (IL-6 and C-reactive protein) and percentage of terminally differentiated T cells. Signs of frailty, especially physical inactivity, was detected in childhood acute lymphoblastic leukemia survivors early in their third decade of life. Survivors who were prefrail/frail also had altered T-cell activation; however, the role of such changes in T-cell phenotype in the etiology of frailty warrant further investigation.
Concurrent Hepatoblastoma and Wilms Tumor Leading to Diagnosis of Beckwith-Wiedemann Syndrome
Authors: Wolfe Danielle M. , Webster Carrion Andrea , Masukhani Mahesh M. , Oberg Jennifer A. , Pavisic Jovana , El-Ali Alexander , Gupta Mala , Weng Katherine , Glasser Chana L.
Published: February 2023

Beckwith-Wiedemann syndrome (BWS) is an epigenetic overgrowth disorder and cancer predisposition syndrome caused by imprinting defects of chromosome 11p15.5-11p15.4. BWS should be considered in children with atypical presentations of embryonal tumors regardless of clinical phenotype. Risk of malignancy correlates with specific molecular subgroups of BWS making molecular subclassification important for appropriate cancer screening. We report the first case of concurrent embryonal tumors in a phenotypically normal child, leading to the diagnosis of BWS with paternal uniparental disomy and describe the molecular classification of BWS as it relates to malignancy risk, along with approach to management.
Pediatric Hemophagocytic Lymphohistiocytosis: Formation of an Interdisciplinary HLH Working Group at a Single Institution
Authors: Watts Shelley , Diaz Maranda , Teller Christa , Hamby Tyler , Guirola Ricardo , Perez Maria , Eames Gretchen , Howrey Richard , Rios Ana , Trinkman Heidi , Ray Anish
Published: February 2023

Fever of unknown origin is a common presentation in children with an extensive differential diagnosis that encompasses multiple specialties. From a hematologic standpoint, the differential includes hyperinflammatory syndrome, such as hemophagocytic lymphohistiocytosis (HLH), among others. Due to the rarity of HLH and nonspecific symptoms at initial presentation, specialists are often consulted later in the disease progression, which complicates disease evaluation further. Cook Children’s Medical Center (CCMC) has recently developed a multidisciplinary histiocytic disorder group that is often consulted on cases presenting with fever of unknown origin to increase awareness and potentially not miss new HLH cases. In this study, we examine the clinical presentation and workup of 13 patients consulted by the HLH work group at a single institution and describe the clinical course of 2 patients diagnosed with HLH. The goal of this project was to describe the formation of a disease-specific team and the development of a stepwise diagnostic approach to HLH. A review of the current diagnostic criteria for HLH may be warranted given findings of markers such as soluble IL2 receptor and ferritin as nonspecific and spanning multiple disciplines including rheumatology, infectious disease, and hematology/oncology.
Successful Treatment of Patient With Ewing Sarcoma in the Setting of Inherited Cholestatic Liver Disease
Authors: Daley Jessica , Halligan Katharine , Howrie Denise , Salgado Claudia M. , Superdock Alexandra , Friehling Erika , Bailey Kelly M.
Published: February 2023

Progressive familial intrahepatic cholestasis type 1 (PFIC1) is an inherited, progressive cholestatic liver disease. Here, we present an approach to the treatment of Ewing sarcoma in a patient with PFIC1. The diagnosis of PFIC1 presents a unique challenge in the treatment of Ewing sarcoma, as the standard-of-care vincristine, doxorubicin, cyclophosphamide/ifosfamide and etoposide chemotherapy backbone for Ewing sarcoma therapy treatment relies heavily on intact hepatic metabolism. In addition, we report prolonged lymphopenia and severe infectious complications in this patient, both of which may be attributed to more severe immunosuppression in setting of poor hepatic metabolism of chemotherapeutic agents.
Health-related quality-of-life during rehabilitation in patients with critical illness neuropathy/myopathy after severe coronavirus disease 2019
Authors: Zupanc Aleksander , Vidmar Gaj , Majdič Neža , Novak Primož
Published: February 2023

Our aim was to evaluate health-related quality-of-life (HRQoL) of the patients with critical illness neuropathy and/or myopathy after severe COVID-19 during their rehabilitation. The prospective cohort study included 157 patients (median age 64 years) admitted to rehabilitation. HRQoL was assessed the using European Quality 5-Dimensions questionnaire [EQ-5Dindex, range 0(or exceptionally less) to 1, and Visual Analogue Scale (VAS), range 0–100], which was completed by the patients at admission and discharge. Additionally, they were assessed with the de Morton Mobility Index (DEMMI), the 6-Minute Walk Test (6MWT), and the Functional Independence Measure (FIM). Median EQ-5Dindex was 0.32 and median EQ VAS was 48 at admission, and median EQ-5Dindex was 0.61 and median EQ VAS 80 at discharge. Some or extreme problems were reported by 154 (98%) patients regarding the mobility dimension, 151 (96%) regarding usual activities, 136 (87%) regarding self-care, 84 (54%) regarding pain or discomfort dimension, and 52 patients (34%) regarding anxiety or depression at admission. At discharge, some or extreme problems were still reported by 96 patients (61%) regarding mobility, 95 (61%) regarding usual activities, 70 patients (45%) regarding pain or discomfort, 46 (29%) regarding self-care, and 19 patients (12%) regarding anxiety or depression. At the same time, the patients exhibited significant improvements in the DEMMI (median increased from 41 to 67 points), 6MWT (from 60 to 293 m) and motor FIM (from 56 to 84 points). The improvement of the self-reported HRQoL was, thus, paralleled by the improvements in clinician-assessed mobility, walking endurance and functional independence.
Clinically ill patients’ experiences of early mobilisation after liver transplantation: a qualitative study using Pender’s health promotion model
Authors: Zhong Lixia , Jin Yanhong , Gu Yanmei , He Wenjing , Zheng Yulin , Yang Tongnan , Li Yingying , Fu Li , Zhang Weiwei , Xu Qiuying
Published: February 2023

The aim of this study is to explore the factors influencing early mobilisation behaviours and patients’ needs in critically ill patients after liver transplantation (LT). This interview study used phenomenological research, and Pender’s health promotion model (HPM) was used to construct the interview guide. With the use of purposeful sampling, a total of 19 critically ill patients who experienced early mobilisation after LT were recruited at three tertiary hospitals in Beijing from August to November 2022. Data were collected through semi-structured interviews and analysed using Colaizzi’s seven-step method. Nine themes were categorised into the three domains of Pender’s HPM. The first domain was individual characteristics and experiences: (1) symptoms of end-stage liver disease limiting premobility behaviours and (2) previous treatment experience affecting understanding of early mobilisation after LT. The second domain was behaviour-specific cognition and affect: (3) coexistence of benefits and concerns in early mobilisation after LT, (4) barriers to early mobilisation after LT, (5) high self-efficacy in early mobilisation after LT, (6) individual differences in early mobilisation and (7) support and encouragement from family, wardmates and medical staff. The final domain was behavioural outcomes: (8) the need for sufficient staff, a quiet environment, safety, goals, guidance and family participation and (9) a strong willingness to comply with early mobilisation plans. The three areas and nine themes extracted in this study are helpful for the long-term development of early mobilisation in patients after LT.
Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke
Authors: Li Dongxia , Zha Fubing , Wang Yulong
Published: February 2023

Background:

Activities of daily living comprise an important risk factor for falls among patients who have suffered a stroke.

Purpose:

To investigate the incidence of falls in patients with stroke, categorized by their Longshi grades (bedridden, domestic, community), and to explore their risk factors for falls.

Methods:

A cross-sectional descriptive design was used. Patients completed a survey during face-to-face interviews.

Results:

Of the 869 participants, 15.7% experienced a fall. Those in the domestic Longshi group had the highest rate of falls. Approximately 30% experienced either a moderate or severe injury as a result of falling. In addition, being older than 70 years was significantly correlated with fall risk. Intermediate Longshi grades, from moderately dependent to slightly dependent, were also positively correlated with falls.

Conclusion:

Patients with stroke in the domestic Longshi group have a higher rate of falls. The risk of falling increased significantly in those with intermediate Longshi grades.
The Relationship Between Workplace Incivility and Patient Safety in Pediatric Nurses
Authors: Aljuaid Noof H. , Alharbi Manal F.
Published: February 2023

Background:

Workplace incivility may directly influence nurses' involvement in patient safety; however, research on this topic in the pediatric setting has yet to be established.

Purpose:

The purpose of this study was to address the prevalence of workplace incivility in pediatric settings in Saudi Arabia (SA) and examine its impact on patient safety culture.

Methods:

A cross-sectional study design was used. Surveys, including the Nursing Incivility Scale and Hospital Survey on Patient Safety Culture, were sent to nurses across 6 pediatric units in Taif, SA.

Results:

A total of 300 nurses completed the surveys. A significant negative modest correlation was found between incivility and patient safety domains (P < .05). A higher stress score was associated with older age (>35 years), Saudi nationality, and subdegree education.

Conclusion:

This study found that pediatric nurses experience high rates of incivility, mostly originating from patients and their families.
Evolving the Assessment of Clinical Judgment
Authors: Delle Janelle M. , Cross Lacey , Weaver Angela , Jessee Mary Ann
Published: February 2023

Background:

Nurses make decisions about care individually and as part of a team. Collective competence, the effective team management of patient care situations, is partially dependent on nurses' individual confidence and clinical judgment competence.

Purpose:

To describe individual and team-based facilitators and barriers to collective competence in teams of senior baccalaureate-level prelicensure nursing students during a team-based simulation.

Methods:

With a cross-sectional design, the study used a 26-item survey based on the National Council of State Boards of Nursing (NCSBN)-Clinical Judgment Measurement Model (CJMM) (α= .86) to assess individual student confidence and perceptions of clinical judgment competence while observation of team dynamics and task completion assessed collective competence.

Results:

Closed-loop communication and role assignment were facilitators of collective competence when present and barriers when absent. Additional barriers were lack of student confidence and perceived competence with Layers 3 and 4 of the NCSBN-CJMM.

Conclusions:

Team-based simulation strategies can be effectively used to assess collective clinical judgment competence.
Introspective Learning From Interprofessional Virtual Grand Rounds
Authors: Buelow Janet R. , Tillman Paula , Taggart Helen
Published: February 2023

Background:

Interprofessional collaboration in health care settings improves patient safety and outcomes, yet collaboration among health professionals requires specific competencies and skills. Providing nursing students with interprofessional learning experiences with multiple health professions is possible yet challenging.

Problem:

Opportunities for effective online interprofessional learning are lacking.

Approach:

This article explores nursing students' reflections on how an interprofessional learning experience, Virtual Grand Rounds (VGRs), influenced their personal development and provided meaningful learning that they can use in their practices as professional nurses. Thematic analysis was done on the open-ended questions in students' final reflection assignment.

Outcomes:

Analysis of student reflections identified 5 learning themes including the value of teamwork and collaboration, the importance of communication skills, professional identity, plans to engage diverse health professions, and the desire for future learning.

Conclusions:

Student reflections indicate the VGR was an effective method for nursing students to experience collaboration with multiple health professions without disrupting curriculums.
Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs
Authors: Fusco Nicholas M. , Foltz-Ramos Kelly , Ohtake Patricia J. , Mann Catherine
Published: February 2023

Background:

Interprofessional (IP) socialization is important to develop early in the training of health professions students.

Purpose:

This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game (Friday Night at the ER [FNER]).

Methods:

The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing.

Results:

IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development.

Conclusions:

An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.
Enhancing Nurse Roles in Community Health (ENRICH)
Authors: Lawlor Mary Ann C. , L. Mitchell Rebecca , Burant Patricia A. , Quinn Griffin Mary , Dolansky Mary A.
Published: February 2023

Background:

Low numbers of new graduate nurses entering careers in primary care settings are insufficient to meet the demand of the current nursing shortage. The Enhancing Nurse Roles in Community Health (ENRICH) Fellowship is aimed at increasing undergraduate nursing students' exposure to population health concepts by providing opportunities to practice in primary care settings.

Purpose:

The purpose of this study was to implement and evaluate an undergraduate nursing fellowship program to enhance competency development in the primary care setting.

Methods:

Fellows received targeted exposure to population health content and immersive primary care experiences through participation in 150 dedicated clinical hours in primary clinics, coupled with up to 250 hours of dedicated curriculum.

Results:

Students who participated in the ENRICH Fellowship showed increased knowledge, improved perception of skills performance, and changed attitudes about population health and primary care nursing.

Conclusion:

Participation in a population health-based fellowship that includes targeted curricular content and primary care–based clinical experiences during an undergraduate nursing program improves knowledge, attitudes, and competency-based skills related to primary care and population health.
Effective Interventions for Nursing Student Burnout
Authors: Burleson Shannon , Thomas Lisa , DeBoor Stephanie
Published: February 2023

Background:

Burnout in nursing students negatively impacts students' health, decreases academic success, increases attrition, and threatens the quality of patient care.

Purpose:

To identify empiric research evaluating the effectiveness of interventions to prevent nursing student burnout.

Methods:

This scoping review examined the PubMed, CINAHL, PsycINFO, and Google Scholar databases to identify original studies evaluating burnout interventions in nursing students.

Results:

Of the 258 studies identified in the primary search, 208 were screened and 29 were selected for full-text review. Five quantitative reports and 1 qualitative study met the inclusion criteria. Effective interventions included recreational music-making, mindfulness-based and resilience education, integral-caring-holistic-science curriculum, Acceptance and Commitment Training, and progressive muscle relaxation. Statistically significant reductions in burnout were reported in all 5 of the quantitative studies.

Conclusion:

This review demonstrates a need for further research. Burnout interventions should be embedded in the nursing curriculum to yield a more sustainable profession.
Relationship of Organizational Support, Psychological Capital, and Engagement Among Clinical Nursing Teachers
Authors: Kong Ling-Na , Liao He-Ping , Liu Dun-Xiu , Chen Shuo-Zhen
Published: February 2023

Background:

Clinical nursing teachers play a critical role in nursing education, and their engagement is important to ensure the quality of clinical teaching.

Purpose:

To describe the level of engagement and determine the relationships among organizational support, psychological capital, and engagement among clinical nursing teachers.

Methods:

A cross-sectional study was conducted among 246 clinical nursing teachers, from 4 teaching hospitals in China, using a self-report questionnaire. The questionnaire measured organizational support, psychological capital, and work engagement.

Results:

Clinical nursing teachers reported a medium level of engagement in teaching. Both organizational support and psychological capital had positive effects on teachers' engagement. Psychological capital partially mediated the relationship between organizational support and engagement.

Conclusions:

Measures to improve organizational support and psychological capital are essential to enhance the engagement among clinical nursing teachers.
Primary Central Nervous System Vasculitis Following Alemtuzumab Treatment for Multiple Sclerosis
Authors: Varela Lucía , Pappolla Agustín , Heriz Alejandra , Márquez Rocío , Vega Otto , Christiansen Silvia , Rugiero Marcelo , Midaglia Luciana , Salerno Annalaura , Tintoré Mar , Rovira Àlex
Published: February 2023

Introduction:

Cerebral vasculitides are often devastating conditions that require immediate diagnosis and treatment.

Case report:

We report a pathologically proven clinical case of primary central nervous system vasculitis in a 50-year-old man with a diagnosis of relapsing-remitting multiple sclerosis after alemtuzumab therapy, which required additional immunosuppression to control this life-threatening condition.

Conclusion:

In patients presenting subacute neurological deterioration after alemtuzumab therapy, primary central nervous system vasculitis should be considered as a differential diagnosis among other autoimmune conditions.
Case Report: Nyctalopia Due to Severe Liver Cirrhosis–induced Vitamin A Deficiency
Authors: Chen Shuyi , Quan Amy Jill
Published: February 2023

SIGNIFICANCE

Vitamin A is a micronutrient critical for retinal function. Patients with a deficiency may notice a progressive decline in night vision as rod photoreceptors become unable to regenerate rhodopsin. Although uncommon in developed nations, vitamin A deficiency should be considered in symptomatic patients with chronic, severe liver disease.

PURPOSE

This report presents a rare case of night blindness secondary to poor vitamin A metabolism due to severe liver cirrhosis.

CASE REPORT

A 62-year-old White woman presented with progressively worsening vision in dim lighting over the past 6 to 8 months. She was asymptomatic in daylight but “blind in the dark” to the extent that she was afraid to go outside at night. She had no personal or family history of night blindness or retinal disorders. Ocular health was unremarkable with dilation. Given her medical history of severe nonalcoholic liver cirrhosis, malabsorption of vitamin A was suspected and subsequently confirmed by the very low vitamin A level in her serum analysis. The patient was sent to endocrinology for evaluation, and appropriate repletion therapy was implemented. Subjective improvement in symptoms, along with better performance on visual field testing, was noted after initiating oral vitamin A supplementation for 5 months.

CONCLUSIONS

Although vitamin A deficiency is a relatively rare disorder in the United States, it should be suspected in patients with severe liver disease or other conditions causing malabsorption who experience a loss of night vision.
Fetal Age Assessment From Primary Teeth and Long Bones
Authors: Crumpton Mark W. , Mileusnic-Polchan Darinka , Lewis James , Heidel R. Eric , Marks Murray K.
Published: February 2023

This study evaluated traditional and expedited methods for assessing the age of fetal remains. Because of their rare occurrence, the discovery of fresh, decomposing, disfigured, or skeletal fetuses engenders heightened awareness by forensic pathologists primarily tasked with age estimation in relation to viability. With decomposed complete or isolated fetal remains, dentists focus on primary molar mineralization, whereas anthropologists perform long bone measurements along with discernment of other indicators of skeletal maturity to obtain an age estimation.

The results of this study are 4-fold: (1) The “best” technique for harvesting fetal tooth buds and long bones is the dissection of the developing tooth buds with maceration for the long bones. (2) Metric analysis was applied to the tooth buds and long bones for age estimation, and the findings were correlated. (3) There is a statistically significant difference between known age and dental age and between dental age and long bone age. The difference between known age and long bone age is not statistically significant, but a type II error exists because of the small sample size. (4) A central incisor staging technique for fetuses younger than 26 weeks was developed as a supplement to the molar staging system of Kraus and Jordan (1965).
Microsecretory Adenocarcinoma of Salivary Glands
Authors: Bishop Justin A. , Sajed Dipti P.
Published: February 2023

Salivary gland classification has benefitted immensely from the growing field of molecular diagnostics. Microsecretory adenocarcinoma, a novel salivary gland malignancy recently included in the fifth edition of the World Health Organization Classifications of Head and Neck Tumours, is one such example. This novel entity was discovered among the umbrella category of adenocarcinoma, not otherwise specified, using a combination of careful histologic analysis and advanced molecular techniques. Its strikingly characteristic histologic features including subtle infiltration, flattened tubules, and abundant blue secretions highlight the necessity of meticulous morphologic observation, even in the age of increased molecular testing. It harbors a recurrent novel MEF2C::SS18 gene fusion, which is amenable to fluorescence in situ hybridization analysis. It presents predominantly in the oral cavity with a propensity for the palate and the majority are thus far low grade, clinically indolent tumors. The recent discovery of a cutaneous corollary to this tumor suggests that the spectrum of its presentation has not entirely been delineated. In the context of expanding molecular testing, pathologists are tasked to sift through constantly evolving molecular data to incorporate diagnostically relevant tests into their practice. In salivary gland pathology, the example of microsecretory adenocarcinoma demonstrates that primary histologic assessment, with sensible use of immunohistochemistry, can lead to accurate diagnosis. Molecular testing is beneficial in cases with significant diagnostic challenges.
Randomization to a Liberal Versus Conservative Oxygenation Target: Redox Responses in Critically Ill Children
Authors: Jones Gareth A. L. , Eaton Simon , Orford Michael , Ray Samiran , Wiley Daisy , Ramnarayan Padmanabhan , Inwald David , Grocott Michael P. W. , Griksaitis Michael , Pappachan John , O’Neill Lauran , Mouncey Paul R. , Harrison David A. , Rowan Kathryn M. , Peters Mark J. ,   the Oxy-PICU Investigators of the Paediatric Critical Care Society Study Group (PCCS-SG)
Published: February 2023

RATIONALE:

Optimal systemic oxygenation targets in pediatric critical illness are unknown. A U-shaped relationship exists between blood oxygen levels and PICU mortality. Redox stress or iatrogenic injury from intensive treatments are potential mechanisms of harm from hyperoxia.

OBJECTIVES:

To measure biomarkers of oxidative status in children admitted to PICU and randomized to conservative (oxygen-hemoglobin saturation [Spo2] 88–92%) versus liberal (Spo2> 94%) peripheral oxygenation targets.

DESIGN:

Mechanistic substudy nested within the Oxygen in PICU (Oxy-PICU) pilot randomized feasibility clinical trial (ClinicalTrials.gov: NCT03040570).

SETTING:

Three U.K. mixed medical and surgical PICUs in university hospitals.

PATIENTS:

Seventy-five eligible patients randomized to the Oxy-PICU randomized feasibility clinical trial.

INTERVENTIONS:

Randomization to a conservative (Spo288–92%) versus liberal (Spo2> 94%) peripheral oxygenation target.

MEASUREMENTS AND MAIN RESULTS:

Blood and urine samples were collected at two timepoints: less than 24 hours and up to 72 hours from randomization in trial participants (March 2017 to July 2017). Plasma was analyzed for markers of ischemic/oxidative response, namely thiobarbituric acid-reactive substances (TBARS; lipid peroxidation marker) and ischemia-modified albumin (protein oxidation marker). Total urinary nitrate/nitrite was measured as a marker of reactive oxygen and nitrogen species (RONS). Blood hypoxia-inducible factor (HIF)–1a messenger RNA (mRNA) expression (hypoxia response gene) was measured by reverse transcription- polymerase chain reaction. Total urinary nitrate/nitrite levels were greater in the liberal compared with conservative oxygenation group at 72 hours (median difference 32.6 μmol/mmol of creatinine [95% CI 13.7–93.6];p< 0.002, Mann-Whitney test). HIF-1a mRNA expression was increased in the conservative group compared with liberal in less than 24-hour samples (6.0-fold [95% CI 1.3–24.0];p= 0.032). There were no significant differences in TBARS or ischemia-modified albumin.

CONCLUSIONS:

On comparing liberal with conservative oxygenation targets, we show, first, significant redox response (increase in urinary markers of RONS), but no changes in markers of lipid or protein oxidation. We also show what appears to be an early hypoxic response (increase in HIF-1a gene expression) in subjects exposed to conservative rather than liberal oxygenation targets.
Continuous Venovenous Hemofiltration Performed by Neonatologists With Cardio-Renal Pediatric Dialysis Emergency Machine to Treat Fluid Overload During Multiple Organ Dysfunction Syndrome: A Case Series
Authors: Regiroli Giulia , Loi Barbara , Pezza Lucilla , Sartorius Victor , Foti Anna , Barra Pasquale Fabio , Centorrino Roberta , Di Nardo Matteo , De Luca Daniele
Published: February 2023

OBJECTIVES:

A new device is available for neonates needing extracorporeal renal replacement therapy. We reviewed the use of this device (in continuous venovenous hemofiltration [CVVH] mode) in term or preterm neonates affected by multiple organ dysfunction syndrome (MODS) with fluid overload.

DESIGN:

Case series.

SETTING:

Academic specialized referral neonatal ICU (NICU) with expertise on advanced life support and monitoring.

PATIENTS:

Neonates with MODS and fluid overload despite conventional treatments and receiving at least one CVVH session.

INTERVENTION:

CVVH with the Cardio-Renal Pediatric Dialysis Emergency Machine.

MEASUREMENTS AND MAIN RESULTS:

Ten (three preterm) neonates were treated using 18 consecutive CVVH sessions. All patients were in life-threatening conditions and successfully completed the CVVH treatments, which almost always lasted 24 hr/session, without major side effects. Three neonates survived and were successfully discharged from hospital with normal follow-up. CVVH reduced fluid overload (before versus after represented as a weight percentage: 23.5% [12–34%] vs 14.6% [8.2–24.1%]; p = 0.006) and lactate (before versus after: 4.6 [2.9–12.1] vs 2.9 mmol/L [2.3–5.5 mmol/L]; p = 0.001). CVVH also improved the Pao
2 to Fio
2 (before vs after: 188 mm Hg [118–253 mm Hg] vs 240 mm Hg [161–309 mm Hg]; p = 0.003) and oxygenation index (before vs after: 5.9 [3.8–14.6] vs 4 [2.9–11]; p = 0.002). The average cost of CVVH in these patients was minor (≈3%) in comparison with the median total cost of NICU care per patient.

CONCLUSIONS:

We have provided CVVH to critically ill term and preterm neonates with MODS. CVVH improved fluid overload and oxygenation. The cost of CVVH was minimal compared with the overall cost of neonatal intensive care.
A Randomized Trial of Incentivization to Maximize Retention for Real-Time Symptom and Activity Monitoring Using Ecological Momentary Assessment in Pediatric Concussion
Authors: Corwin Daniel J. , Orchinik Julia , D'Alonzo Bernadette , Agarwal Anish K. , Pettijohn Kevin W. , Master Christina L. , Wiebe Douglas J.
Published: February 2023

Objective

The aims of this study were to determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) after pediatric concussion, and assess the feasibility of tracking concussed youth using EMA from the emergency department (ED) setting.

Methods

This study was a randomized controlled trial of participants ages 13 to 18 years with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Participants were randomized to 1 of 4 incentive arms: 2 dynamic (loss-based and streak) and 2 control flat-rate (monetary and electronic device). Participants reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a Fitbit (kept by participants in the device flat-rate arm). The primary outcome was proportion of prompts to which participants responded. Secondary outcomes included differential response rates by demographics, and comparison of outcome determination between EMA and subsequent clinical visits.

Results

Thirty participants were enrolled, with a median age of 15.5 years and 60% female. Median cumulative proportion of prompts responded to was 68.3% (interquartile range, 47.6%–82.5%) in the dynamic arms versus 54.0% (interquartile range. 20.6%–68.3%) in the flat-rate arms,P= 0.065. There were nonsignificant differences in median response by sex (65.9% for female vs 40.0% for male,P= 0.072), race/ethnicity (61.9% for non-Hispanic White vs 43.7% for non-Hispanic Black participants,P= 0.097), and insurance (61.9% for private insurance vs 47.6% for public insurance,P= 0.305). Recovery at 3 weeks was discernible for all but 2 participants (93.3%) using EMA data, compared with only 9 participants (30.0%) (P< 0.001) from clinical visits.

Conclusions

Dynamic incentivization showed higher rates of response to tridaily symptom prompts compared with flat-rate incentivization. These data show tracking concussed youth using EMA from the ED is feasible using a dynamic incentivization strategy, with improved ability to discern outcomes compared with prospective monitoring using follow-up clinical visits.
Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations
Authors: Forster Brian L. , Thomas Fridtjof , Arnold Sandra R. , Snider Mark A.
Published: February 2023

Background

Severe asthma exacerbations in pediatric patients occur frequently and can require pediatric intensive care unit (PICU) admission.

Objective

To determine if early administration of intravenous magnesium sulfate (IVMg) to pediatric patients experiencing severe asthma exacerbations, defined as a respiratory clinical score (RCS) of 9 to 12, resulted in fewer PICU admissions.

Methods

Retrospective chart review of pediatric patients aged from 2 to 17 years presenting with a severe asthma exacerbation to a single tertiary care pediatric emergency department. Univariable and multivariable logistic regression analyses were used to determine if admission to the PICU was associated with early IVMg treatment, within 60 minutes of registration.

Results

A total of 1911 patients were included in the study, of which 1541 received IVMg. The average time to IVMg was 79 minutes, with 35% of the patients receiving it within 60 minutes of arrival. Two hundred forty-eight (13%) were admitted to the PICU, 641 (34%) were admitted to the general inpatient floor, and 1022 (53%) were discharged home. Factors associated with increased odds ratio (OR) of PICU admission were: early IVMg (OR, 1.63; 95% CI: 1.16–2.28), arrival mode to the emergency department via ambulance (OR, 2.23; 95% CI: 1.45–3.43), history of PICU admission for asthma (OR, 1.73; 95% CI: 1.22–2.44), and diagnosis of status asthmaticus (OR, 8.88; 95% CI: 3.49–30.07). Calculated OR of PICU admission subcategorized by RCS for early IVMg patients, after controlling for PICU risk factors, are as follows: RCS 9 (reference), RCS 10 (OR, 2.52; 95% CI: 0.89–2.23), RCS 11 (OR, 2.19; 95% CI: 1.3–3.70), and RCS 12 (OR, 4.12; 95% CI: 2.13–7.95).

Conclusions

Early administration of IVMg to pediatric patients experiencing severe asthma exacerbations does not result in fewer PICU admissions.
Two Cases of Biphasic Synovial Sarcoma With Expression of PAX8 and ER: A Diagnostic Pitfall
Authors: Zheng Lan , Wang Xiaohong I. , Chen Shaoxiong , Moosvi Ali Mehdi , Wan David Q. , Zhang Songlin
Published: February 2023

Synovial sarcoma (SS) is a high-grade malignant neoplasm frequently arising in the deep soft tissue of the lower and upper extremities of young adults. Primary SS in the pelvis is extremely rare with scattered case reports. It often causes a diagnostic challenge in small biopsy and/or with aberrant expression of immunohistochemical markers. Here, we report 2 unusual cases of SS in the pelvis. Microscopically both cases present with biphasic morphology including spindle and epithelioid cells. In addition, the tumor cells in both cases expressed PAX8 and estrogen receptor. PAX8 is a transcription factor usually expressed in tumors of thyroid gland, kidney, and Müllerian system origin. The expression of PAX8 especially with co-expression of estrogen receptor can be misleading and result in a diagnosis of Müllerian tumors in female patients with pelvic masses. The diagnosis of SS for both cases was confirmed either with the fluorescence in situ hybridization or reverse transcription polymerase chain reaction showing a SS18 (SYT) (18q11) gene rearrangement. It is imperative to include SS in the differential diagnosis for malignant neoplasms exhibiting monotonous spindle cells (monophasic SS) and biphasic mixed monotonous spindle and epithelioid tumor cells in female patients with a pelvic mass. Molecular study for SS18 translocation is essential for the diagnosis in such cases.
Fumarate Hydratase and S-(2-Succinyl)-Cysteine Immunohistochemistry Shows Evidence of Fumarate Hydratase Deficiency in 2% of Uterine Leiomyosarcomas: A Cohort Study of 348 Tumors
Authors: Chapel David B. , Sharma Aarti , Maccio Livia , Bragantini Emma , Zannoni Gian Franco , Yuan Liping , Quade Bradley J. , Parra-Herran Carlos , Nucci Marisa R.
Published: February 2023

Approximately 1% to 1.5% of uterine leiomyomas are fumarate hydratase (FH)-deficient (FHd). A subset of these are associated with germline FH mutations. However, the prevalence and clinicopathologic characteristics of FHd uterine leiomyosarcoma (uLMS) remain unknown. Clinicopathologic data were collected for 348 uLMS. Morphologic features associated with FH deficiency (staghorn-type vessels, alveolar-pattern edema, macronucleoli with perinucleolar clearing, eosinophilic cytoplasmic inclusions, and chain-like nuclear arrangement) were documented. All 348 tumors were studied by FH immunohistochemistry. Eighty-nine were also studied by S-(2-succinyl)-cysteine (2SC) immunohistochemistry. Seven (2%) FHd uLMS were identified. Five showed uniformly negative FH and diffusely positive 2SC immunostaining; 1 showed variably negative to weak to strong FH and diffusely positive 2SC immunostaining; and 1 showed retained FH staining alongside positive 2SC confined to a morphologically distinct subclone. Three of 7 patients had extrauterine disease at presentation, and 3 of 6 had persistent disease or died from disease. Macronucleoli with perinucleolar clearing were significantly more common in FHd uLMS (7/7) than in uLMS with retained FH (182/341; P=0.017). Disease-specific survival, disease-free survival, and other morphologic features of FH deficiency did not differ significantly between FHd and FH-retained tumors. Our data emphasize that immunohistochemical FH deficiency does not preclude malignancy in uterine smooth muscle tumors. However, the biological significance and molecular basis of FH deficiency in uLMS, including any relationship to germline FH mutation, remain unknown, and a larger multi-institutional effort is necessary to gather sufficient FHd uLMS for more robustly powered clinicopathologic and for molecular characterization.
Creating Novel Surveillance Data Products for Briefing Health Department Leadership and Elected Officials During the COVID-19 Pandemic in Texas
Authors: Chapman Leah Elizabeth , Cobb Kai , Hall Emily , Seidel Sarah
Published: February 2023

Beginning in March 2020, the Texas Department of State Health Services (DSHS) developed several internal surveillance tools for briefing state health department leadership and elected officials on the status of the COVID-19 pandemic in Texas. This case study describes the initial conceptualization and daily production of 3 of these internal surveillance tools: (1) a COVID-19 data book displaying daily case, fatality, hospitalization, and testing data by county; (2) graphs and data files displaying new daily COVID-19 fatalities among residents of long-term care facilities in Texas; and (3) graphs and data files comparing COVID-19 cases and hospitalizations between the 4 COVID-19 waves in Texas. In addition, this case study uses qualitative interview data to describe how DSHS leadership used these surveillance products during the pandemic. Finally, details on challenges and lessons learned around creating and maintaining these tools are provided. These surveillance products are easily replicable, and our methods and lessons learned may be helpful for researchers or health department officials working on COVID-19 or other disease surveillance teams.
Qualitative Analysis of a Roundtable Exercise “Reflecting on the COVID-19 Experience of Public Health Professionals”
Authors: Strand Mark A. , Sidhu Savita , Hohman Adam , Jansen Rick , McDonough Stephen
Published: February 2023

Context:

Public health professionals around the country faced significant challenges responding to the COVID-19 pandemic. Reflecting on their experience is an essential element in making sense of their experience and learning from it.

Objective:

The objective of this qualitative study was to (1) describe the lived experiences of public health professionals working during the COVID-19 pandemic, (2) discuss the effectiveness of a guided reflection exercise to help public health professionals process these experiences, and (3) provide lessons learned and best practices to inform preparation for a future infectious disease pandemic.

Design:

Qualitative focus group study design.

Setting:

This activity was conducted at a Midwestern state public health professional meeting.

Participants:

Forty-eight public health professionals self-selected to participate in this study.

Results:

Five themes were elicited in this analysis, including Communication, Leadership and Collaboration, Data Management, Community Relationships, and Resources and Planning. In addition, public health professionals reported numerous lessons learned, including the need for more leadership from the state government, the conflicted response of their communities, and the benefits of community solidarity where it was present.

Conclusions:

This article provides a detailed account of public health workers' experiences during the COVID-19 pandemic. It also provides lessons learned that will help public health workers lead more effectively in the future. Guided reflection on a traumatic professional experience can assist participating individuals in making sense of their experience and learning important lessons from it.
Association between knee extension strength and functional capacity after intensive care unit discharge: A six-month prospective cohort study
Authors: Pinto-Ramos João , Moreira Tiago , Costa Liliana , Costa Frederico , Barroso Joana , Sousa-Pinto Bernardo
Published: February 2023

Introduction

Assessing functional improvement after Intensive Care Unit (ICU) discharge is particularly challenging. We aimed to measure the association between (i) changes in knee extension muscle strength or quadriceps femoris and rectus femoris muscle thickness, and (ii) changes in functionality/function-related measurements in post-ICU patients.

Methods

This prospective cohort study included adult patients without previous disability, consecutively selected after ICU discharge. We measured some parameters, such as Short Form 36 (SF-36), 6 Minutes Walking Test (6MWT), 1-Minute Sit-to-Stand (1MSTS), and Short Physical Performance Battery (SPPB) at baseline and three and six months after discharge. We assessed the correlation and built regression models to assess the association between evolution in knee extension strength or muscle thickness and evolution in functional tests.

Results

Thirty patients completed the follow-up. Moderate correlation was found between knee extension strength change and SF-36 Physical Function (correlation coefficient [ρ] = 0.53), 6MWT (ρ = 0.38), 1MSTS (ρ = 0.52) and SPPB (ρ = 0.38). Baseline values and changes in knee extension strength moderately predicted evolution in SF-36 Physical function (r2
= 0.32; p = 0.006). Changes in muscle thickness were overall not associated with changes in functional variables.

Conclusion

Changes in knee extension muscle strength may inform on functional progression over time after ICU discharge, although confirmatory studies are needed.
The Relationship Between Patient-Specific Factors and Discharge Destination After COVID-19 Hospitalization
Authors: Lewis Christopher W. , Gray Elizabeth , Dreyer Sean , Goodman Daniel , Jayabalan Prakash
Published: February 2023

Objective

The aim of this study was to determine the discharge destinations and associated patient-specific factors among patients hospitalized with COVID-19.

Design

A retrospective cohort study was carried out at a single-site tertiary acute care hospital.

Results

Among 2872 patients, discharge destination included home without services (n = 2044, 71.2%), home with services (n = 379, 13.2%), skilled nursing facility (117, 4.1%), long-term acute care hospital (n = 39, 1.3%), inpatient rehabilitation facility (n = 97, 3.4%), acute care facility (n = 23, 0.8%), hospice services (n = 20, 0.7%), or deceased during hospitalization (n = 153, 5.3%). Adjusting by covariates, patients had higher odds of discharge to a rehabilitation facility (skilled nursing facility, long-term acute care hospital, or inpatient rehabilitation facility) than home (with or without services) when they were older (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.80–3.11; P < 0.001), had a higher Charlson Comorbidity Index score (3–6: OR, 2.36; 95% CI, 1.34–4.15; P = 0.003; ≥7: OR, 2.76; 95% CI, 1.56–4.86; P < 0.001), were intubated or required critical care (OR, 2.15; 95% CI, 1.48–3.13; P < 0.001), or had a longer hospitalization (3–7 days: OR, 12.48; 95% CI, 3.77–41.32; P < 0.001; 7–14 days: OR, 28.14; 95% CI, 8.57–92.43; P < 0.001). Patients were less likely to be discharged to a rehabilitation facility if they received remdesivir (OR, 0.44; 95% CI, 0.31–0.64; P < 0.001).

Conclusions

Patient-specific factors associated with COVID-19 hospitalization should be considered by physicians when prognosticating patient rehabilitation.
Risk factors for disabling and non-disabling neck pain in a large cohort of adolescents
Authors: Sarto Fabio , Sarto Diego , Cattelan Manuela , Masiero Stefano
Published: February 2023

Objectives

Neck pain (NP) is extremely common and represents a substantial economic burden to our society. We aimed to investigate risk factors for non-disabling and disabling neck pain in a large cohort of Italian adolescents with a cross-sectional study.

Design

Six thousand, two hundred eighty-one students (14–19 years old) answered an online questionnaire, investigating: anthropometric data, lifestyle-related items, NP frequency and intensity, need for medical examination and several risk factors. Students who had to give up social activities due to neck complaints constituted the disabling NP group (DIS-NP).

Results

Our findings revealed that sex, age, sports practice, hours of sleep and family history were risk factors (p < 0.001) for NP in our cohort. Moreover, DIS-NP suffered from NP more frequently (p < 0.001) and with higher levels of pain (p < 0.001) compared to the non-disabling group. The number of hours of sleep was the only risk factor that showed a trend to differ comparing the DIS-NP group with the non-disabling NP one (p = 0.057).

Conclusion

Different risk factors for NP were detected in a very large cohort of adolescents.

This study may pave the way for future prospective studies and for the development of preventive strategies for NP in adolescents.