bluuebunny/crossref_metadata_2025 huggingface dataset:
Feeding and Swallowing Characteristics of Children With Esophageal Atresia and Tracheoesophageal Fistula
Authors: Maybee Jennifer , Deck Jacklyn , Jensen Emily , Ruiz Amanda , Kinder Sarah , DeBoer Emily
Published: February 2023

Objectives:

This study aimed to characterize feeding/swallowing difficulties in children with esophageal atresia and/or tracheoesophageal fistula (EA/TEF) and evaluate associations among feeding difficulties, pharyngeal dysphagia (PD), and other aerodigestive evaluation findings.

Methods:

This was a retrospective cohort study of feeding/swallowing characteristics of 44 patients with EA/TEF treated in the aerodigestive program of a single academic medical institution from 2010 to 2015. Demographics, comorbidities, presence and characteristics of feeding/swallowing difficulties, and results of relevant diagnostic tests [videofluoroscopic swallow studies (VFSS), clinical feeding evaluations (CFEs), chest computerized tomography (CT) scans, pulmonary bronchoscopies, and upper GI (UGI)/esophagrams] were reviewed.

Results:

Fifty percent of the cohort had PD and 88.6% had feeding difficulties. Across 118 encounters (87 VFSS and 31 CFEs), feeding difficulties suggestive of esophageal dysphagia were most frequently seen in children over 48 months and feeding difficulties suggestive of developmental feeding problems were most frequently seen in children from 24 to 48 months. Abnormal findings were present in 59.8% of VFSS, with aspiration (34.5%) and pharyngeal residue (26.4%) the most frequently observed signs of dysphagia. Abnormal UGI/esophagram findings were not associated with significantly increased risk of feeding difficulties during visits within 3 months (risk ratio, RR = 1.33). Presence of dysphagia was associated with increased risk for some abnormal CT findings (RR= 3.0 for airspace and 3.0 for bronchiectasis).

Conclusions:

Feeding/swallowing difficulties are common in EA/TEF, and types of feeding difficulties vary by patient age. The presence of abnormal findings on UGI/esophagram did not increase the risk of feeding complaints; however, the presence of dysphagia increased the risk of abnormal chest CT.
Coronavirus Disease 2019 in Pediatric Oncology Patients: A Matched–Cohort Analysis of the SCCM Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 Registry
Authors: Balakumar Niveditha , Catueno Samanta , Nadiger Meghana , Keshavamurthy Prithvi Raj Sendi , Totapally Balagangadhar R. , Sherani Farha , Mba Nkechi , Gist Katja M. , Tripathi Sandeep , Gajic Ognjen , Deo Neha , Kumar Vishakha , Walkey Allan , Kashyap Rahul , Bhalala Utpal S.
Published: February 2023

Background:

There is a paucity of multicenter data describing the impact of coronavirus disease 2019 (COVID-19) on hospitalized pediatric oncology patients. Using a large, multicenter, Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness University Study (VIRUS) database, we aimed at assessing outcomes of COVID-19 infection in this population.

Method:

This is a matched-cohort study involving children below 18 years of age hospitalized with COVID-19 between March 2020 and January 2021. Using the VIRUS; COVID-19 Registry database, children with oncologic diseases were compared with propensity score matched (age groups, sex, race, and ethnicity) cohort of children without oncologic diseases for the prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C), intensive care unit (ICU) admission, interventions, hospital, and ICU length of stay.

Results:

The number of children in the case and control groups was 45 and 180, respectively. ICU admission rate was similar in both groups ([47.7 vs 51.7%], P=0.63). The proportion of children requiring noninvasive and invasive mechanical ventilation, and its duration were similar between groups, same as hospital mortality. Interestingly, MIS-C was significantly lower in the oncology group compared with the control (2.4 vs 24.6%; P=0.0002).

Conclusions:

In this study using a multicenter VIRUS database, ICU admission rate, interventions, and outcomes of COVID-19 were similar in children with the oncologic disease compared with control patients. The incidence of MIS-C is lower in oncologic patients.
Use of Trametinib in Children and Young Adults With Progressive Low-grade Glioma and Glioneuronal Tumors
Authors: Hanzlik Emily , Archambault Bridget , El-Dairi Mays , Schroeder Kristin , Patel Mallika P. , Lipp Eric S. , Peters Katherine B. , Ashley David M. , Landi Daniel
Published: February 2023

Low-grade gliomas/glioneuronal tumors comprise one-third of all pediatric-type CNS tumors. These tumors are generally caused by activating mutations in the mitogen-activated protein kinase (MAPK) pathway. Targeted drugs, such as trametinib, have shown promise in other cancers and are being utilized in low-grade gliomas. A retrospective chart review was conducted to evaluate radiographic response, visual outcomes, tolerability, and durability of response in progressive circumscribed low-grade gliomas treated with trametinib. Eleven patients were treated with trametinib. The best radiographic response was 2/11 partial response, 3/11 minor response, 3/11 stable disease, and 3/13 progressive disease. In the patients with partial or minor response, the best response was seen after longer durations of therapy; 4 of 5 best responses occurred after at least 9 months of therapy with a median of 21 months. Patients with optic pathway tumors showed at least stable vision throughout treatment, with 3 having improved vision on treatment. Trametinib is effective and well-tolerated in patients with progressive low-grade glioma. Best responses were seen after a longer duration of therapy in those with a positive response. Patients with optic pathway lesions showed stable to improved vision while on treatment.
Change in functioning profile after cervical surgery
Authors: Widbom-Kolhanen Sara S. , Pernaa Katri I. , Saltychev Mikhail
Published: February 2023

The objectives are to (a) introduce an approach to use the Neck Disability Index (NDI) in a way, which is different and more International Classification of Functioning, Disability and Health-oriented than acommon practice – focusing on functional profile instead of composite score only, and (b) to describe the changes in functioning experienced by patients undergoing cervical surgery. This was a register-based study of almost 400 patients undergoing different cervical surgical procedures in a university hospital between 2018 and 2021. The patients responded to repeated surveys preoperatively and 3, 12 and 24 months postoperatively. Linear regression test was performed to analyze the change of the NDI score. The changes in scores during a follow-up were statistically significant (P < 0.001) for all the NDI items as well as for the total score. Each item demonstrated significant improvement postoperatively and a slight worsening between 1 and 2 years after the surgery. The observed slight decline in functioning at the end of follow-up remained below the baseline level for all the items. While the change in the composite score of the NDI was able to describe the overall change in functioning after the surgery, different areas of functioning were affected by the surgery differently. The results suggest that the use of functional profiles, in addition to composite scores, is justified among patients with cervical pathologies.
Importance of factors determining disability caused by neck pain may vary by gender and age
Authors: Saltychev Mikhail , Widbom-Kolhanen Sara S. , Pernaa Katri I.
Published: February 2023

The objective was to investigate if age and gender affect the importance of domains of functioning when grading disability related to neck pain. Multi-group confirmatory factor analysis of register-based data on 392 patients undergoing cervical surgery was applied. The main outcome was item loadings on a common factor. The mean age was 55 years and 52% were women. The factor structure was different for both gender and age groups, P < 0.0001. Reading, driving, pain intensity, and recreational activity had the highest loadings while headaches, lifting, and sleep placed the lowest. Reading and pain intensity had bigger weight among men than women, while recreational activity and driving had higher loadings in women. Reading and work were more important for the younger than for the older respondents, while recreational activity was more important for the older respondents. The importance of factors determining disability caused by neck pain may vary by gender and age.
Stroke impairment, balance, and cognitive status on admission predict walking independence up to 90 days post-stroke but their contributions change over time
Authors: Hiratsuka Kenta , Tamiya Takamichi , Matsuoka Shinji , Kimura Kazushi
Published: February 2023

This study aimed to identify predictors of gait independence in three successive patient cohorts that received inpatient rehabilitation for at least 30 days, 60 days, or 90 days post-stroke. A total of 26 independent variables were collected within 3 days of stroke onset, including basic information (age, sex, stroke type), sensorimotor function (Stroke Impairment Assessment Set), gait function, balance function, and cognitive function. The dependent variable was walking independence (without assistance from another person) at 30, 60, or 90 days post-stroke. A decision tree was developed for predicting gait independence at each assessment time point. The predictors of walking independence differed among the cohorts that received inpatient rehabilitation for at least 30, 60, and 90 days post-stroke. Specifically, the Short Form Berg Balance Scale score was in the higher layer and was a strong predictor of gait at all time points. The cognitive Functional Independence Measure progressed to the higher layer at later time points. The lower extremity motor function was an additional predictor in the 30-day cohort. For later cohorts, the predictive value of balance and cognitive function declined whereas the contribution of the paralyzed grip strength and trunk function increased. These results suggest that sensorimotor and cognitive function within 3 days of stroke can predict walking independence between 1 and 3 months post-stroke; however, the prognostic value of predictors varies among the patients who receive inpatient rehabilitation for shorter versus longer time.
Inflammatory Breast Cancer: Understanding the Patient Experience
Authors: Whisenant Meagan S. , Alexander Angela , Woodward Wendy A. , Teshome Mediget , Ueno Naoto Tada , Williams Loretta A.
Published: February 2023

Background

Inflammatory breast cancer (IBC) is an aggressive, locally advanced cancer with a 5-year survival rate of approximately 40%. Although patients with IBC likely experience significant and variable symptom burden from diagnosis through survivorship, the description of the symptom burden in this population is limited.

Objectives

The purpose of this study was to describe the experience of patients with IBC and define the content domain for a patient-reported outcome measure of IBC symptom burden.

Methods

Twenty patients with IBC described their experience in single qualitative interviews. Content analysis was used to define the symptom burden content domain. Relevance ratings by a panel of experts reduced the number of items for a preliminary patient-reported outcome symptom burden measure.

Results

The mean (SD) participant age was 52.8 (12.0) years; 50.0% had distant metastatic disease, and 85.0% were currently receiving treatment. Content analysis revealed 45 symptoms, with 20 symptoms reported by greater than or equal to 20% of participants. All participants described localized disease-related symptoms. Treatment-related symptoms varied among participants based on the modalities received.

Conclusion

Patients with IBC experience symptom burden that is distinct from the symptom burden experienced by patients with non-IBC.

Implications for Practice

Differentiating the disease-related symptoms of IBC may assist clinicians in making timely and accurate diagnoses for IBC. A disease- and treatment-specific measure of the symptom burden of IBC should be incorporated in clinical practice to allow for regular assessment and evaluation of symptom burden and implementation of evidence-based interventions for symptom management.
Family Caregivers of Adult Cancer Patients in Oman: Predictors of Caregivers’ Self-efficacy for Cancer Pain and Related Symptom Management at Home
Authors: Kizza Irene B. , Muliira Joshua K. , Al Jabri Kawthar Ali , Al-Kindi Sumaiya Nasser
Published: February 2023

Background

Family caregivers (FCGs) contribute significantly to the management of pain and other symptoms experienced by their family member with cancer and may not receive preparation to meet the changing patient needs.

Objective

The aim of this study was to identify the predictors of FCG self-efficacy (SE) for pain and related symptom management of adult family members with cancer.

Methods

Data were collected from 165 Omani FCGs. The questionnaire comprised the caregiver cancer pain and related symptom management SE scale, the Katz index, Caregiver Reaction Assessment, and Family Pain Questionnaire. Electronic medical records provided data on patients’ cancer diagnosis, pain, and symptoms. Predictors of SE were examined using linear regression analysis.

Results

Most FCGs were female (58.2%) and children of the patient (53.9%). Most patients were on chemotherapy or palliative care (82.4%) and had at least stage 3 cancer (58.8%). Family caregivers reported average SE. The predictors of SE were as follows: patients’ functional status (β = 40.90, P = .001), patients’ pain intensity (β = −15.10, P = .036), FCGs’ confidence in controlling the patients’ pain (β = 28.80, P = .000), FCGs’ self-rated health (β = −25.90, P = .038), and interaction of FCGs’ knowledge level with patients’ pain intensity (β = −1.31, P = .008), caregiving hours (β = −0.10, P = .025), and impact of caregiving on FCGs’ physical health (β = 1.29, P = .031).

Conclusion

Family caregivers’ health status, knowledge, caregiving demands, patient functional status, and pain intensity have a significant effect on caregivers’ symptom management.

Implications for Practice

A deliberate model of care that includes supportive interventions to enhance the abilities of FCGs with symptom management is needed in Oman.
The Effects of Self-Acupressure on Pain, Fatigue, and Sleep Quality in Colon and Pancreatic Cancer Patients Receiving Chemotherapy
Authors: Bahçecioğlu Turan Gülcan , Özer Zülfünaz , Yanmış Safiye , Aksoy Asude
Published: February 2023

Background

Pancreatic and colon cancer are among important gastrointestinal cancer diseases. Pain, fatigue, and insomnia are among the most common symptoms in cancer patients receiving chemotherapy. Self-acupressure may improve patients’ pain, fatigue, sleep quality, quality of life, and functional well-being.

Objective

The aim of this study was to examine the effects of self-acupressure application on pain, fatigue, and sleep quality in colon and pancreatic cancer patients receiving chemotherapy.

Methods

This randomized controlled study was conducted with 60 patients in treatment for pancreatic or colon cancer, 30 in the intervention and 30 in the control group, between June and October 2021. Participants in the intervention group were asked to complete 16 acupressure sessions for 4 weeks, 2 days a week in the morning and afternoon for a total of 18 minutes, depending on the preparation and pressure time on 4 pressure points. Control group participants did not receive any interventions during the study. The data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Piper Fatigue Scale, and the visual analog scale.

Results

After self-acupressure, the visual analog scale, Piper Fatigue Scale, and Pittsburgh Sleep Quality Index scores of the intervention group decreased when compared with the control group scores; the difference between the 2 groups was statistically significant.

Conclusion

Self-acupressure was effective in reducing the pain, fatigue, and sleep disorder scores of patients with colon or pancreatic cancer receiving chemotherapy.

Implications for Practice

In nursing practice, self-acupressure, an applicable, accessible, and inexpensive method in the management of cancer-related symptoms, can be supported and maintained during a 4-week period.
Race, Neighborhood Opportunity, and Life-Threatening Complications in Children With Cancer
Authors: Savage Beth , Cole Peter D. , Lin Haiqun
Published: February 2023

Background

Racial disparities exist in the incidence and severity of life-threatening complications of childhood cancer and its treatment. Little research has been conducted to examine the sociocultural pathways that are underlying these inequities.

Objective

This study examined the association between race and complications and the intermediary pathway of a child’s access to opportunity in the neighborhood environment. A secondary objective was to determine if this indirect effect differs as the child becomes older and exposure to the neighborhood environment increases.

Methods

This is an analysis of publicly available data. Regression models estimated direct associations between race and complications, as well as the effect of the mediator, neighborhood opportunity. Moderated-mediation analysis was used to determine the conditional influence of age.

Results

Compared with non-Hispanic White children, non-Hispanic Black and Hispanic children are at increased odds of developing 1 or more life-threatening complications when hospitalized with cancer. Neighborhood opportunity is a significant indirect pathway underlying these relationships. This intermediary effect is significant only for older children.

Conclusions

Neighborhood opportunity is a significant indirect pathway underlying the racial inequities in the risk of life-threatening complications. This effect is significant only for older children.

Implications for Practice

The inclusion of indicators such as inequitable allocation of resources to highly segregated neighborhoods and rigorous statistical model development in outcomes research are critical in addressing and mitigating racial disparities in childhood cancer.
Socratic Inquiry, Syllogism, Schematic Cases, and Symbolism
Authors: Fink Anne M. , Martyn-Nemeth Pamela
Published: February 2023

Background:

Critical thinking is an essential nursing competency. Faculty can teach students how to think critically by emphasizing the connections between their philosophy and nursing curricula to ensure that students recognize the cognitive processes they use to make complex decisions.

Purpose:

The purpose of this article is to examine the definitions, history, and utility of philosophical perspectives that inform critical thinking. We explain several approaches: Socratic inquiry, syllogism, schematic cases, and symbolism.

Methods:

We conducted a narrative review about educational approaches and their associated philosophies.

Results:

Philosophical awareness can enhance students' abilities to examine data, communicate ideas, evaluate diverse opinions, understand theories, and apply innovative solutions to problems they will encounter in clinical practice.

Conclusions:

Clinical issue dialogues, dramatizations (that link philosophical and practical themes), self-reflection exercises, and case studies (that are less content-laden and more focused on nurses' theories and decision-making processes) represent important and innovative critical thinking skill-building exercises.
Community Health Outside the Exam Room
Authors: Yingling Charles T. , Nisi Robyn , McNamara Mary , House Keisha , Cotler Karen , Durham Marianne , Handrup Cynthia T. , Vaez Kelly
Published: February 2023

Background:

The curricular requirements of nurse practitioner (NP) programs are well established. NP students' clinical practicums provide a context for the extracurricular acquisition of administrative, operational, and systems-focused NP skills.

Problem:

Acquisition of extracurricular NP skills is variable and highly dependent on a student's clinical placements. The COVID-19 pandemic exacerbated this variability by limiting students' access to traditional clinical rotations.

Approach:

With our practice partners, we inventoried the behaviors that are associated with new graduate NP readiness for practice in community health centers. We then developed an extracurricular seminar series to develop these behaviors. Each seminar in the series was presented by a preceptor.

Outcomes:

Students reported gains in their perceived readiness to practice. The casual format and preceptor presenters were highly valued by students.

Conclusions:

NP educators should consider leveraging academic-practice partnerships to standardize students' acquisition of administrative, operational, and systems-focused NP competencies.
What Would You Do?
Authors: Littleton Caroline , Bolus Victoria , Wood Tara , Clark James , Wingo Nancy , Watts Penni
Published: February 2023

Background:

Engaging remote learners can be challenging for nurse educators. With an increase in virtual learning, nurse educators are seeking activities that support engagement and improve critical thinking.

Problem:

Students in virtual classes need learning experiences that support critical thinking and involve appropriate case studies for knowledge application.

Approach:

Stop-action video vignettes as unfolding case studies employ technology that can facilitate critical thinking and active learning in a virtual setting. Stop-action video vignettes can be useful in enhancing student learning through 3 methods: video-based discussion, text-based discussion, and branching matrices.

Conclusion:

Stop-action video vignettes with unfolding case studies may provide effective and versatile activities to engage students and enhance learning
Maintaining and Enhancing Nursing Students’ Pharmacology Knowledge to Improve Patient Safety
Authors: Prochnow Laura , Harden Karen , Riley Penny
Published: February 2023

Background:

Nurses play a vital role in the medication administration process and are frequently involved in adverse drug events (ADEs). One identified cause of ADEs is lack of pharmacology knowledge received during their training and/or failure to maintain this core information: the latter cause has been described as skill decay.

Purpose:

The purpose of this quality improvement project was to implement an online pharmacology review program to maintain and/or improve nursing students’ pharmacology knowledge, thus decreasing skill decay over the school’s summer break.

Methods:

Nursing students enrolled in a 4-year BSN program participated in a virtual pharmacology knowledge review program consisting of a pretest survey, learning modules, quizzes, and a final posttest survey.

Results:

Comparisons showed statistical significance in test score improvement from pretest to posttest.

Conclusions:

This project demonstrates that a review program can enhance nursing students’ pharmacology knowledge throughout their summer break. It adds to the limited data about the need for pharmacology programs to decrease skill decay.
Neonatal Fragile Skin
Authors: Moss Colleen Reilly
Published: February 2023

Background:

Infants with fragile skin pose challenges to neonatal providers, including the difficult nature of securing lifesaving devices. A paucity of information exists supporting best simulation practices in educating neonatal nurse practitioner (NNP) students on how to care for infants with fragile skin.

Purpose:

To evaluate whether simulation improved student knowledge and self-confidence related to caring for infants with fragile skin.

Methods:

This quality improvement project included a pre/posttest survey with a sample of 14 NNP students. Participants practiced application of a multilayered dressing to secure a catheter to a neonatal manikin. Knowledge and self-confidence were measured before and after simulation.

Results:

Correct responses on posttest survey knowledge items increased along with students' confidence ratings following simulation. Students reported high levels of satisfaction with the simulation experience.

Conclusions:

Simulation of caring for fragile skin allows NNP students the opportunity to improve self-confidence, knowledge, and performance of a necessary skill for NNPs.
Clinical Judgment Development and Assessment in Clinical Nursing Education
Authors: Calcagni Laura , Lindell Deborah , Weaver Amy , Jackson Molly
Published: February 2023

Background:

There is a gap in evidence for effective clinical teaching strategies to promote nursing students' development of clinical judgment (CJ).

Purpose:

This study examined the effect of active learning strategies (ALSs) during clinical postconference sessions on the CJ of undergraduate nursing students.

Methods:

This quasi-experimental study of ALSs or standard postconferences used the Lasater Clinical Judgment Rubric (LCJR) to rate CJ at 3 time points. All faculty members and students were trained on use of the LCJR. Ratings were done by both faculty and students.

Results:

All ratings of CJ improved over time (P< .001). Ratings of CJ varied between the control and intervention groups.

Conclusions:

The findings of this study contribute to knowledge regarding the effectiveness of clinical teaching strategies for CJ and preparation for entry to nursing practice.
Faculty Practice as an Educational Strategy
Authors: Gonzales Kelly , Holmes LeAnn , Klein Abbey , Hanish Alyson , Struwe Leeza
Published: February 2023

Background:

Outcomes data are deficient in demonstrating the impact of faculty practice on education.

Purpose:

To examine nurse practitioner (NP) student, faculty, and administrator perspectives on faculty practice as an educational strategy.

Methods:

NP students, faculty, and administrators from 6 different universities were surveyed.

Results:

A total of 173 students, 25 faculty members, and 11 administrators participated. Results provide information on perspectives of faculty practice as an educational strategy pertaining to evaluation of education outcomes, overall education, didactic education, and clinical education.

Conclusion:

Faculty practice has educational benefits and brings value to nursing education, although evidentiary support is lacking.
In Vitro Isolation of Treponema pallidum subsp. pallidum From Fresh and Frozen Needle Aspirates of Primary Experimental Syphilis Lesions
Authors: Tantalo Lauren C. , Molini Barbara J. , Bose Mahashweta , Klausner Jeffrey D. , Giacani Lorenzo
Published: February 2023

Isolation of Treponema pallidum subsp. pallidum strains still relies on rabbit intratesticular inoculation of clinical samples. In this article, we report an alternative isolation approach based on the inoculation of fresh and frozen needle aspirates of primary experimental lesions into culture plates suitable for in vitro propagation of the syphilis agent.
Effectiveness of Cefixime for the Treatment of Neisseria gonorrhoeae Infection at 3 Anatomic Sites: A Systematic Review and Meta-Analysis
Authors: Yang Kevin J. , Kojima Noah , Bristow Claire C. , Klausner Jeffrey D.
Published: February 2023

Background

To treat Neisseria gonorrhoeae infection, the Centers for Disease Control and Prevention recommends a single oral dose of cefixime as an alternative to injectable ceftriaxone.

Methods

We conducted a systematic review and meta-analysis to describe the effectiveness of cefixime in treating N. gonorrhoeae infection at 3 different anatomic sites.

We searched PubMed and Embase database to abstract treatment success rates and cefixime dosage/frequency for studies that reported the anatomical site of infection. We included reports published between January 1, 1980, and December 7, 2021. Twenty studies published between 1989 and 2015 were included in our meta-analysis. We calculated pooled treatment success percentages and 95% confidence intervals (CIs) using random-effects models.

Results

Of patients who received a 400-mg single dose of cefixime, 824 of 846 (97%; 95% CI, 96%–98%) patients with urogenital infection, 107 of 112 (97%; 95% CI, 84%–100%) patients with rectal infection, and 202 of 242 (89%; 95% CI, 76%–96%) patients with pharyngeal infection were cured. Of patients who received an 800-mg single dose of cefixime, 295 of 301 (98%; 95% CI, 96%–99%) patients with urogenital infection and 21 of 26 (81%; 95% CI, 61%–92%) patients with pharyngeal infection were cured.

Conclusions

Our meta-analysis found that cefixime is highly effective at treating urogenital infections and less effective at treating pharyngeal infections. We recommend more investigation into the effectiveness of cefixime in treating rectal infections and studying multidose therapy for the cefixime treatment of pharyngeal infection.
Factors Associated With Chlamydia and Gonorrhea Treatment Completion Among Sexual Health Clinic Patients, Baltimore City, Maryland; 2018 to 2019
Authors: Stracker Norberth , Williford Sarah L. , Gilliams Elizabeth , Rives Sarah , Page Kathleen R. , Hamill Matthew M. , Greenbaum Adena , Schumacher Christina M.
Published: February 2023

Background

Prompt and appropriate treatment of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is critical to prevent transmission and serious sequelae. The objectives were to determine the prevalence of CT/NG treatment completion and identify demographic, behavioral, and clinical factors associated with treatment completion at sexual health clinics in Baltimore City, Maryland.

Methods

Electronic health record data from patients diagnosed with CT/NG during 2018–2019 were analyzed. Treatment completion was defined as documentation of Centers for Disease Control and Prevention–recommended treatment ≤30 days after testing. Regression was used to assess differences in treatment completion across groups; analyses were stratified by birth sex.

Results

Most of the 2426 male (86%) and 754 (72%) female patients diagnosed with CT/NG completed treatment in ≤30 days; 74% of male and 36% of female patients were treated same-day. Among 890 male patients not treated same-day, treatment completion was associated with other same-day antimicrobial treatments (adjusted prevalence ratio, 0.76 [95% confidence interval, 0.61–0.94]), longer test processing times (≥10 days; 0.78 [0.65—0.95]) infection at multiple anatomic sites (1.49 [1.25–1.76]), and patients with previous clinic visits (1.16 [1.03–1.31]). Among 483 female patients not treated same-day, treatment completion was associated with diagnosis year (2019 vs. 2018; 1.23 [1.05–1.43]) and residential addresses 2 to 5 miles (vs. <2 miles) from clinic (1.25 [1.02–1.53]). Demographic and behavioral characteristics were not associated with treatment completion.

Conclusions

Substantial proportions of male and female sexual health clinic patients did not complete treatment. Our findings underscore the need for implementation of highly sensitive and specific point-of-care (POC) CT/NG testing to improve treatment completion in this setting.
Primary Clear Cell Sarcoma of Bone
Authors: Odintsov Igor , Jagannathan Jyothi P. , Al-Ibraheemi Alyaa , Selig Martin K. , Newman Erik T. , Fletcher Christopher D.M. , Nielsen Gunnlaugur P. , Hornick Jason L.
Published: February 2023

Clear cell sarcoma (CCS) is an uncommon malignant mesenchymal neoplasm of young adults with a predilection for tendons and aponeuroses of distal extremities, a distinctive nested growth pattern, melanocytic differentiation, and usually an EWSR1::ATF1 fusion. Distinction from melanoma can be challenging but is critical for clinical management. Rare cases of primary bone CCS have been reported. The purpose of this study was to evaluate the clinicopathologic features of a series of primary bone CCS. Three cases of primary bone CCS were identified out of 140 CCS diagnosed between 2010 and 2021. Two patients were female, and 1 patient was male; ages were 19, 47, and 61 years. All tumors arose in the long bones of the extremities (femur, humerus, fibula). Two tumors also involved regional lymph nodes at presentation. Two showed characteristic histologic features, in the form of nests and fascicles of uniform epithelioid to spindle cells with prominent nucleoli and pale eosinophilic to clear cytoplasm; 1 tumor showed sheet-like growth, unusual focal pleomorphism, and more notable nuclear atypia. By immunohistochemistry, S100 protein was positive in 2/3 cases, SOX10 in 3/3, HMB-45 in 2/3, MiTF in 2/2, and melan A in 1/3. All cases were confirmed to harbor EWSR1 rearrangement and EWSR1::ATF1 fusion or t(12;22). On follow-up, all 3 patients developed metastases and died of disease, 5, 18, and 21 months after diagnosis. In summary, CCS rarely presents in the skeleton. At such locations, distinction from metastatic melanoma is particularly challenging. Clinical and pathologic features are similar to conventional CCS of soft tissue. Primary bone CCS may pursue an aggressive clinical course.
Strong Annexin A10 Expression Supports a Pancreatic Primary and Combined Annexin A10, Claudin 18, and SOX2 Expression Supports an Esophagogastric Origin in Carcinomas of Unknown Primary
Authors: Isidro Raymond A. , Abukhiran Ibrahim , Dunseth Craig D. , Gosse Matthew D. , Humble Robert M. , Pelletier Daniel J. , Varshney Neha , Bellizzi Andrew M. , Hornick Jason L.
Published: February 2023

Primary tumor site determination for gastrointestinal (GI) tract and pancreaticobiliary (PB) tree carcinomas that present as metastasis of unknown primary can be problematic. Annexin A10 (ANXA10), claudin 18 (CLDN18), and trefoil factor 1 (TFF1) have been identified through expression profiling as markers of gastric lineage commitment; sex-determining region Y (SRY)-box transcription factor 2 (SOX2) expression has been reported in several tumor types, including gastric adenocarcinomas. We evaluated the diagnostic utility of immunohistochemistry for ANXA10, CLDN18, SOX2, and TFF1 for determining the site of origin for GI/PB adenocarcinomas. Immunohistochemistry for all 4 markers was performed on tissue microarrays including 559 GI/PB tumors and 421 other tumors. H-scores were calculated as the product of the intensity (0 to 3) and extent (percentage, 0% to 100%) of staining. Positive staining was defined as >5% staining. ANXA10 expression was most frequent in pancreatic adenocarcinomas when compared with all other GI/PB tumors (96.4% vs. 43.5%, P<0.001). Strong staining for ANXA10 (H-score ≥200) distinguished pancreatic ductal adenocarcinoma from intrahepatic cholangiocarcinoma and adenocarcinomas of the gallbladder and colorectum (69.6% vs. 0%, P<0.001). Triple positivity for ANXA10, CLDN18, and SOX2 was more frequent in esophagogastric tumors than in other GI/PB tumors (22.6% vs. 4.1%; P<0.001). TFF1 expression was observed in nearly all tumor types. Staining for ANXA10, CLDN18, and SOX2 as part of a panel may aid in distinguishing esophagogastric adenocarcinomas from lower GI/PB tumors. ANXA10 staining may be particularly useful in distinguishing pancreatic adenocarcinomas from intrahepatic cholangiocarcinoma and adenocarcinomas of the gallbladder and colorectum.
Intact Chorionic Vesicle in Very Early Products of Conception Specimens
Authors: Kayraklioglu Neslihan , Gasper Cynthia , Cho Soo Jin , Lage Janice , Rabban Joseph T.
Published: February 2023

Among the morphologic mimics of hydatidiform moles, the chorionic vesicle of early first-trimester pregnancy has received scant attention. The chorionic vesicle is the stage of the implanted blastocyst in which the cytotrophoblastic shell is circumferentially lined by primary and secondary villi and envelops the notochord stage embryo, yolk sac, and amniotic sac, ∼5 to 6 weeks since the last menstrual period. Miscarriage specimens at this early gestational age that contain an intact chorionic vesicle may be misinterpreted as a complete hydatidiform mole because of its large size, cistern-like cavity, and circumferentially radiating villi and trophoblast, particularly so when embryonic tissue is absent. We present the clinicopathologic features of 26 products of conception specimens containing a chorionic vesicle, some of which were submitted for consultation as a possible complete mole. The median gestational age was 6 weeks. The majority were free-floating in the specimen, unattached to endometrium. The median diameter was 6.3 mm and ranged up to 11.3 mm. The embryo was absent in 81% of cases, leaving an empty cavity resembling the cistern of a complete mole in all but 2 cases. Most cases exhibited circumferential villi and variable degrees of proliferating polarized villous trophoblast and extravillous trophoblast but trophoblast atypia was absent. Villous stromal karyorrhexis and blue-gray myxoid extracellular stromal matrix were observed in the majority of cases. A minority exhibited focal abnormal villous morphology concerning for early molar pregnancy, including irregular projections (27%), invaginations (12%), or bulbous shapes (4%) of the villous contours and trophoblast pseudoinclusions (15%). In contrast, orderly hierarchical branching of the secondary villi occurred in 31%. p57 immunoexpression was intact in all 25 cases tested. Short tandem repeat genotype testing confirmed a biparental diploid genotype in both of 2 cases tested. Although uncommonly observed in early first-trimester products of conception specimens, the normal chorionic vesicle merits awareness as a potential diagnostic pitfall. While some morphologic features resemble those of a well-developed complete mole, at this early gestational age such features are not expected in a very early complete mole. Attention to the reported gestational age, if available, and presence of embryonic tissues will mitigate against misclassification as complete mole. As with the workup of any potential gestational trophoblastic disease, partnering the clinical and morphologic evaluation with molecular evaluation (intact p57 immunoexpression and lack of any of the characteristic molar genotypes) offers the most precise classification.
The Relationship Between Postoperative Complications and Children’s Quality of Life: A Mediation Analysis to Explore the Role of Family Factors
Authors: Brown Katherine L. , Moinuddin Mohammed , Jones Alison , Sheehan Karen , Wellman Paul , Rodrigues Warren , Ridout Deborah , Wray Jo
Published: February 2023

OBJECTIVES:

To explore whether postoperative morbidities after pediatric cardiac surgery affected children’s health-related quality of life (HRQOL) at 6 months, through potentially modifiable parental psychological factors.

DESIGN:

We undertook a mediation analysis, to explore the causal pathway, based on data from a prospective, case-matched cohort study.

PATIENTS:

Six hundred sixty-six children undergoing cardiac surgery.

SETTING:

Five centers in the United Kingdom.

INTERVENTIONS:

No intervention.

MEASUREMENTS AND MAIN RESULTS:

Cases of morbidity were identified early after pediatric cardiac surgery, and matched controls with no morbidities were identified at discharge. Four mediators were assessed at 6 weeks after surgery, using the PedsQL Family Impact Module (Parent HRQOL and Family Function) and the PHQ-4 (Anxiety and Depression). The study outcome of child HRQOL was assessed at 6 months with the PedsQL. Of 666 children, 408 (65% of those surviving) contributed to the primary outcome. Children who had extracorporeal life support (ECLS) (n = 11) (p < 0.05) and multiple morbidities (n = 62) (p < 0.01) had worse 6-month HRQOL than those with a single morbidity (n = 125) or no morbidity (n = 209). After adjustment for case mix complexity and sociodemographic variables, there were significant indirect effects of parent HRQOL at 6 weeks, on the PedsQL Total Score (ECLS, –5.1 [–8.4 to –1.8]; p = 0.003; multiple morbidities, –2.1 [–3.7 to –0.5]; p = 0.01), PedsQL Physical Score (ECLS, –5.1 [–8.7 to –1.4]; p = 0.007; multiple morbidities, –2.1 [–3.8 to –0.4]; p = 0.016), and PedsQL Psychosocial Score (ECLS: –5.3 [–8.7 to –1.8); p = 0.003; multiple morbidities, –2.2 [–3.9 to –0.5]; p = 0.01). The proportion of the total effect of ECLS and multiple morbidity on the study outcomes mediated through parent HRQOL ranges between 18% and 61%. There was no evidence that the other three mediators had indirect effects on the study outcome.

CONCLUSIONS:

Parental HRQOL at 6 weeks after surgery contributes to child HRQOL at 6 months, among those with the severest types of morbidity, and as such should be a target for future interventions.
Adolescent Drug Ingestions Requiring ICU Stay: Single-Center Retrospective Cohort Study
Authors: Titus Lauren , Kosasih Matthew , Liegl Melodee , Pan Amy , Porada Kelsey , McFadden Vanessa
Published: February 2023

OBJECTIVES:

Ingestions are a prevalent form of self-harm in teenagers and are unfortunately an increasingly common reason for admission to both acute care and critical care services. The goal of this study was to identify characteristics associated with requiring PICU stay among adolescents hospitalized for ingestions.

DESIGN:

Retrospective cohort study comparing patients admitted to hospital medicine service and critical care service from January 2019 to December 2019.

SETTING:

Freestanding children’s hospital in the midwestern United States.

PATIENTS:

Adolescents 12–18 years old hospitalized for ingestion.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Out of 209 patients included in the study cohort, 95 required PICU admission. High-risk behaviors (having had sex or usage of alcohol, drugs, tobacco, or vaping) were endorsed by 190 of 209 patients (91%). We compared patient characteristics, ingestion history, workup, and pharmacological and PICU-specific interventions between patients hospitalized on the hospital medicine service and the PICU. We failed to identify an association between reason for ingestion, substance ingested, and previously identified suicide risk factors including previous suicide attempt, previous self-harm, and psychiatric comorbidity and admission to PICU, as opposed to non-PICU admission. PICU stay was associated with longer peak corrected QT interval value, receiving a pharmacological intervention, and longer duration of hospital stay. Fifteen of 95 patients (16% [95% CI, 9–25%]) in the PICU received a PICU-specific intervention.

CONCLUSIONS:

We failed to identify specific patient demographics or mental behavioral health characteristics associated with PICU stay after ingestion. Therefore, we believe that all adolescents hospitalized due to ingestion—irrespective of disposition—should receive standardized high-risk behavior screening due to the pervasive nature of these behaviors among this patient population. PICU-specific care, beyond observation, could be needed in as high as one-in-four PICU admissions. Further research is needed to inform optimal disposition and resource allocation for this patient population.
Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial
Authors: Olszewski Aleksandra E. , Dervan Leslie A. , Smith Mallory B. , Asaro Lisa A. , Wypij David , Curley Martha A. Q. , Watson R. Scott
Published: February 2023

OBJECTIVES:

To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation.

DESIGN:

Nonprespecified secondary analysis of a randomized clinical trial.

SETTING:

Thirty-one U.S. PICUs.

PATIENTS:

Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov) over 8 years old who completed PTSD screening 6 months after discharge.

INTERVENTIONS:

RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care.

MEASUREMENTS AND MAIN RESULTS:

PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork (n = 18, 58%) and happiness (n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family’s residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3–458.1 and $40,000–$79,999 OR, 15.6; 95% CI, 1.3–182.8), renal dysfunction (OR 5.3, 95% CI 1.7–16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9–35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen.

CONCLUSIONS:

Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.
Pediatric Croup Due to Omicron Infection Is More Severe Than Non-COVID Croup
Authors: Scribner Camille , Patel Kavita I. , Tunik Michael
Published: February 2023

Objective

Croup due to infection with the omicron variant of COVID is an emerging clinical entity, but distinguishing features of omicron croup have not yet been characterized. We designed a study to compare the clinical features of croup patients presenting to the pediatric emergency department pre-COVID pandemic with COVID-positive croup patients who presented during the initial omicron surge.

Methods

This was a retrospective observational cohort study of children 0 to 18 years old who presented to our urban, tertiary care pediatric emergency department with symptoms of croup. The study compared a cohort of croup patients who presented in the year before the onset of the COVID pandemic to a cohort of COVID-positive croup patients who presented during the initial omicron surge. The primary outcomes included illness severity and treatments required in the emergency department. The secondary outcome was hospital admission rate.

Results

There were 499 patients enrolled in the study, 88 in the omicron croup cohort and 411 in the classic croup cohort. Compared with the classic croup patients, omicron croup patients were more likely to present with stridor at rest (45.4% vs 31.4%; odds ratio [OR], 1.82; confidence interval [CI], 1.14–2.91) and hypoxia (3.4% vs 0.5%; OR, 7.22; CI, 1.19–43.86). Omicron croup patients required repeat dosing of inhaled epinephrine in the emergency department more often (20.4% vs 6.8%; OR, 3.51; CI, 1.85–6.70), and they were more likely to require respiratory support (9.1% vs 1.0%; OR, 10.18; CI, 2.99–34.60). Admission rates were significantly higher for omicron croup patients than for classic croup patients (22.7% vs 3.9%; OR, 7.26; CI, 3.58–14.71), and omicron croup patients required intensive care more frequently (5.7% vs 1.5%; OR, 4.07; CI, 1.21–13.64).

Conclusions

Pediatric patients with omicron croup develop more severe disease than do children with classic croup. They are more likely to require additional emergency department treatments and hospital admission than patients with croup before the COVID pandemic.