bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse Events of Endoscopic Clip Placement
Authors: Ramai Daryl , Deliwala Smit S. , Mozell Daniel , Facciorusso Antonio , Chandan Saurabh , Persaud Alana , Singh Kelita , Anderloni Andrea , Barakat Monique T.
Published: February 2023

Background:

Clips are endoscopic mechanical devices with tensile and closure strength that can approximate tissue and provide hemostasis through a tamponade effect. Clips are ubiquitously used in endoscopic practice, and numerous studies have validated the clinical efficacy of clips, with recent guidelines recommending them as a first-line intervention for recurrent and persistent nonvariceal gastrointestinal bleeding. However, the safety profile for these devices has yet to be delineated, thus, we aim to investigate this feature by examining the adverse events reported to the Food and Drug Administration.

Methods:

Postmarketing surveillance data from the Food and Drug Administration Manufacturer And User Facility Device Experience database were analyzed from January 2012 to January 2021. The Manufacturer And User Facility Device Experience database is a reporting software and does not independently verify the details of complications.

Results:

Two thousand five hundred forty reports were issued, of which 287 were patient adverse events and 2766 were device problems. Activation, separation, and positioning issues were most common. No consequences or clinically significant impact on patients were seen in 1968 reports. Foreign bodies were seen in 97 cases, hemorrhage in 57 cases, tissue damage in 42 cases, embedded clips in tissues/plaques in 16 cases, perforation in 15 cases, lacerations in 6 cases, and infection in 3 cases.

Conclusions:

While the most commonly reported device problems involved activation, separation, and positioning, most patients were clinically unaffected. Moreover, perforation and infection were exceedingly rare, further highlighting the safety profile of endoscopic clips.
Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness
Authors: Gressies Carla , Schuetz Philipp
Published: February 2023

Purpose of review

ICU survivors often spend long periods of time in general wards following transfer from ICU in which they are still nutritionally compromised. This brief review will focus on the feeding of patients recovering from critical illness, as no formal recommendations or guidelines on nutrition management are available for this specific situation.

Recent findings

While feeding should start in the ICU, it is important to continue and adapt nutritional plans on the ward to support individuals recovering from critical illness. This process is highly complex – suboptimal feeding may contribute significantly to higher morbidity and mortality, and seriously hinder recovery from illness. Recently, consensus diagnostic criteria for malnutrition have been defined and large-scale trials have advanced our understanding of the pathophysiological pathways underlying malnutrition. They have also helped further develop treatment algorithms. However, we must continue to identify specific clinical parameters and blood biomarkers to further personalize therapy for malnourished patients. Better understanding of such factors may help us adapt nutritional plans more efficiently.

Adequate nutrition is a vigorous component of treatment in the post-ICU period and can enhance recovery and improve clinical outcome. To better personalize nutritional treatment because not every patient benefits from support in the same manner, it is important to further investigate biomarkers with a possible prognostic value.
Dysregulated amino acid metabolism in heart failure: role of gut microbiome
Authors: Tang W.H. Wilson
Published: February 2023

Purpose of review

The importance of amino acid metabolism in heart failure has often been overlooked, especially in advanced stages. Metabolism of dietary compounds by gut microbiota generates a wide range of metabolites that can directly or indirectly modulate end-organ functions in their hosts. Herein, we describe recently discovered mechanistic links between various gut microbial metabolic pathways of amino acids and their derivatives in the pathophysiology of heart failure.

Recent findings

Growing evidence points to incremental prognostic value in amino acid profiling in patients with heart failure. Reducing branched-chain amino acid levels in the failing heart may have a cardioprotective role. Gut microbiome-related amino acid, including amino acid supplementation, dietary interventions, or microbial enzyme inhibition, can be targeted to modify cardiovascular risks.

Interplay between the gut microbiome and amino acid metabolism may contribute to disease progression in heart failure. Further investigations are warranted to uncover opportunities for intervention.
The effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis
Authors: Poulsen Eva , Aagaard Rasmus , Bisgaard Jannie , Sørensen Heidi T. , Juhl-Olsen Peter
Published: February 2023

Identifying patients at risk of difficult intravenous access (DIVA) and increasing the success rates of peripheral intravenous catheterization (PIVC), preferably on the first catheterization attempt, is of clinical importance. The aim of this study was to compare the use of dynamic ultrasound guidance for PIVC with the traditional technique of visualization and palpation in patients with predicted DIVA. A systematic review and meta-analysis comparing ultrasound-guided PIVC with the traditional technique was performed. Data were systematically collected through MEDLINE and EMBASE databases from inception to March 2021. Eligibility criteria included randomized controlled trials performed on patients meeting criteria for difficult catheterization comprising either (a) no palpable or visible veins, (b) previous history of difficult venous catheterization, (c) patient age less than 4 years, (d) suspicion of difficult catheterization by operator, or (e) two or more unsuccessful attempts using the traditional technique before enrollment were included. For all outcomes, a random-effects meta-analysis using the DerSimonian and Laird method was performed. The primary outcome was the first-attempt success rate, and the secondary outcomes were the overall success rate and the number of attempts for successful intravenous catheterization. Bias was assessed using the Revised Cochrane Risk of Bias tool. Seven studies with a total of 994 patients were included. Patients comprised both children and adults and settings included operating rooms, emergency departments, and intensive care units. Ultrasound guidance was associated with a higher first-attempt success rate (OR, 3.07; 95% CI, 1.66–5.65; P < 0.001). For the secondary outcomes, ultrasound guidance was associated with a higher overall success rate (OR, 3.02; 95% CI, 1.04–8.79; P = 0.04); however, this finding did not meet statistical significance in a sensitivity analysis (OR, 2.90; 95% CI, 0.71–11.93; P = 0.14). Ultrasound was not associated with a significantly different number of attempts compared with the traditional technique (difference in means, 0.14; 95% CI, −0.32 to 0.05; P = 0.15). The use of ultrasound guidance resulted in an almost three-fold increase in odds for the first-attempt success rate in patients with predicted DIVA compared with the traditional technique of PIVC.
Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA
Authors: Kucharska-Newton Anna M. , Halladay Jacquie R. , Psioda Matthew A. , Jones Sara B. , Johnson Anna M. , Coleman Sylvia W. , Cummings Doyle M. , Freburger Janet K. , Daras Laurie C. , Rosamond Wayne D. , Duncan Pamela W. , Bushnell Cheryl D.
Published: February 2023

Background and Objectives:

We examined transitional care management within 90 days and 1 year following discharge home among acute stroke and transient ischemic attack patients from the Comprehensive Post-Acute Stroke Services (COMPASS) Study, a cluster-randomized pragmatic trial of early supported discharge conducted in 41 hospitals (40 hospital units) in North Carolina, United States.

Methods:

Data for 2262 of the total 6024 (37.6%; 1069 intervention and 1193 usual care) COMPASS patients were linked with the Centers for Medicare and Medicaid Services fee-for-service Medicare claims. Time to the first ambulatory care visit was examined using Cox proportional hazard models adjusted for patient characteristics not included in the randomization protocol.

Results:

Only 6% of the patients [mean (SD) age 74.9 (10.2) years, 52.1% women, 80.3% White)] did not have an ambulatory care visit within 90 days postdischarge. Mean time (SD) to first ambulatory care visit was 12.0 (26.0) and 16.3 (35.1) days in intervention and usual care arms, respectively, with the majority of visits in both study arms to primary care providers. The COMPASS intervention resulted in a 27% greater use of ambulatory care services within 1 year postdischarge, relative to usual care [HR=1.27 (95% CI: 1.14–1.41)]. The use of transitional care billing codes was significantly greater in the intervention arm as compared with usual care [OR=1.87 (95% CI: 1.54–2.27)].

Discussion:

The COMPASS intervention, which was aimed at improving stroke post-acute care, was associated with an increase in the use of ambulatory care services by stroke and transient ischemic attack patients discharged home and an increased use of transitional care billing codes by ambulatory providers.
Long-term Outcomes of a 1-year Hypertension Quality Improvement Initiative in a Large Health System
Authors: Pfoh Elizabeth R. , Dalton Jarrod , Jones Robert , Rothberg Michael B.
Published: February 2023

Background:

Understanding whether practices retain outcomes attained during a quality improvement (QI) initiative can inform resource allocation.

Objective:

We report blood pressure (BP) control and medication intensification in the 3 years after a 2016 QI initiative ended.

Research Design:

Retrospective cohort

Subjects:

Adults with a diagnosis of hypertension who had a primary care visit in a large-integrated health system between 2015 and 2019

Measures:

We report BP control (<140/90 mm Hg) at the last reading of each year. We used a multilevel regression to identify the adjusted propensity to receive medication intensification among patients with an elevated BP in the first half of the year. To examine variation, we identified the average predicted probability of control for each practice. Finally, we grouped practices by the proportion of their patients whose BP was controlled in 2016: lowest performing (<75%), middle (≥75%–<85%), and highest performing (≥85%).

Results:

The dataset contained 184,981 patients. From 2015 to 2019, the percentage of patients in control increased from 74% to 82%. In 2015, 38% of patients with elevated BP received medication intensification. This increased to 44% in 2016 and 50% in 2019. Practices varied in average BP control (from 62% to 91% in 2016 and 68% to 90% in 2019). All but one practice had a substantial increase from 2015 to 2016. Most maintained the gains through 2019. Higher-performing practices were more likely to intensify medications than lower-performing practices.

Conclusions:

Most practices maintained gains 3 years after the QI program ended. Low-performing practices should be the focus of QI programs.
Novel immune directed therapies in myelodysplastic syndromes and acute myeloid leukemia
Authors: Brunner Andrew M.
Published: February 2023

Purpose of review

Therapies that target the immune system are increasingly used across oncology, including in hematologic malignancies such as myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). While allogeneic transplant has been a key therapy in these cancers, new approaches that target the immune system are being explored including immune checkpoint therapies, antibody−drug conjugates, and cellular therapies.

Recent findings

This review outlines updates in the preclinical rationale for immune directed therapies in MDS and AML, as well as recent clinical trials exploring these therapies. This manuscript summarizes the development of therapies targeting T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) and CD47, which are being evaluated in late phase studies in MDS and AML. It also reviews the landscape of other immune based therapies including antibody-drug conjugates, chimeric antigen receptor-T cells, bispecific antibodies, and tumor vaccines.

The treatment landscape in MDS and AML is rapidly changing; with a goal of improving the quality and duration of responses, a number of immune based therapies are under investigation. This review outlines recent advances with these therapies as well as some of the challenges that remain to incorporate them into leukemia care.
Systematic Review of Antimicrobial Lock Solutions for Prevention of Bacteremia in Pediatric Patients With Intestinal Failure
Authors: Gibson Bridget , McNiven Claire , Sebastianski Meghan , Vandermeer Ben , Persad Rabin , Robinson Joan L.
Published: February 2023

Objectives:

The goal of this systematic review was to determine whether antimicrobial lock (AML) solutions prevent catheter-related bloodstream infections (CRBSI) in children with intestinal failure (IF).

Methods:

Electronic databases were searched: Ovid MEDLINE (1946–), Ovid Embase (1974–), Wiley Cochrane Library (inception–), and Web of Science Core Collection via Clarivate Analytics (1900–). Randomized and nonrandomized trials, case or cohort studies that studied any AML solution, and used comparator groups were included if they studied children with IF. A meta-analysis compared the rates of CRBSI with AML solutions versus controls, and a Boucher analysis was used to indirectly compare AML solutions.

Results:

Twenty-eight studies met eligibility criteria (1 open label and 27 observational studies). Quality was good (N = 13), fair (N = 9), and poor (N = 6). All but 4 studied ethanol and taurolidine. Of 15 ethanol studies, 11 reported a decrease and 3 reported a trend toward a decreased incidence of CRBSI compared to controls; 1 reported no difference. Of 9 taurolidine studies, 7 reported a decrease and 2 a trend toward decreased CRBSI rates. There was a decrease in CRBSI with ethanol versus control (P= 0.008) and with taurolidine-citrate versus control (P< 0.0005). Using Bucher indirect comparison of the pooled estimates from ethanol versus control to taurolidine versus control, the estimated difference was −0.99 (−4.125, 2.27;P= 0.55).

Conclusions:

There were no randomized trials and over half of the 28 included studies were fair or poor quality. All but 1 reported at least a trend toward reduction in CRBSI. AML solutions appear to prevent CRBSI.
Isolated Terminal Ileitis in Children
Authors: Alper Arik , Bennett Aaron , Rottmann Douglas , Morotti Raffaella , Escalera Sandra , Padhye Phatak Uma , Pashankar Dinesh S.
Published: February 2023

Isolated terminal ileitis in adults is a well described entity that rarely progresses to Crohn disease (CD), and pediatric literature on this topic is very limited. We describe the prevalence, clinical, endoscopic, histologic, and radiological features, along with long‐term outcome of isolated terminal ileitis in our institution. We reviewed charts of 956 children who underwent colonoscopy from 2013 to 2017. Thirty‐three children had isolated histologically‐defined terminal ileitis. Seventeen children were diagnosed with CD and 16 children had idiopathic terminal ileitis. Children with CD had higher prevalence of abnormal C‐reactive protein levels, severe inflammation, and radiological evidence of bowel wall thickening compared with children with idiopathic ileitis. Children with idiopathic ileitis did not develop CD over a follow‐up period of 83 months. In contrast to adults, CD is common in children with isolated terminal ileitis and those with idiopathic ileitis do well over long‐term.
Intussusception as Rare Presenting Sign of Pediatric Celiac Disease
Authors: Shoshany Cory , Fahey Lisa M.
Published: February 2023

Intussusception is the most common cause of gastrointestinal obstruction in children and typically presents with acute abdominal pain. Intussusception usually occurs in children under the age of 3 in the ileocecal region. Over the past 5 years, multiple patients at the Children’s Hospital of Philadelphia have been diagnosed with both intussusception and biopsy‐confirmed celiac disease (CD). Intussusception may be a presenting sign of pediatric CD and should raise clinical suspicion for celiac screening, especially if it is a small bowel‐small bowel intussusception that occurs after the age of 3 in a malnourished patient.
Perioperative and Long-Term Outcome in Patients Treated for Jejunoileal Atresia
Authors: Røkkum Henrik , Johannessen Hanna , Bjørnland Kristin
Published: February 2023

Objectives:

Jejunoileal atresia is a common cause of neonatal intestinal obstruction. Results of long-term outcome are very limited. The aim of this study was to describe perioperative and postoperative outcome, and to evaluate long-term gastrointestinal quality of life (QoL) in patients treated for jejunoileal atresia.

Methods:

We conducted a combined retrospective and cross-sectional observational study of patients treated for jejunoileal atresia during 2001–2019. Perioperative data were registered, and complications were classified according to the Clavien-Dindo classification. To evaluate long-term clinical status and QoL, the PedsQL Gastrointestinal Symptoms Scales questionnaire and a self-designed questionnaire were used. Approval from the Data Protection Office was obtained.

Results:

Seventy patients were included in the retrospective part of the study. Of these, 70% got a primary anastomosis. Concomitant anomalies were registered in 46%. Median length of stay was 28 (5–140) days. Early (<28 days) complication rate was 66%. Early abdominal surgical reinterventions were performed in 11%, most frequently due to anastomotic leak. Late (>28 days) abdominal surgical reinterventions were performed in 21%, and most commonly for bowel obstruction. Overall mortality rate was 4%. Thirty-two patients with median 8 (2–19) years returned the questionnaires. Overall gastrointestinal QoL was good. However, concomitant gastrointestinal anomalies were associated with impaired outcome. Embarrassment of the scar was reported in 38%. Three (9%) patients used medication (laxatives, proton pump inhibitor) for gastrointestinal symptoms.

Conclusions:

Jejunoileal atresia is associated with significant morbidity during initial treatment. Despite this, the majority of the patients have excellent long-term outcomes.
Disseminated Cunninghamella elegans Infection Diagnosed by mNGS During Induction Therapy in a Child With Intermediate-risk Acute Lymphoblastic Leukemia: A Case Report and Review of Literature
Authors: Yu Nan , Ye Sheng , Yang Zihao , Chen Zhenjie , Zhang Chenmei
Published: February 2023

We described a 14-year-old girl with acute lymphoblastic leukemia who developed disseminated mucormycosis during induction therapy. Disseminated Cunninghamella elegans infection was confirmed by histopathology, microbiological culture, and metagenomic next-generation sequencing analysis of skin tissue, blood, and cerebrospinal fluid. Subsequently, the patient received a combination of liposomal amphotericin B, posaconazole, and caspofungin for antifungal treatment, but eventually died because of severe fungal pneumonia, respiratory failure, and septic shock. Moreover, case reports of pulmonary mucormycosis in children published since 1959 were reviewed. In summary, metagenomic next-generation sequencing is an effective diagnostic method for Cunninghamella with high speed and sensitivity.
Cancer-Related Fatigue and Daily Living Activities in Pediatric Cancer Survivors
Authors: Tanriverdi Müberra , Çakir Fatma Betül
Published: February 2023

Cancer-related long-term complications such as cardiovascular disease, fatigue, weight-related problems, and emotional disturbances are found to be increased in pediatric cancer survivors (PCSs). The relationship between daily living activities (DLAs) and such complications is still being investigated. Our aim in this study was to investigate the relationship between the cancer-related fatigue and DLA in PCS. Cancer-related fatigue was assessed by “PedsQL Multidimensional Fatigue Scale (MFS)” and “visual analog scale (VAS).” The DLA was evaluated by WeeFIM. There were 77 PCS (44 boys) with a mean age of 10.76 years. The mean value of fatigue scales were VAS 2.48, and MFS total score 71.14. WeeFIM total result was 118.64. While there was a statistically significant relationship between VAS fatigue score and WeeFIM total score (r=−0.387; P=0.007), there was no such correlation between WeeFIM total score with MFS total score (r=0.250; P=0.080). It is established that there is a relationship between level of fatigue and DLA. Risk factors like tumor type or treatment modalities for fatigue should be investigated in larger samples of specific survivor groups. Fatigue and its association with DLA should be screened clinically as a routine surveillance in PCS and treatment options be planned.
Reinventing the Clinical Audit in a Pediatric Oncology Network
Authors: Russo Carolyn , Morgan Jennifer
Published: February 2023

Providing equal access to pediatric cancer patients regardless of their geographic location is a major goal of the Affiliate Program at St. Jude Children’s Research Hospital (St. Jude). Thirty-five percent of new cancer patients enrolled on St. Jude clinical trials reside in the communities of 1 of the 8 affiliate clinics, which serve 9 states in the Southeast and Midwest United States. The affiliate clinics support participant recruitment for clinical trials and the geographic extension of St. Jude clinical care. To ensure high-quality pediatric cancer care, we instituted on-site clinical audits, however, we did not see improvement in clinical outcomes including the time to antibiotics in febrile immunocompromised patients, consistent hand-off communication, consistent documentation of oral chemotherapy, and adherence to a central line bundle in the ambulatory setting. We then moved to a more comprehensive clinical audit which involved self-reflection of clinic staff members, transparent data sharing, development of local quality champions, and engagement of senior leaders. The comprehensive approach was more successful in improving clinical outcomes including the time to antibiotics, hand-off communication, documentation of oral chemotherapy administration, and adherence to a central line bundle in the ambulatory setting.
Atypical Molecular Features of Pediatric Tectal Glioma: A Single Institutional Series
Authors: Yakir Maayan Joy , Elster Jennifer D. , Paul Megan R. , Khanna Paritosh C. , Malicki Denise M. , Levy Michael L. , Crawford John Ross
Published: February 2023

We present 4 children (diagnosed between 1 and 8 y, 3 females and 1 male) with molecularly distinct tectal gliomas (2 KRAS mutant, 1 EGFR mutant, 1 SRGAP3-RAF-1 fusion) that contributes to the growing literature of this uncommonly biopsied tumor. The patient with EGFR R222C mutation had a more severe course, earlier diagnosis, subsequent leptomeningeal metastatic disease, required more aggressive therapies, and died 9 years after diagnosis. Patients with KRAS mutations and SRGAP3-RAF-1 fusion had a more indolent course. Our series expands the molecular phenotype of tectal glioma with the potential for leptomeningeal dissemination. Future studies on establishing genotypic/phenotypic correlation from those who undergo biopsy are needed.
Physical functioning and health-related quality of life after COVID-19: a long-term perspective case series
Authors: Ferrarello Francesco , Iacopino Carmela , Pierinelli Catia , Paci Matteo
Published: February 2023

The purpose of our study was to monitor the long-term changes in physical functioning and health-related quality of life in individuals who received outpatient rehabilitation after COVID-19. Individuals referred to outpatient rehabilitation for post-COVID-19 physical therapy were assessed before the treatment, at the end of the treatment, and 2 and 6 months after the end of the treatment. The physical functioning was assessed by Barthel Index, Timed Up and Go test, Short Physical Performance Battery test (SPPB), Patient-Specific Functioning Scale (PSFS), and EuroQOL 5D-3L. Friedman’s test was utilized to assess changes in the assessments. The proportions of individuals showing variation in performance equal to or greater than the absolute minimal detectable change (MDC) value of the SPPB and PSFS were calculated. Forty-four cases were monitored for 7.3–15.6 months. At baseline, they showed substantial independence in activities of daily living, moderate mobility limitations, and below-average health-related quality of life. Their status significantly improved over time (Friedman’s test P = 0.002 to <0.001); post hoc analysis confirmed the improvement of mobility and health-related quality of life at 6-month follow-up relative to the baseline. After accounting for MDC values, 55% meaningfully improved on SPPB and 45% on PSFS, although some worsened (11 and 5%, respectively) and the remaining showed no meaningful change. Despite good independence in activities of daily living and perceived health, individuals surviving the COVID-19 may not have fully recovered their premorbid functioning status seven to 15 months after the infection.
Telephone-based assessment of the fear of falling in older people and factors associated
Authors: Duarte Daniele de Oliveira Nunes , Soares Cordeiro Isabela Cristina , de Freitas Maria Aparecida Silva , Silva Geice Kely Karina , Soares Pires Lucas Eugênio , Siqueira Silva Victor , Avelino Patrick R , de Menezes Kênia Kiefer Parreiras
Published: February 2023

This study aimed to validate the telephone-based application of the Falls Efficacy Scale–International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC3,1) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, −4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.
Physical, Leisure, and Daily Living Activities in Patients Before, During, and After Radiotherapy for Cancer
Authors: Efverman Anna
Published: February 2023

Background

Avoiding inactivity and staying active during cancer therapy have great health effects.

Objective

The aims of this study were to describe level of daily, leisure, and physical activities before, during, and after radiotherapy and to investigate whether patients who had not restored activity level after radiotherapy differed from patients who had restored activity level regarding different characteristics.

Methods

In this descriptive longitudinal study, 196 patients undergoing pelvic-abdominal radiotherapy reported their activity level at baseline, weekly during radiotherapy, and at 1 month after radiotherapy.

Results

Patients decreased activity level during radiotherapy (P < .001 for all activities): physical activity (34% of patients decreased level), walking (26%), leisure activities (44%), social activities (15%), housework (34%), shopping (28%), and activities in general (28%). Almost half (47%) had not restored activity level after radiotherapy. Patients with colorectal cancer, older than 65 years, who had less education than university, and high capacity in overall daily activities at baseline were more likely than other patients not to restore activity level after radiotherapy. The patients not restoring their activity level after radiotherapy were more likely than others to experience anxious mood (P = .016), depressed mood (P = .003), and poor quality of life (P = .003) after radiotherapy.

Conclusion

Patients’ activity level decreased during radiotherapy, and almost half of patients did not restore activity level after radiotherapy.

Implications for Practice

Given that restored activity level after radiotherapy was less common in certain subgroups and that patients who restored activity level experienced better quality of life and less frequent anxious and depressed mood, cancer nursing professionals should consider supporting these subgroups of patients in performing activities.
“Their Bodies Just Give It Away”
Authors: Plummer Karin J. , McCarthy Maria C. , Newall Fiona H. , Manias Elizabeth
Published: February 2023

Background

Children undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to pain.

Objective

This study aimed to examine how healthcare providers and parents assessed pain and what contextual factors influenced their pain assessment practices for children hospitalized after allogeneic HSCT therapy.

Methods

A qualitative case study was conducted in a tertiary level pediatric HSCT unit in 2 phases. Semistructured interviews with parents were conducted at 30 and 90 days after HSCT therapy. Healthcare providers participated in naturalistic observations of pain-related care provided to children during their hospitalization for HSCT therapy and a semistructured interview.

Results

The assessment of pain after transplantation by healthcare providers and parents was predominantly reliant on the observation of children for behaviors indicative of pain, rather than the application of validated pain assessment tools. Without formal measures of the pain experience, judgments regarding the severity of children’s pain were influenced by the context of high acuity of care posttransplantation and the emotional responses of healthcare providers and parents from bearing witness to children’s pain.

Conclusion

Pain assessments mostly reflected children’s ability to tolerate pain, rather than a genuine measurement of how significantly pain impacted the child.

Implication for Practice

This study has emphasized how the assessment of pain for children hospitalized during HSCT therapy is limited by the complexity of the clinical environment. It is recommended that validated methods of assessing pain by healthcare providers and parents be implemented into clinical practice to ensure children’s pain is visible.
Survivorship Experiences of Chinese Hematopoietic Stem Cell Transplantation Survivors
Authors: Ruan Jiayin , Qian Ying , Zhuang Yiyu
Published: February 2023

Background

The number of global hematopoietic stem cell transplantation (HSCT) survivors is increasing rapidly. Survivors encounter many challenges, but studies regarding survivorship experiences in China are scarce.

Objectives

This study aimed to explore the survivorship experiences of Chinese patients with hematological cancers after HSCT and to describe the impact of HSCT on the survivors’ lives.

Methods

Descriptive qualitative research was used. Purposive sampling was used to recruit HSCT survivors who were treated in a teaching hospital in Zhejiang Province from June 2021 to June 2022. Audio-recorded semistructured interviews were conducted, transcribed verbatim, and analyzed via conventional content analysis.

Results

Fifteen HSCT survivors aged 18 to 59 years participated in this study. Four themes and 11 subthemes emerged: (1) transplant being harder than you thought (body function impaired, forced to modify diet, disturbed by survivorship uncertainty), (2) difficulty blending into circles (limited activity space, suffering from discrimination), (3) adjusting value judgment (health being a top priority, contributing to family as much as possible, feeling worthless), and (4) still being the lucky one (recovered better than others, genuine relationships acquired, self-improvement achieved).

Conclusion

This study offers insight into subjective survivorship experiences of patients with hematological cancers post-HSCT within a Chinese sociocultural context and presents changed perceptions of HSCT, life alterations, adjusted value judgments, and positive self-evaluation since treatment.

Implications for Practice

Nurses can provide person-centered survivorship care based on the understanding of survivorship experiences of Chinese HSCT survivors. Intervention programs and informational materials should be developed to address difficulties encountered by Chinese HSCT survivors.
Use of Theory in Quality Innovations
Authors: Cronn Susan , Trevino Colleen , Jansen Kay
Published: February 2023

Background:

Inconsistent and nonstandardized patient handoffs can increase the risk of adverse events. Using change theory may promote adoption of effective handoff processes.

Local Problem:

A Midwest emergency department (ED) had no standardized practice for shift change handoffs. Previous handoff quality improvement efforts had been unsuccessful.

Methods:

A pre/postintervention pilot project design was used. Nurses' compliance with the new handoff protocol was evaluated.

Interventions:

Using Diffusion of Innovation (DOI) theory, an evidence-based shift change protocol was designed and implemented, which included a comprehensive handoff tool specific to the ED.

Results:

Four elements in the new shift change process saw statistically significant improvements after implementation, including discussion of the patient's illness severity (P = .001), synthesis of the patient's care (P < .001), completing a bedside safety checklist (P < .001), and providing a formal transition-of-care process (P < .001).

Conclusions:

Using DOI theory may improve the adoption of new shift change practices.
Use of the Modified Early Warning Score by Medical-Surgical Nurses to Initiate the Rapid Response Team
Authors: Miles Iman , Anderson Maighdlin , Ren Dianxu , Coker Tamara , Fennimore Laura
Published: February 2023

Background:

Cardiac arrests are often preceded by several hours of physiological deterioration that may go undetected.

Local Problem:

Cardiac arrests frequently occurred on medical-surgical units without prior rapid response team intervention.

Methods:

A pre/postintervention design was used to evaluate a protocol to guide the use of the Modified Early Warning Score (MEWS) by medical-surgical nurses to escalate the care of deteriorating adult patients.

Interventions:

Following staff education, the MEWS protocol was implemented across 8 medical-surgical units.

Results:

There was a significant increase in patients experiencing a rapid response prior to a cardiac arrest after implementing the MEWS protocol (P < .0001).

Conclusion:

Implementing a consistent review of MEWS values allows medical-surgical nurses to initiate assistance from a rapid response team that may prevent an inpatient cardiac arrest.
Development and Implementation of a Real-Time Inpatient Palliative Care Screening Process to Promote Earlier Palliative Care Referrals
Authors: Haranis Marika , Lampkin Natasha , Roche-Green Alva , Burgher Seaman Jennifer , Fennimore Laura
Published: February 2023

Despite the previous development of criteria for palliative screening tools, there remains a lack of validated and practical screening processes for the general hospitalized patient population for everyday clinical use. This quality improvement project's aim was to implement a practical institution-based adult inpatient palliative care screening tool embedded into the electronic medical record with an automated alert process to assist in identifying patients earlier within hospital admission. The project used a preimplementation and postimplementation design and followed the Plan-Do-Study-Act process to measure the effectiveness of the tool and alert process in decreasing time from admission to palliative care referral and impact on referring patterns. During the project period, 1851 palliative care referrals were completed, and minimal difference (0.6%) was noted in the average time from admission to referral preimplementation and postimplementation (P = .939). There was a 3.7% increase in referrals postimplementation and a shift in referring service patterns (P = .321). Although the expected outcome of earlier palliative referrals during admissions was not met, the development and implementation of the tool and alert process is a step toward the creation of a standard practical tool for the general hospitalized patient population.
OB HUB
Authors: Lowery Deb , De Leon Betsy , Krening Cynthia , Dempsey Amy , Dwork Peter , Brou Lina , Tynes John , Thompson Lisa
Published: February 2023

Objective:

The purpose of this project was to implement a remote fetal surveillance unit with increased vigilance and timelier responses to electronic fetal monitor tracings to improve neonatal outcomes and increase safety.

Methods:

A pilot project, OB HUB, facilitated implementation of a centralized remote fetal surveillance unit including artificial intelligence software and nurse experts dedicated to fetal monitoring interpretation. A telemetry room was established. Notification parameters were created to promote consistent communication between OB HUB nurses and bedside nurses. Outcomes for term neonates included body cooling, arterial cord pH less than 7.0, Apgar scores less than 7 at 5 minutes, emergency cesarean births, and cesarean births. Surveys were used to evaluate team perceptions of fetal safety.

Results:

There were 2,407 births 6 months pre OB HUB implementation and 2,582 births during the 6-month trial, for a total sample of 4,989 births included in the analysis. Six births (0.25%) resulted in cooling prior to implementation and 2 (0.08%) cooling events occurred during the trial; these differences were not significant (p = .10). There were no significant differences between groups for neonatal outcomes. Average level of safety perceived by nurses and providers remained relatively unchanged when comparing pre- and postimplementation survey results; however, of those responding, 78.8% of nurses indicated the OB HUB improved safety.

Clinical Implications:

There were few adverse events in either group, thus it was a challenge to demonstrate statistically significant improvement in neonatal outcomes even with a sample of nearly 5,000 births. A larger sample is needed to support clinical utility. The OB HUB was perceived favorably by most of the L&D nurses.
Development and Implementation of a Game-Based Neonatal Resuscitation Refresher Training
Authors: Billner-Garcia Renee M. , Spilker Arlene
Published: February 2023

Game-based learning theory and Google Docs Editors suite were used to develop an online, self-directed neonatal resuscitation refresher training for registered nurses to improve their resuscitation knowledge and skills and enhance their learning motivation and engagement. Results indicated that a self-directed, online game-based refresher training was motivating, engaging, and improved nurses’ resuscitation knowledge and skill performance. Nurse professional development practitioners can use similar game-based online materials to enhance learning.
Relationships Between Remote Learning Modalities and Nursing Students' Perceptions of Their Sleep Quality During the COVID-19 Pandemic
Authors: Ngo Thye Peng , Antisdel J'Andra L. , Xing Kuan , Reising Deanna L.
Published: February 2023

Background:

The relationship between learning modalities and nursing students' sleep quality during the coronavirus disease (COVID-19) pandemic is unknown.

Purpose:

This study examined the relationships between remote learning and the sleep quality of nursing students during the COVID-19 pandemic.

Methods:

Using a cross-sectional descriptive design, 890 nursing students were surveyed online to identify sleeping habits and learning modalities.

Results:

There were no significant correlations between remote learning hours, self-reported sleep hours, and sleep quality. The asynchronous-only group reported better sleep quality than the in-person and online hybrid group after controlling for health conditions and grade point average. Students who reported that remote learning had impacted their sleep had poorer sleep quality.

Conclusions:

This study provides insight into how different learning modalities impact nursing students' sleep quality during the pandemic.
Effect of Multiple-Patient Simulation on Baccalaureate Nursing Students' Anxiety and Self-confidence
Authors: Ross Jennifer Gunberg , Meakim Colleen H. , Latz Eleanor , Arcamone Angelina , Furman Gail , Prieto Patricia , Reynolds Kathryn , Franklin Ashley E.
Published: February 2023

Background:

Multiple-patient simulation (MPS) allows nursing students to develop leadership skills. Limited research examining student outcomes following MPS exists.

Purpose:

This pilot study investigated the impact of MPS on (1) anxiety with transition to practice, (2) anxiety with clinical decision-making, (3) self-confidence with clinical decision-making, and (4) perceptions about MPS as a learning strategy.

Methods:

Twenty-two senior baccalaureate nursing students participated in this 2-group mixed-methods study. Data were collected before and after a leadership course using the State-Trait Anxiety Inventory, Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale, and a researcher-developed perceptions survey.

Results:

Self-confidence with clinical decision-making significantly increased for all participants regardless of group assignment. Anxiety and anxiety with clinical decision-making decreased without significant changes. No significant differences were found between groups. Qualitative findings yielded 3 themes: preparation for clinical practice, overcoming anxiety, and confidence.

Conclusion:

Research investigating additional student outcomes after MPS with larger, more diverse samples is needed.
Social Determinants of Health and Symptom Burden During Cancer Treatment
Authors: Badger Terry A. , Segrin Chris , Crane Tracy E. , Chalasani Pavani , Arslan Waqas , Hadeed Mary , Sikorskii Alla
Published: February 2023

Background

Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety).

Objectives

The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors.

Methods

This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies–Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic.

Results

Non-Hispanic White survivors (n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors (n = 168) and non-Hispanic survivors of other races (n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races.

Discussion

These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.
Lumbosacral Radiculoplexus Neuropathy After COVID-19
Authors: Aragon Pinto Catarina , Pinto Marcus V. , Engelstad JaNean K. , Dyck P. James B.
Published: February 2023

Introduction:

Lumbosacral Radiculoplexus Neuropathy (LRPN) is a subacute, painful, paralytic, asymmetric immune-mediated lower-limb neuropathy associated with weight loss and diabetes mellitus (called DLRPN). Approximately one-third of LRPN cases have a trigger. Our purpose is to show that COVID-19 can trigger LRPN.

Case Report:

We describe the clinical, neurophysiological, radiologic, and pathologic findings of a 55-year-old man who developed DLRPN after severe acute respiratory syndrome coronavirus-2 infection. Shortly after mild coronavirus disease 2019 (COVID-19), the patient developed severe neuropathic pain (allodynia), postural orthostasis, fatigue, weight loss, and weakness of bilateral lower extremities requiring wheelchair assistance. One month after COVID-19, he was diagnosed with type 2 diabetes mellitus. Neurological examination showed bilateral severe proximal and distal lower extremity weakness, absent tendon reflexes, and pan-modality sensation loss. Electrophysiology demonstrated an asymmetric axonal lumbosacral and thoracic radiculoplexus neuropathies. Magnetic resonance imaging showed enlargement and T2 hyperintensity of the lumbosacral plexus. Cerebral spinal fluid (CSF) showed an elevated protein (138 mg/dL). Right sural nerve biopsy was diagnostic of nerve microvasculitis. He was diagnosed with DLRPN and treated with intravenous methylprednisolone 1 g weekly for 12 weeks. The patient had marked improvement in pain, weakness, and lightheadedness and at the 3-month follow-up was walking unassisted.

Conclusion:

COVID-19 can trigger postinfectious inflammatory neuropathies including LRPN.
Successful Treatment of Persistent 5-Nitroimidazole–Resistant Trichomoniasis With an Extended Course of Oral Secnidazole Plus Intravaginal Boric Acid
Authors: McNeil Candice J. , Williamson John C. , Muzny Christina A.
Published: February 2023

We describe a case of persistent 5-nitroimidazole–resistant trichomoniasis cured after 14 days of oral secnidazole and intravaginal boric acid. Secnidazole may be an important treatment option for resistant trichomoniasis, particularly in women who fail other regimens, including higher doses of oral metronidazole and tinidazole for longer durations of time.