bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary Vein Stenosis: A Review
Authors: Jia Mengfei , Wang Juan , Jiang Kaiyu , Su Hongling , Li Yu , Guo Zhaoxia , Zhu Hai , Wang Aqian , Pan Xin , Cao Yunshan
Published: February 2023

Pulmonary vein stenosis (PVS) is an extremely rare and lethal disease caused by multiple etiologies. PVS has a bimodal distribution in the population, affecting children and adults. Congenital PVS is the usual PVS type in children, which sometimes develops after cardiothoracic surgery. Acquired PVS, in turn, is the most common PVS type in adults. A review of the relevant literature has shown that PVS after radiofrequency ablation of atrial fibrillation is the most common, as well as that caused by compression of proliferative fibrous tissues or tumor in the mediastinum (eg, PVS caused by fibrosing mediastinitis, lung tumors, metastases, etc). This article provides a comprehensive review of PVS in terms of embryology and anatomy, etiology and triggers, classification, clinical symptoms and signs, treatment, and prognosis, intending to promote the understanding and treatment of this disease.
Successful Stenting for Pulmonary Vein Thrombosis Complicating Pulmonary Vein Stenosis Following Atrial Fibrillation Ablation: A Case Report
Authors: Li Yanjie , Ma Lan , Pan Xin , Wang Cheng
Published: February 2023

Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of pulmonary tumors, lung lobectomy, and atrial fibrillation ablation. Although it is a potentially life-threatening condition, it is easily misdiagnosed because of non-specific symptoms and its characteristics on imaging modalities. Here, we report a case of thrombotic occlusion at the ostium of the left superior pulmonary vein resulting from pulmonary vein stenosis following radiofrequency ablation for atrial fibrillation. This report extends the available approach with anticoagulant therapy and interventional angioplasty to pulmonary vein thrombosis secondary to pulmonary vein stenosis.
Designing a Checklist for Directly Observing Use of One-Minute Preceptor Steps on Inpatient Rounds: A Pilot Study
Authors: Puri Aditi , Lee Cheryl K. , Feinglass Joseph M. , Chen Yeh , Lee Jungwha , Miller Corinne H. , Peterson Jonna , Didwania Aashish K.
Published: February 2023

Background:

“One-minute preceptor” (OMP) is a well-established educational technique; however, primary literature on OMP lacks a tool to assess behavioral change after delivery of curricula.Primary aim of this pilot study was to design a checklist for direct observation of teachers using OMP on general medicine rounds and obtain inter-rater reliability evidence for the checklist.

Methods:

This study pilots an internally designed 6-item checklist to assess change in directly observed behavior. We describe the process of developing the checklist and training the observers. We calculated a percent agreement and Cohen's kappa to assess inter-rater reliability.

Results:

Raters had a high percent agreement ranging from 0.8 to 0.9 for each step of OMP. Cohen's kappa ranged from 0.49 to 0.77 for the five OMP steps. The highest kappa obtained was for getting a commitment (κ = 0.77) step, whereas the lowest agreement was for correcting mistakes (κ = 0.49).

Conclusion:

We showed a percent agreement ≥0.8 and moderate agreement based on Cohen's kappa with most steps of OMP on our checklist. A reliable OMP checklist is an important step in further improving the assessment and feedback of resident teaching skills on general medicine wards.
Maternal treatment with aripiprazole prevents the development of a valproic acid-induced autism-like phenotype in juvenile male mice
Authors: de Oliveira Ferreira Emerson , Pessoa Gomes Jéssica Maria , Neves Kelly Rose Tavares , Lima Francisco Arnaldo Viana , de Barros Viana Glauce Socorro , de Andrade Geanne Matos
Published: February 2023

Autism spectrum disorder (ASD) describes a heterogeneous group of neurodevelopmental conditions characterized by deficits in social communication and repetitive behaviors. Aripiprazole (APZ) is an atypical antipsychotic that can safeguard mice against autism-like behavior induced by valproic acid (VPA). In the present study, we examined the effects of maternal treatment with APZ (10 mg/kg) in juvenile mice prenatally exposed to VPA on neurodevelopmental behaviors, social interactions, communication, and working memory, as well as synaptophysin (SYP), synaptosomal-associated protein, 25 kDa (SNAP-25) and microtubule-associated protein 2 (MAP-2) expression in the medial prefrontal cortex (mPFC) and cell viability in the hippocampus. In addition, to evaluate possible APZ interference with the anticonvulsant properties of VPA on pentylenetetrazole (PTZ)-induced seizures were evaluated. Maternal treatment with APZ significantly prevented body weight loss, self-righting, eye-opening, social interactions, social communication, and working memory deficits in mice prenatally exposed to VPA. Additionally, the decrease in the SYP, SNAP-25, and MAP-2 expressions in the mPFC and cell death in the hippocampus was prevented by APZ. Furthermore, APZ (10 mg/kg) did not interfere with the anticonvulsant effect of VPA (15 mg/kg) in animals with PTZ-induced seizures. These findings indicate that maternal treatment with APZ in pregnant mice exposed to VPA protects animals against the ASD-like behavioral phenotype, and this effect may be related, at least in part, to synaptic plasticity and neuronal protection in the PFC and hippocampus. APZ may serve as an effective pharmacological therapeutic target against autistic behaviors in the VPA animal model of ASD, which should be further investigated to verify its clinical relevance.
Association of the ACE and AGT gene polymorphisms with global disparities in COVID-19-related deaths
Authors: Saab Yolande B. , Nakad Zahi S. , Mehanna Stephanie J.
Published: February 2023

Objective

The aim of the study was to investigate the gene polymorphisms of angiotensin-converting enzyme (ACE), angiotensinogen (AGT), and angiotensin type 1 receptor (AT1R) in association with coronavirus disease 2019 (COVID-19) mortality rates worldwide.

Methods

The prevalence of ACE I/D, AGT M235T, and AT1R A1166C alleles’ frequencies in different populations was assessed. Data on COVID-19-related cases and deaths were acquired from the European Center for Disease Prevention and Control, which included weekly reports by country and continent. An Excel tool was developed to visualize the acquired data of mortality and incidence by classifying them by continent/country across specific periods of time. Spearman’s nonparametric correlation was used to evaluate the association between country-based frequencies in RAS gene polymorphisms and COVID-19-related deaths.

Results

While China constituted the initial reservoir of COVID-19, incidence/mortality rates in Europe and America outnumbered the figures in the former. A clear association was identified between death rates and ACE D/I (r = 0.3659; P = 0.033), as well as AGT A/G variants (r = 0.7576; P = 0.015). Data on AT1R polymorphisms suggested no correlation with mortality rates.

Conclusion

Our results demonstrated a significant disparity in COVID-19-related susceptibility and mortality among different populations and corroborate the importance of gene polymorphisms in predicting and consequently improving patients’ outcomes.
Pharmacogenetic impact of SLC22A1 gene variant rs628031 (G/A) in newly diagnosed Indian type 2 diabetes patients undergoing metformin monotherapy
Authors: Singh Shalini , Shukla Ashwin Kumar , Usman Kauser , Banerjee Monisha
Published: February 2023

Objectives

Type 2 diabetes (T2D) imposes an enormous burden all over the world in both developed and developing countries. Inter-individual differences are attributed to polymorphisms in candidate genes resulting in altered absorption, transportation, distribution, and metabolism of oral antidiabetic drugs (OADs). Hence, the present study was undertaken to evaluate the pharmacogenetic impact of SLC22A1 gene variant rs628031 (G/A) on metformin monotherapy in newly diagnosed untreated T2D patients.

Methods

Newly diagnosed T2D patients (n = 500) were enrolled according to inclusion/exclusion criteria. Initially, enrolled subjects were prescribed metformin monotherapy and followed up for at least 12 weeks. Response to metformin was evaluated in 478 patients who revisited for follow-up by measuring HbA1c.

Result

Out of 478 patients, 373 were responders to metformin monotherapy while 105 were non-responders. The pharmacogenetic impact was evaluated by genotype, haplotype, and pharmacogenetic analyses. ‘GG’ genotype and ‘G’ allele of SLC22A1 rs628031 G/A were observed in 48.8% and 67.7% of Met responders, respectively, while 20.9% and 49.1 % were in non-responders. Therefore, there was a 2.18-fold increase in the success rate of Met therapeutics.

Conclusion

Individuals carrying the ‘GG’ genotype or ‘G’ allele for SLC22A1 gene variant rs628031 G/A are better responders for Metformin monotherapy.
Macular Thickness After Ultrathin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty Combined With Cataract Surgery: A Randomized Controlled Clinical Trial
Authors: Molbech Madsen Morten Brok , Ivarsen Anders , Hjortdal Jesper
Published: February 2023

Purpose:

The aim was to investigate alterations in central retinal thickness (CRT) and their implications for visual acuity after ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) combined with cataract surgery.

Methods:

A total of 72 eyes of 72 patients with Fuchs endothelial dystrophy and cataract were included and equally randomized to either UT-DSAEK or DMEK. A control group of 40 eyes of 40 patients with cataract were included for cataract surgery. All participants were examined preoperatively as well as 3 and 6 months postoperatively.

Results:

There was no significant difference in CRT between the study groups after surgery (P = 0.896). A significant difference in best-corrected visual acuity (BCVA) progression over time was found between the study groups (P < 0.0001). Average improvements of 8.03 EDTRS after UT-DSAEK (P < 0.001) and 16.77 EDTRS after DMEK (P < 0.001) were found 6 months postoperatively. No significant correlation was found between the change in BCVA and CRT from baseline to 3 months postoperatively (r2 < 0.0001, P = 0.96) and from baseline to 6 months postoperatively (r2 = 0.0053, P = 0.46).

Conclusions:

CRT was not altered by UT-DSAEK, DMEK, or cataract surgery 3 and 6 months postoperatively. BCVA significantly improved 3 and 6 months after UT-DSAEK and DMEK, respectively. No significant correlations were found between the change in BCVA and CRT postoperatively. As such CRT alterations were comparable after UT-DSAEK, DMEK, and cataract surgery.
Outcomes of Combined Penetrating Keratoplasty and Limbal Stem Cell Transplantation: A Meta-Analysis on Simultaneous Versus Sequential Surgery
Authors: Giachos Ioannis , Angelidis Constantine D. , Doumazos Spyros , Tzavara Chara , Palioura Sotiria
Published: February 2023

Purpose:

The objective of this study is to perform a systematic review and meta-analysis of the published studies on limbal stem cell transplantation (LSCT) combined with penetrating keratoplasty (PK) performed either simultaneously or sequentially.

Methods:

An extensive search was conducted in the MEDLINE and Google Scholar databases. Prospective and retrospective trials and case series reporting on the outcomes of LSCT with PK were included. Primary outcomes were the stability of the ocular surface and the rejection and/or failure of the corneal graft.

Results:

A total of 209 eyes from 13 studies were included in the simultaneous group and 489 eyes from 33 studies in the sequential group. Ocular surface stability was 88% [95% confidence interval (CI), 79%–96%] for sequential cases and 64% (95% CI, 43%–82%) for simultaneous cases (P = 0.001). The graft failure rate was 15% (95% CI, 6%–26%) for sequential cases and 44% (95% CI, 31%–58%) for simultaneous cases (P < 0.001). For cases performed sequentially, subgroup analysis revealed a stable ocular surface in 97% (95% CI, 91%–100%) of autograft cases and 63% (95% CI, 45%–80%) of allograft cases (P < 0.001). The graft failure rate in sequential cases was 7% (95% CI, 0%–18%) for autografts and 34% (95% CI, 18%–52%) for allografts (P < 0.001).

Conclusions:

Sequential LSCT followed by PK demonstrated superior results in terms of ocular surface stability and graft retention compared with simultaneous LSCT and PK. Limbal stem cells of autologous origin fare better than allogeneic ones in sequential cases.
Comparison of Subjective Responses to Cyclosporine 0.05% Versus Lifitegrast 5.0% in Individuals With Dry Eye Disease
Authors: Locatelli Elyana Vittoria Tessa , Acuna Kelly Ann , Betz Jason , Tovar Arianna Alicia , Galor Anat
Published: February 2023

Purpose:

The aim of the study was to examine subjective responses to cyclosporine A (CsA) 0.05% versus lifitegrast 5% in individuals with dry eye disease.

Methods:

This study was a retrospective review of individuals with clinically diagnosed dry eye disease treated with both CsA 0.05% and lifitegrast 5% over the course of their disease. Information collected included demographics, comorbidities, and dry eye disease signs. Treatment preferences were noted as mild or strong for a particular medication, no preference, or unable to tolerate either medication. The primary outcome measure was patient-reported medication preference. The secondary outcome measure was an examination of individual and eye factors that related to medication preference.

Results:

Sixty-four individuals (mean age 66.73 ± 13.17 years; 82.8% male, 71.9% White, 29.7% Hispanic) used both CsA and lifitegrast over the course of their disease. Of those, 33 preferred CsA (12.5% mildly and 39.1% strongly), 14 preferred lifitegrast (3.1% mildly and 18.8% strongly), 12 had no preference (18.8%), and 5 could not tolerate either medication (7.8%) due to side effects. No demographic characteristics, comorbidities, or ocular surface findings correlated with medication preference.

Conclusions:

In individuals who used both CsA 0.05% and lifitegrast 5% over the course of their disease, a higher frequency of individuals preferred CsA. No clinical factors correlated with medication preference.
Pseudomonas Bacteremia in Children: Clinical and Microbiologic Features and Risk Factors of Mortality: A Retrospective Cohort Study
Authors: Abu Shqara Rozeen , Kassis Imad , Damouni Shalabi Ranaa , Dabaja Younis Halima
Published: February 2023

Background:

Pseudomonas bacteremia is most commonly acquired in hospital. The aim of this study was to investigate the clinical features and antibiotic susceptibility, mortality rate and risk factors of mortality in children with Pseudomonas bacteremia.

Methods:

A retrospective cohort study that included children 18 years of age or younger admitted to a tertiary hospital with Pseudomonas bacteremia between 2005 and 2020.

Results:

A total of 196 patients with Pseudomonas bacteremia were identified. The proportional rate of Pseudomonas bacteremia was 33.9/100,000 hospital days. Underlying disease was documented in 81.1% of patients, 61% had hemato-oncological disease. Pseudomonas bacteremia was healthcare related in 180 (91.8%) episodes. Multidrug-resistant (MDR) Pseudomonas accounted for 16 (8.2%) and difficult-to-treat organism to 3 (1.5%) of all isolates. Thirty-day mortality was reported in 27 (13.8%) patients, all had Pseudomonas aeruginosa. In multivariate regression analysis, the first model showed that younger age [P = 0.038, odds ratio (OR) = 1.095, 95% confidence interval (CI): 1.005–1.192] and inappropriate empiric antibiotic treatment (P = 0.004, OR = 3.584, 95% CI: 1.490–8.621) were significantly associated with higher mortality. The second model also showed higher morality in younger age (P = 0.021, OR = 1.114, 95% CI: 1.016–1.221) and MDR isolates (P = 0.001, OR = 9.725, 95% CI: 2.486–38.039).

Conclusions:

Significant morbidity and mortality due to Pseudomonas bacteremia, but relatively lower mortality than previously published. Although young age, MDR isolates and inappropriate antibiotic treatment have been associated with increased mortality, these factors, especially with low prevalence of MDR isolates, may reflect the baseline mortality rate in vulnerable hosts with continuous contact with healthcare facilities facing such severe infection, and more efforts should be made to emphasize infection control practices to prevent such severe infection.
Indirect Rectus Femoris Injury Mechanisms in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings
Authors: Jokela Aleksi , Mechó Sandra , Pasta Giulio , Pleshkov Pavel , García-Romero-Pérez Alvaro , Mazzoni Stefano , Kosola Jussi , Vittadini Filippo , Yanguas Javier , Pruna Ricard , Valle Xavier , Lempainen Lasse
Published: February 2023

Objective:

To describe injury mechanisms and magnetic resonance imaging (MRI) findings in acute rectus femoris (RF) injuries of soccer players using a systematic video analysis.

Design:

Descriptive case series study of consecutive RF injuries from November 2017 to July 2022.

Setting:

Two specialized sports medicine hospitals.

Participants:

Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after a RF injury, with an available video footage of the injury and a positive finding on an MRI.

Independent Variables:

Rectus femoris injury mechanisms (specific scoring based on standardized models) in relation to RF muscle injury MRI findings.

Main Outcome Measures:

Rectus femoris injury mechanism (playing situation, player/opponent behavior, movement, and biomechanics), location of injury in MRI.

Results:

Twenty videos of RF injuries in 19 professional male soccer players were analyzed. Three different injury mechanisms were seen: kicking (80%), sprinting (10%), and change of direction (10%). Isolated single-tendon injuries were found in 60% of the injuries. Of the kicking injuries, 62.5% included complete tendon ruptures, whereas both running injuries and none of the change of direction injuries were complete ruptures. The direct tendon was involved in 33% of the isolated injuries, and the common tendon was affected in all combined injuries.

Conclusions:

Rectus femoris injuries typically occur during kicking among football players. Most of the RF injuries involve a complete rupture of at least one tendon. Kicking injuries can also affect the supporting leg, and sprinting can cause a complete tendon rupture, whereas change of direction seems not to lead to complete ruptures.
Agreement Between Dual-Energy X-ray Absorptiometry and Bioelectric Impedance Analysis for Assessing Body Composition in Athletes: A Systematic Review and Meta-Analysis
Authors: Dzator Stephen , Weerasekara Ishanka , Shields Melissa , Haslam Rebecca , James Daphne
Published: February 2023

Objective:

To compare dual-energy x-ray absorptiometry (DXA) and bioelectric impedance analysis (BIA) in the assessment of body composition in athletes.

Data Sources:

A systematic review and meta-analysis was conducted collating peer-reviewed studies that compared BIA with DXA for the assessment of body composition in athletes that indexed in MEDLINE, CINAHL, EMBASE, and PsycINFO databases.

Main Results:

After duplicate removal, 267 articles remained for full-text screening. Sixty-three studies remained for the final inclusion, with 8 focused on athletes (n = 461). Five studies were included in the meta-analysis and were rated as positive after risk of bias assessment, whereas the remaining were neutral. BIA overestimated fat-free mass (FFM) over DXA 2.78 (1.38-4.18) (mean difference ± 95% CI) with an effect size of 3.9(P < 0.001).

Conclusions:

BIA was found to overestimate total FFM when compared with DXA. Correlations are high between BIA and DXA; however, the limits of agreement are wide. Hence, BIA may not be a suitable substitute for DXA body composition scanning of athletes. Because of the low level of ionizing radiation exposure, the use of DXA should always be medically justified, and therefore, it is not recommended for repeat, longitudinal measurements in healthy subjects.

We recommend that clinicians do not use BIA interchangeably with DXA in the assessment of body composition in athletes. Considerations should be made over the safety and appropriateness of DXA in young healthy adults. For long-term use, BIA can be warranted for athletes.

PROSPERO Registration Number: CRD42020183777
Field Hockey–Related Injuries Treated in US Emergency Departments, 2000 to 2020
Authors: White Elizabeth R. , McAdams Rebecca J. , Roberts Kristin J. , McKenzie Lara B.
Published: February 2023

Objective:

To describe the epidemiology of field hockey–related injuries of patients aged 6 to 24 years who were treated in US emergency departments from 2000 to 2020.

Design:

The researchers conducted a retrospective analysis using data from the National Electronic Injury Surveillance System (NEISS).

Setting:

The NEISS collects data on recreational activity–related and consumer product–related injuries treated in US Eds.

Patients:

Patients aged 6 to 24 years who were treated for field hockey-related injuries in Eds from 2000 to 2020.

Independent Variables:

The researchers analyzed characteristics that included age, body part injured, injury diagnosis, disposition from the ED, injury locale, injury mechanism, contact, and equipment type.

Main Outcome Measures:

All cases of field hockey–related injuries were identified using the NEISS product code for field hockey (1295).

Results:

There were an estimated 82 639 (95% CI = 45 536-119 742) field hockey–related injuries for patients aged 6 to 24 years treated in US emergency departments from 2000 to 2020. The rate of field hockey–related injuries per 100 000 population did not significantly change from 7.4 in 2000 to 7.4 in 2011 (slope = 0.048; P = 0.581) but significantly decreased from 7.4 in 2011 to 3.7 in 2019 (slope = −0.40; P = 0.018). As player age increased, the risk of injury due to contact with equipment increased (

13 years: RR = 0.90; 95% CI = 0.82-0.98, 19-24 years: RR = 1.17; 95% CI = 1.06-1.29). Concussions or traumatic brain injuries accounted for 9.2% of injuries and were most associated with contact with the ball.

Conclusion:

Although there was a decrease in the field hockey–related injuries, field hockey remains an important source of injuries for children and young adults.
The Psychological Impacts of Taking Physiotherapy Teaching Online in 2020: What Did We Learn?
Authors: Bampton Julie , Tang Clarice Y. , McKay Marnee J. , Paul Serene S. , Allen Natalie E. , Darwell Christina , Frawley Jessica , Dennis Sarah
Published: February 2023

Introduction.

The rapid shift to online learning due to the COVID-19 pandemic presented challenges for physical therapy (PT) education worldwide. This article aims to explore the factors influencing the well-being of the PT faculty and department chairs involved in delivering PT programs during the initial stages of the COVID-19 pandemic.

Review of Literature.

The literature has focused on the pedagogical impacts of the rapid shift to online learning. Little is known about the social and psychological impacts of this rapid transition on the well-being of the faculty involved in implementing PT programs.

Subjects.

Physical therapy faculty and department chairs at 3 universities in metropolitan Sydney, Australia who taught into or led PT programs in 2020.

Methods.

Focus group methodology was used to explore the experiences of PT faculty and department chairs during the initial stages of the COVID pandemic. The focus groups were digitally recorded and transcribed verbatim and the transcripts analyzed thematically.

Results.

The main finding of this study was the extent of stress experienced by PT program faculty and chairs during this period. Both work-related institutional and faculty factors and non–work-related personal factors contributed to perceived high levels of stress. Overall, there was a feeling that the stressors had not improved over the duration of the pandemic and that this had left the faculty and chairs feeling more fatigued, less collegiate, and may have ongoing impacts on their mental health.

Discussion.

The pandemic created stresses for faculty and program chairs over and above the usual stress of faculty and college work. The reality of taking steps to reduce the stressors in the current climate is very difficult.

Conclusion.

Moving forward, it is vital to secure increased institutional support, including the support for creating realistic boundaries without the risk of penalty, to address the psychological health and well-being of PT faculty and chairs to enable high-quality education in the future.
Learning and Study Strategies of Students in the First Year of an Entry-Level Physical Therapist Program
Authors: Scales Melissa H. , Vallabhajosula Srikant
Published: February 2023

Introduction.

The learning and study strategies of entry-level physical therapist (PT) students may not be as effective as those needed for success in an entry-level PT education program. The Learning and Study Strategies Inventory, third edition (LASSI) is a reliable tool to assess learning and study strategies. The purpose of this study was to assess the learning and study strategies of first-year PT students and if the strategies change over the first year.

Review of Literature.

There is little research on using the LASSI with PT students; however, the LASSI has been used with other health care professional students.

Subjects.

The participants (n = 211) were from 5 cohorts of PT students in their first year of an entry-level PT education program.

Methods.

In the first week of the curriculum the students took the LASSI in class. The results were released individually to each student. No intervention was provided. At the end of the first year, the students retook the LASSI. Paired samples t-tests were run to determine whether the 10 subtest mean percentile scores changed significantly from baseline to follow-up and how they compared to established LASSI benchmarks.

Results.

Six subtest scores, Anxiety, Attitude, Concentration, Information Processing, Selecting Main Ideas, and Test Strategies, showed significant changes (P ≤ .005) from baseline to follow-up. However, all subtest averages fell below the 75th percentile mark, which is reported as the threshold requiring reflection to improve skills for learning and study strategies.

Discussion and Conclusion.

Students, on average, may not have adequate learning and study strategies when they start an entry-level PT education program. The LASSI may be an effective tool to focus resources in a timely and proactive manner for those students who may need them. Determining the resources needed earlier may decrease the need for later remediation, attrition, or licensure examination failures.
Professional Experience Related to Self-Assessed Teaching Effectiveness Among Physical Therapist Clinical Instructors
Authors: Carmel Stacy , Kupczynski Lori , Groff Shannon , Bannon William
Published: February 2023

Introduction.

Physical therapist (PT) students learn through clinical practice with the supervision of a clinical instructor (CI). Clinical instructors have teaching, education, and practice experiences that can positively affect their self-assessed clinical teaching effectiveness (CTE), which may improve learning outcomes for students.

Review of Literature.

Identifying CI experiences, such as specific teaching, education, or practice expertise, as they relate to effective clinical teaching may be beneficial in the selection of PT CIs and allow instructors to focus on professional experiences that will elevate their self-assessed teaching abilities.

Subjects.

The study included 851 PTs from a large geographical area. The participants had varying educational, clinical, and professional experiences and each had been a CI for at least 1 student clinical education experience.

Methods.

Specific PT CI professional experiences associated with CTE were determined through a correlation study using quantitative data collected online through a validated survey instrument, the Clinical Teaching Effectiveness Questionnaire. This study examined degree earned, PT residency and PT fellowship training, the American Board of Physical Therapy Specialties (ABPTS), American Physical Therapy Association (APTA) Credentialed Clinical Instructor Program (CCIP) level 1 and level 2, years of clinical experience, number of students taught, and number of years of clinical teaching.

Results.

Results indicated that a higher level of self-assessed CTE was associated with ABPTS certification, CCIP level 1 and level 2, and a higher number of students mentored by a CI. Physical therapist residency training, PT fellowship training, years of clinical experience, and number of years of clinical teaching were not related to self-assessed CTE.

Discussion and Conclusion.

Specific teaching, clinical, and practice experiences were related to CTE. To increase PT CI CTE, CIs are encouraged to consider ABPTS certification, CCIP level 1 and level 2, and mentoring students regularly. The PT profession, APTA, and Doctor of Physical Therapy programs should support these endeavors.
Effects of an Ocrevus Rapid Infusion Protocol: A Literature Review and Quality Improvement Project
Authors: Brandt Courtney
Published: February 2023

The administration of Ocrevus, an infusion therapy for the treatment of multiple sclerosis, is time and labor intensive, leading to poor patient adherence, treatment delays due to scheduling issues, and significant staff workload. This problem worsened during the COVID-19 pandemic, which created scheduling difficulties due to space restrictions. A US Food and Drug Administration-approved rapid infusion protocol for Ocrevus decreases the infusion time by 1.5 hours per patient. The purpose of this project was to complete a literature review on rapid infusion protocols and analyze the effects of the Ocrevus rapid infusion protocol on 2 outcomes of interest: total visit time and infusion reaction rates. Data were collected using retrospective chart review and analyzed by comparing the results of each outcome to the same data points prior to the implementation of the project. Results found a statistically significant decrease in visit time, with no increase in infusion reaction rates. These findings support the implementation of this rapid Ocrevus infusion protocol in the outpatient setting with the potential to improve patient scheduling, patient satisfaction, and nursing workload, while maintaining patient safety.
Scoping Review of Early Intravenous Infiltration and Extravasation Detection Devices
Authors: Kamada Sneha , Mosier Rebecca , El-Khalili Taj , Triantis Sophia , Yang Robin
Published: February 2023

Failure to promptly detect intravenous (IV) infiltration can often lead to damaging effects, such as necrosis and compartment syndrome, which increase the length of hospital stay and cost of care. Currently, nurses periodically monitor the vascular access device (VAD) site and extremity for symptoms of swelling, blanching, and change in temperature. However, nurses are often unable to monitor the VAD site frequently enough to detect subtle symptoms that may present immediately following an infiltration or extravasation. Nurses need a highly sensitive way to rapidly detect IV infiltration to minimize the time between infiltration and intervention. This study reviews technologies with the potential to detect IV infiltration earlier and suggests priorities for future research in this area.
A Thematic Survey on the Reporting Quality of Randomized Controlled Trials in Rehabilitation: The Case of Multiple Sclerosis
Authors: Ventura Lucia , Moreno-Navarro Pedro , Martinez Gianluca , Cugusi Lucia , Barbado David , Vera-Garcia Francisco Jose , Kalron Alon , Dvir Zeevi , Deriu Franca , Manca Andrea
Published: February 2023

Background and Purpose:

Optimal reporting is a critical element of scholarly communications. Several initiatives, such as the EQUATOR checklists, have raised authors' awareness about the importance of adequate research reports. On these premises, we aimed at appraising the reporting quality of published randomized controlled trials (RCTs) dealing with rehabilitation interventions. Given the breadth of such literature, we focused on rehabilitation for multiple sclerosis (MS), which was taken as a model of a challenging condition for all the rehabilitation professionals.

A thematic methodological survey was performed to critically examine rehabilitative RCTs published in the last 2 decades in MS populations according to 3 main reporting themes: (1) basic methodological and statistical aspects; (2) reproducibility and responsiveness of measurements; and (3) clinical meaningfulness of the change.

Summary of Key Points:

Of the initial 526 RCTs retrieved, 370 satisfied the inclusion criteria and were included in the analysis. The survey revealed several sources of weakness affecting all the predefined themes: among these, 25.7% of the studies complemented the P values with the confidence interval of the change; 46.8% reported the effect size of the observed differences; 40.0% conducted power analyses to establish the sample size; 4.3% performed retest procedures to determine the outcomes' reproducibility and responsiveness; and 5.9% appraised the observed differences against thresholds for clinically meaningful change, for example, the minimal important change.

Recommendations for Clinical Practice:

The RCTs dealing with MS rehabilitation still suffer from incomplete reporting. Adherence to evidence-based checklists and attention to measurement issues and their impact on data interpretation can improve study design and reporting in order to truly advance the field of rehabilitation in people with MS.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A424).
Landscape Review of Mail-in Self-Collection, Programs for Sexually Transmitted Infections
Authors: Pontes Miya F. , Armington Gretchen , Fink Rachel , Gaydos Charlotte A. , Manabe Yukari C.
Published: February 2023

Background

Mail-in self-collection of samples with centralized reference laboratory sexually transmitted infection (STI) testing has been shown to be feasible with equivalent performance. Commercial, fee-for-service mail-in testing Web sites seem to be popular. These sites are currently unregulated by the US Food and Drug Administration.

Methods

To compile a list of US organizations offering mail-in testing for STIs/HIV, the phrases “mail-in STI testing” and “home STI testing” were entered into search engines. Supplementary information was collected by organization email or “Contact Us” submission.

Results

Information was collected from 20 programs in the United States offering STI mail-in, self-collection testing services. Five programs (25%) were free to consumers. Six organizations (30%) only offered prefixed kits (STIs tested could not be selected). Half of the organizations provided extragenital testing, 2 (10%) did not provide extragenital testing, and the 8 others (40%) did not clarify. Three organizations (15%) used their own laboratory, 11 (55%) did not provide laboratory information. One commercial laboratory provided services to 5 organizations.

Conclusions

Mail-in self-collection services are ubiquitous and exist in all states except 2; STI testing public health programs that offer testing at no cost to the consumer are only in 46% of states. Mail-in testing is likely a permanent fixture in sexual health services and will be an important component of a hybrid approach that complements that of static clinic services.
L1-CAM in Mucinous Ovarian Carcinomas and Borderline Tumors
Authors: Wiedenhoefer Rebekka , Schmoeckel Elisa , Grube Marcel , Sulyok Mihály , Pasternak Iana , Beschorner Christine , Greif Karen , Brucker Sara , Mayr Doris , Kommoss Stefan , Fend Falko , Staebler Annette , Fischer Anna K.
Published: February 2023

Mucinous ovarian carcinoma (MOC) is a rare histotype of primary ovarian carcinoma. Frequent pathogenic molecular alterations include mutations in KRAS, TP53, and overexpression of human epidermal growth factor receptor 2, but without having prognostic relevance. As L1-CAM (cell adhesion molecule) has previously shown prognostic relevance in other epithelial tumors of the female genital tract, we analyzed whether L1-CAM expression affected MOC prognosis. In addition, we investigated L1-CAM expression in mucinous borderline tumors (MBOTs) with and without adjacent MOC to identify its potential role in the pathogenesis of MOC. We examined a well-characterized collective of 39 MOCs by immunohistochemistry and compared their expression with clinicopathologic data. L1-CAM positivity was defined as any (even single-cell) positivity. Furthermore, we compared the L1-CAM expression in 20 MBOT regions adjacent to a MOC with that of 15 pure MBOTs. L1-CAM expression in MOC was significantly associated with recurrence, independent of tumor stage. Overall, 7/20 positive cases recurred versus 0/19 L1-CAM-negative cases (P=0.032), showing a significant difference in time to progression. Furthermore, the presence of at least 1 defined molecular alteration (L1-CAM, aberrant p53, or human epidermal growth factor receptor 2) was found more frequently in the MBOT regions adjacent to a MOC (14/20) than in pure MBOTs (3/15) (P=0.024). Expression of the tumor marker L1-CAM is frequent (51%) in MOC and is associated with tumor recurrence. The lack of L1-CAM may serve to characterize cases with a low risk of recurrence. Furthermore, the presence of specific molecular alterations in MBOTs is associated with adjacent carcinomas and may define potential pathways in tumor progression.
A Quality Improvement Initiative to Decrease Central Line–Associated Bloodstream Infections During the COVID-19 Pandemic: A “Zero Harm” Approach
Authors: Redstone Carol S. , Zadeh Maryam , Wilson Mary-Agnes , McLachlan Samantha , Chen Danny , Sinno Maya , Khamis Safiyya , Malis Kassia , Lui Flavia , Forani Steven , Scerbo Christina , Hutton Yuka , Jacob Latha , Taher Ahmed
Published: February 2023

Introduction

Central line–associated bloodstream infections (CLABSIs) are associated with significant patient harm and health care costs. Central line–associated bloodstream infections are preventable through quality improvement initiatives. The COVID-19 pandemic has caused many challenges to these initiatives. Our community health system in Ontario, Canada, had a baseline rate of 4.62 per 1000 line days during the baseline period.

Objectives

Our aim was to reduce CLABSIs by 25% by 2023.

Methods

An interprofessional quality aim committee performed a root cause analysis to identify areas for improvement. Change ideas included improving governance and accountability, education and training, standardizing insertion and maintenance processes, updating equipment, improving data and reporting, and creating a culture of safety. Interventions occurred over 4 Plan-Do-Study-Act cycles. The outcome was CLABSI rate per 1000 central lines: process measures were rate of central line insertion checklists used and central line capped lumens used, and balancing measure was the number of CLABSI readmissions to the critical care unit within 30 days.

Results

Central line–associated bloodstream infections decreased over 4 Plan-Do-Study-Act cycles from a baseline rate of 4.62 (July 2019–February 2020) to 2.34 (December 2021–May 2022) per 1000 line days (51%). The rate of central line insertion checklists used increased from 22.8% to 56.9%, and central line capped lumens used increased from 72% to 94.3%. Mean CLABSI readmissions within 30 days decreased from 1.49 to 0.1798.

Conclusions

Our multidisciplinary quality improvement interventions reduced CLABSIs by 51% across a health system during the COVID-19 pandemic.
Evaluation of National Patient Safety Implementation Framework in Selected Public Healthcare Facilities of Tamil Nadu: An Operational Research
Authors: Krishnamoorthy Yuvaraj , Govindan Dhanajayan , Rajaa Sathish , Sinha Isha , Kanth Krishna , Krishnan Murali , Samuel Gerald
Published: February 2023

Background

The Ministry of Health and Family Welfare has introduced the “National Patient Safety Implementation Framework” to ensure the patient safety at different levels of healthcare delivery system. However, there is limited effort made in evaluating the implementation status of this framework. Hence, we have performed the process evaluation of National Patient Safety Implementation Framework across the public healthcare facilities in Tamil Nadu.

Methods

This was a facility-level survey conducted by research assistants who visited 18 public health facilities across 6 districts of Tamil Nadu, India, for the purpose of documenting the presence of structural support systems and strategies to promote patient safety. We developed a tool for data collection based on the framework. It comprised a total of 100 indicators under the following domains and subdomains: structural support, systems for reporting, workforce, infection prevention and control, biomedical waste management, sterile supplies, blood safety, injection safety, surgical safety, antimicrobial safety, and COVID-19 safety.

Results

Only one facility (subdistrict hospital) belonged to the high-performing category with a score of 79.5 on the implementation of patient safety practices. About 11 facilities (4 medical colleges and 7 Government Hospitals) belonging to medium-performing category. The best-performing medical college had a score of 61.5 for patient safety practices. Six facilities (2 medical colleges, 4 Government Hospitals) belonged to low-performing category in terms of patient safety. The least-performing facilities (both subdistrict hospitals) had scores of 29.5 and 26 for patient safety practices, respectively. Because of COVID-19, there was a positive effect on biomedical waste management and infectious disease safety across all facilities. Most performed poor in the domain with structural systems to support quality and efficiency of healthcare and patient safety.

Conclusions

The study concludes that based on the current situation of patient safety practices in public health facilities, it will be difficult to perform full-fledged implementation of patient safety framework by the year 2025.
Respiratory metagenomics: route to routine service
Authors: Edgeworth Jonathan D.
Published: February 2023

Purpose of review

The coronavirus disease 2019 pandemic demonstrated broad utility of pathogen sequencing with rapid methodological progress alongside global distribution of sequencing infrastructure. This review considers implications for now moving clinical metagenomics into routine service, with respiratory metagenomics as the exemplar use-case.

Recent findings

Respiratory metagenomic workflows have completed proof-of-concept, providing organism identification and many genotypic antimicrobial resistance determinants from clinical samples in <6 h. This enables rapid escalation or de-escalation of empiric therapy for patient benefit and reducing selection of antimicrobial resistance, with genomic-typing available in the same time-frame. Attention is now focussed on demonstrating clinical, health-economic, accreditation, and regulatory requirements. More fundamentally, pathogen sequencing challenges the traditional culture-orientated time frame of microbiology laboratories, which through automation and centralisation risks becoming increasingly separated from the clinical setting. It presents an alternative future where infection experts are brought together around a single genetic output in an acute timeframe, aligning the microbiology target operating model with the wider human genomic and digital strategy.

Pathogen sequencing is a transformational proposition for microbiology laboratories and their infectious diseases, infection control, and public health partners. Healthcare systems that link output from routine clinical metagenomic sequencing, with pandemic and antimicrobial resistance surveillance, will create valuable tools for protecting their population against future infectious diseases threats.
Tumi Flap: A Novel Modification to Frontal Flap for Orbital Exenteration Defects
Authors: Ziegler Otto R. , Ozkan Burak , Gamio Andrea H.
Published: February 2023

Orbital exenteration remains a significant disfigurement in the face. Many reconstructive options were reported for one stage covering the defects. Local flaps are used primarily in elderly patients who are not candidates for microvascular procedures. Local flaps generally close the gap without achieving 3-dimensional adjustment perioperatively. Secondary procedures or shrinking by time are needed for better orbital adaptation. In this case report, we describe a novel frontal flap design influenced by a Tumi knife, an ancient Peruvian trepanation instrument. The design helps us to create a conic shape that can resurface the orbital cavity at the time of the operation.
Emergency department versus operating room intubation of patients undergoing immediate hemorrhage control surgery
Authors: Dunton Zachary , Seamon Mark J. , Subramanian Madhu , Jopling Jeffery , Manukyan Mariuxi , Kent Alistair , Sakran Joseph V. , Stevens Kent , Haut Elliott , Byrne James P.
Published: February 2023

BACKGROUND

Hemorrhage control surgery is an essential trauma center function. Airway management of the unstable bleeding patient in the emergency department (ED) presents a challenge. Premature intubation in the ED can exacerbate shock and precipitate extremis. We hypothesized that ED versus operating room intubation of patients requiring urgent hemorrhage control surgery is associated with adverse outcomes at the patient and hospital-levels.

METHODS

Patients who underwent hemorrhage control within 60 minutes of arrival at level 1 or 2 trauma centers were identified (National Trauma Data Bank 2017–2019). To minimize confounding, patients dead on arrival, undergoing ED thoracotomy, or with clinical indications for intubation (severe head/neck/face injury or Glasgow Coma Scale score of ≤8) were excluded. Two analytic approaches were used. First, hierarchical logistic regression measured the risk-adjusted association between ED intubation and mortality. Secondary outcomes included ED dwell time, units of blood transfused, and major complications (cardiac arrest, acute respiratory distress syndrome, acute kidney injury, sepsis). Second, a hospital-level analysis determined whether hospital tendency ED intubation was associated with adverse outcomes.

RESULTS

We identified 9,667 patients who underwent hemorrhage control surgery at 253 trauma centers. Patients were predominantly young men (median age, 33 years) who suffered penetrating injuries (71%). The median initial Glasgow Coma Scale and systolic blood pressure were 15 and 108 mm Hg, respectively. One in five (20%) of patients underwent ED intubation. After risk-adjustment, ED intubation was associated with significantly increased odds of mortality, longer ED dwell time, greater blood transfusion, and major complications. Hospital-level analysis identified significant variation in use of ED intubation between hospitals not explained by patient case mix. After risk adjustment, patients treated at hospitals with high tendency for ED intubation (compared with those with low tendency) were significantly more likely to suffer in-hospital cardiac arrest (6% vs. 4%; adjusted odds ratio, 1.46; 95% confidence interval, 1.04–2.03).

CONCLUSION

Emergency department intubation of patients who require urgent hemorrhage control surgery is associated with adverse outcomes. Significant variation in ED intubation exists between trauma centers not explained by patient characteristics. Where feasible, intubation should be deferred in favor of rapid resuscitation and transport to the operating room.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.