bluuebunny/crossref_metadata_2025 huggingface dataset:
P689 Multicenter, cross-sectional, observational study on Epstein–Barr viral infection status and thiopurine use by age group in patients with inflammatory bowel disease in Japan
Authors: Miura M , Shimizu H , Saito D , Miyoshi J , Matsuura M , Kudo T , Hirayama D , Yoshida M , Arai K , Iwama I , Nakase H , Shimizu T , Hisamatsu T
Published: January 2022

Background

The Epstein–Barr virus (EBV) infection status in patients with inflammatory bowel disease (IBD), particularly those using thiopurines, may be associated with the risk of lymphoproliferative disorder and hemophagocytic lymphohistiocytosis. This was the first multicenter survey of EBV infection in Japanese patients with IBD (UMIN000033004). Factors related to the EBV infection status were also investigated.

Methods

This cross-sectional observational study of the EBV infection status in pediatric and adult patients with IBD was conducted at five tertiary institutions in Japan. Serum EBV anti-viral capsid antigen (VCA) IgG, and EBV anti-VCA IgM were measured in 495 patients with IBD□(UC:313 patients, CD:174 patients, IBD-U:8 patients). Patient characteristics (sex, age at diagnosis, age at onset, duration of illness, and disease location), treatments, and blood examination results were obtained from the medical records at each institution. Prior EBV infection was defined as anti-VCA IgM negativity and anti-VCA IgG positivity.

Results

mong the 495 patients, 56.2% (278/495) were male, and the median age at diagnosis of IBD was 18 years. The median age at the time of the anti-VCA IgG examination was 25 years(range: 0–92 years). Of the 495 patients, 9 were anti-VCA IgM-positive and 354 were anti-VCA IgG-positive (seroprevalence: 72.8%). The proportion of patients with prior EBV infection was 0% for those aged <5 years, <60% for those aged <30 years, and >90% for those aged >30 years. The patients’ current thiopurine use was 37.8% (187/486) for all anti-VCA IgM negative patients and 42.3% (85/201) for anti-VCA IgM negative patients aged <20 years. The proportion of EBV-uninfected patients using thiopurines was 28.4% (52/183) for all patients and 51.8% (44/85) for aged <20 years. Age was significantly associated with anti-VCA IgG seropositivity (p < 0.01, odds ratio: 0.902, 95% confidence interval: 0.880–0.925). No cases of lymphoproliferative disorder, hemophagocytic lymphohistiocytosis, or chronic active EBV infection were reported.

Conclusion

Approximately 30% of Japanese patients with IBD were EBV-uninfected, including those using thiopurines. Age was a significant factor for anti-VCA IgG seropositivity.
P690 Rates of IBD in New Zealand Māori population at Lakes District Health Board: low but increasing
Authors: Qiu M , Patel R N , Gearry R B
Published: January 2022

Background

Inflammatory bowel disease (IBD) is a chronic, inflammatory disease that is increasingly prevalent in New Zealand (NZ). Previous regional studies describe significantly lower rates of IBD in Māori (the indigenous people of NZ) compared to non-Māori. We aimed to describe IBD incidence and prevalence at Lakes District Health Board (DHB), with a focus on the Māori population.

Methods

All patients with IBD at Lakes DHB are managed using an IBD database. The database was reviewed and demographic, clinical, IBD phenotype, treatment and surgical data were extracted. Rates of IBD and other characteristics were compared between Māori and non-Māori.

Results

197 IBD patients were identified, consisting of 100 (51%) with Crohn’s disease, 77 (39%) with ulcerative colitis, and 20 with IBD-unspecified. The median age was 48±17 and 100 (50.8%) were males. 15 (7.6%) patients were Māori and 182 (92.4%) European/other (Figure 1), leading to IBD ethnic-specific prevalences of 34.9 and 256.8/100,000, respectively. Rates of current/ex-smoking were similar in Māori and non-Māori (~30%), so was biologic use (40%). Despite statistically insignificant, Māori were more likely to be hospitalised over the last ten years (mean admissions 1.8 vs 1.1). In the last 20 years, there has been a steady increase in IBD incidence among non-Maori population. In Māori population, although the rates were consistently lower, more were diagnosed over the last 5 years, demonstrating an increasing incidence (Figure 2).

Figure 1. Lakes DHB demographics and IBD status

Figure 2. Comparison of IBD incidence in Māori and non-Māori at Lakes DHB

Conclusion

Our findings are concordant with previous studies showing gradually increased rates of IBD in NZ and low rates in Māori. However, rates in the last five years are increasing in Māori population which may reflect a true increase in incidence due to changes in environmental risk factor exposure or increased rates of presentation and diagnosis in Māori over the last five years.
P705 The effects of commonly consumed dietary fibres on the gut microbiome and its fibre fermentative capacity in adults with inflammatory bowel disease in remission
Authors: Gerasimidis K , Nichols B , McGowan M , Svolos V , Papadopoulou R , Kokkorou M , Rebull M , Bello Gonzalez T , Hansen R , Russell R K , Gaya D R
Published: January 2022

Background

It has been suggested that the gut microbiome of patients with inflammatory bowel disease (IBD) is unable to ferment dietary fibre. This project explored the in vitro effect of fibre fermentation on production of short chain fatty acids (SCFA) and on microbiome composition.

Methods

Faecal samples were collected from 40 adults (>16 y) with IBD (n=20 with Crohn’s disease and n=20 with Ulcerative colitis) in clinical remission and 20 healthy controls (HC). In vitro batch culture fermentations were carried out using as substrates maize starch, apple pectin, raftilose, wheat bran, α cellulose and a mixture of these 5 fibres. SCFA concentration (umol/g) was quantified with gas chromatography and microbiome was profiled with 16S rRNA sequencing.

Results

Fibre fermentation did not correct the baseline microbial dysbiosis or lower diversity seen in either CD or UC. For all fibres, up to 51% of baseline ASVs or genera changed in abundance in HC. In patients with IBD, fermentation of fibre substrates had no effect on species or genera abundance. Production of SCFA varied among the different fibre substrates but this was not different between the two IBD groups and compared to HC after either 5 or 24 hour fermentation.

Conclusion

Despite extensive microbial dysbiosis, patients with IBD have a similar capacity to ferment fibre and release SCFA as HC. Fibre supplementation alone may be unlikely to restore to a healthy status the compositional shifts characteristic of the IBD microbiome.
N03 Medication adherence in relation to Health-related Quality of Life in patients with Inflammatory Bowel Disease – A cross-sectional study
Authors: Johansson E , Lovén Wickman U
Published: January 2022

Background

Inflammatory Bowel Diseases are chronic diseases often with complex treatment. The treatment is lifelong and complex and may include several different pharmaceutical groups and sometimes surgery. Not rarely is treatment resistance developed and the treatment may come with different degrees of side effects. Earlier research has shown insufficient to medication adherence and a lower degree of health-related quality of life in patients with inflammatory bowel disease.

The aim is to describe the relationship between medication adherence and health-related quality of life in a Swedish population diagnosed with inflammatory bowel disease. Additional research questions are if any risk factors of low medication adherence can be identified from the collected variables.

Methods

This cross-sectional study included N=206 patients from three different regions in Sweden. The questionnaires MMAS-8 and Short Health Scale were used combined with a questionnaire regarding patient characteristics. The data and patient characteristics were described and analyzed using descriptive statistics.

Ethical approval has been received from the Regional Ethical Review Board, Linköping, Sweden (no.: 2015/369-31).

Results

The majority of patients had Ulcerative Colitis (62.6%) There were no significant differences between the different groups of Inflammatory Bowel Disease regarding patient characteristics apart from having gone through surgical procedures, which were more common in patients with Crohn’s disease. A small correlation was shown between medication adherence and the health-related quality of life dimension social function (rho = -0.146; p <0.05). Medication adherence showed no significant correlations to the remaining health-related quality of life dimensions: disease related worry, symptom burden and sense of general well-being. Possible risk factors identified for low medication adherence were age between 30 and 50, working at high occupational level, and higher educational level.

Conclusion

The complexity of measuring medication adherence has been established, making it difficult to make any certain conclusions regarding the hypothesis in this report. This study showed no clear association between medication adherence and health-related quality of life in patients with inflammatory bowel disease. However, it visualized the need of optimizing the instruments used to measure medication adherence in individuals with a non-conventional treatment plan
The Law’s Business: Peculiar Profits in Edward Jones’sThe Known World
Authors: Yukins Elizabeth
Published: January 2022

This essay examines Edward Jones’s radical historiography in The Known World (2003), specifically how he represents law as a mercurial, illogical, and generative force in the workings of American slavery. Centrally, Jones highlights the viability and profitability of the American nineteenth-century legal system’s absurdities. The essay extends current scholarship to reckon with a central tension in Jones’s novel: his linking of the quotidian with the bizarre. Jones’s understated realism is, paradoxically, rife with freakish phenomenon, from two-headed chickens to cannibalistic lawmen, and his juxtaposition of the commonplace and the freakish compels readers to recognize the absurd and potent powers of American slave law. Beginning with Jones’s anachronistic reference to a historian and a local story of two-headed chickens, the essay shows how conjoined entities and other anomalous phenomenon in Jones’s novel enable three key historiographic interventions. First, the symbol of conjoined entities connects with the dual and dysfunctional status of slaves before the law—namely, a slave’s legal identity as coexistent person and property. Second, “two-headedness” serves as means to interrogate the mental acrobatics necessitated by antebellum law. Specifically, Jones creates an intensely ambivalent officer of the law—a sheriff of two minds, I argue—to explore the psychological exertions needed to administer a nonsensical legal paradigm. Finally, and most importantly, Jones’s metaphors of conjoined entities illuminate the interconnected, interdependent workings of law and economics in fictional Manchester County, Virginia. Two-headed chickens link with a far more profitable conjoining in American history—namely, what Jones calls “the law’s business” in slavery.
Biochemical characterization and analysis of gene expression of an α-mannosidase secreted by Paracoccidioides brasiliensis
Authors: Corrêa Priscila C , Fernandes Fabrício F , Costa Marcelo V , Landgraf Taise N , Panunto-Castelo Ademilson
Published: January 2022

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by fungi of the Paracoccidioides genus, being endemic in Latin America and with the highest number of cases in Brazil. Paracoccidioides spp. release a wide range of molecules, such as enzymes, which may be important for PCM establishment. Here, we identified the 85- and 90-kDa proteins from the supernatants of P. brasiliensis cultures as being an α-mannosidase. Because the expected mass of this α-mannosidase is 124.2-kDa, we suggest that the proteins were cleavage products. Indeed, we found an α-mannosidase activity in the culture supernatants among the excreted/secreted antigens (ESAg). Moreover, we determined that the enzyme activity was optimal in buffer at pH 5.6, at the temperature of 45ºC, and with a concentration of 3 mM of the substrate p-NP-α-D-Man. Remarkably, we showed that the gene expression of this α-mannosidase was higher in yeasts than hyphae in three P. brasiliensis isolates with different virulence degrees that were grown in Ham's F12 synthetic medium for 15 days. But in complex media YPD and Fava Netto, the significantly higher gene expression in yeasts than in hyphae was seen only for the virulent isolate Pb18, but not for intermediate virulence Pb339 and low virulence Pb265 isolates. These results about the high expression of the α-mannosidase gene in the pathogenic yeast form of P. brasiliensis open perspectives for studying this α-mannosidase concerning the virulence of P. brasiliensis isolates.

Lay summary

Paracoccidioides brasiliensis causes deep mycosis, paracoccidioidomycosis. We determined for the first time the biochemical properties of an α-mannosidase released by this fungus. We suggest that the enzyme gene expression in the fungus is associated with fungal morphology, stress, and virulence.
Quantitative Analysis of Growth Factors From Cancellous Bone Graft Collected With a Reamer-Irrigator-Aspirator System From Native Long Bones Versus Previously Reamed Long Bones
Authors: Cereijo Cesar , Johnson Samuel R. , Schoenecker Jonathan G. , Collinge Cory A. , Obremskey William T. , Moore-Lotridge Stephanie N.
Published: January 2022

Objective:

Collection of bone graft with the Reamer-Irrigator-Aspirator (RIA) system has become common practice across the field of orthopaedic surgery. While RIA bone graft is typically obtained from native long bones, grafting material can likewise be harvested from long bones that have previously undergone the placement and removal of an intramedullary nail, a process termed re-reamed RIA (RRR). The purpose of this study was to evaluate the total protein and growth factor concentrations present in native-RIA (NR) compared with RRR samples.

Methods:

NR and RRR bone grafts were collected intraoperatively with the RIA system and processed to evaluate both the aqueous and the hard tissue components. Total protein concentration and specific growth factors were analyzed using standard bicinchoninic acid and multiplex assays, respectively. Analyte levels were then normalized to the total amount of protein detected.

Results:

Total protein levels were comparable between NR and RRR samples for both the aqueous filtrate and the hard tissue samples. When normalized, while levels of bone morphogenic protein-2 and vascular endothelial growth factor were comparable in the hard tissue component, the aqueous filtrate from the RRR sample was found to have elevated levels of growth factors, with bone morphogenic protein-2 reaching statistical significance.

Conclusions:

This study demonstrates that ample protein is found within both NR and RRR samples, with comparable or elevated levels of osteogenic growth factors found within RRR samples. Future, larger, prospective studies will be required to evaluate the osteogenic potential and clinical efficacy of NR and RRR cancellous bone grafts to validate their equivalency.
The impact of transcatheter edge-to-edge repair on mitral valve annular geometry
Authors: Eqbal Adam , Gupta Saurabh , Fam Neil , Ong Géraldine , Bisleri Gianluigi
Published: January 2022

Purpose of review

Mitral valve transcatheter edge-to-edge repair (TEER) is becoming increasingly common to treat severe mitral regurgitation. However, the lack of concomitant annuloplasty raises concerns regarding its durability. As a result, there is an emerging body of literature evaluating the impacts of TEER on mitral annular geometry. In this review, we summarize the most recent literature evaluating the impacts of TEER on annular geometry in the acute, intermediate and long-term. We also review the relationship between changes in annular geometry and clinical endpoints.

Recent findings

Current evidence suggests that TEER acutely induces favourable changes in mitral annular size and shape, which may persist for at least up to 1 year. Few studies suggest that TEER-induced annular remodelling is associated with positive clinical outcomes.

The current body of literature is sparse and limited to primarily small case series. Data from the surgical literature suggest that ringless edge-to-edge repair is associated with eventual failure. Unfortunately, few studies evaluate TEER-induced annular changes beyond the acute postprocedural phase. Future research needs to focus on and evaluate the significance of TEER-induced changes in annular dimensions in the long-term.
Valve-sparing aortic root replacement: a primer for cardiologists
Authors: Mazine Amine , Chu Michael W.A. , El-Hamamsy Ismail , Peterson Mark D.
Published: January 2022

Purpose of review

The purpose of this article is to review the contemporary evidence supporting valve-sparing aortic root replacement as the best option for patients with aortic root aneurysms and preservable aortic valves as well as to review the technical variations and modern adjuncts of these operations that impact both short and long-term durability.

Recent findings

In patients with an aortic root aneurysm, with or without aortic valve regurgitation, valve-sparing aortic root replacement provide excellent clinical outcomes and stable valve function over several decades. Successful execution of this operation depends on careful patient selection and a thorough understanding of the anatomical and physiological relationships between the various components of the aortic root. Echocardiography remains the mainstay of imaging to determine the feasibility of valve-sparing root replacement.

Valve-sparing aortic root replacement is an excellent alternative to composite valve graft replacement in nonelderly patients with aortic root aneurysms. Dedicated aortic root surgeons perform several technical variations of valve-sparing procedures aimed at matching the specific aortic root disorder with the optimal operation.
Volunteering Improves Employee Health and Organizational Outcomes Through Bonding With Coworkers and Enhanced Identification With Employers
Authors: Pfeffer Jeffrey , Singer Sara , Stepanek Martin
Published: January 2022

Objective:

To understand the consequences of employee volunteering and possible psychological mechanisms that produce these effects.

Methods:

Using data from more than 50,000 responses to Britain's Healthiest Workplace survey, we employed structural equation modeling to investigate the effects of people volunteering.

Results:

Net of a number of controls, people who volunteered reported better self-reported health, less risk of depression, and higher levels of engagement and satisfaction. These results were partly explained by volunteering creating higher levels of interpersonal social bonding and greater identification with their employers.

Conclusion:

Employers Employers should sponsor volunteer activities and provide workplace flexibility, because employees who volunteer have greater individual wellbeing and also higher levels of pro-employer outcomes such as engagement and job satisfaction.
Insights into Presbycusis From the First Temporal Bone Laboratory Within the United States
Authors: Andresen Nicholas S. , Winslow Marjorie Kehoe , Gregg Lydia , Seal Stella M. , Lehar Mohamed , Ward Bryan K. , Lauer Amanda M.
Published: January 2022

The Johns Hopkins Otologic Research Laboratory was founded in 1924 as the first human temporal bone laboratory within the United States. To better understand the contributions of the Johns Hopkins Otologic Research Laboratory to our understanding of presbycusis, we consulted with a medical librarian and archivist to search the Alan Mason Chesney Medical Archives, PubMed, JSTOR, and Johns Hopkins Bulletin for published and unpublished works from the lab. Between 1924 and 1938, Samuel J. Crowe, the Chairman of Otolaryngology, and anatomist Stacy R. Guild amassed a collection of ∼1,800 temporal bones. This collection allowed for an unprecedented period of discovery related to otologic disease. They combined hearing thresholds measured by the recently invented audiometer with new techniques for temporal bone decalcification, sectioning, and staining, and a method for the graphic reconstruction of the cochlea. Crowe and Guild used this unique opportunity to correlate otopathology with hearing and to make the first detailed descriptions of the otopathology of presbycusis. In 1931 and 1934, they observed spiral ganglion neuron and outer hair cell loss in the basal turn of the cochlea in individuals with high-frequency hearing loss. These were the first studies to reveal that stria vascularis degeneration and middle ear pathology were not the most common causes for high-frequency hearing loss. Aside from revealing the primary driving factors of presbycusis, this work provided insight into the tonotopic organization of the cochlea. After initially being recruited to help raise money for the laboratory, medical illustrator Max Brödel used the vertical histologic cross-sections of the cochlea to produce illustrations of the ear. The decision to produce histologic sections in the plane of the superior semicircular canal likely influenced Brödel's illustrations that share a similar orientation and would later become widely circulated. Significant contributions from the Otologic Research Laboratory were also made by Mary Hardy, D.Sc., a woman who has previously received little recognition for her work. The sectioning of temporal bones was stopped in 1938 due to World War II, but much of Crowe's and Guild's work continued into the 1940s until a rift between the two resulted in the temporary closure of the laboratory in 1949. Nearly 100 years after its founding, discoveries from the Johns Hopkins Otologic Research Laboratory remain relevant and emphasize the importance of continued human temporal bone research to improve our understanding and treatment of otologic disease.
Individualized cerebral perfusion pressure in acute neurological injury: are we ready for clinical use?
Authors: Weiss Miriam , Meyfroidt Geert , Aries Marcel J.H.
Published: January 2022

Purpose of review

Individualizing cerebral perfusion pressure based on cerebrovascular autoregulation assessment is a promising concept for neurological injuries where autoregulation is typically impaired. The purpose of this review is to describe the status quo of autoregulation-guided protocols and discuss steps towards clinical use.

Recent findings

Retrospective studies have indicated an association of impaired autoregulation and poor clinical outcome in traumatic brain injury (TBI), hypoxic–ischemic brain injury (HIBI) and aneurysmal subarachnoid hemorrhage (aSAH). The feasibility and safety to target a cerebral perfusion pressure optimal for cerebral autoregulation (CPPopt) after TBI was recently assessed by the COGITATE trial. Similarly, the feasibility to calculate a MAP target (MAPopt) based on near-infrared spectroscopy was demonstrated for HIBI. Failure to meet CPPopt is associated with the occurrence of delayed cerebral ischemia in aSAH but interventional trials in this population are lacking. No level I evidence is available on potential effects of autoregulation-guided protocols on clinical outcomes.

The effect of autoregulation-guided management on patient outcomes must still be demonstrated in prospective, randomized, controlled trials. Selection of disease-specific protocols and endpoints may serve to evaluate the overall benefit from such approaches.
Hydromorphone vs sufentanil in patient-controlled analgesia for postoperative pain management
Authors: Nie Zhong-Biao , Li Zhi-Hong , Lu Bin , Guo Yao-Yao , Zhang Ran
Published: January 2022

Background:

Patient-controlled analgesia (PCA) is an effective method of postoperative pain, there have been many studies performed that have compared the efficacy of hydromorphone with continuous sufentanil. The purpose of this systematic review is to compare the efficacy and safety of hydromorphone and sufentanil.

Methods:

Seven databases were searched for controlled trials to compare the efficacy and safety of hydromorphone and sufentanil. After selecting the studies, extracting the data, and assessing study quality, the meta-analysis was performed on several of the studies with RevMan 5.3.

Results:

Thirteen studies comprised of 812 patients were found. The pain intensity of the hydromorphone group was significantly lower than that of the sufentanil group at 12 hours. With no statistical difference at 24 to 48 hours (MD12 = −1.52, 95% CI [−2.13, −1.97], P <.05). The sedation intensity of the hydromorphone group at 12, 24, and 48 hours were lower than those of the sufentanil group, with no statistical difference (MD12 = −0.03, 95% CI [−0.18, 0.12], P > .05; MD24 = −0.20, 95% CI [−0.42, 0.03], P > .05; MD48 = −0.03, 95% CI [−0.18, 0.11)], P > .05). The PCA requests in the hydromorphone group were less than that in the sufentanil group, and there was no significant difference (RR = −0.20, 95% CI [−1.93,1.53], P > .05). The incidence of adverse events in the hydromorphone group was less than that in the sufentanil group, and there was a statistical difference: (RR = 0.61, 95% CI [0.47,0.79], P < .05).

Conclusion:

Compared with sufentanil, PCA with hydromorphone was more effective in relieving pain and PCA requests 12, 24, and 48 hours after operation, and significantly reduced the incidence of adverse events, but it did not have an advantage in sedation intensity.
Clinical characteristics and outcomes of post-COVID-19 pulmonary fibrosis
Authors: Farghaly Shereen , Badedi Mohammed , Ibrahim Rehab , Sadhan Murad H. , Alamoudi Aymn , Alnami Awaji , Muhajir Abdulrahman
Published: January 2022

The development of pulmonary fibrosis is a rare complication of the novel coronavirus disease 2019 (COVID-19). Limited information is available in the literature about that, and the present study aimed to address this gap.

This case-control study included 64 patients with post-COVID-19 pulmonary fibrosis who were hospitalized for COVID-19.

The percentage of patients aged ≥65 years (44%) who demised was higher than those who survived (25%). Male patients (62%) had higher mortality than female patients (37%). The most frequently reported clinical symptoms were shortness of breath (98%), cough (91%), and fever (70%). Most COVID-19 patients with pulmonary fibrosis (81%) were admitted to an intensive care unit (ICU), and 63% required mechanical ventilation. Bilateral lung infiltrates (94%), “ground glass” opacity (91%), “honeycomb” lung (25%), and pulmonary consolidation (9%) were commonly identified in COVID-19 patients with pulmonary fibrosis who survived. The findings for computed tomography and dyspnea scale were significantly higher in severe cases admitted to the ICU who required mechanical ventilation. A higher computerized tomography score also correlated significantly with a longer duration of stay in hospital and a higher degree of dyspnea. Half of the COVID-19 patients with pulmonary fibrosis (50%) who survived required oxygen therapy, and those with “honeycomb” lung required long-term oxygen therapy to a far greater extent than others. Cox regression revealed that smoking and asthma were significantly associated with ICU admission and the risk of mortality.

Post-COVID-19 pulmonary fibrosis is a severe complication that leads to permanent lung damage or death.
Predictors of Advance Care Planning Engagement Among Muslim Americans
Authors: Bani Melhem Ghaith Ahmad , Wallace Debra C. , Adams Judith A. , Ross Ratchneewan , Sudha S.
Published: January 2022

Advance care planning (ACP) enables people to discuss their physical, psychological, social, and spiritual needs before nearing death. Most literature examining the determinants of ACP engagement is limited and does not include minority faith communities in the United States, including Muslim communities. The purpose of this cross-sectional correlational study was to examine ACP engagement determinants among Muslims in the United States. Using the Social Ecological Model, we conceptualized the determinants of ACP engagement into intrapersonal, interpersonal, and community factors. The study self-administered questionnaires were distributed using convenience and snowball techniques. Multiple linear regression was used to predict ACP engagement. The total sample was 148 Muslim adults. The age range was 18 to 79 years. Among all tested factors, being Asian American, knowing a deceased person who had received aggressive or minimal medical treatments near death, being born in the United States, having knowledge and awareness about ACP, and being accepting of the American culture were the determinants of ACP engagement. Engagement in ACP is a multifactorial behavior. Several intrapersonal and interpersonal factors, but none of the community factors, were associated with ACP engagement among Muslim adults. Future ACP interventions targeted toward Muslim Americans should be planned with an understanding of the multifactorial nature of ACP engagement.
Dispelling Magnet® Myths
Authors: Lal M. Maureen
Published: January 2022

Organizations on the journey to Magnet® excellence have questions. In many cases, those questions are based on myth, not fact. In this month's Magnet Perspectives, we break down the most commonly asked questions, dispel the myths, and explore the resources available to help organizations get the answers they need to achieve Magnet® recognition.
Human-Centered Design Innovation to Help All Patients THRIVE
Authors: Reid-Ponte Patricia
Published: January 2022

In this column, Dr J. Margo Brooks Carthon discusses her work to support access to quality healthcare services for patients in minority and less than affluent circumstances. Dr Brooks Carthon has worked in a collaborative known as THRIVE. The program has offered intensive wrap-around clinical and social services and has positively impacted the wellness of chronically ill individuals.
Nurses' Perspectives of Their Impact While Serving on Boards
Authors: Sundean Lisa J. , O'Lynn Chad E. , Christopher Roberta , Cherry Barbara
Published: January 2022

OBJECTIVE

The study objective was to identify nurses' perceptions of their impact while serving on boards.

BACKGROUND

Nurse leaders serving as voting board members are key experts for board effectiveness and may be associated with stronger performing organizations. Extant research indicates that nurse leaders are qualified for board service; however, no research explores the impact of nurses on boards.

METHODS

We conducted an exploratory qualitative study by interviewing 20 nurses serving on boards. Hermeneutic analysis of the data resulted in 1 overarching pattern and 7 traversing themes.

RESULTS

Nurses who serve on boards reported leveraging expert knowledge of healthcare and caring wisdom to influence strategic thinking to meet stakeholder needs.

CONCLUSION

Nurses promote effective board governance by ensuring that the perspectives and needs of all stakeholders are represented in board processes. We recommend health-related organization executives and board leaders appoint nurses as voting members of their governing boards.
Posttraumatic Stress Disorder in Nurses During a Pandemic
Authors: Zeiher Wendy , Sego Emily , Trimmer Derek , Bowers Cynthia
Published: January 2022

OBJECTIVE

This study aimed to explore the association between nurses' practice environment (NPE), posttraumatic stress disorder (PTSD), and intent to leave among nurses working during the COVID-19 pandemic.

BACKGROUND

High levels of physiological and psychological stress in the workplace render nurses susceptible to PTSD. To date, little research has focused on the relationship between NPE, PTSD, and intent to leave during a major health crisis such as the COVID-19 pandemic.

METHODS

A cross-sectional online survey was completed by nurses who were members of northeastern and midwestern state nurses' associations.

RESULTS

Approximately 44% of nurses sampled indicated a preference for leaving their position. Significant associations were identified between NPE and PTSD and between NPE and intent to leave.

CONCLUSION

This assessment of nurses working during the COVID-19 pandemic may inform future mental health strategies and stress management interventions that support nurses continuing to work during a major health crisis.
Bilateral Hypertrophic Olivary Degeneration as a Paraneoplastic Syndrome of a Poorly Differentiated Carcinoma of the Upper Gastrointestinal Tract
Authors: Daneshmand Ameneh , Borhani-Haghighi Afshin , Monabati Ahmad , Karimi Mojtaba , Ostovan Vahid R.
Published: January 2022

Introduction:

Hypertrophic olivary degeneration (HOD) is a unique form of trans-synaptic neuronal degeneration within the dentato-rubro-olivary pathway which is manifested by the enlargement and hyperintensities of the inferior olivary nucleus in the brain magnetic resonance imaging.

Case Report:

We report a 53-year-old man admitted to our emergency department with a history of progressive ataxia and vertigo for 6 months before admission. Neurological examination revealed cerebellar dysfunction, and the brain magnetic resonance imaging showed bilateral HOD without an identifiable causative lesion within the brain or abnormal meningeal enhancement. Cerebrospinal fluid analysis showed mild lymphocytic pleocytosis, elevated protein, and negative cytology. Malignancy and paraneoplastic workup exhibited marked elevation of carbohydrate antigen 19-9 level and para-aortic lymphadenopathy. A histologic examination demonstrated the infiltration of lymph nodes by a malignant, poorly differentiated carcinomatous tumor that arises from the upper gastrointestinal tract. Considering the primary site of the tumor and HOD as a paraneoplastic effect of carcinoma, a FOLFIRINOX regimen, intravenous immunoglobulin, and pulse methylprednisolone were started. A follow-up imaging after 3 months depicted a significant resolution of HOD but the neurological status only mildly improved. The patient developed liver and adrenal metastasis over the following 6 months, culminating in his death.

Conclusion:

This study strengthens a relationship between HOD and malignancy as a paraneoplastic syndrome and provides a new incentive for further researches to confirm this association.
Major Neurological Deficit Following Neck Hyperextension During Dental Treatment
Authors: El-Hajj Victor G. , El-Hajj Gabriel , Mantoura Joseph
Published: January 2022

Introduction:

Medical literature has long reported the disastrous effects of neck hyperextension on posterior cerebral circulation. Hairdresser-related ischemic cerebrovascular event, also called beauty parlor syndrome, among other examples, is considered an epitome of this phenomenon.

Case Report:

In this report, alluding to hairdresser-related ischemic cerebrovascular event, 2 cases of neurological impairment following hyperextension of the neck during dental treatment append to the many others, yet being 2 of the first reported in this setting. In one of the cases, the patient developed classic stroke symptoms during dental treatment, while in the other, the deficit developed the day after the dental procedure. Both patients were treated with low–molecular-weight heparin during their stay at the hospital. In the first patient, the deficit was permanent, while in the second, the deficit was more subtle and temporary.

Conclusions:

Pathogenesis, as well as predisposing factors, are discussed, and new terminology is established as a means to encourage research on this rare complication of neck positioning on dental chairs.
AiRDose
Authors: Waltuch Temima , Munjal Kevin , Loo George T. , Lim Czer Anthoney
Published: January 2022

Objectives

Inaccurate weight estimation is a contributing factor to medical error in pediatric emergencies, especially in the prehospital setting. Current American Heart Association guidelines recommend the use of length-based weight estimation tools such as the Broselow tape. We developed the AiRDose smartphone application that uses augmented reality to provide length-based weight estimates, as well as medication dosing, defibrillation energy, and equipment sizing recommendations; AiRDose was programmed to use Broselow conversions to obtain these estimates. The primary objective was to compare the length estimated by AiRDose with the actual length obtained by the standard tape measure. The secondary objectives were to compare the estimated weights and critical medication doses from AiRDose with current established methods.

Methods

In this prospective validation study, lengths and estimated weights were obtained for children presenting to 2 emergency departments using AiRDose, Broselow, and a standard tape measure; actual weight was recorded from the patient chart. Using the AiRDose estimated weights, hypothetical doses of epinephrine and lorazepam were calculated and compared with doses recommended via Broselow and to actual weight-based doses. Spearman rank correlation coefficients were calculated. We defined an acceptable difference of 20% between AiRDose and standard measurements as clinically relevant.

Results

Five hundred forty-nine children (mean age, 4.8 years; standard deviation [SD], 2.9 years) were recruited. There were 99.6% of AiRDose lengths within a 20% difference of tape-measure lengths. There was a significant correlation between AiRDose and tape-measure length measurements (r = 0.989, P < 0.0001), and between AiRDose and Broselow weights (r = 0.983, P < 0.0001) and AiRDose and actual weights (r = 0.886, P < 0.0001). AiRDose lorazepam and epinephrine doses correlated significantly with Broselow lorazepam (r = 0.963, P < 0.0001) and epinephrine (r = 0.966, P < 0.0001) doses.

Conclusions

Anthropometric estimates and medication dose recommendations provided by AiRDose strongly correlate with established techniques. Further study will establish the feasibility of using AiRDose to accurately obtain weight estimates and medication doses for pediatric patients in the prehospital setting.
A Quality Improvement Initiative to Increase Central Line Maintenance Bundle Compliance through Nursing-led Rounds
Authors: Hugo Maria C. , Rzucidlo Rheannon R. , Weisert Lauren M. , Parakati Isaac , Schroeder Sangeeta K.
Published: January 2022

Introduction:

Improvements in maintenance bundle compliance around central line-associated bloodstream infections (CLABSIs) lack standardization. The objective was to implement a formalized nursing-led rounding process, Rounds for Influence, with a goal of 12 rounds/wk on each inpatient unit and Ambulatory Infusion Center, achieving > 90% maintenance bundle compliance.

Methods:

Nurses served as peer “influencers” to perform rounds. The CLABSI prevention team created three comprehensive rounding tools (line access, dressing change/port needle insertion, and cap change) on a digital platform. The team designed these tools to assess clinical competence for maintenance bundle components and implemented nine plan-do-study-act cycles throughout the study period.

Results:

Influencers completed 191 rounds after the first month of implementation, resulting in a 264.2% increase from the baseline of 52.5 rounds per month. Over the 2.5 years postimplementation, rounds resulted in 7836 total observations. Maintenance bundle compliance decreased from 86.9% (centerline value from November 2017 to September 2018) to 40.8% after the first month of implementation. Compliance increased iteratively (two separate centerline shifts) to a current centerline value of 87.1%. The CLABSI 12-month cumulative standardized infection ratio (SIR) was 0.9 in November 2017 and dropped to 0.53 in June 2021.

Conclusion:

Implementing a formalized nursing-led rounding process led to increased maintenance bundle compliance, decreased CLABSI SIR, and is an integral part of nursing practice. Given this success, there is interest from other hospital-acquired condition improvement teams in applying this rounding practice to their improvement work.
Shifting the Paradigm: A Quality Improvement Approach to Proactive Cardiac Arrest Reduction in the Pediatric Cardiac Intensive Care Unit
Authors: Riley Christine M. , Diddle J. Wesley , Harlow Ashleigh , Klem Kara , Patregnani Jason , Hochberg Evan , Cheng Jenhao Jacob , Bhattarai Sopnil , Hom Lisa , Fortkiewicz Justine M. , Klugman Darren
Published: January 2022

Introduction:

Children with cardiac conditions are at higher risk of in-hospital pediatric cardiopulmonary arrest (CA), resulting in significant morbidity and mortality. Despite the elevated risk, proactive cardiac arrest prevention programs in the cardiac intensive care unit (CICU) remain underdeveloped. Our team developed a multidisciplinary program centered on developing a quality improvement (QI) bundle for patients at high risk of CA.

Methods:

This project occurred in a 26-bed pediatric CICU of a tertiary care children’s hospital. Statistical process control methodology tracked changes in CA rates over time. The global aim was to reduce CICU mortality; the smart aim was to reduce the CA rate by 50% over 12 months. Interprofessional development and implementation of a QI bundle included visual cues to identify high-risk patients, risk mitigation strategies, a new rounding paradigm, and defined escalation algorithms. Additionally, weekly event and long-term data reviews, arrest debriefs, and weekly unit-wide dissemination of key findings supported a culture change.

Results:

After bundle implementation, CA rates decreased by 68% compared to baseline and 45% from the historical baseline. Major complications decreased from 17.1% to 12.6% (P < 0.001) and mortality decreased from 5.7% to 5.0% (P = 0.048). These results were sustained for 30 months.

Conclusions:

Cardiac arrest is a modifiable, rather than inevitable, metric in the CICU. Reduction is achievable through the interprofessional implementation of bundled interventions targeting proactive CA prevention. Once incorporated into widespread efforts to engage multidisciplinary CICU stakeholders, these patient-focused interventions resulted in sustained improvement.
Characterization and Utility of Remote Interpretation of Visual Field Diagnostic Testing in an Academic Center
Authors: Kung Felix F. , Xu Timothy T. , Leavitt Jacqueline A. , Lossen Victoria I. , Lai Kevin E. , Ko Melissa W. , Bhatti M. Tariq , Chen John J.
Published: January 2022

Background:

The use of remote interpretation of data has risen in neuro-ophthalmology to increase efficiency and maintain social distancing due to the coronavirus disease-19 pandemic. The purpose of this study is to characterize the use and efficiency of remote interpretation of visual fields (VFs) in an academic center and to determine how often the VF interpretation was consistent with the patient's clinical history and imaging at the time of the consult.

Methods:

This is a retrospective study at a single academic center that enrolled all patients receiving a remote interpretation of VF from January 1, 2012, through December 31, 2012. Data were collected regarding the referring department, indication for the VF, interpretation of the VF and comparison with any prior VFs, any associated interventions with the VF, and available follow-up VFs. The main outcome measures included 1) characterizing the use of remote VF interpretations and 2) how many remote VF interpretation results were consistent with the referring diagnosis based on the patient's clinical history and imaging.

Results:

One hundred eighty patients received remote interpretation of VFs. The most frequent referring departments were endocrinology (79; 44%), neurology (51; 28%), and neurosurgery (43; 24%). The VF indications included parasellar lesion (107; 59%), seizure disorder (26; 14%), meningioma (19; 11%), vascular lesion (11; 6%), and others (17; 9%). There were 78 patients (43%) that had an intervention before the VF, whereas 49 (27%) were preoperative VFs. Eighty-seven (48%) of the VFs were interpreted as abnormal. Of all the 180 remote interpretation of VFs, 156 (87%) had VF interpretations that were consistent with the clinical question posed by the referring provider based on clinical history and imaging. Among the other 24 remote VF interpretations (13% of total remote VF interpretations), there was no clear interpretation because of either additional unexpected VF defects (n = 5, 21%), VF defect mismatch (n = 6, 25%), or unreliable VFs (n = 13, 54%). The median wait time for patients receiving remote VF interpretations was 1 day.

Conclusions:

Remote interpretation of VFs was most often requested by endocrinology, neurology, and neurosurgery and could be performed very quickly. The most common indications were parasellar lesions, and just less than half of patients receiving remote VF interpretations had a prior intervention. A majority of remote VF interpretations were able to answer the clinical question, given the patient's clinical history and imaging. Remote interpretation of VFs may thus offer referring departments a more efficient method of obtaining VF interpretations than in-office neuro-ophthalmology examinations.
Coronavirus Disease 2019, Eye Pain, Headache, and Beyond
Authors: Landis Brianna C. , Brooks Amanda E. , Digre Kathleen B. , Seay Meagan D.
Published: January 2022

Background:

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in December 2019 and became a devastating pandemic. Although its respiratory effects can be deadly and debilitating, it can lead to other systemic disorders, such as those causing eye pain and headache. This literature review aims to describe presentations of eye pain and headache in relation to COVID-19, with an emphasis on how these disorders help us to understand the pathophysiology of COVID-19.

Evidence Acquisition:

Literature was mined from the PubMed database using the key terms: “eye pain,” “conjunctivitis,” “episcleritis,” “optic neuritis,” “migraine,” and “headache” in conjunction with “COVID-19” and “SARS-CoV-2.” With the exception of general background pathology, articles that predated 2006 were excluded. Case reports, literature reviews, and meta-analyses were all included. Where SARS-CoV-2 research was deficient, pathology of other known viruses was considered. Reports of ocular manifestations of vision loss in the absence of eye pain were excluded. The primary search was conducted in June 2021.

Results:

The literature search led to a focused review of COVID-19 associated with conjunctivitis, episcleritis, scleritis, optic neuritis, and myelin oligodendrocyte glycoprotein–associated optic neuritis. Four distinct COVID-19–related headache phenotypes were identified and discussed.

Conclusions:

Eye pain in the setting of COVID-19 presents as conjunctivitis, episcleritis, scleritis, or optic neuritis. These presentations add to a more complete picture of SARS-CoV-2 viral transmission and mechanism of host infection. Furthermore, eye pain during COVID-19 may provide evidence of hypersensitivity-type reactions, neurovirulence, and incitement of either novel or subclinical autoimmune processes. In addition, investigation of headaches associated with COVID-19 demonstrated 4 distinct phenotypes that follow third edition of the International Classification of Headache Disorders categories: headaches associated with personal protective equipment, migraine, tension-type headaches, and COVID-19–specific headache. Early identification of headache class could assist in predicting the clinical course of disease. Finally, investigation into the COVID-19–associated headache phenotype of those with a history of migraine may have broader implications, adding to a more general understanding of migraine pathology.