bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational prestige and job satisfaction in high-stress public safety work
Authors: Mumford Elizabeth A , Alfaro Hudak Katelin , Liotta Madeleine M , O’Leary Meghan S , Ramey and Sandra
Published: April 2022

Many factors play into public safety officers’ levels of stress, with relevance to community relations and public safety. This study examined perceptions of occupational prestige, job satisfaction, and resilience, drawing on a sample of 68 officers from two US municipal police agencies and one county jail. Focus group findings about the prestige of public safety work indicated that although officers were aware of—and sometimes adversely affected by—the negative public narrative and perceptions of information asymmetry, many also reported on positive interactions with the local communities that they served. Findings about job satisfaction illustrated officers’ pride in their performance but awareness of the need for resiliency and coping strategies in the face of occupational and administrative stressors and impact on their personal lives. Given the current broader discourse about criminal justice professions, attention to officers’ perceptions of their work is an important input to both policy and public safety.
The new Polish family foundation: legal framework and tax considerations
Authors: Krzywański Tomasz
Published: April 2022

In 2021, the Polish authorities published a draft Act on Family Foundations. This new legal construct, created as a combination of solutions functioning in various European countries, is aimed at facilitating succession into Polish family businesses. In addition, due to preferential taxation, it may turn out to be an attractive alternative for families from other Central and Eastern European countries. The purpose of this article is to summarise the most important, currently available information about the draft of the new law.
A review of train passenger safety—Inspiration from passive safety passenger protection technology of automobile
Authors: Xu Ping , Xiao Xianliang , Yao Shuguang
Published: April 2022

A train collision accident will cause many casualties, so the passive safety protection of the train occupants is very important. The purpose of this article is to obtain recommendations on the research directions of train passenger safety by comparing the passive safety protection of passengers in the fields of automobiles and trains. First, we analyse the collision standards and regulations of automobiles and trains and summarize the content related to the passive safety protection of occupants. Then, based on an extensive literature review, the development status of passive safety protection for automobiles and trains is analysed from three aspects: interior, human characteristics and passenger posture. Finally, some conclusions and recommendations on passive safety protection of train passengers are put forward. The protection method provided by automobile interiors is mainly restraints, while in trains it is mainly separation. For human characteristics, in addition to male and female, the elderly, obese and children are also studied in the automobile. As for posture, the automobile mainly focuses on the posture in reality and future automated vehicles, while in train, there is more research on lateral passengers and standing passengers. Although the protection of automobiles and trains is different, for the passive safety protection of train passengers, the design of automobile interiors can be used for reference to reduce passenger injuries. In addition, human characteristics and posture have a great impact on passenger injury, which should be considered in the passive safety protection of trains.
Older Age Discrimination at Work: Not So Weak and Feeble
Authors: Marchiondo Lisa A
Published: April 2022

In their focal article, Murphy and DeNisi (Murphy, K. R., & DeNisi, A. S. [2021]. Do age stereotypes predict per­sonnel decision? The state of the evidence. Work, Aging, & Retire­ment. https://doi.org/10.1093/workar/waab019) contend that older age stereotypes do not appear to meaningfully shape organizational decisions in ways that disadvantage older workers. My commentary centers on several issues: (1) a critical assessment of effect sizes, including their labels (e.g., small, medium, large), practical significance, and compounding impact, and (2) consideration of targets’ perspectives of ageism, including Equal Employment Opportunity Commission (EEOC) reports and self-report surveys, which provide important insight into the frequency and manifestation of workplace age discrimination. These issues challenge the notion that age stereotypes have minimal effects on the treatment of older workers. Three calls for future research are provided to guide readers in advancing scholarship on age stereotypes and discrimination.
Fluorescent Imaging as a Component of Diagnosing Pyoderma Gangrenosum: A Case Report
Authors: MacLeod Brett G. , Klarich Carissa S. , Wessman Laurel L. , Gaddis Kevin J. , Konstantinov Nikifor K. , Wubben Angie , Melin M. Mark
Published: April 2022

A 64-year-old White woman was admitted to the hospital with complaint of progressive right hip ulceration at the wound site following a total right hip arthroplasty. Initial history and physical examination gave a leading differential diagnosis of pyoderma gangrenosum. Until recently, the exclusion of infection for pyoderma gangrenosum has been largely clinical and supported by cultures/biopsies demonstrating the absence of infection. The MolecuLight i:X (MolecuLight, Toronto, Ontario, Canada) is a novel bedside fluorescent imaging device capable of determining the bacterial burden within a wound in real time. Fluorescent imaging excluded infection at the initial visit, and debridement was avoided. Subsequently, pathergy was avoided as well. The patient was started on topical clobetasol with hypochlorous acid-soaked dressings. She also received 80 mg daily of prednisone and high-dose vitamin D3 (10,000 IU). Recovery was complicated by a deep tunnel along the incisional line at 3 months postdiagnosis, which required slowing of the prednisone taper and the addition of colchicine. Repeat cultures grew Parvimonas, Pseudomonas, and Streptococcus species. Appropriate antibiotics were given. The patient was transitioned from prednisone to adalimumab and started on negative-pressure wound therapy. Negative-pressure wound therapy was discontinued at 5 months, and the wound resolved at 6 months.
Repositioning Strategies to Prevent Pressure Injuries in the ICU: Integrative Review on Implementation Factors
Authors: Everett Day Symone , Koirala Binu , McIltrot Kimberly
Published: April 2022

OBJECTIVE

To survey the literature to gain insight into nursing facilitators of and barriers to implementation of positioning/turning strategies to prevent hospital-acquired pressure injuries (PIs) in adult critical care patients.

DATA SOURCES

This integrative review surveyed literature across databases including PubMed, CINAHL, Embase, and Cochrane Library, and through hand searching.

STUDY SELECTION

Key terms included “pressure ulcer” OR “pressure sore*” OR “pressure injur*” AND “patient positioning” OR “turn” OR “turning” OR “patient repositioning” AND “critical care” OR “intensive care unit*” OR “inpatient*” AND “prevent*.” Peer reviewed, English language articles published within the past 10 years were included. Inclusion and exclusion criteria narrowed the database yield to 432 articles. After title/abstract and full text review, 11 articles were included.

DATA EXTRACTION

Articles were appraised using the PRISMA flow diagram and the Johns Hopkins Nursing Evidence-Based Practice appraisal tool. Data was extracted and major themes were identified.

DATA SYNTHESIS

The identified themes were synthesized into factors that facilitated or impeded the nursing implementation of turning/repositioning strategies to prevent hospital-acquired PIs. Facilitators were the use of verbal cues and alerts to improve compliance and nursing education on PI prevention. Barriers to successful implementation were increased nursing workload or burden, lack of staff, and perceived hemodynamic instability in ICU patients.

CONCLUSIONS

Future interventions can be tailored to mitigate barriers and reinforce facilitators to improve nursing compliance with repositioning/turning strategies. Increased compliance with these measures could aid in PI prevention in adult ICU patients.
Clinical Burden of Inpatient Wound Care in Internal Medicine Units During the First Wave of COVID-19 Outbreak
Authors: Nieto-García Leticia , Carpio-Pérez Adela , Moreiro-Barroso María Teresa , Ruíz-Antúnez Emilia , Nieto-García Ainhoa , Alonso-Sardón Montserrat
Published: April 2022

Objective

To explore the clinical burden and epidemiologic profile of hospitalized patients with wounds during the first wave of COVID-19.

Methods

A retrospective and observational study was conducted to analyze the inpatient episodes of wound care in the University Hospital of Salamanca (Spain) during the initial COVID-19 crisis from March 1, 2020, to June 1, 2020. Data were collected from nursing care reports and clinical discharge reports. Included patients were 18 years or older, had a hospital length of stay of 1 day or longer, and were hospitalized in an internal medicine unit. Surgical and traumatic wounds and pediatric patients were excluded.

Results

A total of 116 patients and 216 wounds were included. The overall wound prevalence was 7.6%, and incidence was 3.5% in the internal medicine units. Pressure injuries (PIs) were the most common wound type, and patients with COVID-19 had significantly higher PI risk (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1–4.0; P = .042). Significant differences in PI staging were noted: 83.2% of wounds in patients with COVID-19 were stages I-II versus 67.8% in patients without COVID-19; the probability of stage III-IV PIs among patients without COVID-19 was doubled (OR, 2.3; 95% CI, 1.2–4.5; P = .009). The probability of acute wounds tripled in patients with COVID-19 (OR, 3.7; 95% CI, 2.1–6.6; P < .001). Patients with COVID-19 also had longer mean hospital stays and higher ICU admission rates. No case fatality rate differences were observed.

Conclusions

In this context of clinical practice, protocolized assessment and implementation of preventive measures must be ensured among older adult populations, patients with associated comorbidities, and ICU patients.
The National Practitioner Database Malpractice Study of Severity of Alleged Malpractice Injuries Trends 2008–2018
Authors: Goode Victoria , Douglas Christian , Merwin Elizabeth
Published: April 2022

This research examined trends and severity of alleged injury in malpractice over a 10-year period. An understanding of the severity of patient outcomes is important to gauge improvements in care delivery.

Analysis of the National Practitioner Database (NPDB) investigated malpractice payments from 2008 to 2018 by physicians, advanced nurse practitioners, and registered nurses and assessed the relationship of years of practice on the severity of alleged malpractice injury.

Malpractice payments over the study period, primarily represented payments for significant permanent or major permanent injuries (25.97%) or death (32.74%). Claims overall have shown a decline, including claims by the severity of malpractice injury, for most outcomes. The clinicians represented in the NPDB with >15 years of practice have greater odds for severity of malpractice injuries classified as minor permanent injury and significant permanent injury than those clinicians represented in the NPDB with fewer years of practice. Top allegation categorizations for malpractice payment were diagnostics, treatment, and surgery related for 4 of the severities of alleged injury.
COVID-19 and Physician Assistant Faculty Burnout: A Year into the Pandemic
Authors: Garvick Sarah , Peacock Brian , Gillette Chris
Published: April 2022

Purpose:

The psychological effects of COVID-19 have been extensive and have affected health care workers and educators alike. The aims of this study were to evaluate how the COVID-19 pandemic has impacted PA faculty and their attitudes toward work.

Methods:

Two quantitative, pre/post surveys were offered to 21 PA faculty at one institution prior to and then one year into the COVID-19 pandemic. PA faculty perceptions of workplace culture and burnout were included in the online surveys.

Results:

Data were collected on 17 PA faculty (81% response rate). There was a statistically nonsignificant decrease in faculty disengagement (2.1 v 2.1, p = 0.87) and a statistically significant increase in faculty exhaustion (2.2 v 2.5, p = 0.005). There were statistically significant increases in communication, value, job satisfaction, and wellbeing workplace items.

Conclusion:

As many workplace protocols remain changed as a result of COVID-19, institutions should monitor and adjust processes to reduce the risk of burnout for faculty.
Preoperative Peroneal Artery Perforator Mapping Using Indocyanine Green Angiography: A Prospective Clinical Trial
Authors: Fichter Andreas M. , von Bomhard Achim , Grill Florian D. , Georg Rali , Frohwitter Gesche , Kesting Marco R. , Kehl Victoria , Wolff Klaus-Dietrich , Ritschl Lucas M.
Published: April 2022

Background:

Perforator imaging is a prerequisite in preoperative planning of the peroneal perforator flap and the fibula skin island. Although reports indicate that indocyanine green angiography assessment method might be advantageous over conventional ultrasound-based techniques (i.e., Doppler and color duplex), in practice, clear evidence is lacking. Thus, a comparative assessment of the utility of indocyanine green angiography and ultrasound-based techniques in the identification of suitable lower leg skin perforators was performed.

Methods:

A prospective clinical cohort study with a series of 12 consecutive patients was conducted to assess indocyanine green angiography, Doppler ultrasound, and color duplex ultrasound techniques for preoperative perforator detection in the lower leg before free fibula flap harvest. Anatomical dissection served as a reference. Parameters measured were perforator spatial distance to the reference (precision), operative time expenditure, and ease of device usage for assessment/outcomes.

Results:

This study included 12 patients, with a total of 27 perforators. Exhibition of technique sensitivity and positive predictive values were as follows: indocyanine green angiography, 93 percent and 100 percent; Doppler ultrasound, 82 percent and 82 percent; and color duplex ultrasound, 89 percent and 86 percent, respectively. With regard to the indocyanine green angiography technique, the distance to the actual perforator location was significantly shorter, which aided detection and lesser time expenditure during operation.

Conclusions:

The indocyanine green angiography technique proved to have high precision, sensitivity, positive predictive value, and easy-to-use capabilities because of its exceptional spatial and temporal information, compared to the conventional, ultrasound-based techniques. Therefore, indocyanine green angiography is superior for preoperative perforator imaging of the lateral lower leg.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
A Systematic Review and Meta-Analysis of Extracorporeal Membrane Oxygenation in Patients with Burns
Authors: Chiu Yu-Jen , Huang Yu-Chen , Chen Tai-Wei , King Yih-An , Ma Hsu
Published: April 2022

Background:

Severely burned patients are at high risk for cardiopulmonary failure. Promising studies have stimulated interest in using extracorporeal membrane oxygenation as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. However, the findings from previous studies vary.

Methods:

In this study, the authors conducted a systematic review and meta-analysis using standardized mortality ratios to elucidate the benefits associated with the use of extracorporeal membrane oxygenation in patients with burn and/or inhalation injuries. A literature search was performed, and clinical outcomes in the selected studies were compared.

Results:

The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving extracorporeal membrane oxygenation (standardized mortality ratio, 2.07; 95 percent CI, 1.04 to 4.14). However, the subgroup of burn patients with inhalation injuries had lower mortality rates compared to their predicted mortality rates (standardized mortality ratio, 0.95; 95 percent CI, 0.52 to 1.73). Other subgroup analyses reported no benefits from extracorporeal membrane oxygenation; however, these results were not statistically significant. Interestingly, the pooled standardized mortality ratio values decreased as the selected patients’ revised Baux scores increased (R = −0.92), indicating that the potential benefits from the treatment increased as the severity of patients with burns increased.

Conclusions:

The authors’ meta-analysis revealed that burn patients receiving extracorporeal membrane oxygenation treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with revised Baux scores over 90, would benefit from the treatment. The authors suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for the treatment and early transfer to an extracorporeal membrane oxygenation center.
Prognostic Potential of Postoperative 18F-Fluorocholine PET/CT in Patients With High-Grade Glioma. Clinical Validation of FuMeGA Postoperative PET Criteria
Authors: García Vicente Ana María , Pena Pardo Francisco José , Amo-Salas Mariano , Villena Martín Maikal , López Menéndez Carlos , Soriano Castrejón Ángel María , Pérez-Beteta Julián
Published: April 2022

Objective

The aim of this study was to assess the prognostic performance of postoperative 18F-fluorocholine PET/CT in patients with high-grade glioma (HGG).

Methods

Patients with HGG who underwent preoperative and postoperative 18F-fluorocholine PET/CT were prospectively enrolled in the study. Postoperative MRI was classified as complete versus incomplete resection. Postoperative 18F-fluorocholine PET/CT was classified as negative (complete) or positive for metabolic residual tumor (incomplete resection) using a 5-point score system. The correlation of positive locations on PET/CT with the sites of subsequent tumor recurrence was evaluated. The concordance of postoperative imaging techniques (Cohen κ) and their relation with progression-free survival and overall survival were assessed using Kaplan-Meier method and Cox regression analysis.

Results

Fifty-one studies, belonging to 47 patients, were assessed. Four patients underwent 2 postoperative 18F-fluorocholine PET/CT scans as they needed a second tumor resection for recurrence. In the follow-up, 42 patients progressed, and 37 died. Concordance between postoperative PET/CT and MRI assessment was poor. Resection grade on MRI did not show any significant association with prognosis. In multivariate analysis, only age and postoperative PET/CT showed significant association with progression-free survival (hazard ratio [HR], 1.03 [1.01–1.06, P = 0.006] and 1.88 [0.96–3.71, P = 0.067], respectively) and overall survival (HR, 1.04 [1.01–1.07, P = 0.004] and 2.63 [1.22–5.68, P = 0.014], respectively). Postoperative positive 18F-fluorocholine PET/CT locations correlated with the sites of subsequent tumor recurrence in 81.82% of cases.

Conclusion

Postoperative 18F-fluorocholine PET/CT seems superior to postoperative MRI in the outcome prediction of patients with HGG, outperforming it in the identification of the most probable location of tumor recurrence.
Pituitary Metastasis of Non–Small Cell Lung Cancer With High FDG Uptake on PET/CT Pituitary Metastasis of Non–Small Cell Lung Carcinoma
Authors: Le Meur Coline , Campedel Luca , Kharroubi Dris , Amrane Karim
Published: April 2022

Pituitary metastasis is a rare event, and the pituitary gland is an uncommonly involved location in patients with intracranial metastases as it accounts for only approximately 2% of malignant metastases. Here, the authors present the 18F-FDG PET study of a very rare case of relapsed non–small cell lung cancer, locally and with 1 pituitary metastasis, in a 75-year-old White woman with asthenia and diabetes insipidus. 18F-FDG PET and cerebral MRI were performed to guide the therapeutic strategy due to an atypical pituitary high FDG avidity.
A Frequently Missed Pulmonary Infarction
Authors: Ji Yu , Wang Yaru , Shao Chunchun , Cui Yong , Su Na , Shao Guangrui , Zheng Jingsong
Published: April 2022

Purpose

This study aimed to summarize the clinical and 18F-FDG PET/CT manifestations of hilar tumor–induced pulmonary infarction.

Methods

A retrospective analysis was performed on patients with hilar masses who underwent FDG PET/CT scans between July 2015 and January 2021 and had complete clinical data. Pulmonary infarction was confirmed by concurrent chest CT and imaging follow-up or pathology.

Results

A total of 58 patients (mean age, 56 [SD, 13] years; 44 males) with 122 infarcts were included in the study. Hilar masses were mostly associated with small cell lung cancer (64%). The most common clinical manifestations were cough (64%) and hemoptysis (36%). Most patients (62%) had multiple pulmonary infarcts. The CT findings of pulmonary infarcts included the “Hampton hump” (48%) and patchy consolidation (52%). The density of infarcts included “bubbly consolidation” (61%) and “homogenous consolidation” (39%). The metabolic activity of 95 infarcts (78%) was higher than lung parenchyma, with the SUVmax of 3.3 (SD, 1.1). The metabolic patterns on PET/CT were “rim sign,” “mismatch between PET and CT,” and “no metabolism.” Pulmonary vein involvement was found in 25 patients (43%), pleural effusion in 22 patients (38%), and the pleural curvilinear sign in 8 patients (14%).

Conclusions

The clinical manifestations of hilar tumor–induced pulmonary infarction are not specific, and 18F-FDG PET/CT could be an effective diagnostic tool.
68Ga-DOTA-FAPI-04 PET/CT Imaging in a Case of Cardiac Angiosarcoma
Authors: Xu Tingting , Ding Haoyuan , Ban Hongjian , Zhu Yan , Chen Yue
Published: April 2022

A 30-year-old woman presented with sudden syncope. Further examination revealed a mass in the right atrium. 18F-FDG showed increased tracer uptake in the mass. 68Ga-DOTA-FAPI-04 showed increased tracer uptake of thickened pericardium around the mass, but no obviously increased tracer uptake in the mass. The mass that invaded the adjacent pericardium was found during the operation. Postoperative pathology confirmed the diagnosis of right atrium angiosarcoma. Our case demonstrated that 68Ga-DOTA-FAPI-04 is not superior to 18F-FDG in the imaging of cardiac angiosarcoma, but it is still possible to produce beneficial value in the evaluation of the involvement of the lesion.
FDG PET/CT Image of Soft Tissue Aneurysmal Bone Cyst
Authors: Xiao Liu , Cheng Junjun , Li Lin
Published: April 2022

Soft tissue aneurysmal bone cyst is very rare. Herein, we report FDG PET/CT findings of aneurysmal bone cyst in a 19-year-old man. On conventional image, it presented as a paravertebral soft tissue mass with heterogeneous enhancement and rim eggshell-like calcification. On PET/CT, this solitary lesion had intense FDG uptake with an SUVmax of 10.33. The final pathology supported a diagnosis of aneurysmal bone cyst. Our case suggests that soft tissue aneurysmal bone cyst should be regarded as a differential diagnosis of solitary paravertebral mass with intense FDG uptake.
Solitary Periaortic Tuberculous Granuloma Mimicking Neoplastic Disease on 18F-FDG PET/CT
Authors: Guo Na , Zhu Anhui , Zhao Meixin , Li Hui , Zhang Weifang
Published: April 2022

Solitary tuberculoma of periaortic space is extremely rare. We report a case of periaortic tuberculous granuloma revealed by 18F-FDG PET/CT in a 51-year-old woman without pulmonary or any other organ involvement. Awareness of this rare but possible atypical presentation of tuberculosis is helpful for the differential diagnosis of periaortic mass.
Cardiac Magnetic Resonance at 3.0 T in Patients With C282Y Homozygous Hereditary Hemochromatosis
Authors: Byrne Danielle , Walsh John P. , Murphy Ross T. , McMorrow Jason , Fagan Andrew J. , Kecler Poetrzyk Aneta , Durand Michael E. , Norris Suzanne , McKiernan Susan , King Gerard , Meaney James F. , Daly Caroline
Published: April 2022

Background:

Iron-overload cardiomyopathy initially manifests with diastolic dysfunction and can progress to dilated cardiomyopathy if untreated. Previous studies have shown that patients with primary and secondary hemochromatosis can have subclinical left ventricle dysfunction with abnormalities on strain imaging. This study aimed to evaluate the relationship between cardiac T2* values and myocardial-wall strain in patients with hereditary hemochromatosis (HH) at the time of diagnosis and after a course of venesection treatment.

Materials and Methods:

Baseline cardiac magnetic resonance (CMR) at 3 T was performed in 19 patients with newly diagnosed HH with elevated serum ferritin levels and repeated after a course of treatment with venesection. Quantitative T2* mapping and strain analysis were performed offline using dedicated relaxometry fitting and feature-tracking software.

Results:

The majority (84%) of patients had normal baseline myocardial T2* values (mean 19.3 ms, range 8.9 to 31.2 ms), which improved significantly after venesection (mean 24.1 ms, range 11 to 38.1 ms) (P=0.021). Mean global radial strain significantly improved from 25.0 (range: 15.6 to 32.9) to 28.3 (range: 19.8 to 35.8) (P=0.001) and mean global circumferential strain improved, decreasing from −15.7 (range: −11.1 to −19.2) to −17.1 (range: −13.0 to −20.1) (P=0.001).

Conclusion:

Patients with HH may have normal T2* values in the presence of subclinical left ventricle dysfunction, which can be detected by abnormal radial and circumferential strain. As strain imaging improves following venesection in HH, it may serve as a useful biomarker to guide treatment.
The Presence of Donor-specific Antibodies Around the Time of Pancreas Graft Biopsy With Rejection Is Associated With an Increased Risk of Graft Failure
Authors: Parajuli Sandesh , Djamali Arjang , Mandelbrot Didier , Aziz Fahad , Radke Nancy , Kaufman Dixon , Odorico Jon
Published: April 2022

Background.

Donor-specific antibodies (DSA) against HLA are an important biomarker predicting graft injury, rejection (Rej), and failure in various solid-organ transplant recipients. However, the impact of DSA with or without histopathological evidence of rejection among pancreas transplant recipients (PTRs) is unknown.

Methods.

In this study, we included all PTRs at our center between 2005 and 2020, with pancreas allograft biopsy before March 31, 2021, and with DSA checked within 15 d of the biopsy. PTRs were divided into 4 groups based on the biopsy findings on the index biopsy and DSA status as Rej–/DSA–, Rej+/DSA–, Rej–/DSA+, and Rej+/DSA+.

Results.

Two hundred two PTRs had a pancreas allograft biopsy during the study period. Thirty-nine were in Rej–/DSA–, 84 Rej+/DSA–, 24 Rej–/DSA+, and 55 Rej+/DSA+. The mean interval from transplant to index biopsy was not statistically different between the 4 groups. The most common type of rejection was T cell–mediated rejection; however, antibody-mediated rejection was more prevalent in the Rej+/DSA+ group. At 5 y postbiopsy, the rate of death-censored graft failure (DCGF) for Rej–/DSA– was 18%, 24% in Rej+/DSA–; 17% in Rej–/DSA+ and 36% in Rej+/DSA+ (P = 0.14). In univariate analysis, mixed rejection (hazard ratio [HR], 3.0; 95% confidence intervals [CI], 1.22-7.39; P = 0.02) along with solitary pancreas transplantation and Rej+/DSA+ were associated with DCGF. In multivariate analysis, compared with Rej–/DSA–, Rej+/DSA+ was significantly associated with DCGF (HR, 2.32; 95% CI, 1.03-5.20; P = 0.04); however, Rej+/DSA– was not (HR, 1.06; 95% CI, 0.32-3.56; P = 0.92).

Conclusions.

PTRs with pancreas allograft rejection and concomitant DSA have an increased risk of DCGF.
Prognosticators of Visual Acuity After Indirect Traumatic Optic Neuropathy
Authors: Wright Alex J. , Queen Joanna H. , Supsupin Emilio P. , Chuang Alice Z. , Chen John J. , Foroozan Rod , Adesina Ore-Ofe O.
Published: April 2022

Background:

The purpose of this study is to determine whether there are radiographic and systemic clinical characteristics that can predict final visual outcomes in patients with indirect traumatic optic neuropathy (iTON).

Methods:

This study is a retrospective, multicenter case series of adult patients with iTON treated initially at large, urban, and/or academic trauma centers with follow-up at an affiliated ophthalmology clinic. In addition to detailed cranial computed tomography characteristics, demographics, systemic comorbidities, coinjuries, blood products administered, and intracranial pressure, along with other factors, were gathered. LogMAR visual acuity (VA) at the initial presentation to the hospital and up to 12 months follow-up was collected.

Results:

Twenty patients met inclusion criteria; 16 (80%) were men with a mean age of 40.9 years (±20.9). Mean initial VA was 1.61 logMAR (∼20/800, ± 0.95), and final VA was 1.31 logMAR (∼20/400, ± 1.06). Three patients (4 eyes) had no light perception (NLP) VA at presentation and remained NLP at final follow-up. Of the predictors analyzed, only the initial VA was found to be a significant predictor of visual outcome. The presence of orbital fractures, intraconal and/or extraconal hemorrhage, as well as systemic comorbidities, were not found to significantly affect visual outcome.

Conclusions:

After evaluating multiple factors, initial VA was the only factor associated with visual prognosis in iTON. This knowledge may better enable clinicians to predict visual prognosis and set reasonable expectations with patients and families at the time of injury.
Internuclear Ophthalmoplegia Characterizes Multiple Sclerosis Rather Than Neuromyelitis Optica Spectrum Disease
Authors: Hamza Mahmoud M. , Alas Basheer F. , Huang Connie , Quon Justin C. , Amezcua Lilyana , Robers Michael V. , Gokoffski Kimberly K.
Published: April 2022

Background:

Neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS) share clinical presentations including optic neuritis and brainstem syndromes. Internuclear ophthalmoplegia (INO) is characterized by slowed ipsilateral adduction saccades and results from a lesion in the medial longitudinal fasciculus (MLF). Although INO is a common clinical finding in MS, its prevalence in NMOSD is unknown. The objective of this work is to determine the comparative frequencies of INO in patients with NMOSD and MS and compare clinical features of both disease processes.

Methods:

This is a retrospective study of patients 18 years and older who have an established diagnosis of NMOSD or MS and were evaluated by both neuro-ophthalmology and neuro-immunology specialists between 2014 and 2020. Electronic medical records were screened for documentation of an acute INO at any time during follow-up. Incidence rates were calculated from number of cases of new-onset INO and patient years observed. Logistic regression was used to evaluate the likelihood of developing an INO at any time point for NMOSD vs MS patients. Multivariable analysis was performed by adjusting for age, race, gender, and length of follow-up.

Results:

Two hundred eighty patients (80 NMOSD, 200 MS) were included. Age range was 18–79 years with a mean age of 35.14 (SD ± 12.41 years). Average length of follow-up in MS and NMOSD patients was 4.18 years vs 3.79 years, respectively (P > 0.05), and disease duration before the start of the study in MS and NMOSD was 8.76 years vs 4.65 years, respectively (P < 0.01). Mean disease duration and follow-up time of both groups was 7.58 years and 4.07 ± 2.51 years, respectively. NMOSD patients were predominantly seropositive for AQP4 antibody (61.25%, n = 49). Individuals who had MOG antibody but also met NMOSD criteria were also included (18.75%, n = 15). The frequency of INO at any time point was 1.25% (n = 1) in NMOSD compared with 16% (n = 32) in MS. The incidence rate of new-onset INO in NMOSD (excluding MOGAD) was 3.8/1,000 person years and 23.9/1,000 person years in MS. Adjusted analysis showed that NMOSD patients were 13.89 times (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.01–0.598, P = 0.015) less likely to develop an INO compared with those with MS when including MOGAD patients, 12.5 times less likely (OR 0.08, 95% CI: 0.10–0.67, P = 0.02) when excluding MOGAD patients and 9.62 times less likely (OR 0.10, 95% CI: 0.01–0.87, P = 0.036) for AQP4+ patients.

Conclusions:

Our study shows that the incidence of new INO (3.8 vs 23.9 per 1,000 person years), and the odds of having INO at any time point are significantly lower in NMOSD than MS. This suggests that INO and consequently MLF lesions are less common in NMOSD. The presence of an INO may help in the differentiation of NMOSD from MS and may aid in earlier implementation of disease appropriate therapy.
Increased Incidence of Pseudotumor Cerebri Syndrome Among Users of Tetracycline Antibiotics
Authors: Passi Samuel F. , Butcher Ryan , Orme Daniel R. , Warner Judith E.A. , Stoddard Gregory J. , Crum Alison V. , Gouripeddi Ramkiran , Kirk Brian H. , Digre Kathleen B. , Katz Bradley J.
Published: April 2022

Background:

To determine whether the use of a tetracycline-class antibiotic is associated with an increased risk of developing pseudotumor cerebri syndrome (PTCS).

Methods:

We identified patients in the University of Utah Health system who were prescribed a tetracycline-class antibiotic and determined what percentage of those individuals were subsequently diagnosed with PTCS secondary to tetracycline use. We compared this calculation to the number of patients with PTCS unrelated to tetracycline use.

Results:

Between 2007 and 2014, a total of 960 patients in the University system between the ages of 12 and 50 were prescribed a tetracycline antibiotic. Among those, 45 were diagnosed with tetracycline-induced PTCS. We estimate the incidence of tetracycline-induced PTCS to be 63.9 per 100,000 person-years. By comparison, the incidence of idiopathic intracranial hypertension (IIH) is estimated to be less than one per 100,000 person-years (Calculated Risk Ratio = 178).

Conclusions:

Although a causative link between tetracycline use and pseudotumor cerebri has yet to be firmly established, our study suggests that the incidence of pseudotumor cerebri among tetracycline users is significantly higher than the incidence of IIH in the general population.
Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis
Authors: Kaufman Aaron R. , Gulati Shawn , Pula John H. , Janetos Timothy M. , Cherayil Neena R. , Chiu Eric , Shepherd Emily Anne , Golnik Karl C. , Garcia-Valenzuela Enrique , MacIntosh Peter W. , Johnson Brooke T. , Curnyn Kimberlee M.
Published: April 2022

Background:

Topical glycopyrronium tosylate (GT) is an anticholinergic medication for treatment of axillary hyperhidrosis. Pharmacologic mydriasis and anisocoria from topical GT has been reported and may be underrecognized. This study aims to clinically characterize patients presenting with pharmacologic mydriasis from exposure to this medication.

Methods:

This study is a retrospective observational case series. A multicenter chart review of 16 patients diagnosed with pharmacologic mydriasis secondary to topical GT was performed.

Results:

Eight patients (50.0%) were age 18 years and younger, and 14 patients (87.5%) were female. Unilateral mydriasis (anisocoria) occurred in 14 patients (87.5%). Fourteen patients (87.5%) did not initially volunteer topical GT as a “medication,” and the history of topical GT exposure needed to be elicited with further questioning. Hand hygiene details were known for 12 patients, and all reported that they did not wash their hands after GT application. Six patients (37.5%) were soft contact lens users. One patient had possible exposure through a family member's use of the medication. Ocular symptoms were common (blurry vision [11 patients, 68.8%] and eye dryness [7 patients, 43.8%]), but systemic anticholinergic symptoms were uncommon (such as constipation [1 patient, 6.3%] and urinary symptoms [3 patients, 18.8%]).

Conclusions:

Mydriasis associated with topical GT seems to be a consequence of local exposure rather than systemic toxicity. Because patients may not volunteer topical GT as a medication, eliciting a history of exposure often requires further specific questioning. Soft contact lens wear and poor postapplication hand hygiene seem to be associated with mydriasis in GT use.
Comparison of the Range of Lumbar Cerebrospinal Fluid Pressure in Adults With Normal Cerebrospinal Fluid Pressure and in Idiopathic Intracranial Hypertension
Authors: Bateman David E. , Wingrove Barbara
Published: April 2022

Background/Methods:

Lumbar puncture CSF pressure measurements in a large group of adults (116) having lumbar puncture (LP) for diagnostic reasons with no clinical indication of raised intracranial pressure were used to establish the normal range of CSF pressure. The cerebrospinal fluid (CSF) pressure was also measured in a smaller unselected series of patients (35) with the syndrome of idiopathic intracranial hypertension (IIH). All the lumbar punctures were performed by the same highly skilled operator, a consultant nurse, to ensure accuracy of measurement.

Results:

The results showed that the mean CSF pressure was 18.7 cm H2O with a range of 1–29 cm H2O in the group with normal CSF pressure. Ninty-five percentage of values was below 29 cm H2O in the group with normal CSF pressure. In the series with IIH, the mean and range were 37.7 cm H2O and 29.5–66 cm H2O, respectively. The lowest recorded pressure in the IIH group was 29.5 cm H2O with 95% of values above 31.

Conclusions:

This is the first time that the normal range of CSF pressure and that found in a group of patients with IIH has been reported after LP performed by the same operator to ensure inaccuracy of measurement has not biased the results. It suggests that the current upper limit of normal adopted by the revised diagnostic criteria for IIH (25 cm H2O) may be too low. The range of normal CSF pressure and that found in patients with IIH in our study suggests that consideration should be given to revising the upper limit of normal CSF pressure to around 30 cm H2O.
Association between Patient and Hospital Characteristics and Adherence to a Surgical Site Infection Reduction Bundle in a Statewide Surgical Quality Improvement Collaborative
Authors: Brajcich Brian C , Schlick Cary Jo R , Halverson Amy L , Huang Reiping , Yang Anthony D , Love Remi , Bilimoria Karl Y , McGee Michael F
Published: April 2022

BACKGROUND:

Adherence to bundled interventions can reduce surgical site infection (SSI) rates; however, predictors of successful implementation are poorly characterized. We studied the association of patient and hospital characteristics with adherence to a colorectal SSI reduction bundle across a statewide surgical collaborative.

STUDY DESIGN:

A 16-component colorectal SSI reduction bundle was introduced in 2016 across a statewide quality improvement collaborative. Bundle adherence was measured for patients who underwent colorectal operations at participating institutions. Multivariable mixed-effects logistic regression models were constructed to estimate associations of patient and hospital factors with bundle adherence and quantify sources of variation.

RESULTS:

Among 2,403 patients at 35 hospitals, a median of 11 of 16 (68.8%, interquartile range 8 to 13) bundle elements were completed. The likelihood of completing 11 or more elements was increased for obese patients (56.8% vs 51.5%, odds ratio [OR] 1.39, 95% CI 1.05 to 1.86, p = 0.022) but reduced for underweight patients (31.0% vs 51.5%, OR 0.51, 95% CI 0.26 to 1.00, p = 0.048) compared with patients with a normal BMI. Lower adherence was noted for patients treated at safety net hospitals (n = 9 hospitals, 24.4% vs 54.4%, OR 0.08, 95% CI 0.01 to 0.44, p = 0.004). The largest proportion of adherence variation was attributable to hospital factors for six bundle elements, surgeon factors for no elements, and patient factors for nine elements.

CONCLUSION:

Adherence to an SSI reduction bundle is associated with patient BMI and hospital safety net status. Quality improvement groups should consider institutional traits for optimal implementation of SSI bundles. Safety net hospitals may require additional focus to overcome unique implementation barriers.
The Need to Routinely Convert Emergency Cricothyroidotomy to Tracheostomy: A Systematic Review and Meta-Analysis
Authors: Choi Jeff , Anderson Taylor N , Sheira Dina , Sousa John , Borghi John A , Spain David A , Knowlton Lisa M
Published: April 2022

BACKGROUND:

Traditional surgical teaching advocates converting emergency cricothyroidotomies to tracheostomies to mitigate the risk of subglottic stenosis. A conversion procedure that may risk losing a tenuous airway should have clear benefits over risks. We aimed to evaluate the necessity of routine cricothyroidotomy to tracheostomy conversion by conducting a systematic review and meta-analysis of contemporary literature.

STUDY DESIGN:

We performed a systematic review of experimental and observational studies (published between January 1, 2008, and March 1, 2021) reporting hospital outcomes of adults aged ≥18 years who underwent emergency cricothyroidotomies or tracheostomies. We followed PRISMA guidelines and assessed quality of data using GRADE methodology. Meta-analysis pooled incidence of procedure-specific complications (bleeding, subglottic stenosis, and others) using Freeman-Tukey double arcsine transformation and sensitivity analysis addressed survival bias.

RESULTS:

A total of 18 studies including 1246 patients were analyzed. Incidence of bleeding (5 [1 to 11]% vs 3 [1 to 7]%), subglottic stenosis (0 [0 to 3]% vs 0 [0 to 0]%) and other complications (12 [8 to 16]% vs 13 [5 to 23]%) were similar among patients undergoing emergency cricothyroidotomy or tracheostomy. Sensitivity analysis evaluating the incidence of complications among only survivors found similar results. Only one study reported complications attributable to cricothyroidotomy to tracheostomy conversion.

CONCLUSIONS:

Subglottic stenosis, the main harm conversion seeks to avoid, appears to be a rare complication after cricothyroidotomy. We did not find evidence supporting routine need to convert cricothyroidotomies to tracheostomies; for many patients, conversion is unlikely to rectify complications attributable to emergency cricothyroidotomy. However, our findings cannot be generalized to patients who require prolonged or permanent airway cannulation. Providers should consider performing cricothyroidotomy to tracheostomy selectively when the benefits clearly outweigh the risks of disrupting a secured airway.
Area Deprivation Index and Rurality in Relation to Financial Toxicity among Breast Cancer Surgical Patients: Retrospective Cross-Sectional Study of Geospatial Differences in Risk Profiles
Authors: Corkum Joseph , Zhu Victor , Agbafe Victor , Sun Susie X , Chu Carrie , Colen Jessica Suarez , Greenup Rachel , Offodile Anaeze C
Published: April 2022

BACKGROUND:

Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT.

STUDY DESIGN:

A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients using survey data retrospectively collected between January 2018 and June 2019. Chart reviews were used to obtain patient information, and FT was identified using the COmprehensive Score for Financial Toxicity questionnaire, which is a validated instrument. Patients’ home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. ADI was analyzed in tertiles for univariate statistical analyses, and as a continuous variable to develop multivariable logistic regression models to evaluate the independent associations of geospatial location with FT.

RESULTS:

A total of 568 surgical breast cancer patients were included. Univariate analyses found significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. In multivariable analysis, advanced cancer stage (odds ratio [OR] 2.26, 95% CI 1.15 to 4.44) and higher ADI (OR 1.012, 95% CI 1.01 to 1.02) were associated with worsening odds of FT. Increasing age (continuous) (OR 0.976, 95% CI 0.96 to 0.99), married status (vs unmarried) (OR 0.46, 95% CI 0.30 to 0.70), and receipt of bilateral mastectomy (OR 0.56, 95% CI 0.32 to 0.96) were protective of FT.

CONCLUSIONS:

FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.
Impact of Intraoperative Molecular Imaging after Fluorescent-Guided Pulmonary Metastasectomy for Sarcoma
Authors: Azari Feredun , Kennedy Gregory T , Zhang Kevin , Bernstein Elizabeth , Maki Robert G , Gaughan Colleen , Jarrar Doraid , Pechet Taine , Kucharczuk John , Singhal Sunil
Published: April 2022

BACKGROUND:

Intraoperative molecular imaging (IMI) has been shown to improve lesion detection during pulmonary sarcomatous metastasectomy. Our goal in this study was to evaluate whether data garnered from IMI-guided resection of pulmonary sarcoma metastasis translate to improved patient outcomes.

STUDY DESIGN:

Fifty-two of 65 consecutive patients with a previous history of sarcomas found to have pulmonary nodules during screening were enrolled in a nonrandomized clinical trial. Patients underwent TumorGlow the day before surgery. Data on patient demographics, tumor biologic characteristics, preoperative assessment, and survival were included in the study analysis and compared with institutional historical data of patients who underwent metastasectomy without IMI. p values < 0.05 were considered significant.

RESULTS:

IMI detected 42 additional lesions in 31 patients (59%) compared with the non-IMI cohort where 25% percent of patients had additional lesions detected using tactile and visual feedback only (p < 0.05). Median progression-free survival (PFS) for patients with IMI-guided pulmonary sarcoma metastasectomy was 36 months vs 28.6 months in the historical cohort (p < 0.05). IMI-guided pulmonary sarcoma metastasectomy had recurrence in the lung with a median time of 18 months compared with non-IMI group at 13 months (p < 0.05). Patients with synchronous lesions in the IMI group underwent systemic therapy at a statistically higher rate and tended to undergo routine screening at shorter interval.

CONCLUSIONS:

IMI identifies a subset of sarcoma patients during pulmonary metastasectomy who have aggressive disease and informs the medical oncologist to pursue more aggressive systemic therapy. In this setting, IMI can serve both as a diagnostic and prognostic tool without conferring additional risk to the patient.