bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality Rates After Nonoperative Geriatric Hip Fracture Treatment: A Matched Cohort Analysis
Authors: Shin Edward D. , Sandhu Kevin P. , Wiseley Benjamin R. , Hetzel Scott J. , Winzenreid Alec E. , Simske Natasha M. , Johnson Kristina P. , Goodspeed David C. , Doro Christopher J. , Whiting Paul S.
Published: February 2023

Objective:

To compare the mortality rate between geriatric patients with hip fracture treated nonoperatively and a matched cohort treated operatively.

Design:

Retrospective Observational Matched Cohort Study.

Setting:

Academic Level 1 Trauma Center.

Patients:

Geriatric patients who sustained femoral neck and intertrochanteric/peritrochanteric fractures, excluding isolated greater trochanteric fractures. All patients older than 65 years with hip fractures over a 10-year period were identified. Operative patients were matched at a 2:1 ratio, when possible, to nonoperative patients based on Charlson Comorbidity Index and American Society of Anesthesiologists score.

Intervention:

Nonoperative treatment or operative treatment (femoral neck fractures: cannulated screw fixation or hemiarthroplasty; intertrochanteric/peritrochanteric fractures: sliding hip screw or cephalomedullary nail fixation; or proximal femoral locking plate).

Main Outcomes:

Mortality calculated at 30 and 90 days, and 1-year after injury. Mortality was compared between groups using logistic regression while controlling for age, CVA/TIA, and dementia.

Results:

Seven hundred seventy-two patients (171 nonoperative and 601 operative) were initially identified. After applying the matching algorithm, 128 nonoperative and 239 operative patients were included in the analysis. There were no significant differences in age, sex, Charlson Comorbidity Index, or American Society of Anesthesiologists score between the cohorts. Nonoperative patients had a significantly higher 1-year mortality rate than operative patients [46.1% vs. 18.0%, Odds Ratio (95% confidence interval): 3.85 (2.34–6.41), P < 0.001].

Conclusions:

Geriatric patients with hip fracture treated nonoperatively had a 1-year mortality rate of 46.1%, more than double the rate among operative patients.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Comparison of Intramedullary Versus Extramedullary Implants for Fixation of Simple Pertrochanteric Fractures
Authors: Schader Jana F. , Zderic Ivan , Dauwe Jan , Sommer Christoph , Gueorguiev Boyko , Stoffel Karl
Published: February 2023

Objectives:

To evaluate the biomechanical performance of the intramedullary TFN-ADVANCED Proximal Femoral Nailing System (TFNA) versus the extramedullary Femoral Neck System (FNS) for fixation of simple pertrochanteric fractures in a human cadaveric model.

Methods:

Ten human cadaveric femoral pairs were implanted pairwise with either TFNA or FNS. A simple pertrochanteric fracture OTA/AO 31-A1 was created and all specimens were biomechanically tested under progressively increasing cyclic loading until failure. Interfragmentary and bone-implant movements were monitored by motion tracking.

Results:

Axial stiffness was comparable between TFNA and FNS, P = 0.34. Similarly, varus deformation, femoral head rotation around neck axis and implant migration remained without significant differences between TFNA and FNS after 3000 cycles (800 N peak load), P ≥ 0.10. However, cycles to 15-mm leg shortening were significantly higher for TFNA versus FNS, P < 0.01.

Conclusions:

From a biomechanical perspective, with its current design, FNS does not seem to be a valid alternative to TFNA for treatment of simple pertrochanteric fractures.
Risk Factors for Nonunion of Distal Femur Fractures
Authors: Cone Ryan , Roszman Alex , Conway Yvonne , Cichos Kyle , McGwin Gerald , Spitler Clay A.
Published: February 2023

Objectives:

To determine patient, fracture, and construct related risk factors associated with nonunion of distal femur fractures.

Design:

Retrospective cohort study.

Setting:

Academic Level I trauma center.

Participants:

Patients 18 years and older presenting with OTA/AO 33A and 33C distal femur fractures from 2004 to 2020. A minimum follow-up of 6 months was required for inclusion. OTA/AO 33B and periprosthetic fractures were excluded, 438 patients met inclusion criteria for the study.

Main Outcomes:

The primary outcome of the study was fracture nonunion defined as a return to the OR for management of inadequate bony healing. Patient demographics, comorbidities, injury characteristics, fixation type, and construct variables were assessed for association with distal femur fracture nonunion. Secondary outcomes include conversion to total knee arthroplasty, surgical site infection, and other reoperation.

Results:

The overall nonunion rate was 13.8% (61/438). The nonunion group was compared directly with the fracture union group for statistical analysis. There were no differences in age, sex, mechanism of injury, Injury Severity Score, and time to surgery between the groups. Lateral locked plating characteristics including length of plate, plate metallurgy, screw density, and working length were not significantly different between groups. Increased body mass index [odds ratio (OR), 1.05], chronic anemia (OR, 5.4), open fracture (OR, 3.74), and segmental bone loss (OR, 2.99) were independently associated with nonunion. Conversion to total knee arthroplasty (TKA) (P = 0.005) and surgical site infection (P < 0001) were significantly more common in the nonunion group.

Conclusion:

Segmental bone loss, open fractures, chronic anemia, and increasing body mass index are significant risk factors in the occurrence of distal femoral nonunion. Lateral locked plating characteristics did not seem to affect nonunion rates. Further investigation into the prevention of nonunion should focus on fracture fixation constructs and infection prevention.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Clinical study of a new type of telescopic rod for the treatment of congenital pseudarthrosis of the tibia in children
Authors: Liu Yaoxi , Zheng Yu , Huang Yiyong , Yang Ge , Zhu Guanghui , Tan Qian , Wu Jiangyan , Liu Kun , Mei Haibo
Published: February 2023

The purpose of this study was to investigate the initial efficacy of a new telescopic rod in the treatment of congenital pseudarthrosis of tibia (CPT) in children. A new type of telescopic rod for children was designed and its clinical results were evaluated. There were nine cases of CPT on the right and six cases on the left; there were six females and nine males. The average age at operation was 35.5 months. There were 12 cases with neurofibromatosis type 1 and 4 cases with proximal tibial dysplasia. The initial healing of tibial pseudarthrosis, proximal tibial valgus deformity, tibial length, ankle valgus, ankle function, and intramedullary rod displacement were evaluated during follow-up. All 15 cases were followed up for an average of 18.2 months, 14 cases achieved initial healing, with an average healing time of 4.3 months. Ten cases had unequal lengths of the tibia, with an average of 0.9 cm. Proximal tibial valgus occurred in seven cases and ankle valgus occurred in one child. The average range of motion of the ankle joint was 23° and the average plantar flexion was 42°. The average extension of the new telescopic rod was 1.6 cm. The displacement of the telescopic rod occurred in seven cases, there was no epiphyseal plate tethering and re-fracture. The new children’s telescopic rod has a reasonable design and can extend with the growth of tibia. There are no complications of epiphyseal plate tethering and re-fracture. It provides a new choice of intramedullary fixation for the treatment of CPT.
Intermediate-term Outcomes in Adolescent Recurrent Ankle Instability Managed With a Modified Broström-Gould Procedure Augmented With Distal Fibular Periosteum Incorporation
Authors: Boutelle Kelly E. , Rickert Kathleen D. , Carroll Alyssa N. , Pennock Andrew T. , Manhard Claire E. , Edmonds Eric W.
Published: February 2023

Background:

Once a child has developed chronic ankle instability with recurrent events despite conservative treatment, then ligamentous repair is warranted. We utilize a modification of the modified Broström-Gould technique that further incorporates the distal fibular periosteum into the construct. The purpose of this study was to describe the intermediate-term outcomes of our modified Broström-Gould technique for chronic lateral ankle instability in childhood athletes.

Methods:

A retrospective review of children who underwent the surgical technique over a 10-year time period (2010 to 2019) was performed, excluding those with <2 years of follow-up. Demographic, surgical, and clinical data were recorded, as well as outcome scores: (1) the Marx activity scale, (2) University of California, Los Angeles activity score, and (3) foot and ankle outcomes score. Recurrent instability events, repeat surgeries, satisfaction with the surgical experience, and return to sport (if applicable) were also recorded.

Results:

Forty-six children (43 females) with 1 bilateral ankle met the criteria with a mean age at surgery of 14.8 years, and a mean follow-up duration of 4.9 years. The mean Marx activity score was 9.0±5.1, the mean University of California, Los Angeles score was 8.3±1.8, and the mean total foot and ankle outcomes score was 84.0±15.6. Twenty-six ankles (55.3%) reported having at least 1 recurrent episode of instability and 6 of the ankles (12.8%) underwent revision surgery between 3.5 months and 6.5 years of the index procedure. Thirty-nine (84.8%) patients responded that they would undergo our surgery again.

Conclusion:

A modified Broström-Gould procedure can be performed in children with the incorporation of the adjacent periosteum, but recurrence of instability is distinctly possible with longer follow-up with a risk for revision surgery despite good subjective outcomes.

Level of Evidence:

Level IV; retrospective case series.
Exposed Intramedullary Fixation Produces Similar Outcomes to Buried Fixation for Acute Pediatric Monteggia Fractures
Authors: Lightdale-Miric Nina R. , Obana Kyle K. , Fan Bensen B. , Padilla Abigail N. , Lin Adrian J. , Bennett James T. , Wren Tishya A.L.
Published: February 2023

Background:

Treatment of acute pediatric Monteggia fractures requires ulnar length stability to maintain reduction of the radiocapitellar joint. When operative care is indicated, intramedullary ulna fixation can be buried or left temporarily exposed through the skin while under a cast. The authors hypothesized that treatment with exposed fixation yields equivalent results to buried fixation for Monteggia fractures while avoiding secondary surgery for hardware removal.

Methods:

A retrospective review of children with acute Monteggia fractures at our Level 1 pediatric trauma center was performed. Patient charts and radiographs were evaluated for age, fracture type, fracture location, Bado classification, type of treatment, complications, cast duration, time to fracture union, time to hardware removal, and range of motion.

Results:

Out of 59 acute Monteggia fractures surgically treated (average age 6 y, range 2 to 14), 15 (25%) patients were fixed with buried intramedullary fixation and 44 (75%) with exposed intramedullary fixation under a cast. There were no significant differences between buried and exposed intramedullary fixation in cast time after surgery (39 vs. 37 d; P=0.55), time to fracture union (37 vs. 35 d; P=0.67), pronation/supination (137 vs. 134 degrees; P=0.68) or flexion/extension (115 vs. 114 degrees; P=0.81) range of motion. The exposed fixation had a return to OR of 4.5% (2 out of 44), and the buried fixation returned to the OR for removal on all patients.

Conclusion:

Exposed intramedullary fixation yielded equivalent clinical outcomes to buried devices in the treatment of acute pediatric Monteggia fractures while eliminating the need for a second surgery to remove hardware, reducing the associated risks and costs of surgery and anesthesia, but had a higher complication rate. Open Monteggia fractures or patterns with a known risk of delayed union may benefit from buried instead of exposed intramedullary fixation for earlier mobilization.

Level of Evidence:

III.
A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy
Authors: Raad Micheal , Xu Amy L. , Ortiz-Babilonia Carlos , Marrache Majd , Durand Wesley M. , Greenberg Marc , Jain Amit
Published: February 2023

Study Design.

Retrospective cost-utility analysis.

Objective.

To conduct a cost-analysis comparing synthetic cage (SC) versus allograft (Allo) over a five-year time horizon.

Summary of Background Data.

SC and Allo are two commonly used interbody choices for anterior cervical discectomy and fusion (ACDF) surgery. Previous analyses comparative analyses have reached mixed conclusions regarding their cost-effectiveness, yet recent estimates provide high-quality evidence.

Materials and Methods.

A decision-analysis model comparing the use of Allo versus SC was developed for a hypothetical 60-year-old patient with cervical spondylotic myelopathy undergoing single-level ACDF surgery. A comprehensive literature review was performed to estimate probabilities, costs (2020 USD) and quality-adjusted life years (QALYs) gained over a five-year period. A probabilistic sensitivity analysis using a Monte Carlo simulation of 1000 patients was carried out to calculate incremental cost-effectiveness ratio and net monetary benefits. One-way deterministic sensitivity analysis was performed to estimate the contribution of individual parameters to uncertainty in the model.

Results.

The use of Allo was favored in 81.6% of the iterations at a societal willing-to-pay threshold of 50,000 USD/QALY. Allo dominated (higher net QALYs and lower net costs) in 67.8% of the iterations. The incremental net monetary benefits in the Allo group was 2650 USD at a willing-to-pay threshold of 50,000 USD/QALY. One-way deterministic sensitivity analysis revealed that the cost of the index surgery was the only factor which significantly contributed to uncertainty.

Conclusion.

Cost-utility analysis suggests that Allo maybe a more cost-effective option compared with SCs in adult patients undergoing ACDF for cervical spondylotic myelopathy.
Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion
Authors: Shah Akash A. , Devana Sai K. , Lee Changhee , Olson Thomas E. , Upfill-Brown Alexander , Sheppard William L. , Lord Elizabeth L. , Shamie Arya N. , van der Schaar Mihaela , SooHoo Nelson F. , Park Don Y.
Published: February 2023

Study Design.

A retrospective, case-control study.

Objective.

We aim to build a risk calculator predicting major perioperative complications after anterior cervical fusion. In addition, we aim to externally validate this calculator with an institutional cohort of patients who underwent anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

The average age and proportion of patients with at least one comorbidity undergoing ACDF have increased in recent years. Given the increased morbidity and cost associated with perioperative complications and unplanned readmission, accurate risk stratification of patients undergoing ACDF is of great clinical utility.

Methods.

This is a retrospective cohort study of adults who underwent anterior cervical fusion at any nonfederal California hospital between 2015 and 2017. The primary outcome was major perioperative complication or 30-day readmission. We built standard and ensemble machine learning models for risk prediction, assessing discrimination, and calibration. The best-performing model was validated on an external cohort comprised of consecutive adult patients who underwent ACDF at our institution between 2013 and 2020.

Results.

A total of 23,184 patients were included in this study; there were 1886 cases of major complication or readmissions. The ensemble model was well calibrated and demonstrated an area under the receiver operating characteristic curve of 0.728. The variables most important for the ensemble model include male sex, medical comorbidities, history of complications, and teaching hospital status. The ensemble model was evaluated on the validation cohort (n=260) with an area under the receiver operating characteristic curve of 0.802. The ensemble algorithm was used to build a web-based risk calculator.

Conclusion.

We report derivation and external validation of an ensemble algorithm for prediction of major perioperative complications and 30-day readmission after anterior cervical fusion. This model has excellent discrimination and is well calibrated when tested on a contemporaneous external cohort of ACDF cases.
Prospective Randomized Control Trial to Compare the Role of Injection Cerebrolysin for 10 Days Duration Against Placebo in Operated Cases of Degenerative Cervical Myelopathy
Authors: Sharma Ayush , Agrawal Harsh , Naseem Atif , Marathe Nandan , Gajbhiye Komalchand , Subramanian Santhoshkumar , Rocos Brett
Published: February 2023

Study Design.

Prospective randomized control trial.

Objective.

To analyze outcomes following the injection of cerebrolysin in surgically treated patients with degenerative cervical myelopathy (DCM).

Summary of Background Data.

Previous research has concluded that superior functional outcomes are achieved with the use of cerebrolysin in surgically treated patients of DCM for 21 days. Our study has been conducted to analyze the use of this drug for a shorter duration (10 days) and compare its clinical efficacy.

Methods.

Ninety operated cases of mild to severe DCM were randomized into two groups. Sixty patients received the injection Cerebrolysin for 10 days postoperatively. The remaining 30 patients received a placebo. Functional outcomes were measured using modified Japanese Orthopaedic Association (mJOA) scores and visual analogue scale (VAS). The American Spinal Injury Association (ASIA) scale was used to document neurological recovery. Hand function was assessed by measuring the grip strength and the upper limb function score the upper extremity motor mJOA plus upper extremity sensory mJOA score. Assessments were performed and preoperatively and postoperatively and at one-month, three-month, six-month, and one-year following surgery.

Results.

Preoperative mJOA and VAS scores were comparable in both groups (P>0.05). Both groups experienced an improvement in mJOA and VAS scores at all time-points during follow-up as compared with preoperative scores. However, the cerebrolysin group demonstrated significantly greater mJOA scores (16.37±1) when compared with the placebo (15.2±1.8) at one-year follow-up (P<0.0001). Neurological improvement with cerebrolysin therapy was also superior (P=0.04). No significant adverse reactions were documented.

Conclusion.

Injection cerebrolysin, when administered for 10 days postoperatively, can result in significantly greater neurological improvement and hand function in patients with DCM who also receive surgery.
Evaluating Changes to the Modified K-Line Using Kinematic MRIs
Authors: Bajouri Zabiullah , Telang Sagar , Fresquez Zoe , Kim Michael , Gilbert Zachary , Pickering Trevor , Buser Zorica , Hah Raymond J. , Wang Jeffrey C. , Alluri Ram Kiran
Published: February 2023

Study Design.

Retrospective cross-sectional review of a large database

Objective.

Little is known regarding extension K-lines for treatment of cervical myelopathy. Therefore, this study seeks to examine differences between K-lines drawn in neutral and extension.

Summary of Background Data.

The modified K-line is a radiological tool used in surgical planning of the cervical spine. As posterior cervical decompression and fusion often results in patients being fused in a more lordotic position than the preoperative neutral radiograph, a K-line measured in the extension position may offer better utility for these patients.

Materials and Methods.

Total of 97 patients were selected with T2-weighted, upright cervical magnetic resonance imaging taken in neutral and extension. For each patient, the K-line was drawn at the mid-sagittal position for both neutral and extension. The distance from the most posterior portion of each disk (between C2 and C7) to the K-line was measured in neutral and extension and the difference was calculated. Paired t test was used to assess significant differences.

Results.

Across all levels between C2 and C7 there was an increase in the distance between the dorsal aspect of the disk and K-line when comparing neutral and extension radiographs. The average change in difference (extension minus neutral) at each cervical spinal level was 0.9 mm (C2–C3), 2.5 mm (C3–C4), 2.6 mm (C4–C5), 2.0 mm (C5–C6), and 0.9 mm (C6–C7). A paired t test showed that the K-line increase from neutral to extension was statistically significant across all disk levels (P<0.001).

Conclusion.

When positioned in extension, patients experience a significant increase in distance from the dorsal aspect of a disk to the K-line compared to when positioned in neutral, especially between C3 and C6. This is clinically relevant for surgeons considering a posterior cervical decompression and fusion in patients with a negative modified K-line on preoperative magnetic resonance imaging, as these patients may have enough cervical cord drift back when fused in an extended position, maximizing likelihood of improving postoperative DSM functional outcomes.
The Influence of Covid-19 on Utilization of Epidural Procedures in Managing Chronic Spinal Pain in the Medicare Population
Authors: Manchikanti Laxmaiah , Pampati Vidyasagar , Knezevic Nebojsa Nick , Kaye Alan D. , Abdi Salahadin , Sanapati Mahendra R. , Abd-Elsayed Alaa , Kosanovic Radomir , Soin Amol , Beall Douglas P. , Shah Shalini , Hirsch Joshua A.
Published: February 2023

Study Design.

A retrospective cohort study of utilization patterns and variables of epidural injections in the fee-for-service (FFS) Medicare population.

Objectives.

To update the utilization of epidural injections in managing chronic pain in the FFS Medicare population, from 2000 to 2020, and assess the impact of COVID-19.

Summary of Background Data.

The analysis of the utilization of interventional techniques also showed an annual decrease of 2.5% per 100,000 FFS Medicare enrollees from 2009 to 2018 contrasting to an annual increase of 7.3% from 2000 to 2009. The impact of the COVID-19 pandemic has not been assessed.

Methods.

This analysis was performed by utilizing master data from the Centers for Medicare and Medicaid Services (CMS), physician/supplier procedure summary from 2000 to 2020. The analysis was performed by the assessment of utilization patterns using guidance from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Results.

Epidural procedures declined at a rate of 19% per 100,000 Medicare enrollees in the FFS Medicare population in the United States from 2019 to 2020, with an annual decline of 3% from 2010 to 2019. From 2000 to 2010, there was an annual increase of 8.3%. This analysis showed a decline in all categories of epidural procedures from 2019 to 2020. The major impact of COVID-19 with closures taking effect from April 1, 2020, through December 31, 2020, will be steeper and rather dramatic, comparing to April 1 to December 31, 2019. However, monthly data from CMS is not available as of now. Overall declines from 2010 to 2019 showed a decrease for cervical and thoracic transforaminal injections with an annual decrease of 5.6%, followed by lumbar interlaminar and caudal epidural injections of 4.9%, followed by 1.8% for lumbar/sacral transforaminal epidurals, and 0.9% for cervical and thoracic interlaminar epidurals.

Conclusion.

Declining utilization of epidural injections in all categories was exacerbated to a decrease of 19% from 2019 to 2020 related, in part, to the COVID-19 pandemic. This followed declining patterns of epidural procedures of 3% overall annually from 2010 to 2019.

Level of Evidence:

4.
Development of Auer bodies from giant inclusions associated with rough endoplasmic reticulum in acute promyelocytic leukemia
Authors: Ru Yong-Xin , Dong Shu-Xu , Liu Jing , Eyden Brian
Published: February 2023

Giant inclusions and Auer bodies in promyeloblasts were investigated in a study which included transmission electron microscopy (TEM) for morphology and ultrastructural cytochemistry for myeloperoxidase in 10 patients with acute promyelocytic leukemia (APL). Ultrastructural cytochemistry demonstrated positive myeloperoxidase reactivity in giant inclusions, expanded rER cisternae, Auer bodies and primary granules. TEM revealed that giant inclusions were adorned by degenerated rER membrane, some of them sharing features with Auer bodies. We hypothesize a novel origin for Auer body development in promyeloblasts of APL, namely that they originate from peroxidase-positive and expanded rER cisternae, and that primary granules were directly released from these expanded rER elements, bypassing the Golgi apparatus.
PD-L1: expression regulation
Authors: Zhou Yu-Jie , Li Guoli , Wang Jiyin , Liu Mengyuan , Wang Zihan , Song Yu , Zhang Xulong , Wang Xi
Published: February 2023

Programmed death-ligand 1 (PD-L1), expressed on the surface of tumor cells, can bind to programmed cell death-1 (PD-1) on T cells. The interaction of PD-1 and PD-L1 can inhibit T-cell responses by decreasing T-cell activity and accelerating their apoptosis. Various cancers express high levels of PD-L1 and exploit PD-L1/PD-1 signaling to evade T-cell immunity, and immunotherapies targeting the PD-1/PD-L1 axis have been shown to exert remarkable anti-tumor effects; however, not all tumor patients benefit from these therapies. Therefore, study of the mechanisms regulating PD-L1 expression are imperative. In this review, we explore regulation of PD-L1 expression in the contexts of gene transcription, signaling pathways, histone modification and remodeling, microRNAs, long noncoding RNAs, and post-translational modification. Current developments in studies of agents that block PD-L1 and correlations between immunotherapies targeting PD-1/PD-L1 and PD-L1 expression are also summarized. Our review will assist in understanding of PD-L1 expression regulation and discusses the implications of reported findings in cancer diagnosis and immunotherapy.
Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis
Authors: McHenry Ryan D. , Moultrie Christopher E. J. , Quasim Tara , Mackay Daniel F. , Pell Jill P.
Published: February 2023

Objectives:

Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on outcomes in critical care has produced inconsistent findings. Our objective was to synthesize the available evidence on the association between socioeconomic status and outcomes in critical care.

Data Sources:

A systematic search of CINAHL, Ovid MEDLINE, and EMBASE was undertaken on September 13, 2022.

Study Selection:

Observational cohort studies of adults assessing the association between socioeconomic status and critical care outcomes including mortality, length of stay, and functional outcomes were included. Two independent reviewers assessed titles, abstracts, and full texts against eligibility and quality criteria.

Data Extraction:

Details of study methodology, population, exposure measures, and outcomes were extracted.

Data Synthesis:

Thirty-eight studies met eligibility criteria for systematic review. Twenty-three studies reporting mortality to less than or equal to 30 days following critical care admission, and eight reporting length of stay, were included in meta-analysis. Random-effects pooled analysis showed that lower socioeconomic status was associated with higher mortality at less than or equal to 30 days following critical care admission, with pooled odds ratio of 1.13 (95% CIs, 1.05–1.22). Meta-analysis of ICU length of stay demonstrated no significant difference between socioeconomic groups. Socioeconomic status may also be associated with functional status and discharge destination following ICU admission.

Conclusions:

Lower socioeconomic status was associated with higher mortality following admission to critical care.
Evaluation of an Academic Detailing Program to Improve Blood Pressure Measurement and Hypertension Treatment in Urban Community Health Centers
Authors: Holliday Michael , Burnett Alexandra , Leavitt Molly , Knapke Jackie , Hargraves Daniel , Pallerla Harini
Published: February 2023

Introduction:

Hypertension is estimated at a prevalence of 30 to 50% in the United States. Only 54% of patients with hypertension have their condition adequately controlled. This study aimed to use academic detailing (AD) to improve practice team knowledge and confidence in blood pressure (BP) management, specifically in low-income, underresourced patient populations.

Methods:

AD was developed for five practices that care for high percentages of Medicaid-eligible patients. A needs assessment was administered to each site's practice champion to determine high-yield AD sessions for their team. Presession and postsession evaluations were completed by practice team members.

Results:

Fifty providers and eight staff member participants completed evaluations over nine sessions for two AD topics at four practice sites. Statistical significance was found for several items within sessions including accurately choosing cuff sizes and identifying barriers to home BP monitoring.

Discussion:

AD is a potentially financially efficient model to improve knowledge and confidence in hypertension care at the practice level. Tailoring session content to specific needs of a practice site, along with an identified practice champion, facilitated implementation of the program. This replicable model is one way to deliver evidence-based information to those who serve Medicaid-eligible patients.
Development and Contribution of a Serious Game to Improve Nursing Students' Clinical Reasoning in Acute Heart Failure: A Multimethod Study
Authors: Maheu-Cadotte Marc-André , Dubé Véronique , Lavoie Patrick
Published: February 2023

Clinical reasoning is essential for nurses and nursing students to recognize and intervene when hospitalized patients present acute heart failure. Serious games are digital educational interventions that could foster the development of clinical reasoning through an engaging and intrinsically motivating learning experience. However, elements from a playful approach (eg, rewards, narrative elements) are often absent or poorly integrated in existing serious games, which may limit their contribution to learning. Thus, we developed and studied the contribution of a novel serious game on nursing students' engagement, intrinsic motivation, and clinical reasoning in the context of acute heart failure. We adopted a multimethod design and randomized 28 participants to receive two serious game prototypes in a different sequence, one that fully integrated elements of a playful approach (SIGN@L-A) and one that offered only objectives, feedback, and a functional aesthetic (SIGN@L-B). Through self-reported questionnaires, participants reported higher levels of engagement and intrinsic motivation after using SIGN@L-A. However, negligible differences in clinical reasoning scores were found after using each serious game prototype. During interviews, participants reported on the contribution of design elements to their learning. Quantitative findings should be replicated in larger samples. Qualitative findings may guide the development of future serious games.
Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19
Authors: Schorn Mavis N. , Myers Carole R. , Barroso Julie , Hande Karen , Hudson Tamika , Kim Jennifer , Kleinpell Ruth
Published: February 2023

The sudden, expanded need for telehealth during the COVID-19 pandemic added to the challenges advanced practice RNs face in the United States. The purposes of this article are to summarize advanced practice RNs' responses about the use of telehealth before and during the pandemic and to analyze free-text comments about how the use of telehealth changed during the pandemic. A 20-item survey was distributed using convenience sampling to advanced practice RNs from June 1 to September 23, 2020. Analyses of descriptive and open text responses related to telehealth were conducted. Most of the respondents did not use telehealth prior to the pandemic (n = 5441 [73%]), but during the pandemic, half used telehealth at least daily (n = 3682 [49%]). The most common barriers related to telehealth were about the difficulty some populations had in accessing the necessary technology. The most common favorable comments cited by respondents were related to some patients' improved access to care. Telehealth use is unlikely to return to prepandemic levels. As a result, considerations of telehealth-related recommendations provided for advanced practice RN education, policy, and practice are encouraged for the purpose of increasing healthcare access.
Use of Text Messaging to Help Family Caregivers
Authors: Wang Chen , Foronda Cynthia
Published: February 2023

Text messaging is a promising family-centered intervention to promote health and prevent illness among children. Little is known about the effectiveness of texting parents of children with chronic conditions on health outcomes. The aims of this integrative review were to determine what ways texting has been used as an intervention to help family caregivers and examine the outcomes from the use of texting to help family caregivers. Applying Whittemore and Knafl's method of integrative review, 16 studies were reviewed. The majority of studies suggested that text message–based health interventions were feasible and acceptable for parents of children with chronic conditions. Of the studies that examined effectiveness of the interventions, six studies noted effectiveness, four studies noted results signifying no differences, and two studies obtained insignificant results. Although the state of the science regarding health providers' use of text messaging to support parents of children with chronic illness is in its early stage, text messaging demonstrates potential to assist parents to better manage their child's chronic disease. More research is warranted in the future to determine the effectiveness as well as best practices in text messaging.
Clinical Perspectives on the Development of a Gamified Heart Failure Patient Education Web Site
Authors: Lukey Alexandra , Mackay Martha , Hasan Khalad , Rush Kathy L.
Published: February 2023

Heart failure is a complex, chronic disease that requires self-care to manage, and patients need support and education to perform adequate self-care. Although electronic health interventions to support behavior change and self-care in cardiovascular disease are gaining traction, there is little engaging online education specifically designed for heart failure patients. This paper describes the design and development of a heart failure self-care patient education Web site that integrated gamification, meaning the use of game design elements in a non-game context. We sought feedback on the Web site from a group of heart failure clinicians in a focus group using a semi-structured interview guide, and data were analyzed thematically. Clinician input during the design phase touched on themes such as patients' decision-making in heart failure and older adults' adoption of technology. Clinicians recommended that a narrative gamification technique should reflect real-life dilemmas patients encounter in their self-care. Clinicians also discussed the need to carefully plan reward-based gamification techniques to avoid unintended effects. Overall, a gamified Web site has the potential to support heart failure self-care, but efforts are needed to address the disparity of those with limited computer literacy or access.
Effectiveness of Screen-Based Simulation as a Strategy to Improve Nurse Practitioner Students' Access to Electronic Health Records in Clinical Education
Authors: Whitt Karen J. , Pericak Arlene , Allen Cynthia L. , Knestrick Joyce , Beebe Sarah L. , Braungart Carol , McNelis Angela M.
Published: February 2023

Learning to use electronic health records is essential for family nurse practitioner students to inform practice and clinical decision-making. Limited access to electronic health records during clinical training can lead to suboptimal use. Academic programs often rely on healthcare organizations to provide opportunities for students to learn electronic health record skills. However, clinical experiences are highly individualized, and students may not have access to electronic health records. Alternatives are needed to develop this critical competency. This study compared self-reported ratings regarding comfort and access to electronic health record documentation between students who participated in screen-based simulation and students who completed traditional clinical experiences with a preceptor during the last 70 hours of clinical training in one family nurse practitioner program. There was a significant difference in electronic health record access between students who participated in simulated versus traditional clinical experiences (P= .002). There were no significant differences in ratings of comfort using electronic health records between groups. Both groups reported limited access to electronic health records in the first 500 hours of clinical experience. However, students who participated in screen-based simulation reported a quarter-fold increase in electronic health record access during their last 70 hours of clinical training.
Barriers to Increasing Prescription Drug Monitoring Program Use
Authors: St. Marie Barbara J. , Witry Matthew J. , Reist Jeffrey C.
Published: February 2023

Prescription drug monitoring programs are implemented through individual state policies and are one solution to curb the opioid crisis. The objectives of this study are to: (1) describe the multidisciplinary experiences using this program in practice; (2) identify limitations of the program and the desired features for improvement; and (3) characterize expectations for improved access when prescription drug monitoring programs are embedded in the electronic health record. A qualitative descriptive study design used semistructured interviews of 15 multidisciplinary healthcare providers. Textual data were analyzed using content analysis. Results showed the prescription drug monitoring program was helpful to decision-making processes related to opioid prescribing and referral to treatment; there were barriers limiting healthcare providers' use of the prescription drug monitoring program; preferences were delineated for integrating prescription drug monitoring program into electronic health record; and recommendations were provided to improve the program and increase use. In conclusion, the prescription drug monitoring program was viewed as useful in making strides to reduce the impact of inappropriate opioid prescribing in our country. By engaging a multidisciplinary group of healthcare providers, solutions were offered to improve the interface and function of the prescription drug monitoring program to assist in increasing use.
An open-label evaluation of safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide for post-exposure prophylaxis following potential exposure to human immunodeficiency virus-1
Authors: Liu An , Xin Ruolei , Zhang Hongwei , Dai Lili , Wu Ruojun (Esther) , Wang Xi , Li Aixin , Hua Wei , Li Jianwei , Shao Ying , Gao Yue , Wang Zhangli , Ye Jiangzhu , bu dou re xi ti Gulimila A , Li Zaicun , Sun Lijun
Published: January 2023

Background:

Single-tablet regimen (STR) provides a convenient once-daily regimen for the prevention of human immunodeficiency virus (HIV) infection. Here, we investigated the safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a three-drug, STR for post-exposure prophylaxis (PEP) in Chinese individuals.

Methods:

This was a prospective, open-label, single-arm trial conducted in a sexually transmitted diseases and acquired immunodeficiency syndrome clinic of a tertiary hospital in Beijing, China. Adults requiring PEP were prescribed BIC/FTC/TAF one pill once a day for 28 days. Clinical and laboratory data were collected and analyzed at baseline, weeks 2, 4, 8, 12, and 24.

Results:

Of 112 participants enrolled in the study, 109 (97.3%) were male and the mean age was 30 ± 8 years. PEP completion was 96.4% (95% confidence interval: 91.1–99.0). Two participants stopped PEP after 2 days because the source partner was identified as HIV uninfected. One participant was excluded due to hepatitis B virus infection according to the exclusion criteria. One discontinued due to the participant's decision. No participant acquired HIV through week 24. Adherence was 98.9% (standard deviation [SD]: 3.3) by self-reporting and 98.5% (SD: 3.5) by pill count. Only five participants experienced mild clinical adverse events attributed to the study drug (including headache, diarrhea, and nausea) and four participants had elevated serum creatinine (grade 1).

Conclusions:

A once daily, STR of BIC/FTC/TAF used as PEP was safe and well-tolerated with a high rate of completion and adherence in Chinese. BIC/FTC/TAF may be a good option for PEP.

Trial Registration:

ChiCTR.org.cn, ChiCTR2100048080
Adalimumab Biosimilar–Induced Autoimmunity-Related Sweet-Like Neutrophilic Dermatosis
Authors: Lobato-Berezo Alejandro , Pujol Ramon M. , Fernández-Figueras María Teresa
Published: February 2023

Antitumor necrosis factor therapies have shown to produce a broad range of cutaneous eruptions. We report the case of a patient under adalimumab biosimilar treatment for a punctate inner choroidopathy who developed a cutaneous eruption on sun-exposed areas that showed a diffuse dermal neutrophilic infiltrate consistent with a Sweet-like neutrophilic dermatosis and some features of autoimmunity.
Challenging Case: Leveraging Community Partnerships to Address Barriers to Care for Students with Autism
Authors: Cerda Natalie , Brinster Meredith , Turner Caroline , Shahidullah Jeffrey D. , Augustyn Marilyn
Published: January 2023

CASE:

Sam is an 11-year-old young boy with autism spectrum disorder (ASD), unspecified anxiety disorder, and attention-deficit/hyperactivity disorder, combined presentation. He was initially diagnosed with ASD at 6 years of age after evaluation by a developmental-behavioral (DB) pediatrician. He presents to the DB pediatrics clinic to reestablish care. He established care with psychiatry 5 months ago after his school referred him to a hospital-school-community telepartnership bridge program following statements of self-harm and numerous concerns with his behavior, including elopement.

Sam currently receives special education support under the classifications of “Emotional Disturbance” and “Speech Impairment.” His parents report significant challenges with having his medical diagnosis of autism recognized by the school, which has impeded him receiving educational support as a student with autism. This has resulted in Sam being penalized for challenging behaviors related to his neurodevelopmental disorder. He is not currently making meaningful progress in the school setting. Sam currently demonstrates avoidance, physical and verbal aggression, and difficulty adapting to change across settings. In addition to difficulties advocating for more individualized support at school, Sam has never received applied behavior analysis (ABA) therapy because of challenges obtaining insurance approval. There are no additional barriers to accessing care, such as language, geographic, or socioeconomic factors.

Sam's visit to reestablish care with DB pediatrics consisted of an individual clinician evaluation model. The Childhood Autism Rating Scale, Second Edition, (CARS-2) and Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), were administered, and Sam continued to meet DSM-5 criteria for ASD following re-evaluation. A new referral for ABA therapy was submitted. Shortly afterward, his family received an insurance denial letter specifying that additional developmental testing was needed before ABA therapy would be approved. His clinician called the insurance company to appeal this decision but was unsuccessful. Sam was then seen by the DB pediatrics embedded psychologist, who completed additional testing, including assessment of cognitive functioning, administration of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and autism-specific rating scales. This process led to further delays in access to ABA services. Throughout this process, the parents reported feeling helpless and frustrated given the barriers faced in receiving appropriate services. What are your next steps to advocate for supports through the school and insurance company?
Controversial preservation of eye drops: the toxicity of benzalkonium chloride
Authors: Hedengran Anne , Kolko Miriam
Published: January 2023

Eye drops are a major cornerstone in the treatment of ophthalmic diseases, and adherence is crucial. Most eye drops are preserved with the surfactant benzalkonium chloride (BAK). Great controversy revolves around the use of BAK, as BAK has continuously been proven to be cytotoxic. In cell cultures, BAK-preserved eye drops cause increased cell death, and in patients, preservation with BAK causes more side effects and ocular surface damage. Side effects can negatively affect adherence and, with this, disease control. This is namely a problem in glaucoma patients. Glaucoma is irreversible, and a lack of disease control may lead to incurable blindness. The purposes of treating ophthalmic diseases are to secure good visual acuity, ocular comfort, and good quality of life for the patients. When administering, BAK-preserved eye drops ocular damage may be inflicted and these purposes are put at risk. Preservative-free and alternatively preserved eye drops are available, why there is no need for the use of BAK.
Implementation of pharmacogenomics into inpatient general medicine
Authors: Chen Thomas , O’Donnell Peter H. , Middlestadt Merisa , Ruhnke Gregory W. , Danahey Keith , van Wijk Xander M.R. , Choksi Anish , Knoebel Randall , Hartman Seth , Yeo Kiang-Teck Jerry , Friedman Paula N. , Ratain Mark J. , Nutescu Edith A. , O’Leary Kevin J. , Perera Minoli A. , Meltzer David O.
Published: February 2023

Pharmacogenomics is a crucial piece of personalized medicine. Preemptive pharmacogenomic testing is only used sparsely in the inpatient setting and there are few models to date for fostering the adoption of pharmacogenomic treatment in the inpatient setting. We created a multi-institutional project in Chicago to enable the translation of pharmacogenomics into inpatient practice. We are reporting our implementation process and barriers we encountered with solutions. This study, ‘Implementation of Point-of-Care Pharmacogenomic Decision Support Accounting for Minority Disparities’, sought to implement pharmacogenomics into inpatient practice at three sites: The University of Chicago, Northwestern Memorial Hospital, and the University of Illinois at Chicago. This study involved enrolling African American adult patients for preemptive genotyping across a panel of actionable germline variants predicting drug response or toxicity risk. We report our approach to implementation and the barriers we encountered engaging hospitalists and general medical providers in the inpatient pharmacogenomic intervention. Our strategies included: a streamlined delivery system for pharmacogenomic information, attendance at hospital medicine section meetings, use of physician and pharmacist champions, focus on hospitalists’ care and optimizing system function to fit their workflow, hand-offs, and dealing with hospitalists turnover. Our work provides insights into strategies for the initial engagement of inpatient general medicine providers that we hope will benefit other institutions seeking to implement pharmacogenomics in the inpatient setting.