bluuebunny/crossref_metadata_2025 huggingface dataset:
Decoding enigma: Turner syndrome with ring chromosome
Authors: Das Debarup , Roy Debaditya , Basu Kaushik , Sarkar Anupam
Published: December 2021

Ring chromosome X is one of the rarest with some unique phenotypical features in Turner syndrome. A young female presented to us with anasarca developed over the past 2 months due to congestive cardiac failure along with jaundice and orthopnea. She had growth retardation, intellectual disability, primary amenorrhea, lack of secondary sexual character development and dysmorphic features like low posterior hairline, shield chest and cubitus valgus. She had dilated cardiomyopathy (DCM) with intracardiac thrombus on echocardiography. Skeletal survey revealed short fourth metacarpal/tarsal on limbs. Karyotyping showed a mosaic pattern, with 45, X/46, X,r(X)(p22.3q28), i.e. Turner syndrome karyotype with ring chromosome. Her heart failure with reduced ejection fraction was managed with vasopressor along with anticoagulant and given oral contraceptive pills for hormone replacement therapy. The ring chromosomal pattern of karyotype in this patient and DCM is a rare cardiological phenomenon that can be associated with Turner syndrome, making this case a unique one.
Spondylodiscitis due to Salmonella Typhi: a series of four cases
Authors: Saravu Kavitha , Bhat Shyamasunder N , Gupta Nitin
Published: December 2021

Salmonella Typhi is very rarely associated with focal bone and joint complications. Classically, they are described in patients with risk factors such as haemoglobinopathies. We report four cases of spondylodiscitis, where the aetiology was found to be Salmonella Typhi. All four cases were treated successfully with variable duration of ceftriaxone followed by cotrimoxazole. We report these cases to highlight the importance of obtaining a microbiological diagnosis and the possibility of a rare infection in endemic settings.
Analysis of REM sleep without atonia in 22q11.2 deletion syndrome determined by domiciliary polysomnography: a cross sectional study
Authors: Mauro Jorge , Diaz Mario , Córdova Teresa , Villanueva Katiuska , Cáceres Tania , Bassi Alejandro , Fritsch Rosemarie , Repetto Gabriela M , Ocampo-Garcés Adrián
Published: December 2021

Study Objectives

Our aim is to evaluate the presence of REM sleep without atonia (RWA), the objective hallmark of REM sleep Behaviour Disorder (RBD), as prodromal marker of Parkinson’s disease (PD), in an adult cohort of 22q11.2 deletion syndrome (22qDS).

Methods

Sleep quality was assessed by means of Pittsburgh quality scale index (PSQI), and RBD symptoms by means of RBD questionnaire-Hong-Kong (RBDQ-HK). Attended domiciliary video-Polysomnography (v-PSG) were performed in 26 adults (18–51 years, 14 females) 22qDS patients. Electromyogram during REM sleep was analyzed by means of SINBAR procedure at 3-second time resolution (miniepochs).

Results

An overall poor sleep quality was observed in the cohort and high RBDQ-HK score in 7 of the 26 patients, two additional patients with positive dream enactment reported by close relatives had low score of RBDQ-HK. Nevertheless, SINBAR RWA scores were lower than cut-off threshold for RWA (mean 5.5%, range 0–12.2%). TST and the percentage of light sleep (N1) were increased, with preserved proportions of N2 and N3. Participants reported poor quality of sleep (mean PSQI > 5), with prolonged sleep latency in the v-PSG. No subjects exhibit evident dream enactment episodes during recording sessions.

Conclusions

RWA was absent in the studied cohort of 22qDS adult volunteers according to validated polysomnographic criteria. High RBDQ-HK scores do not correlate with v-PSG results among 22qDS individuals.
Effect of nonylphenol on the colonic mucosa in rats and intervention with zinc-selenium green tea (Camellia sinensis)
Authors: Li Shixu , Zheng Mucong , Yang Xuefeng , Zhang Jianling , Xu Jie , Yu Jie
Published: December 2021

To investigate the effect of nonylphenol (NP) exposure on the colonic mucosa in rats, and the protective effects of Guizhou zinc-selenium tea (Zn-Se tea) on the damage induced by NP, sixty Sprague–Dawley rats were randomly divided into 6 groups (n = 10 in each group): control group (corn oil), and rats gavaged with NP at the doses of 0.4 mg/kg/d (Low NP group), 4 mg/kg/d (Medium NP group), 40 mg/kg/d (High NP group), and 40 mg/kg NP combined with green tea group at the doses of 0.2 g/ml (NP + GT group) and 0.2 g/ml Zn-Se tea group (NP + ZST group). NP at 40 mg/kg/d was administered to the tea groups for 3 months, followed by NP + green tea and NP + Zn-Se tea for 4 months, and the rest of the groups were gavaged for 7 months. With the increase of NP concentration, NP accumulation in colon gradually increased (P < 0.05), colonic villi shortened, tight junctions between cells widened, intestinal integrity was impaired, and goblet cells, intraepithelial lymphocytes and mast cells were significantly lower in NP high-dose group than in control group (P < 0.05). Meanwhile, the protein expression of Caspase-1, IL-1β and Pro-IL-1β in NP high-dose group was significantly higher than that in control group (P < 0.05). Zn-Se tea increased the number of goblet cells in colon and decreased the accumulation of NP in colon (P < 0.05); Zn-Se tea and common green tea decreased the expression of Caspase-1 and Pro-IL-1β protein (P < 0.05). NP exposure can destroy intestinal morphology, reduce the number of intestinal immune cells, reduce intestinal immunity and increase the release of inflammatory factors; Guizhou Zn-Se tea has a certain protective effect on colon damage caused by NP.
Phylogenetic Distribution of Ralstonia solanacearum Species Complex Populations in Potato in Kenya
Authors: Okiro Lilian A. , Mulwa Richard Mwanza , Oyoo Maurice E. , Machuka Eunice M. , Parker Monica L. , Pelle Roger
Published: December 2021

Ralstonia solanacearum is a pathogen causing bacterial wilt disease of potato, resulting in 70% potato production losses in Kenya. A study was conducted to determine the diversity of R. solanacearum species complex strains within the main potato-growing regions of Kenya. Potato tubers were collected in different potato-growing regions of Kenya from visibly wilted potato plants as well as samples of tomato, irrigation water, and cultures for pathogen isolation. Genomic DNA was isolated from 135 purified cultures of RSSC isolates and PCR-amplified using multiplex and sequevar primers targeting the endoglucanase (egl) partial gene sequences. Pathogenicity tests using R. solanacearum strain (phylotype II sequevar I) were done on the cultivars Kenya Karibu, Shangi, Chulu, Wanjiku, and MoneyMaker. Phylogenetic analysis of the partial egl gene identified two genospecies, R. pseudosolanacearum sp. nov. (1.5%) and R. solanacearum (98.5%). All R. solanacearum strains clustered in sequevar I and were distributed in all the potato-growing regions surveyed. The cultivars were grown in a greenhouse for two cycles in a randomized complete block design and inoculated with R. solanacearum strain. The severity scores were assessed and the area under the disease progress curve (AUDPC) was determined. All the cultivars tested for pathogenicity exhibited wilting symptoms at varying intervals after infection, with none showing complete resistance to R. solanacearum. Cultivar Shangi exhibited minimum disease severity and progression of 41.14% and AUDPC of 1041.7, respectively, while ‘Kenya Karibu’ was the most susceptible with a high progression rate of 68.24% and AUDPC of 1897.5, respectively. ‘MoneyMaker’, ‘Chulu’, and ‘Wanjiku’ showed no significant difference in disease severity, depicting a simultaneous rate of infection among them. These findings provide valuable information to better understand the pathogen genetic diversity in Kenya and how it spreads.
Association of Gestational Age at Coronavirus Disease 2019 (COVID-19) Vaccination, History of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, and a Vaccine Booster Dose With Maternal and Umbilical Cord Antibody Levels at Delivery
Authors: Yang Yawei J. , Murphy Elisabeth A. , Singh Sunidhi , Sukhu Ashley C. , Wolfe Isabel , Adurty Sanjana , Eng Dorothy , Yee Jim , Mohammed Iman , Zhao Zhen , Riley Laura E. , Prabhu Malavika
Published: December 2021

OBJECTIVE:

To describe maternal and umbilical cord blood anti-spike immunoglobulin (Ig)G levels at delivery with coronavirus disease 2019 (COVID-19) vaccination before and during pregnancy and to assess the association of prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and a vaccine booster dose with anti-spike maternal and umbilical cord IgG levels.

METHODS:

We conducted a retrospective cohort study of women with self-reported COVID-19 vaccination (Pfizer-BioNTech, Moderna, or Johnson & Johnson/Janssen), including a booster dose, during or before pregnancy, who delivered at 34 weeks of gestation or more. Maternal and umbilical cord blood samples at delivery were analyzed for semi-quantitative anti-spike IgG. We examined the association between timing of maternal vaccination and maternal and umbilical cord anti-spike levels using a rank sum test. The relationships between a prior history of SARS-CoV-2 infection and maternal and umbilical cord anti-spike IgG levels, and between a booster dose and maternal and umbilical cord anti-spike levels, were also evaluated using a rank sum test.

RESULTS:

We included data from 1,359 vaccinated pregnant women, including 20 women who received a booster dose, and 1,362 umbilical cord samples. Maternal anti-spike IgG levels were detectable at delivery regardless of timing of vaccination throughout pregnancy among fully vaccinated women; however, early third-trimester vaccination was associated with the highest anti-spike IgG levels in maternal and umbilical cord blood. Among women with a history of SARS-CoV-2 infection, maternal and cord blood antibody response achieved with vaccination in early pregnancy was comparable with third-trimester vaccination in pregnant women without a history of SARS-CoV-2 infection. A booster dose in the third trimester was associated with maternal anti-spike IgG levels greater than third-trimester vaccination in women with or without a history of SARS-CoV-2 infection.

DISCUSSION:

Vaccination against COVID-19 before and throughout pregnancy was associated with detectable maternal anti-spike IgG levels at delivery. A complete vaccination course, prior history of SARS-CoV-2 infection, and a third-trimester booster dose were associated with the highest maternal and umbilical cord antibody levels.
Is the Presence of a Psychiatric Disorder Associated With More Aggressive Management of Compartment Syndrome?
Authors: Albano Ashley Y. , Landy David C. , Teasdall Robert J. , Isla Alexander E. , Krupko Thomas A. , Wright Raymond D. , Moghadamian Eric S. , Matuszewski Paul E. , Aneja Arun
Published: December 2021

Objective:

To determine whether pre-existing psychiatric disorder is associated with potentially unnecessary fasciotomy.

Design:

Retrospective cohort study.

Setting:

Academic Level-1 trauma center.

Patients:

All the patients with orthopaedic trauma undergoing leg fasciotomy at an academic Level I trauma center from 2006 to 2020.

Intervention:

Pre-existing diagnosis of psychiatric disorder.

Main Outcome Measurements:

Early primary wound closure and delayed primary wound closure.

Results:

In total, 116 patients were included. Twenty-seven patients (23%) had a pre-existing diagnosis of psychiatric disorder with 13 having anxiety, 14 depression, 5 bipolar disorder, and 2 ADHD. Several patients had multiple diagnoses. Fifty-one patients (44%) had early primary closure (EPC), and 65 patients (56%) had delayed primary closure. Of patients with a psychiatric disorder, 52% received EPC compared with 42% of patients without a disorder, P = 0.38. This lack of a strong association did not seem to vary across specific psychiatric conditions. After adjusting for sex, age, injury type, and substance abuse, there was still no significant association between a psychiatric disorder and EPC with an odds ratio of 1.08 (95% CI, 0.43–2.75).

Conclusions:

Among patients with orthopaedic trauma undergoing emergent fasciotomy for acute compartment syndrome, a psychiatric disorder was not associated with a significantly increased rate of possibly unnecessary fasciotomy. Given the potential for a psychiatric condition to complicate the diagnosis of acute compartment syndrome, this data is somewhat reassuring; however, there remains a need for continued vigilance in treating patients with psychiatric conditions and research in this area.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Antibiotic Cement Bead Rouleaux: A Technical Trick to Maximize the Surface Area to Volume Ratio of Cement Beads to Improve the Elution of Antibiotics
Authors: Perry Nicholas P.J. , Tucker Nicholas J. , Hadeed Michael M. , Heare Austin , Stacey Stephen C. , Hammerberg E. Mark , Mauffrey Cyril , Parry Joshua A.
Published: December 2021

The use of antibiotic-impregnated cement as a local antibiotic delivery system is well-established as an adjunctive treatment for chronic osteomyelitis. Because the elution of antibiotics is a surface area phenomenon, the geometry of the cement is an important consideration. The antibiotic cement bead rouleaux technique is a simple and efficient method of bead fabrication that requires only 10 minutes of preparation time and readily available operating room supplies. The discoid structure of the beads provides 3 times the surface-area-to-volume ratio of a spherical bead, which facilitates antibiotic elution. Given the speed and ease of fabrication, along with optimized geometry, the antibiotic cement bead rouleaux is a useful addition to the surgeon's repertoire.
Allergic Bronchopulmonary Aspergillosis Progression to Chronic Pulmonary Aspergillosis
Authors: Tayal Aditi , Greene John N.
Published: December 2021

Allergic bronchopulmonary aspergillosis is a fungal infection of the lung causing a type 1 hypersensitivity reaction to Aspergillus fumigatus colonization. Patients with preexisting lung pathology are extremely susceptible to this organism and show clinical signs of bronchospasm, pulmonary infiltrates, and eosinophilia. In the following case report, we present an asthmatic patient diagnosed with allergic bronchopulmonary aspergillosis, who, despite treatment, progressed to chronic pulmonary aspergillosis with progressive lung damage requiring surgery.
An Unusual Case of Neurobrucellosis Presenting as Acute Flaccid Paralysis
Authors: Boparai Sukhmani , Daoud Nour , Dominguez Anibal , Bawa Danish , Vyas Aditya , Grier Laurie , Motayar Nasim
Published: December 2021

Background

Acute flaccid myelitis (AFM) is a rare clinical entity that can lead to significant mortality and morbidity. It has a broad differential including various autoimmune and infectious etiologies, which can lead to delays in diagnosis and treatment. Acute flaccid myelitis as presentation of neurobrucellosis has rarely been reported and poses a diagnostic and therapeutic challenge to clinicians.

Case Summary

Here we present a case of a young female presenting with acute onset, rapidly progressive, flaccid paralysis caused by Brucella species. This is an atypical presentation of a rare infection in this region. The infection was likely acquired by consuming unpasteurized goat cheese. The patient made a near-complete neurological recovery after treatment with ceftriaxone, doxycycline, and rifampin.

Conclusions

The catastrophic presentation of our patient makes it relevant for clinicians to be cognizant of this entity.
Combined Myopericarditis and Pneumonitis Post–Pfizer Vaccine Against Coronavirus Disease 2019 in a Healthy Caucasian Middle-Aged Man
Authors: Wang Tao , Cayetano Katherine S. , Parvataneni Chaitanya K. , Paranada Kathleen , Sanchez-Metz Cristobal , Haws Caleb R.
Published: December 2021

A generally healthy middle-aged Caucasian man developed significant cough, fever, chest tightness, dyspnea, and orthopnea after second dose of Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. He was hypoxemic and had bilateral patchy ground glass opacities and mediastinal adenopathy. Those objective signs indicated an acute pneumonitis. His acute heart failure, new onset dilated cardiomyopathy with an left ventricular ejection fraction of 25% are consistent with the diagnosis of suspected myopericarditis despite normal troponin. Autoimmune event and acute viral or bacterial infection were ruled out. With steroid, diuretic, and supportive treatment, the patient clinically improved after 3 days of hospitalization and discharged to home on taper dose steroid and oral diuretic. This case is the first reported case with combined myopericarditis and pneumonitis post–Pfizer COVID-19 vaccine on Vaccine Adverse Event Reporting System. The available scientific data on COVID-19 vaccines indicate that they are generally safe and effective. A long-term postmarketing surveillance on COVID-19 vaccine is warranted.
The cannabinoid agonist CB-13 produces peripherally mediated analgesia in mice but elicits tolerance and signs of central nervous system activity with repeated dosing
Authors: Slivicki Richard A. , Yi Jiwon , Brings Victoria E. , Huynh Phuong Nhu , Gereau Robert W.
Published: December 2021

Activation of cannabinoid receptor type 1 (CB1) produces analgesia in a variety of preclinical models of pain; however, engagement of central CB1 receptors is accompanied by unwanted side effects, such as psychoactivity, tolerance, and dependence. Therefore, some efforts to develop novel analgesics have focused on targeting peripheral CB1 receptors to circumvent central CB1-related side effects. In the present study, we evaluated the effects of acute and repeated dosing with the peripherally selective CB1-preferring agonist CB-13 on nociception and central CB1-related phenotypes in a model of inflammatory pain in mice. We also evaluated cellular mechanisms underlying CB-13-induced antinociception in vitro using cultured mouse dorsal root ganglion neurons. CB-13 reduced inflammation-induced mechanical allodynia in male and female mice in a peripheral CB1-receptor-dependent manner and relieved inflammatory thermal hyperalgesia. In cultured mouse dorsal root ganglion neurons, CB-13 reduced TRPV1 sensitization and neuronal hyperexcitability induced by the inflammatory mediator prostaglandin E2, providing potential mechanistic explanations for the analgesic actions of peripheral CB1 receptor activation. With acute dosing, phenotypes associated with central CB1 receptor activation occurred only at a dose of CB-13 approximately 10-fold the ED50 for reducing allodynia. Strikingly, repeated dosing resulted in both analgesic tolerance and CB1 receptor dependence, even at a dose that did not produce central CB1-receptor-mediated phenotypes on acute dosing. This suggests that repeated CB-13 dosing leads to increased CNS exposure and unwanted engagement of central CB1 receptors. Thus, caution is warranted regarding therapeutic use of CB-13 with the goal of avoiding CNS side effects. Nonetheless, the clear analgesic effect of acute peripheral CB1 receptor activation suggests that peripherally restricted cannabinoids are a viable target for novel analgesic development.
Ultrasound Diagnosis of a Pseudotumor Secondary to a Partial Thickness Distal Biceps Tear Resulting in Pronator Syndrome: A Case Report
Authors: Boettcher Brennan J. , Camp Christopher L. , Jelsing Elena J.
Published: December 2021

A 53-year-old right-handed female weightlifter presented to our clinic for evaluation of left elbow pain and intermittent numbness in her first 3 digits. She reported an elbow injury while weight lifting and carrying heavy planters 6 months earlier. A magnetic resonance imaging obtained previously was interpreted as bicipital-radial bursitis, and she had previously undergone a comprehensive nonoperative management program for her pain and numbness. A diagnostic ultrasound performed in clinic revealed distal biceps tendinopathy, bicipital-radial bursitis, and “pseudotumor,” which was dynamically compressed between the biceps tendon and radius with pronation and also caused a mass effect on the median nerve at the level of the pronator teres. Surgical excision of the mass resulted in near-complete resolution of her symptoms, and histology was consistent with scar tissue. This is the first case to the best of our knowledge to describe point-of-care ultrasound diagnosis of a biceps tendon “pseudotumor,” as well as demonstrating dynamic impingement of this pseudotumor causing mass effect on the median nerve.
Co-Use of Opioids and Sedatives Among Retired National Football League Athletes
Authors: Mannes Zachary L. , Hasin Deborah S. , Ben Abdallah Arbi , Cottler Linda B.
Published: December 2021

Objective:

Among the general population, co-use of opioids and sedatives is associated with greater risk of overdose compared with opioid use alone. National Football League (NFL) retirees experience higher rates of opioid use than the general population, although little is known about their co-use with sedatives. The aim of this study was to examine the prevalence and risk factors of opioid and sedative co-use among NFL retirees.

Design:

Retrospective cohort study.

Setting:

Professional American football.

Participants:

NFL retirees (N = 644).

Independent Variables:

Self-reported concussions, pain intensity, heavy alcohol use, physical and mental health impairment, disability status.

Main Outcome Measure:

Any past 30-day co-use of opioids and sedatives.

Results:

Approximately 4.9% of the sample reported past 30-day co-use of opioids and sedatives, although nearly 30% of retirees using opioids also used sedatives. Greater pain was associated with co-use of opioids and sedatives (adjusted odds ratios [aOR] = 1.58; 95% confidence interval [CI] = 1.23-1.98), although retirees with moderate/severe mental health impairment (vs none/mild; aOR = 2.47; 95% CI = 1.04-5.91) and disability (vs no disability; aOR = 1.35; 95% CI = 1.05-1.73) demonstrated greater odds of co-use compared with retirees not using either substance.

Conclusions:

Given the high rate of sedative use among participants also using opioids, NFL retirees may be susceptible to the negative health consequences associated with co-use. Interventions focused on improving pain and mental health may be especially effective for reducing co-use of these substances among NFL retirees.
Macrolide-Resistant Mycoplasma genitalium Impairs Clinical Improvement of Male Urethritis After Empirical Treatment
Authors: Braam Joyce F. , van Dam Alje P. , Bruisten Sylvia M. , van Rooijen Martijn S. , de Vries Henry J.C. , Schim van der Loeff Maarten F. , Vergunst Clarissa E.
Published: December 2021

Background

Mycoplasma genitalium (MG) is associated with urethritis in men and could play a role in clinical outcome. We examined clinical improvement of symptoms in men receiving empirical treatment for urethritis and correlated the outcome with Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), MG, and MG macrolide resistance-associated mutations (MRAM) status.

Methods

At the sexually transmitted infection clinic in Amsterdam, the Netherlands, empirical treatment for gonococcal urethritis is 1 g ceftriaxone and for nongonococcal urethritis 1 g azithromycin. In 2018 to 2019, we tested urine samples of men with urethritis for CT, NG, and MG using transcription-mediated amplification assays. Mycoplasma genitalium–positive samples were tested for MRAM using quantitative polymerase chain reaction. Two weeks after receiving therapy, men were sent a text message inquiring after clinical improvement.

Results

We evaluated 2505 cases of urethritis. The positivity rates of NG, CT, and MG were 26% (648 of 2489), 29% (726 of 2489), and 23% (522 of 2288), respectively. In 768 of 2288 of the cases (34%), no causative agent was detected. Most cases were infected with a single pathogen: NG, 417 of 2288 (18%); CT, 486 of 2288 (21%); and MG, 320 of 2288 (14%). The prevalence of MRAM among MG-positives was 74% (327 of 439). For 642 (25.6%) cases, we could evaluate clinical improvement after treatment of whom 127 (20%) indicated no improvement; 9% (15 of 174) in NG cases, 18% (35 of 195) in CT cases, 14% (4 of 28) in MG wild-type cases, and 40% (38 of 94) in MG-MRAM cases. Clinical improvement in MG-MRAM cases was significantly lower compared with all other groups (P < 0.001).

Conclusions

Presence of MG-MRAM is associated with lack of clinical improvement in azithromycin-treated nongonococcal urethritis.
Feasibility of Capturing Adverse Events From Insurance Claims Data Using International Classification of Diseases, Tenth Revision, Codes Coupled to Present on Admission Indicators
Authors: Kim Juyoung , Choi Eun Young , Lee Won , Oh Hae Mi , Pyo Jeehee , Ock Minsu , Kim So Yoon , Lee Sang-il
Published: December 2021

Objective

The aim of the study was to investigate the feasibility of using administrative data to screen adverse events in Korea.

Methods

We used a diagnosis-related groups claims data set and the information of the checklist of healthcare quality improvement (a part of the value incentive program) to verify adverse events in fiscal year 2018. Adverse events were identified using patient safety indicator (PSI) clusters and a present on admission indicator (POA). The PSIs consisted of 19 clusters representing subcategories of adverse events, such as hospital-acquired infection. Among the adverse events identified using PSI clusters, “POA = N,” which means not present at the time of admission, was only deemed as the case in the final stage. We compared the agreement on the occurrence of adverse events from claims data with a reference standard data set (i.e., checklist of healthcare quality improvement) and presented them by PSI cluster and institution.

Results

The cases of global PSI for any adverse event numbered 27,320 (2.32%) among all diagnostic codes in 2018. In terms of institutional distribution, considerable variation was observed throughout the clusters. For example, only 13.2% of institutions (n = 387) reported any global PSI for any adverse event throughout the whole year. The agreement between the reference standard and the claims data was poor, in the range of 2.2% to 10.8%, in 3 types of adverse events. The current claims data system (i.e., diagnostic codes coupled to POA indicators) failed to capture a large majority of adverse events identified using the reference standard.

Conclusions

Our results imply that the coding status of International Classification of Diseases, Tenth Revision, codes and POA indicators should be refined before using them as quality indicators.
Is a High Medication Risk Score Associated With Increased Risk of 30-Day Readmission? A Population-Based Cohort Study From CROSS-TRACKS
Authors: Thoegersen Trine Worm , Saedder Eva Aggerholm , Lisby Marianne
Published: December 2021

Objectives

The primary aim of this study was to evaluate whether a high Medication Risk Score (MERIS) upon admission to an emergency department is associated with increased risk of 30-day readmission in patients discharged directly home. Mortality, visit to general practitioner, and drug changes within 30 days were included as secondary outcomes.

Methods

This is a historical cohort study with data from the Danish population-based open-cohort CROSS-TRACKS. Cox regression analyses were used to determine whether a high MERIS score was associated with increased risk of 30-day readmission and mortality. Visit to general practitioner and drug changes were tested with χ2 test and Wilcoxon rank sum test.

Results

A total of 2106 patients were eligible: 2017 had a MERIS score lower than 14 (low-risk group), and 89 had a score of 14 or higher (high-risk group). The proportion of patients in the high-risk group who were readmitted was 21.3% compared with 16.3% in the low-risk group, resulting in a hazard ratio for readmission of 1.43 (95% confidence interval, 0.9–1.3). The hazard ratio for mortality was 8.3 (95% confidence interval, 3.0–22.8). No statistical significant difference was found in general practitioner visits; however, significantly more drug changes were observed in the high-risk group.

Conclusions

A high MERIS score was associated with increased risk of readmissions and can potentially assist healthcare professionals in the prioritizing of patients who may benefit from further exam, for example, additional medication review in acute care setting. Further investigation of MERIS and exploration of causal inferences between medication-related harm and medication-related readmissions are warranted.
Free-Text Computerized Provider Order Entry Orders Used as Workaround for Communicating Medication Information
Authors: Kandaswamy Swaminathan , Grimes Joanna , Hoffman Daniel , Marquard Jenna , Ratwani Raj M. , Hettinger Aaron Z.
Published: December 2021

Objectives

Medication information is frequently communicated via free-text computerized provider order entry (CPOE) orders in electronic health records. When such information is transmitted separately from a structured CPOE medication order, there is a significant risk of medication error. Although prior studies have described the frequency of using free-text CPOE orders for communicating medication information, there is a gap in understanding the nature of the medication information contained in the free-text CPOE orders. The aims of this study are to (1) identify the most common medication names communicated in free-text CPOE orders and their risk levels and (2) identify what actions physicians expect that nurses will complete when they place free-text CPOE orders, and (3) describe differences in these patterns across hospitals.

Methods

This study was a retrospective analysis of a sample of 26,524 free-text CPOE orders from 6 hospitals in the mid-Atlantic U.S. region.

Results

Free-text CPOE orders contained in the sample mentioned 193 medication names. Free-text CPOE orders were used frequently to communicate information about naloxone, heparin, flumazenil, and dextrose. Twenty-two percent of the free-text CPOE orders related to discontinuing medication(s), whereas 7% of the free-text CPOE orders relate to giving medication(s). There was high variation across hospitals both in the percentage of free-text CPOE orders mentioning medication information and in the proportion of those that referred to high-risk medications.

Conclusions

The prevalence of medication information in free-text CPOE orders may suggest specific communication challenges in respect to urgency, uncertainty, planning, and other aspects of communication and clinical needs. Understanding and addressing communication challenges around commonly mentioned medication names and actions, especially those that are high risk, can help reduce the risk of medication errors.
Feelings of Trust and of Safety Are Related Facets of the Patient’s Experience in Surgery: A Descriptive Qualitative Study in 80 Patients
Authors: Occelli Pauline , Mougeot Frédéric , Robelet Magali , Buchet-Poyau Karine , Touzet Sandrine , Michel Philippe
Published: December 2021

Objective

Few studies to date have explored the question of the safety of a hospital stay from the patient’s point of view. The aim of this study was to describe patients’ own perspectives on the safety of the surgical care they received. A qualitative study was conducted based on interviews.

Methods

Semidirected interviews were conducted by a sociologist with adult patients admitted for hospitalization in 2 orthopedic and in 2 digestive surgery wards in 4 hospitals.

Results

Eighty interviews were transcribed and analyzed. The patients surveyed averaged 61.7 years old (SD, 16.0 y). Forty-eight percent were men (n = 38). The issue of the safety of care, as defined by professionals, is little apprehended by patients. In their view, sense of safety was related to the trust in the surgeon, which is a requisite condition for a sense of security and is based on interactions with the surgeon and on their communication style. Sense of safety was also related to the preoperative consultation, in which the procedure is explained and illustrated and to a postoperative encounter with a person who participated in the operation.

Conclusions

Patients’ sense of safety is linked to the amount of trust they have in their surgeons. New strategies to improve language practices and surgeon-patient interaction should be developed, along with organizational improvement guaranteeing that participants of the surgery debrief with the patient.

The study has been registered at ClinicalTrials.gov (identifier: NCT02820545).
Development and Adjustment of an Algorithm for Identifying Drug-Related Hospital Admissions in Pediatrics
Authors: Schulze Christopher , Toni Irmgard , Moritz Katrin , Eberl Sonja , Rascher Wolfgang , Neubert Antje
Published: December 2021

Objective

Adverse drug events (ADEs) in the outpatient pediatric pharmacotherapy can be serious and lead to inpatient admissions. Recent research only focused on ADE identification during hospitalization. The aim of the present study was to develop an algorithm to identify drug-related hospital admissions in pediatrics.

Methods

A systematic literature research was performed, and a pediatric trigger tool for identifying drug-related inpatient admissions was built. The initial version was tested in a sample of 292 patients admitted to a German university children’s hospital. Subsequently, the tool was further improved by combining different modules as a novel approach.

Results

The obtained algorithm with 39 triggers in 5 modules identified drug-related inpatient admissions at a sensitivity of 95.5% (95% confidence interval [CI], 89.3%–100%) and a specificity of 16.5% (95% CI, 11.9%–21.2%), respectively. After modifications including trigger activation requiring a combination of different modules, specificity increased to 56.9% (95% CI, 50.7%–63.0%). Identifying 36 of 44 ADEs leading to admission, sensitivity remained high (81.8% [95% CI, 70.4%–93.2%]). The overall positive predictive value was 25.2% (95% CI, 18.1%–32.3%).

Conclusions

The algorithm is the first trigger tool to identify ambulant acquired ADEs leading to hospital admission in pediatrics. However, the underlying patient sample is small.

Using a larger population for refinement will allow further specifications and reduction in the total amount of triggers and thus signals.
Evaluating Potentially Inappropriate Medications in Older Kidney Transplant Recipients
Authors: Cohen Elizabeth A. , DeVietro Lena M. , Richardson Brock A. , Odinet Johlee S. , Toledo Alexander H. , Marin Ethan P. , Szempruch Kristen R.
Published: December 2021

Objectives

Beers Criteria and the Screening Tool of Older Persons’ Prescriptions (STOPP) Criteria/Screening Tool to Alert to Right Treatment Criteria are used to assess potentially inappropriate prescribing and medications, which could pose a harm to those of older age. The purpose of this study was to assess and compare the use of Beers and STOPP Criteria in older kidney transplant recipients.

Methods

This was a dual-center, retrospective chart review from May 1, 2014, to March 1, 2018, including kidney transplant recipients 65 years and older. Those who underwent a dual transplant or had incomplete medical records were excluded. Outcomes included number of potentially inappropriate medications (PIMs) comparing Beers and STOPP Criteria on transplant admission, number of PIMs on admission compared with discharge, and readmissions within 3 months related to these medications.

Results

A total of 121 recipients were evaluated. On admission, 60 medications were listed on the STOPP Criteria compared with 106 medications on the Beers Criteria. When comparing PIMs on admission to discharge, there was a 38% decrease in the number of medications on discharge using the STOPP Criteria, whereas there was a 9% increase using the Beers Criteria.

Conclusions

Older recipients were more likely to be on a medication listed in the Beers Criteria on admission and have a new medication listed in the Beers Criteria upon discharge compared with the STOPP Criteria.
Psychological Impact and Risk of Suicide in Hospitalized COVID-19 Patients, During the Initial Stage of the Pandemic: A Cross-Sectional Study
Authors: Benavente-Fernández Alberto , Gutiérrez-Rojas Luis , Torres-Parejo Úrsula , Parejo Morón Ana Isabel , Fernández Ontiveros Sergio , Vinuesa García David , González-Domenech Pablo , Laínez Ramos-Bossini Antonio Jesús
Published: December 2021

Objectives

This study aimed to assess the psychological impact and risk of suicide in patients hospitalized for COVID-19.

Methods

A cross-sectional study was conducted on a representative sample of patients hospitalized for COVID-19 at the “San Cecilio” University Hospital (Granada, Spain) between March and May 2020. Sociodemographic and clinical variables were collected. All participants were evaluated using the Gijon’s Social-Familial Evaluation Scale to assess social problems, the Impact of Event Scale-6 and the Hospital Anxiety-Depression Scale to assess psychological impact, the Columbia Suicide Severity and Beck Hopelessness scales to assess risk of suicide, and the List of Threatening Experiences questionnaire to control for confounding bias.

Results

Thirty-six COVID-19 patients were evaluated. Of them, 33.3% had a significant psychological impact; 13.9% showed symptoms of anxiety, 13.9% showed symptoms of depression, and 47.2% showed symptoms of anxiety-depression. Moderate and severe risk of suicide were found in 75% and 2.8% of the patients, respectively. Suicidal ideation was observed in 16.7% and suicide behaviors in 5.6% of the patients. Psychological impact was associated with previous psychological treatment, a greater degree of functional dependency, and increased social-familial risk. In addition, the risk of suicide was mainly associated with active treatment of a psychiatric illness and active smoking. No significant correlation was found between psychological impact and risk of suicide.

Conclusions

Psychological impact and risk of suicide were significant in patients admitted for COVID-19. Although the risk of suicide was not associated with increased psychological impact, both should be assessed, especially in patients at higher risk based on significantly associated factors.
A full-proteome, interaction-specific characterization of mutational hotspots across human cancers
Authors: Chen Siwei , Liu Yuan , Zhang Yingying , Wierbowski Shayne D. , Lipkin Steven M. , Wei Xiaomu , Yu Haiyuan
Published: December 2021

Rapid accumulation of cancer genomic data has led to the identification of an increasing number of mutational hotspots with uncharacterized significance. Here we present a biologically informed computational framework that characterizes the functional relevance of all 1107 published mutational hotspots identified in approximately 25,000 tumor samples across 41 cancer types in the context of a human 3D interactome network, in which the interface of each interaction is mapped at residue resolution. Hotspots reside in network hub proteins and are enriched on protein interaction interfaces, suggesting that alteration of specific protein–protein interactions is critical for the oncogenicity of many hotspot mutations. Our framework enables, for the first time, systematic identification of specific protein interactions affected by hotspot mutations at the full proteome scale. Furthermore, by constructing a hotspot-affected network that connects all hotspot-affected interactions throughout the whole-human interactome, we uncover genome-wide relationships among hotspots and implicate novel cancer proteins that do not harbor hotspot mutations themselves. Moreover, applying our network-based framework to specific cancer types identifies clinically significant hotspots that can be used for prognosis and therapy targets. Overall, we show that our framework bridges the gap between the statistical significance of mutational hotspots and their biological and clinical significance in human cancers.
“Seeking meaning in self: the dialogical process of storytelling and educating the professional practitioner”
Authors: Higgins David
Published: December 2021

Purpose

The paper seeks to illustrate the impact, a narrative based approach to learning in practice could have in relation to management education, where reflexive critiques may provide a platform for integrating more closely the appreciation/analysis of the nature of management development with the experiences of practice.

Design/methodology/approach

Collaborative ethnography seeks to connect the self with others and the social with context; it is a method which embraces the opportunity to understand/appreciate lived experience in moments of learning.

Findings

The use of storytelling as a method to aid reflexive dialogue forces the student to move away from their pre-existing assumptions and practices and provide them with the power and conviction to seek out and recognise new meaning and differing alternatives of practice. The implication of this position in terms of an educational agenda involves challenging the “self-conceptions” of what it means to be a “practitioner” (Alvesson and Willmott, 1992; Martin, 1992; Zubizarreta, 2004).

Practical implications

The authors argue that focus must be placed on methods through which learning resides in action. Recognising action in learning allows for the development of management education which re-directs thinking and conceptualising towards understanding the social tensions, complex relations and connections in the co-construction of knowing.

Social implications

The article has sought to exemplify how storytelling can contribute to professional and personal development in new and more enriched ways. This reflexive-style paper presented a perspective from which the writers' values and beliefs are informed, as opposed to making a claim for authenticity and authority in regards to the subject area.

Originality/value

The paper highlights the need to explore imaginative modes of management education practices (Hjorthet al., 2018). Teaching students to simply tell stories is not the goal; rather, it is about sensitising students to the aesthetics of organising and the potential of approaching learning from sensuous and experimental perspectives.
Voluntary part-time and mandatory full-time telecommuting: a comparative longitudinal analysis of the impact of managerial, work and individual characteristics on job performance
Authors: Jamal Mohd Tariq , Anwar Imran , Khan Nawab Ali
Published: December 2021

Purpose

Based on self-determination theory (SDT), the present study aims to assess the effect of managerial (manager trust and support), work (job autonomy) and individual (intrinsic motivation) characteristics on job performance of telecommuters in a pre- and post-coronavirus disease 2019 (COVID-19) outbreak period and is further studied longitudinally after six months of continued mandatory telecommuting.

Design/methodology/approach

Data were collected from information technology (IT) sector employees in three phases and model fitness, reliability and validity of the data for all three phases were assessed through CFA models, while the hypotheses were tested through path analysis.

Findings

Perceived manager trust and support increases job performance and the effect strengthens with an increase in telecommuting extent. Job autonomy had similar effects with the exception that employees did not enjoy autonomy when mandatory telecommuting arrangement was initially introduced. Lastly, intrinsic motivation fades away as employees continue to work permanently from their homes.

Practical implications

Permanent full-time telecommuting is expected to continue for the unforeseeable future; the present study suggests that while ensuring increased trust, support and job autonomy to employees, managers must also ensure that employees do not feel professionally isolated and attempt to keep individuals intrinsically motivated.

Originality/value

The authors assess the effect of managerial (manager trust and support), work (job autonomy) and individual (intrinsic motivation) characteristics on job performance under three different types of telecommuting arrangements (voluntary part-time, mandatory full-time and continued mandatory full-time) by collecting data in three different time frames from the same individuals.
Meaning making of mentorship for the tuition-free student
Authors: Parnther Ceceilia , Collier Daniel
Published: December 2021

Purpose

The study aimed to explore how student recipients of a full-tuition scholarship envision, define and experience mentorship and the types of relationships they have and expect from mentors. The study adds to the growing body of literature on mentorship as supplemental support for college student success.

Design/methodology/approach

Semi-structured interviews of 20 first-year college students in the Mid-West United States were collected as a part of a more extensive mixed-methods study. The authors used a four-phase process to refine, derive meaning and develop themes. Kegan's orders of consciousness explain how students make meaning of mentorship.

Findings

Students described mentoring as a service that could provide specific transactional features. Ten participants were unable to acknowledge a mentoring relationship at all, despite describing mentoring experiences and opportunities. Students often align with Kegan's second order, which focuses on self and valuing transactional, short-term relationships. Adjusting approaches to explaining mentorship and the value of building relationships appear to be an opportunity for research and practice.

Originality/value

This study illustrates an apparent disconnect between the intent of mentorship and the experiences of mentees. The students' experiences add a valuable perspective that supports the need to further refine mentoring practices in meaningful ways to impact student success, persistence and retention.
Exploring blockchain adoption intentions in the supply chain: perspectives from innovation diffusion and institutional theory
Authors: Hartley Janet L. , Sawaya William , Dobrzykowski David
Published: December 2021

Purpose

Despite blockchain's potential supply chain benefits, few organizations have moved beyond pilot projects. The paper aims to explore blockchain adoption intentions for supply chain applications using two theoretical perspectives: innovation diffusion theory (IDT) and institutional theory (IT).

Design/methodology/approach

Based on theory, five propositions were developed addressing the intention to adopt blockchain. The propositions were tested using scenario-based experiments with supply chain professionals. To provide additional insights, interviews with 21 supply chain professionals in 15 organizations representing 8 industries were content analyzed.

Findings

Experiments suggest that the intention to adopt blockchain is higher when there are government regulations regarding product origin, organizations are using updated cloud-based information systems and organizations are working with third-party consultants. The content analysis suggests that organizations that face normative pressures to adopt blockchain supply chain applications and recognize blockchain's relative advantage, compatibility and complexity are more likely to be actively seeking information about and adopting blockchain supply chain applications. The authors synthesize findings and provide new propositions to guide future research.

Originality/value

Using a multi-method approach, the study provides an important window into supply chain managers' perceptions of the necessary conditions to support organization-level blockchain adoption. The findings also indicate key characteristics present in supply chain networks poised for blockchain adoption.