bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between Burnout and Type A Behavior Pattern in Spanish Social Workers
Authors: Ariza Toledano Leonor Belén , Ruiz-Olivares Rosario
Published: November 2024

The aims of this study were to establish the prevalence of burnout and type A behavior pattern (TABP) among social workers in Spain and to examine their relationship with sociodemographic variables in a sample of 442 members of professional social workers’ associations in Spain. The Spanish version of the Jenkins Activity Survey, form H (JASE-H) and the Maslach Burnout Inventory were used as instruments to measure TABP and burnout, respectively. Bivariate correlation test, analysis of variance, and logistic regression were carried out to analyze the data. The results showed that variables associated with TABP (competitiveness, hostility, impatience, and workload) increase the risk of burnout, with hostility and workload being identified as predictive risk factors. Gender differences impacted burnout, with women experiencing greater emotional exhaustion, while age and time in the job influenced type A behavior, with older age associated with heightened hostility and decreased workload, and longer time in the job linked to reduced competitiveness. Conducting this study was crucial to determine whether there are aspects of TABP that impact the development of burnout, in order to design interventions and prevention strategies that promote the health and well-being of affected individuals.
Trust declarations and creditor protection in insolvency: lessons from Wade & Anor v Singh & Ors
Authors: Mak Charles Ho Wang
Published: November 2024

The High Court case Amanda Wade and Nicholas Nicholson (Joint Liquidators of MSD Cash and Carry Plc (In Liquidation)) v Mohinder Singh, Surjit Singh Deol, Raminder Kaur Deol, the Estate of Bakshish Kaur (Deceased) (‘Wade & Anor v Singh & Ors’) examined the validity of a Declaration of Trust and enforcement of charging orders in a corporate insolvency. Involving a property owned by family members of a liquidated company, the case explored the intersection of trust law, property rights, and creditor protection. The court invalidated the Declaration as an attempt to defraud creditors under the Insolvency Act 1986. This case emphasises the importance of clear intent in trust declarations and reinforces creditor rights protection in insolvency proceedings. The case underscores the need for specialist legal advice in property and trust matters, particularly when creditor claims may arise.
Evidence-Informed Nursing Clinical Practices for Wound Debridement
Authors: Rajhathy Erin M. , Hill Mary C. , Tran David Le , Sibbald R. Gary , Ayello Elizabeth A.
Published: November 2024

Debridement, a mainstay of nursing clinical practice, refers to the removal of dead or unhealthy tissue from a wound to facilitate healing. Debridement is one component of the concept of wound bed preparation that has long guided the approach to wound management. The ability of a wound to heal must be determined prior to the initiation of any method of debridement. In areas where high-quality, comparative studies on the relative benefits of different debridement modalities are lacking, nurses should adopt an evidence-informed approach to care. To do this, nurses must understand the importance of following a comprehensive, holistic approach when treating chronic wounds. Nurses should have knowledge of inflammation and infection control and of the fundamentals of moisture management, recognize the need for debridement in healable wounds, and be familiar with different debridement options. This article provides nurses with a wound management framework, an overview of wound debridement options based on the potential for wound healing, and scope of practice considerations for developing a plan of care. A composite case is presented to illustrate the critical considerations in wound care.
Importance of Modifiable Factors to Infant Health in the Context of Prenatal Opioid Use Disorder
Authors: Ehrenthal Deborah B. , Wang Yi , Kirby Russell S.
Published: November 2024

Objective

The aim of the study is to estimate the contributions of common and modifiable risk factors to birth outcomes of individuals with prenatal opioid use disorder (OUD).

Methods

We conducted an observational cohort study of all Wisconsin Medicaid-covered singleton live births from 2011–2019. Using Blinder-Oaxaca decomposition for continuous, and the Fairlie extension for categorical outcomes, we estimated the contributions of comorbidities, tobacco use, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) to birthweight for gestational age (BW-GA) percentile associated with prenatal OUD and the risk of small for gestational age (SGA), net of other factors.

Results

Among 216,684 births, the 5184 (2.4%) with OUD had greater prevalence of tobacco use, a lower average pre-pregnancy BMI (26.7 kg/m2, SD = 0.09 versus 28.4 kg/m2, SD = 0.02), and on average 2.0 pounds less GWG, when compared to those without OUD. The predicted mean BW-GA percentile among infants with OUD exposure was 11.2 (95% CI 10.5, 11.9) points lower than those without; 62.3% (95% CI 57.4, 67.1) of this difference could be explained by the variables included in the full model and the largest contribution of the explained portion came from the higher prevalence of tobacco use followed by the contributions of comorbidities, GWG, and pre-pregnancy BMI.

Conclusions

More than half of the difference in BW-GA percentile, and risk of SGA associated with prenatal OUD, could be attributed to modifiable factors and not opioids. Moreover, potentially modifiable factors including tobacco use and measures reflecting nutritional status contributed to a majority of the explained portion.
Racial and Ethnic Disparities in Referral Rejection from Postacute Care Facilities among People with Opioid Use Disorder in Massachusetts
Authors: Rosenmoss Sophie , LaRochelle Marc , Bearnot Benjamin , Weinstein Zoe , So-Armah Kaku , Moyo Patience , Yan Shapei , Walley Alexander Y. , Kimmel Simeon D.
Published: November 2024

Objectives

The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD).

Methods

In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects.

Results

We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69).

Conclusions

Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.
Xylazine Positivity in Opioid-Positive Drug Screens on an Inpatient Labor Unit
Authors: Trammel Cassandra , Azimi Vahid , Crews Bridgit , Roper Stephen , Raghuraman Nandini , Carter Ebony B. , Frolova Antonina , Odibo Anthony O. , Lawlor Megan , Kelly Jeannie C.
Published: November 2024

Objective

Untreated opioid use disorder (OUD) is associated with significant morbidity in pregnancy. Recent reports have highlighted the rise of xylazine in the nonprescribed fentanyl supply. The frequency with which pregnant people with OUD are exposed to xylazine has not been characterized. We sought to describe the rate of xylazine detection in urine drug screens (UDS) from pregnant people admitted to a labor unit.

Methods

We performed a cross sectional study of all UDS results from an inpatient obstetric unit at an urban tertiary care center from December 2022, when xylazine was added to the detection panel, through July 2023. We perform universal verbal drug screening, with subsequent urine drug screening only performed after a positive verbal screen and consent. The trend of opioid-positive urine drug screens also positive for xylazine from December to July was measured with the Cochran-Armitage test.

Results

Of 5662 people admitted to Labor and Delivery during the study period, 138 UDS were sent for 123 unique individuals. Ninety-eight (71%) of UDS were positive for nonprescribed substances. Of positive UDS, 36 (37%) were positive for nonprescribed opioids, and of these, 17 (47.2%) were positive for xylazine among 14 pregnant people. The trend of UDS positive for opioids that were also positive for xylazine increased significantly over time (P = 0.030), from 0% in December 2022 to 100% in July 2023.

Conclusions

Over 8 months, xylazine positivity significantly increased in UDSs positive for nonprescribed opioids in an urban Midwestern hospital. These results underscore the critical need to study the impact of xylazine on obstetric outcomes.
Associations Between Sleep Health and Child Behavior at Age 6 Years in the INSIGHT Study
Authors: Dadzie Adwoa , Master Lindsay , Hohman Emily E. , Acton Erika Hernandez , Tauriello Sara , Paul Ian M. , Savage Jennifer S. , Anzman-Frasca Stephanie , Buxton Orfeu M.
Published: November 2024

Objective:

Suboptimal sleep is associated with disruptive behaviors in childhood. We evaluate associations of mean and variability (SD) of sleep duration, quality, and timing with emotion regulation, impulsivity, and prosocial and antisocial behavior in children.

Methods:

Intervention Nurses Start Infants Growing on Healthy Trajectories, a randomized controlled trial designed for obesity prevention, compared a responsive parenting intervention delivered in the first 2.5 years after birth with a home safety control group. At age 6 years, children wore an actigraphy device for 7 days and participated in behavioral tasks evaluating behavioral control, emotion regulation, and prosocial and antisocial behaviors. Separate linear regression models examined associations between sleep and behavioral variables, adjusting for study group, child sex, and household income. Moderation analysis investigated whether the study group moderated relationships between sleep and positive age-appropriate behavior.

Results:

Children (N = 143, age 6.7 ± 0.3 years) were predominantly non-Hispanic White (95%). Mean actigraphic sleep duration, quality, and timing were not associated with behavioral variables. By contrast, greater variability in sleep onset timing was associated with greater impulsivity (B = 0.85, p = 0.004) and poorer emotion regulation (B = −0.65, p = 0.01). Greater variability in sleep midpoint timing was associated with greater impulsivity (B = 0.80, p = 0.03). The study group moderated the effect of sleep onset variability on behavior; only the home safety control group exhibited a significant negative relationship between variability in sleep onset timing and emotion regulation (B = −1.28, p = 0.0002).

Conclusion:

Findings support the importance of consistency in sleep timing and how this may play a greater role in children's behavioral and emotional outcomes than mean actigraphic sleep duration and quality.
Access to maternity care: challenges and solutions for improving equity across US communities
Authors: Kozhimannil Katy B. , Interrante Julia D. , McGregor Alecia J.
Published: November 2024

Purpose of review

Improving maternal health is a clinical and policy priority in the United States. We reviewed recent literature on access to maternity care and impacts on racial and geographic equity.

Recent findings

New research indicates a wide range of consequences of obstetric unit closures, as well as health challenges for lower-volume obstetric units and those who travel long distances to care.

As maternal mortality rates rise, maternity care access is declining in the US, especially in rural areas and communities with a higher proportion of Black, Latinx, or Indigenous residents. Lack of resources and financial strain are challenges for low-volume and Black-serving obstetric units, and targeted investments may help improve safety and access.
Ionizing Radiation Dose to the Skin Assessed after Rapid Detection of 232Th in Consumer Products
Authors: Karbiwnyk Christine , Stafford Philip , Malkin Elon , Garnick Kelly , Scott Thomas A. , Wei Cong
Published: November 2024

After some consumer products indicated elevated levels of 232Th progeny by gamma-ray spectrometry, a microwave digestion and inductively coupled plasma-mass spectrometry (ICP-MS) procedure was implemented for the direct assay of 232Th content to ensure compliance with Federal regulations and guidelines. Levels of 232Th were determined by ICP-MS based on standard calibration using a 205Tl internal standard. The method had a method detection limit (MDL) of 0.15 Bq g−1 and a lower limit of quantification (LLOQ) of 0.65 Bq g−1 for 232Th, making it a suitable confirmatory method following gamma-ray spectrometry. The 232Th activity concentration calculated from the ICP-MS results ranged from 2.0–3.4 Bq g−1 for the kinesiology tape samples and 20 Bq g−1 for the silicone ion bracelet. The VARSKIN+1.0 software program was used to calculate the shallow dose equivalent of ionizing radiation from 232Th and its progeny from the ICP-MS results. The skin dose to the consumer wearing the kinesiology tape ranged from 0.48–1.6 mSv y−1. The skin dose to the consumer with constant wear of the silicone ion bracelet was estimated to be 17 mSv y−1. Although 232Th may be determined indirectly by assay of high abundance gamma rays produced by its progeny, the US Code of Federal Regulations (CFR) requires the direct assay of 232Th for confirmatory analysis. We found this ICP-MS method to be a rapid 232Th confirmatory technique compared to a chemical separation followed by alpha spectrometry procedure.
Reconsidering the City of New York Directive on Mental Health Involuntary Removals
Authors: Camejo Daniel A. , Bido-Medina Richard O. , Koh Katherine A. , Keuroghlian Alex S.
Published: November 2024

Background

Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed.

Methods

We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as “homelessness and mental health,” “policy interventions for homeless populations,” and “health care services costs.” We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care.

Results

Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve.
Phosphatidylserine-Positive Live Sperm as a Biomarker of Fertility Status: Evidence from Patients Undergoing Varicocele Treatment
Authors: George C. D. , Poudel B. , Cielencki C. , Hamzeh Y. , Charles D. , Purcell S. , Manka D. , Ravichandran K. S. , Smith R. P. , Kavoussi P. K. , Lysiak J. J.
Published: November 2024

Purpose:

Phosphatidylserine exposed on live and motile sperm is necessary for sperm:egg fusion, and emerging data suggest it is a biomarker for fertilization competent sperm. Men with varicocele often display infertility, and one of the known causes is poor sperm quality. Here, we sought to determine whether the percentage of phosphatidylserine-positive live sperm (PS+ live sperm) could serve as a reliable indicator of male fertility.

Materials and Methods:

Semen samples from cryo-banked pregnancy-proven donors, from self-identified pregnancy-reported donors, and from men seeking infertility treatment for varicocele were analyzed for phosphatidylserine exposure on live sperm. Semen samples were also analyzed premicrosurgical and postmicrosurgical varicocele repair to determine whether varicocele repair led to a change in the percentage of PS+ live sperm.

Results:

Semen samples from “pregnancy-proven” donors (n = 31) had 82% ± 2% PS+ live sperm and samples from “self-identified pregnancy-reported” donors (n = 34) had 87% ± 1%. Men presenting with a varicocele (n = 80) had significantly lower PS+ live sperm with 68% ± 3%. PS+ live sperm correlated with reported pregnancies in patients with varicocele, whereas total motile sperm count did not. Varicocele repair (n = 10) led to a significant increase in PS+ live sperm, and 2 of the patients reported pregnancies after varicocele repair.

Conclusions:

These results suggest that the percentage of PS+ live sperm in an ejaculate correlates with male fertility status and could help in guiding treatment options for patients with varicoceles.
Early Hearing Outcomes and Audiological Experiences With a Novel Fully Implanted Cochlear Implant
Authors: Dornhoffer James R. , DeJong Melissa D. , Driscoll Colin L.W. , Saoji Aniket A.
Published: November 2024

Objective

To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant.

Study Design

Prospective cohort.

Setting

Tertiary academic medical center.

Patient

Three adults (two—male, one female) with bilateral sensorineural hearing loss.

Interventions

Implantation with a fully implanted cochlear implant as part of an early feasibility study.

Outcomes

Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment.

Results

All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant.

Conclusion

The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.
How to Teach an “Old Dog” New Tricks: Improving Clinical Efficiency in a Well-Established Cochlear Implant Program
Authors: Holcomb Meredith A. , Smeal Molly R.
Published: November 2024

Objective

To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program.

Setting

Tertiary referral center.

Patients

CI candidates and CI users.

Interventions

Implementation of a new CI service delivery model.

Main Outcome Measures

CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden.

Results

De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists' schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019–2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our program's CI utilization rate and reduced our role as a barrier to CI care.

Conclusion

If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.
Hybrid Cochlear Implant Outcomes and Improving Outcomes With Electric–Acoustic Stimulation
Authors: Reinhart Paul , Parkinson Aaron , Gifford René H.
Published: November 2024

Introduction

Electric–acoustic stimulation (EAS) provides cochlear implant (CI) recipients with preserved low-frequency acoustic hearing in the implanted ear affording auditory cues not reliably transmitted by the CI including fundamental frequency, temporal fine structure, and interaural time differences (ITDs). A prospective US multicenter clinical trial was conducted examining the safety and effectiveness of a hybrid CI for delivering EAS.

Materials and Methods

Fifty-two adults (mean age 59.9 yr) were enrolled in the study and followed up to 5 years postactivation. Testing included unaided and aided audiometric thresholds, speech perception (Consonant–Nucleus–Consonant [CNC] words in quiet and AzBio sentences +5 dB SNR), and patient-reported outcomes (Speech, Spatial, and Qualities of Hearing Scale).

Results

Functionally aidable hearing, defined as low-frequency pure-tone average (125–500 Hz) <80 dB HL, was maintained for 77% of patients through 1 year, with 66.7% maintaining through 5 years. Speech perception was significantly improved at all postoperative timepoints compared with preoperative performance with hearing aid(s), and patient-reported outcomes indicated significantly improved subjective speech understanding, spatial hearing, and sound quality. Participants with preserved acoustic hearing using EAS reported significantly higher subjective spatial hearing and sound quality than participants with electric-only hearing in the implanted ear.

Discussion

Patients with high-frequency hearing loss demonstrate significant long-term benefit with a hybrid CI including high rates of functional hearing preservation, significantly improved speech perception, and subjective patient-reported outcomes. EAS with binaural acoustic hearing affords benefit for subjective spatial hearing and sound quality beyond CI listening configurations using monaural acoustic hearing.
Screening for Developmental Delays in Pediatric Cochlear Implant Candidates and Recipients
Authors: Warrick Mallory , Sherman Sophie , King Kaylene , LaRosa Angela , McRackan Theodore R. , Coker-Bolt Patty , Schvartz-Leyzac Kara C.
Published: November 2024

Objective

Conduct a pilot clinical improvement project to effectively screen children with hearing loss for developmental delays. Children with hearing loss and cochlear implants (CIs) are at risk for additional developmental delays; however, screening to aid in early identification and referral for developmental delays is not routinely performed at CI centers. It is important to consider all aspects of child development to maximize CI outcomes and access to language.

Study Design

Caregivers of 31 children completed the Ages and Stages Questionnaire (ASQ) and the Sensory Profile-2 (SP2), which are standardized questionnaires that assess developmental milestones in areas of communication, gross motor, fine motor, problem solving, personal–social, and sensory integration.

Setting

Participants were prospectively evaluated at a CI center in a tertiary medical center.

Patients

Participants included children, aged ≤5 years old with bilateral hearing loss who use CIs or who were CI candidates, and their families.

Main Outcome Measures

Scores on ASQ and SP2 questionnaires.

Results

Thirty-one children were screened, and approximately 40 to 50% screened positive for risk of developmental delay in areas excluding communication and received referrals for evaluations in occupational therapy (n = 16; 51.6%), physical therapy (n = 13; 41.9%), and developmental pediatrics (n = 13; 41.9%). Of children referred and seen for evaluations, six were diagnosed with developmental delays in at least one developmental area beyond the communication domains.

Conclusions

Routine screening in children with significant hearing loss can successfully detect developmental delays, which may go unnoticed. This proactive approach enables timely and comprehensive treatment for developmental delays beyond those solely related to communication.
The Memphis SOUND Project: The Development of a Community-Based Research Project to Address Hearing Health Disparities Among Black Adults Who Qualify for Cochlear Implants
Authors: Warren Sarah E. , Coco Laura , Allen Iris , Flinner Gretchen Nibert , Coffelt Jordan Alyse , Ladner Kathryn , Holloway C. Alise , Yawn Robert J.
Published: November 2024

Objective

The objective of this article is to introduce the concept of community-based participatory research as a means to understand barriers to cochlear implant access racially minoritized populations.

Background

Black adults living in the United States experience unique barriers to cochlear implantation. Community-based research approaches can be used to understand and address these barriers.

Application

The Memphis SOUND Project is a community-based research initiative that seeks to address hearing health disparities by examining utilization of hearing healthcare among Black adults. Preliminary findings introduce motivators and barriers related to CI intervention in this population.

Conclusion

This Memphis SOUND Project provides valuable insights to the benefits of community-based research in understanding and addressing CI utilization disparities.
Artificial Intelligence Tracking of Otologic Instruments in Mastoidectomy Videos
Authors: Liu George S. , Parulekar Sharad , Lee Melissa C. , El Chemaly Trishia , Diop Mohamed , Park Roy , Blevins Nikolas H.
Published: November 2024

Objective

Develop an artificial intelligence (AI) model to track otologic instruments in mastoidectomy videos.

Study Design

Retrospective case series.

Setting

Tertiary care center.

Subjects

Six otolaryngology residents (PGY 3–5) and one senior neurotology attending.

Interventions

Thirteen 30-minute videos of cadaveric mastoidectomies were recorded by residents. The suction irrigator and drill were semi-manually annotated. Videos were split into training (N = 8), validation (N = 3), and test (N = 2) sets. YOLOv8, a state-of-the-art AI computer vision model, was adapted to track the instruments.

Main Outcome Measure(s)

Precision, recall, and mean average precision using an intersection over union cutoff of 50% (mAP50). Drill speed in two prospectively collected live mastoidectomy videos by a resident and attending surgeon.

Results

The model achieved excellent performance for tracking the drill (precision 0.93, recall 0.89, and mAP50 0.93) and low performance for the suction irrigator (precision 0.67, recall 0.61, and mAP50 0.62) in test videos. Prediction speed was fast (~100 milliseconds per image). Predictions on prospective videos revealed higher mean drill speed (8.6 ± 5.7 versus 7.6 ± 7.4 mm/s, respectively; mean ± SD; p < 0.01) and duration of high drill speed (>15 mm/s; p < 0.05) in attending than resident surgery.

Conclusions

An AI model can track the drill in mastoidectomy videos with high accuracy and near–real-time processing speed. Automated tracking opens the door to analyzing objective metrics of surgical skill without the need for manual annotation and will provide valuable data for future navigation and augmented reality surgical environments.
Barriers to Cochlear Implant Uptake in Adults: A Scoping Review
Authors: Neukam Jonathan D. , Kunnath Ansley J. , Patro Ankita , Gifford René H. , Haynes David S. , Moberly Aaron C. , Tamati Terrin N.
Published: November 2024

Introduction

Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake.

Methods

Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework.

Results

The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria.

Discussion

Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.
Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?
Authors: Bulbul Mustafa G. , Jafary Zulkifl , Kellermeyer Brian M. , Shapiro Scott B.
Published: November 2024

Objective

Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery.

Study Design

Retrospective multicenter cohort.

Setting

Two quaternary academic medical centers.

Patients

Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period.

Interventions

Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery.

Main Outcome Measures

Postoperative pain levels during the first week after surgery (0–10); proportion of patients requiring opioid medication.

Results

Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3–6). The median highest level of pain was 5 (IQR 4–8). The median current level of pain was 3 (IQR 1–5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers.

Conclusions

NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.
Whole lung lavage: considerations from the anesthesiology perspective
Authors: Sikachi Rutuja , Anders Megan
Published: November 2024

Purpose of review

Whole lung lavage (WLL) remains the standard treatment for pulmonary alveolar proteinosis (PAP). The procedure involves meticulous preparation, including a multidisciplinary team and appropriate facilities, to ensure patient safety and procedural success. Effective anesthesia management is essential to allow for successful completion of the procedure and prevent complications.

Recent findings

Effective anesthesia management, including total intravenous anesthesia (TIVA) and careful intraoperative monitoring, is essential to prevent complications such as hypoxemia and fluid overload. Proper airway control with a double-lumen tube, careful positioning, and continuous monitoring during the lavage phase are key to minimizing risks. Challenges such as fluid spillage and ventilation-perfusion mismatch must be managed proactively with techniques such as fiberoptic bronchoscopy and recruitment maneuvers. In cases of severe hypoxemia, advanced options like extra-corporeal membrane oxygenation (ECMO) or sequential lavage may be required.

WLL is a pivotal treatment for PAP, offering significant relief and improvement for many patients despite the challenges in standardizing the procedure due to the rare nature of the condition. Involvement of a multidisciplinary team involving pulmonologist, anesthesiologist, critical care personnel, operating room personnel and in some cases and centers, cardiothoracic surgeon and perfusionist is critical to the success of the procedure.
Focal classic intradural extramedullary ependymoma near the conus medullaris: A case report and literature review
Authors: Kang Xingui , Hu Tao , Shi Keqiang , Hu Quanze , Yu Bin , Zhu Ziqi , Wu Desheng , Huang Yufeng
Published: November 2024

Rationale:

To enhance clinicians’ comprehension of conus medullaris region ependymomas and elevate their diagnostic accuracy.

Patient concerns:

A 26-year-old female patient had 10 months of low back pain and right lower limb pain.

Diagnoses:

Lumbar magnetic resonance imaging (MRI) scan revealed a circular abnormal signal in the spinal canal at the level of L2. Pathological examination confirmed classic ependymoma.

Interventions:

The patient underwent tumor resection surgery.

Outcomes:

Postoperatively, the patient’s right lower limb soreness improved, and no new neurological deficits were observed.

Lessons:

Focal classic intradural extramedullary ependymomas near the conus medullaris are rare. Close follow-up with MRI of the craniospinal axis is necessary. Hormonal factors may influence the development of ependymomas in this unusual location. The appearance of these tumors on MRI and contrast-enhanced MRI scans is variable.
Capturing the incidence of patient agitation amongst conscious sedation ERCPs and the impact on therapeutic outcomes
Authors: Keating Eoin , Bennett Gayle , Martir Harvey , Kelleher Barry , Stewart Stephen , Ramlaul Navneet , McKenny Michael , Leyden Jan
Published: November 2024

Background:

Completing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) under conscious sedation is challenging. International recommendations favor enhanced sedation (e.g. propofol) for ERCP. Conscious sedation can result in sedation-related failure (SRF) and agitation for some patients, limiting therapeutic efficacy.

Aim:

The aim of this study is to establish the risk of SRF and the impact on therapeutic success under conscious sedation practice in a single tertiary referral center.

Methods:

A retrospective review of a prospectively maintained ERCP database, analyzing sedation, procedural success, and complications.

Results:

Over 19 months, 807 conscious sedation ERCPs were recorded. Median midazolam dose was 5 mg (range 1–14 mg) and median fentanyl dose was 75 µg (0–200 µg). Sedation reversal was required in 0.1% of cases (1/807). Overall ductal cannulation rate was 92%. Severe agitation was recorded in 11% (86/807) of conscious sedation ERCP reports with SRF present in 3% (22/807). Patient agitation resulted in significantly lower cannulation (81% vs 92%, P = 0.002) and successful clearance rates (49% vs 85%, P = 0.002) versus non-agitated cases. Complication and pancreatitis rates were unaffected. Highest rates of SRF and agitation were identified in female patients, patients aged <50 years old, and post-operative biliary leak indications.

Conclusion:

Over 10% of conscious sedation ERCPs are compromised by sedation issues, resulting in procedure abandonment or significantly diminished therapeutic success. General anesthetic ERCP is beneficial in facilitating biliary access, removing the risk of agitation and providing stability to aid cannulation. Female patients, patients aged <50 years, and post-operative biliary leak ERCPs appear as the priority cases for enhanced sedation support.
Risk factors of complications after thermal ablation for hepatocellular carcinoma: the role of assessment of liver background
Authors: Xie Yuhua , Liu Jing , Shi Yifan , Xie Xiaoyan , Yu Jie , Xu Ming , Xie Xiaohua , Huang Guangliang , Zhuang Bowen , Bi Mingsen , Qu Dongjie , Fan Fangying , Ying Minghua , Sun Qingqing , Lin Manxia , Liang Ping
Published: November 2024

Objective

To use an elastography technology and other clinical and radiological data for assessment of liver background and analyze risk factors of complications after thermal ablation in patients with hepatocellular carcinoma.

Methods

Demographics, laboratory analyses, and radiological characteristics were collected from all patients. Main elastography-related indicators included F index (fibrosis index), A index (inflammation index), ATT (attenuation coefficient), E (kPa), AREA (area of blue parts), and CORR (correlation). All complications after thermal ablation were collected. Univariate analysis was performed to detect significant variables, which subsequently entered a stepwise logistic regression analysis (conditional forward selection) to identify independent variables.

Results

A total of 218 patients from October 2020 to June 2023 with 291 thermal ablation sessions were enrolled. 115 patients (52.8%) developed complications. Fifteen patients (6.9%) developed major complications. Minor complications included postoperative pain (20.6%), fever (19.3%), effusion (22.5%), and hyperammonemia (1.8%). AREA (P = 0.034), tumor size (P = 0.005), and abnormal aspartate aminotransferase (AST) (P = 0.018) were independent predictors for complications. F index (P = 0.021), tumor size (P < 0.001), and abnormal AST (P = 0.047) were independent predictors for effusion. The results of univariate analysis of infection showed that tumor size, CORR, ATT, diabetes, Child–Turcotte–Pugh grade, abnormal AST, total protein, and albumin were significant (all P < 0.05).

Conclusion

Several radiological and combinational elastography indicators related to liver fibrosis, steatosis, or inflammation were significantly correlated with the occurrence of complications. Clinical assessment of the liver background should not be neglected in the management of postablation complications.
Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation
Authors: Tantisattamo Ekamol , Ferrey Antoney J. , Reddy Uttam G. , Redfield Robert R. , Ichii Hirohito , Al Ammary Fawaz , Lau Wei Ling
Published: November 2024

Purpose of review

Evidence for blood pressure (BP) measurement and hypertension management in kidney transplant recipients (KTR) remains lacking.

Recent findings

Accurate BP measurement technique is a critical component of hypertension management, and 24-h ambulatory BP monitoring remains the gold standard for diagnosis of hypertension in KTR. BP target at different periods posttransplant is uncertain, but likely higher than that in nontransplant patients given factors related to long-standing uremic milieu and kidney transplantation such as vascular calcification altering transplant renal hemodynamic and allograft perfusion and immunosuppression. Dividing BP target into immediate, early, and late posttransplant periods can guide differential diagnoses of hypertension and BP control with a target SBP less than 160 mmHg in general and BP 115–135/65–85 mmHg for adult KTR receiving pediatric kidneys during the immediate posttransplant period, 130/80 mmHg during early and late posttransplant periods. Calcium channel blockers were shown to have favorable graft outcomes. Novel antihypertensive medications for resistant and refractory hypertension and device-based therapies are limited due to KTR's ineligibility for participating in clinical trials.

In KTR, BP measurement and monitoring practice should follow the standard clinical practice guideline for nontransplant patients by considering posttransplant factors and immunosuppressive state. Novel treatment options required further studies.
A pilot study of the impact of repeated blink refrainment on ocular surface temperature and the interblink period
Authors: Li Wing , Graham Andrew D. , Lin Meng C.
Published: November 2024

SIGNIFICANCE

This study examines a potential stress test of repeated blink refrainment and its effects on the interblink period and the rate of evaporative ocular surface cooling. Such a test could aid in the study of computer vision syndrome, in which screen users unconsciously delay blinking, leading to onset of symptoms.

PURPOSE

This study aimed to examine the relationship between the length of the maximum achievable interblink time and the rate of ocular surface cooling under stress test conditions of repeated refrainment from blinking for as long as possible.

METHODS

Subjects acclimated to the examination room for 10 minutes before measurement and then were asked to hold the eyes open and refrain from blinking for as long as possible (the maximum blink interval), while ocular surface temperature was recorded using an infrared thermographic video camera. Subjects completed 20 trials with four successive blinks separating each trial.

RESULTS

Fifteen subjects (8 female and 7 male subjects) completed the study. The grand mean ocular surface cooling rate was −0.027°C/s (range, −0.338 to +0.014°C/s). A faster ocular surface cooling rate was significantly related to an exponentially shorter maximum blink interval (p<0.001). An increasing number of trials was related to a clinically insignificant increase in the length of the maximum blink interval overall, and a post hoc analysis revealed subject subgroups for whom the stress test was effective or ineffective.

CONCLUSIONS

The ocular surface evaporatively cools exponentially during periods of blink refrainment. With a subgroup of subjects with initially stable tear films and normal lipid layer thickness, cumulative tear film stress from repeated, longer-term blink refrainment could contribute to tear evaporation and symptoms of computer vision syndrome.
Noninferiority Randomized Clinical Trial: KIM Sling With Reusable Trocars Versus TVT Exact Sling
Authors: Margulies Samantha L. , Osment Anna E. , Bernard Adele , Schroeder Michelle N. , Askew Amy L. , Agu Ijeoma S. , Kunycky Christina A. , Geller Elizabeth J. , Willis-Gray Marcella , Chu Christine M. , Wu Jennifer M.
Published: November 2024

Importance

The Neomedic Knotless Incontinence Mesh (KIM) sling with sterilizable trocars decreases medical waste versus midurethral slings with disposable trocars. Limited comparative data exist.

Objective

The aim of the study was to assess to the success of the retropubic KIM sling compared to the Gynecare TVT Exact sling.

Study Design

This was a single-center, randomized noninferiority trial comparing outcomes of 2 retropubic slings—KIM sling and TVT Exact sling—in women with stress urinary incontinence from August 2021 to May 2023. Primary outcome was subjective success at 6 weeks defined by a composite outcome of the response to the question #17 on the The Pelvic Floor Distress Inventory-20 questionnaire and no retreatment of stress urinary incontinence. Secondary outcomes included rates of urinary retention, mesh erosion, and reoperation for mesh complications. Sample size estimate based on noninferiority margin of 14%, equal success of 90%, alpha 0.05, and 80% power with a 20% dropout was 72 per group.

Results

Among 147 patients, 74 (50.3%) were randomized to KIM sling versus 73 (49.7%) to TVT exact. The rates of 6-week success were 68.5% for the KIM sling and 83.3% for the TVT exact with a risk difference 14.8% (95% confidence interval, 1.1–28.5). The KIM sling is not noninferior to the TVT Exact sling. There were no differences in secondary outcomes.

Conclusions

The KIM sling is not noninferior to the TVT Exact sling for success at 6 weeks based on a composite outcome score. This clinical trial is ongoing to assess outcomes at 6 months and 1 year. (Clinicaltrials.gov NCT04985799)