bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine learning approaches for electronic health records phenotyping: a methodical review
Authors: Yang Siyue , Varghese Paul , Stephenson Ellen , Tu Karen , Gronsbell Jessica
Published: November 2022

Objective

Accurate and rapid phenotyping is a prerequisite to leveraging electronic health records for biomedical research. While early phenotyping relied on rule-based algorithms curated by experts, machine learning (ML) approaches have emerged as an alternative to improve scalability across phenotypes and healthcare settings. This study evaluates ML-based phenotyping with respect to (1) the data sources used, (2) the phenotypes considered, (3) the methods applied, and (4) the reporting and evaluation methods used.

Materials and methods

We searched PubMed and Web of Science for articles published between 2018 and 2022. After screening 850 articles, we recorded 37 variables on 100 studies.

Results

Most studies utilized data from a single institution and included information in clinical notes. Although chronic conditions were most commonly considered, ML also enabled the characterization of nuanced phenotypes such as social determinants of health. Supervised deep learning was the most popular ML paradigm, while semi-supervised and weakly supervised learning were applied to expedite algorithm development and unsupervised learning to facilitate phenotype discovery. ML approaches did not uniformly outperform rule-based algorithms, but deep learning offered a marginal improvement over traditional ML for many conditions.

Discussion

Despite the progress in ML-based phenotyping, most articles focused on binary phenotypes and few articles evaluated external validity or used multi-institution data. Study settings were infrequently reported and analytic code was rarely released.

Conclusion

Continued research in ML-based phenotyping is warranted, with emphasis on characterizing nuanced phenotypes, establishing reporting and evaluation standards, and developing methods to accommodate misclassified phenotypes due to algorithm errors in downstream applications.
The effects of self-viewing in video chat during interpersonal work conversations
Authors: Shin Soo Yun , Ulusoy Ezgi , Earle Kelsey , Bente Gary , Van Der Heide Brandon
Published: November 2022

With the growing use of video chat in daily life, it is critical to understand how visual communication channels affect interpersonal relationships. A potentially important feature that distinguishes video chats from face-to-face interactions is the communicators’ ability to see themselves during the interaction. Our purpose was to determine the effects of self-viewing on the process and outcome of a workplace confrontation. A dyadic experiment with two (self-viewing vs. no self-viewing) conditions was conducted using multi-instruments (self-report, physiological arousal, eye-tracking). Results showed that self-viewing reduced self-evaluation, which subsequently reduced solution satisfaction. Self-viewing also impaired one’s ability to assess their partner’s attitude and lowered partner evaluation. Although self-viewing decreased negative emotional expressions, the effect on conversation tone varied depending on the role an individual played. The overall negative impacts of self-viewing ability have significant implications for the appropriate implementation of a computer-mediated channel for enhancing one’s experience when having a difficult conversation.
Concurrent subglottic and carotid sheath haemangiomas in a paediatric patient – an extremely rare clinical entity
Authors: Dolan Sean , Alatsatianos Anton , McAllister Kerrie , Kunanandam Thushitha
Published: November 2022

Multiple haemangiomas of the head and neck area have been reported sporadically in the literature. Concurrent subglottic and carotid sheath haemangiomas have not been reported before in the paediatric population. The authors present the case of a 13-week-old child admitted under the paediatric ENT team with stridor. Diagnostic micro-laryngoscopy identified a subglottic haemangioma as the cause of stridor and subsequent magnetic resonance imaging demonstrated an incidental 7 cm carotid sheath lesion extending from the skull base to the superior mediastinum. Subsequent biopsy confirmed a benign infantile haemangioma. To our knowledge, this is the first reported case of concurrent subglottic and carotid sheath infantile haemangiomas in a paediatric patient. Here we discuss the clinical features and management of infantile haemangioma.
Effects of soil mitigation on lawn-dwelling invertebrates following residential development
Authors: Borden Matthew A , Benda Nicole D , Bean Eban Z , Dale Adam G
Published: November 2022

Residential areas are the most rapidly expanding land use type in the southeastern USA. Residential development impairs soil functions primarily through compaction and the removal or burial of topsoil and natural vegetation, which reduces water infiltration and retention, root penetration, and plant establishment. Plant stress reduces plant-derived ecosystem services and increases vulnerability to pests, often leading to supplemental management inputs in the form of irrigation, fertilizers, pesticides and labor. Soil-dwelling invertebrates, including detritivores and natural enemies of pests, drive valuable ecosystem functions that facilitate plant establishment and reduce maintenance inputs. Although poorly understood, soil disturbance during residential development likely disturbs these communities and reduces the services provided by soil-dwelling invertebrates. Here, we compare the effects of two soil compaction mitigation techniques, tillage with and without compost incorporation, on invertebrate communities and the services they provide over 2 years following residential development. We focus on the relationships between detritivores and detritus decomposition rates, entomopathogenic nematodes and the activity density of a key turfgrass pest and other arthropod herbivores and predators. We found that soil mitigation had no detectable benefit for epigeal arthropods within 1 year after disturbance, but that compost-amended soils supported greater arthropod richness and predator activity density than unmitigated soils in the second year after disturbance. In contrast, we found reduced insect-parasitic nematode activity associated with compost amendment. All taxa increased in abundance with time after development. These results can inform more sustainable residential development and landscape maintenance practices for more biodiverse and functional urban and residential ecosystems.
Exploring the single-pulse behaviours of PSR J0628+0909 with FAST
Authors: Hsu J A , Jiang J C , Xu H , Lee K J , Xu R X
Published: November 2022

More than 100 rotating radio transients (RRATs) have been discovered since 2006. However, it is unclear whether RRATs radiate in nulling states. PSR J0628+0909 has been classified as an RRAT. In this paper, we study the single pulses and integrated pulse profile of PSR J0628+0909 to check whether we can detect pulsed radio emission in the nulling states. We also aim to study the polarization of the RRAT and its relationship to the general pulsar population. We used the Five-hundred-meter Aperture Spherical radio Telescope (FAST) to observe PSR J0628+0909 in the frequency range from 1.0 to 1.5 GHz. We searched for strong single pulses and looked for pulsed emission in the RRAT nulling states. Polarization profiles, the single-pulse energy distribution, and waiting-time statistics were measured. The Faraday rotation measure and dispersion measure values are updated with the current observation. The single-pulse polarization behaviours show great diversity, similar to the case of pulsars. Based on the integrated pulse profile and single-pulse energy statistics, we argue that continuous pulsar-like emission exists in addition to the transient-like burst emission for PSR J0628+0909. We find that the pulse waiting time is not correlated with the pulse energy and conclude that the strong transient emission of RRAT is not generated by the energy store–release mechanism.
A targeted search for repeating fast radio bursts with the MWA
Authors: Tian J , Anderson G E , Hancock P J , Miller-Jones J C A , Sokolowski M , James C W , Bhat N D R , Swainston N A , Ung D , Meyers B W
Published: November 2022

We present a targeted search for low-frequency (144–215 MHz) fast radio burst (FRB) emission from five repeating FRBs using 23.3 h of archival data taken with the Murchison Widefield Array (MWA) voltage capture system (VCS) between 2014 September and 2020 May. This is the first time that the MWA VCS has been used to search for FRB signals from known repeaters, which enables much more sensitive FRB searches than previously performed with the standard MWA correlator mode. We performed a standard single-pulse search with a temporal and spectral resolution of $400\, \mu$s and 10 kHz, respectively, over a $100\, \text{pc}\, \text{cm}^{-3}$ dispersion measure (DM) range centred at the known DM of each studied repeating FRB. No FRBs exceeding a 6σ threshold were detected. The fluence upper limits in the range of 32–1175 and 36–488 Jy ms derived from 10 observations of FRB 20190711A and four observations of FRB 20201124A, respectively, allow us to constrain the spectral indices of their bursts to ≳−1 if these two repeaters were active during the MWA observations. If free–free absorption is responsible for our non-detection, we can constrain the size of the absorbing medium in terms of the electron temperature T to ${\lt} 1.00\times (T/10^4\,\text{K})^{-1.35}\, \text{pc}$, ${\lt} 0.92\times (T/10^4\,\text{K})^{-1.35}\, \text{pc}$, and ${\lt} [0.22\!-\!2.50]\times (T/10^4\,\text{K})^{-1.35}\, \text{pc}$ for FRB 20190117A, FRB 20190711A, and FRB 20201124A, respectively. However, given that the activities of these repeaters are not well characterized, our non-detections could also suggest they were inactive during the MWA observations.
Mock galaxy surveys for HST and JWST from the IllustrisTNG simulations
Authors: Snyder Gregory F , Peña Theodore , Yung L Y Aaron , Rose Caitlin , Kartaltepe Jeyhan , Ferguson Harry
Published: November 2022

We present and analyse a series of synthetic galaxy survey fields based on the IllustrisTNG simulation suite. With the IllustrisTNG public data release and JupyterLab service, we generated a set of 12 light-cone catalogues covering areas from 5 to 365 square arcmin, similar to several JWST Cycle 1 programs, including JADES, CEERS, PRIMER, and NGDEEP. From these catalogues, we queried the public application programming interface to generate simple mock images in a series of broad-band filters used by JWST-NIRCam and the Hubble Space Telescope cameras. This procedure generates wide-area simulated mosaic images that can support investigating the predicted evolution of galaxies alongside real data. Using these mocks, we demonstrate a few simple science cases, including morphological evolution and close pair selection. We publicly release the catalogues and mock images through MAST, along with the code used to generate these projects, so that the astrophysics community can use these products in their scientific analyses of JWST deep field observations.
Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands
Authors: Slim Marleen A , Appelman Brent , Peters-Sengers Hessel , Dongelmans Dave A , de Keizer Nicolette F , Schade Rogier P , de Boer Mark G J , Müller Marcella C A , Vlaar Alexander P J , Wiersinga W Joost , van Vught Lonneke A ,   NICE COVID-19 Research Consortium and the COVIDPredict study group, Appelman Brent , Schinkel Michiel , Beudel Martijn , Henry Ronald , Haspels-Hogervorst Esther K , Rusch Daisy , van den Oever Niels C Gritters , Simsek Suat , de Ruijter W , van Osch Frits H M , van den Bergh Joop P , de Kruif Martijn D , Douma Renee , de Haan Lianne R , Moeniralam Hazra , Brinkman Kees , Bokhizzou N
Published: November 2022

Background

Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive.

Methods

We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted.

Results

Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67–64 years; P < .001), in in-hospital mortality on the ward (21%–15%; P < .001), and a trend in the ICU (24%–16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22–1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03–1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69–0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality.

Conclusions

Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
TwoO-Methyltransferases from Phylogenetically Unrelated Cow Parsley (Anthriscus sylvestris) and Hinoki-Asunaro (Thujopsis dolabratavar.hondae) as a Signature of Lineage-Specific Evolution in Lignan Biosynthesis
Authors: Yamamura Masaomi , Kumatani Masato , Shiraishi Akira , Matsuura Yu , Kobayashi Keisuke , Suzuki Ayano , Kawamura Atsushi , Satake Honoo , Ragamustari Safendrri Komara , Suzuki Shiro , Suzuki Hideyuki , Shibata Daisuke , Kawai Shingo , Ono Eiichiro , Umezawa Toshiaki
Published: November 2022

O-Methyltransferases (OMTs) play important roles in antitumor lignan biosynthesis. To date, six OMTs catalyzing the methylation of dibenzylbutyrolactone lignans as biosynthetic precursors of antitumor lignans have been identified. However, there is still no systematic understanding of the diversity and regularity of the biosynthetic mechanisms among various plant lineages. Herein, we report the characterization of two OMTs from Anthriscus sylvestris and Thujopsis dolabrata var. hondae [designated as AsSecoNorYatein (SNY) OMT and TdSNYOMT] together with the six known OMTs to evaluate their diversity and regularity. Although A. sylvestris 5-O-methylthujaplicatin (SecoNorYatein) and 4-O-demethylyatein (NorYatein) OMT (AsSNYOMT) and TdSNYOMT accept 5-O-methylthujaplicatin and 4-O-demethylyatein as substrates, phylogenetic analysis indicated that these two OMTs shared low amino acid sequence identity, 33.8%, indicating a signature of parallel evolution. The OMTs and the six previously identified OMTs were found to be diverse in terms of their substrate specificity, regioselectivity and amino acid sequence identity, indicating independent evolution in each plant species. Meanwhile, two-entropy analysis detected four amino acid residues as being specifically acquired by dibenzylbutyrolactone lignan OMTs. Site-directed mutation of AsSNYOMT indicated that two of them contributed specifically to 5-O-methylthujaplicatin methylation. The results provide a new example of parallel evolution and the diversity and regularity of OMTs in plant secondary (specialized) metabolism.
Measuring and Explainingde factoRegional Policy Autonomy Variation in a Constitutionally Symmetrical Federation: The Case of Ethiopia, 1995–2020
Authors: Yimenu Bizuneh
Published: November 2022

This article measures regional policy autonomy and explains the factors that drive autonomy variation in land policy from 1995 to 2020, taking Ethiopia, the late twentieth-century adoption of federalism and a federation of very diverse regions, as a case. By comparing three regions, Benishangul-Gumuz, Oromia, and Southern Nations, Nationalities and Peoples, the article shows that de facto regional policy autonomy varies, although the regions are constitutionally symmetrical. Why do some regions have less de facto autonomy than others? Contrary to conventional expectations, party noncongruence appears less important in explaining the regional autonomy variation. Regional capacity, national integration goals and development objectives appear to have played a major role in generating de facto regional policy autonomy variation without a constitutional amendment. Regions lacking capacity and peripheral regions tend to face more centralization than others. Insights from Ethiopia imply that states embracing federalism should consider regional inequality in development and capacity in designing a federal constitution.
Trading on Talent: Human Capital and Firm Performance
Authors: Fedyk Anastassia , Hodson James
Published: November 2022

How is technically skilled human capital reflected in firm performance? We leverage a uniquely detailed employer–employee matched dataset to measure US firms’ technical human capital in information technology (IT), Software Engineering, Mobile Networks, Data Analysis, and Web Development. All five technical skillsets are associated with higher firm valuations. However, they negatively forecast both financial and operational performance in the future. For example, a one-standard-deviation increase in employees with IT skills corresponds to 2.2% higher Tobin’s q but predictable future returns of –10 basis points per month. Our results are stronger in tighter labor markets, in firms with more cash, and during time periods when each technical skillset is especially popular. These patterns suggest that the market expects too much from popular technologies, leading to over-valuation. Overall, our results highlight how corporate over-investment can extend to intangible capital such as skilled employees.
Physiological recovery of tree water relations upon drought release—response of mature beech and spruce after five years of recurrent summer drought
Authors: Hesse Benjamin D , Gebhardt Timo , Hafner Benjamin D , Hikino Kyohsuke , Reitsam Anna , Gigl Michael , Dawid Corinna , Häberle Karl-Heinz , Grams Thorsten E E
Published: November 2022

As climate change progresses, the frequency and duration of drought stress events are increasing. While the mechanisms of drought acclimation of trees has received considerable attention in recent years, the recovery processes remain critically understudied. We used a unique throughfall exclusion experiment in a mature temperate mixed forest consisting of the more isohydric Norway spruce and more anisohydric European beech, to study the recovery and resilience after drought release. We hypothesized that pre-dawn water potential (ΨPD) of both species will increase within 1 day after watering, while the recovery of stomatal conductance (gs) and the reversal of osmoregulation will be significantly delayed in the more isohydric spruce. Furthermore, we hypothesized that the xylem sap flow density (udaily) will not fully recover within the growing season due to the strong drought impact. After 5 years of summer drought, trees showed significantly reduced ΨPD, udaily and increased osmoregulation in leaves, but only isohydric spruce displayed increased leaf abscisic acid concentrations. In line with our hypothesis, ΨPD and gs recovered within 1 day in beech. Conversely, isohydric spruce showed delayed increases in ΨPD and gs. The delay in recovery of spruce was partially related to the replenishment of the stem water reservoir, as indicated by the missing response of udaily at the crown base compared with DBH level upon watering. However, udaily fully recovered only in the next growing season for beech and was still reduced in spruce. Nevertheless, in both species, osmotic acclimations of leaves were reversed within several weeks. While both species displayed full resilience to drought stress in water-related physiology, the recovery time was in several cases, e.g., udaily, ΨPD and gs, shorter for beech than for spruce. With future increases in the frequency of drought events under ongoing climate change, tree species that recover more quickly will be favored.
Bruising, hair loss, and stretch marks in a 23-year-old woman
Authors: Peters Sonya M.
Published: November 2022

This article describes a 23-year-old woman with bruising, hair loss, and stretch marks, which was found to be due to Cushing syndrome. Because of its nonspecific symptoms, this disease of hypercortisolism can be mistaken for other conditions.
Biologics for eosinophilic granulomatosis with polyangiitis
Authors: Caminati Marco , Maule Matteo , Bello Federica , Emmi Giacomo
Published: November 2022

Purpose of review

The link between severe asthma and eosinophilic granulomatosis with polyangiitis (EGPA) in terms of pathophysiological background, clinical manifestations and disease evolution has leaded to investigate the relevance of anti T2 monoclonal antibodies licensed for severe asthma patients as a treatment option for EGPA. The present review aimed to provide un update on EGPA pathophysiology and to critically summarize the most robust evidence coming from trials and real-life setting on the use of anti T2 biologics in EGPA patients.

Recent findings

Mepolizumab, an anti-interleukin-5 monoclonal antibody, is the only biologic drug targeting eosinophilic inflammation currently approved for EGPA treatment at the dose of 300 mg/4 weeks. Its use is restricted by the American College of Rheumatology guidelines to specific diseases phases and severity grades. However the most appropriate mepolizumab positioning and dose is still under investigation in the real life practice, which is providing an increasing amount of evidence confirming its efficacy, alone or in combination with other options in different disease stages. The relevance of other monoclonal antibodies interfering with T2 inflammation, including omalizumab and benralizumab, is under investigation but the evidence is still scarce

Taking into account the suboptimal medium-long term safety profile of conventional EGPA treatments, the opportunity of selectively targeting eosinophilic inflammation certainly represents a revolutionary approach. However, further real-word evidence is required to effectively position the new treatments in the light of the disease complexity, including different immunological drivers, and individual variability.
Ultrasound-guided Percutaneous Cryoneurolysis to Treat Chronic Postamputation Phantom Limb Pain: A Multicenter Randomized Controlled Trial
Authors: Ilfeld Brian M. , Smith Cameron R. , Turan Alparslan , Mariano Edward R. , Miller Matthew E. , Fisher Rick L. , Trescot Andrea M. , Cohen Steven P. , Eisenach James C. , Sessler Daniel I. , Prologo J. David , Mascha Edward J. , Liu Liu , Gabriel Rodney A. ,   the PAINfRE Investigators
Published: November 2022

Background

Postamputation phantom pain is notoriously persistent with few validated treatments. Cryoneurolysis involves the application of low temperatures to reversibly ablate peripheral nerves. The authors tested the hypothesis that a single cryoneurolysis treatment would decrease phantom pain 4 months later.

Methods

The authors enrolled patients with a lower-limb amputation and established phantom pain. Each received a single-injection femoral and sciatic nerve block with lidocaine and was subsequently randomized to receive either ultrasound-guided percutaneous cryoneurolysis or sham treatment at these same locations. The primary outcome was the change in average phantom pain intensity between baseline and 4 months as measured with a numeric rating scale (0 to 10), after which an optional crossover treatment was offered. Investigators, participants, and clinical staff were masked to treatment group assignment with the exception of the treating physician performing the cryoneurolysis, who had no subsequent participant interaction.

Results

Pretreatment phantom pain scores were similar in both groups, with a median [quartiles] of 5.0 [4.0, 6.0] for active treatment and 5.0 [4.0, 7.0] for sham. After 4 months, pain intensity decreased by 0.5 [–0.5, 3.0] in patients given cryoneurolysis (n = 71) versus 0 [0, 3] in patients given sham (n = 73), with an estimated difference (95% CI) of –0.1 (–1.0 to 0.7), P = 0.759. Following their statistical gatekeeping protocol, the authors did not make inferences or draw conclusions on secondary endpoints. One serious adverse event occurred after a protocol deviation in which a femoral nerve cryolesion was induced just below the inguinal ligament—instead of the sensory-only saphenous nerve—which resulted in quadriceps weakness, and possibly a fall and clavicle fracture.

Conclusions

Percutaneous cryoneurolysis did not decrease chronic lower extremity phantom limb pain 4 months after treatment. However, these results were based upon the authors’ specific study protocol, and since the optimal cryoneurolysis treatment parameters such as freeze duration and anatomic treatment location remain unknown, further research is warranted.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Postoperative Acute Kidney Injury by Age and Sex: A Retrospective Cohort Association Study
Authors: Privratsky Jamie R. , Fuller Matthew , Raghunathan Karthik , Ohnuma Tetsu , Bartz Raquel R. , Schroeder Rebecca , Price Thomas M. , Martinez Michael R. , Sigurdsson Martin I. , Mathis Michael R. , Naik Bhiken , Krishnamoorthy Vijay
Published: November 2022

Background

Acute kidney injury (AKI) after noncardiac surgery is common and has substantial health impact. Preclinical and clinical studies examining the influence of sex on AKI have yielded conflicting results, although they typically do not account for age-related changes. The objective of the study was to determine the association of age and sex groups on postoperative AKI. The authors hypothesized that younger females would display lower risk of postoperative AKI than males of similar age, and the protection would be lost in older females.

Methods

This was a multicenter retrospective cohort study across 46 institutions between 2013 and 2019. Participants included adult inpatients without pre-existing end-stage kidney disease undergoing index major noncardiac, nonkidney/urologic surgeries. The authors’ primary exposure was age and sex groups defined as females 50 yr or younger, females older than 50 yr, males 50 yr or younger, and males older than 50 yr. The authors’ primary outcome was development of AKI by Kidney Disease-Improving Global Outcomes serum creatinine criteria. Exploratory analyses included associations of ascending age groups and hormone replacement therapy home medications with postoperative AKI.

Results

Among 390,382 patients, 25,809 (6.6%) developed postoperative AKI (females 50 yr or younger: 2,190 of 58,585 [3.7%]; females older than 50 yr: 9,320 of 14,4047 [6.5%]; males 50 yr or younger: 3,289 of 55,503 [5.9%]; males older than 50 yr: 11,010 of 132,447 [8.3%]). When adjusted for AKI risk factors, compared to females younger than 50 yr (odds ratio, 1), the odds of AKI were higher in females older than 50 yr (odds ratio, 1.51; 95% CI, 1.43 to 1.59), males younger than 50 yr (odds ratio, 1.90; 95% CI, 1.79 to 2.01), and males older than 50 yr (odds ratio, 2.06; 95% CI, 1.96 to 2.17).

Conclusions

Younger females display a lower odds of postoperative AKI that gradually increases with age. These results suggest that age-related changes in women should be further studied as modifiers of postoperative AKI risk after noncardiac surgery.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Nonopioid Analgesic Prescriptions Filled after Surgery among Older Adults in Ontario, Canada: A Population-based Cohort Study
Authors: Jivraj Naheed K. , Ladha Karim S. , Goel Akash , Hill Andrea , Wijeysundera Duminda N. , Bateman Brian T. , Neuman Mark , Wunsch Hannah
Published: November 2022

Background

The objective was to assess changes over time in prescriptions filled for nonopioid analgesics for older postoperative patients in the immediate postdischarge period. The authors hypothesized that the number of patients who filled a nonopioid analgesic prescription increased during the study period.

Methods

The authors performed a population-based cohort study using linked health administrative data of 278,366 admissions aged 66 yr or older undergoing surgery between fiscal year 2013 and 2019 in Ontario, Canada. The primary outcome was the percentage of patients with new filled prescriptions for nonopioid analgesics within 7 days of discharge, and the secondary outcome was the analgesic class. The authors assessed whether patients filled prescriptions for a nonopioid only, an opioid only, both opioid and nonopioid prescriptions, or a combination opioid/nonopioid.

Results

Overall, 22% (n = 60,181) of patients filled no opioid prescription, 2% (n = 5,534) filled a nonopioid only, 21% (n = 59,608) filled an opioid only, and 55% (n = 153,043) filled some combination of opioid and nonopioid. The percentage of patients who filled a nonopioid prescription within 7 days postoperatively increased from 9% (n = 2,119) in 2013 to 28% (n = 13,090) in 2019, with the greatest increase for acetaminophen: 3% (n = 701) to 20% (n = 9,559). The percentage of patients who filled a combination analgesic prescription decreased from 53% (n = 12,939) in 2013 to 28% (n = 13,453) in 2019. However, the percentage who filled both an opioid and nonopioid prescription increased: 4% (n = 938) to 21% (n = 9,880) so that the overall percentage of patients who received both an opioid and a nonopioid remained constant over time 76% (n = 18,642) in 2013 to 75% (n = 35,391) in 2019.

Conclusions

The proportion of postoperative patients who fill prescriptions for nonopioid analgesics has increased. However, rather than a move to use of nonopioids alone for analgesia, this represents a shift away from combination medications toward separate prescriptions for opioids and nonopioids.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Implementation Science Toolkit for Clinicians
Authors: Reynolds Staci S. , Granger Bradi B.
Published: November 2022

Background

Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence.

Objective

Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects.

Methods

We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice.

Conclusions

Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.
The Value of Risk Rounding
Authors: Dagley Kristen
Published: November 2022

The practice of risk rounding serves as a routine contribution to a highly reliable organization, a culture of curiosity empowering all team members to speak up in real time, and provides insight into areas of uncertainty. Highly reliable organizations protect the time and the team member who disrupts the routine service delivery when a risk is identified. In a 16-week pilot study, staff nurses in a Manhattan cardiothoracic intensive care unit participated in risk rounding wherein the staff identified foreseeable risks in a neighboring patient room. The objective of the pilot study was to foster a culture of safety and improve preparedness for urgent or emergent clinical scenarios. The postsurvey demonstrated improvement in both objectives with potential secondary benefits such as improved patient experience scores and nursing-sensitive indicators.
Using Closed Incision Negative Pressure Therapy Specialty Dressings over Incisions following Sternal Dehiscence Reconstruction
Authors: Gabriel Allen , Chan Vivian , Caldarella Marissa , O’Rorke Erin
Published: November 2022

Background:

Surgical site complications (SSCs) after median sternotomy, such as deep sternal wound infection and sternal dehiscence, are rare but can be catastrophic. If undetected, there is an elevated risk of mortality. Reconstructive surgery consisting of debridement, sternectomy, and muscle flap coverage is widely used as standard of care for deep sternal wound infection.

Methods:

This was an observational, retrospective cohort study of patients with SSCs following index cardiothoracic procedures. A single surgeon performed chest wall reconstruction using muscle flaps followed by closed incision negative pressure therapy (ciNPT; −125 mm Hg) using a ciNPT specialty dressing with an expanded coverage area to resolve sternal defects. Dressing changes occurred every 7 days. Postoperative follow-up appointments occurred after 30 days.

Results:

Sixteen consecutive sternal reconstruction patients (six women and 10 men) with multiple comorbidities and an average age of 61.1 years were included in an initial evaluation of the ciNPT specialty dressing over median sternotomy incisions revised using flaps. The duration of ciNPT was 14 days with a single dressing change at day 7. At the initial dressing change, 93.8% of incisions were closed. Within 30 days postreconstruction, 18.8% of the patients had SSCs (hematoma or dehiscence). No seromas were noted. At 30-day follow-up appointments, 93.8% of incisions remained closed. Patients reported reduced pain and swelling. Average inpatient length of stay was 12.2 ± 14.2 days.

Conclusion:

In these patients, ciNPT using the ciNPT specialty dressing helped to facilitate positive healing outcomes in patients with deep sternal wound infections following sternal defect reconstruction post cardiothoracic surgery.
Guadalupe County Hospital: Facing Unique Social Challenges
Authors: Campos Christina R.
Published: November 2022

Social determinants of health (SDOHs) are the “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Healthy People 2030 2021). These conditions include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Ultimately, social determinants affect health status and outcomes to a greater degree than direct clinical care. Although these factors are experienced at a personal level, their impact can be seen on a community level. Also, while SDOHs vary, they tend to be more negatively impactful in rural communities—which then experience more harmful effects on health outcomes than their urban or suburban counterparts (National Advisory Committee on Rural Health and Human Services 2017). The unique experiences and challenges of rural communities require unique solutions. Guadalupe County Hospital in Santa Rosa, New Mexico, collaborates with community partners to address SDOHs. These efforts have a positive impact on their communities and can be replicated in other rural settings.
Community Health Improvement: Social Care Is Healthcare
Authors: Kryzer Emily , Nolan Christopher M.
Published: November 2022

Like many communities across the United States, St. Louis, Missouri, faces stark inequities in health outcomes, including wellness, quality of life, and life expectancy. These inequities are the result of social systems and policies that have robbed generations of St. Louisans of opportunity. BJC HealthCare's (BJC's) commitment to becoming a catalyst for community health by helping to eliminate health disparities led to the launch of its community health improvement strategy. This article details the community-driven and evidence-informed process that BJC used to create a multiyear, proactive approach to addressing the social and economic factors that are the root causes of health inequities. It examines areas of opportunity through which the strategy will drive change and explores lessons learned and promising practices for other healthcare institutions to consider as they advance health equity.
Pediatric cataract surgery: considerations and updates in diagnosis and management
Authors: Jody Nicole , Santana Margarita , Rudell Jolene
Published: November 2022

Purpose of review

The purpose of this review is to provide an overview of updates in the diagnosis and management of pediatric cataracts, with an emphasis on recent discoveries in the last two years.

Recent findings

Pediatric cataracts remain an infrequent but significant disease with vision threatening consequences. Although much of the management has not changed historically, more recent updates, particularly borrowed from adult cataract management, have influenced the field of cataract management in children. Even these studies emphasize that pediatric cataracts are a distinct clinical entity from adult-onset cataracts, and further research is needed to optimize the diagnosis and management of cataracts in childhood.

This is an overview of the recent advancements in the diagnosis of management of pediatric cataracts, with advancements that originate from the adult cataract surgery field in addition to studies that challenge classical surgical techniques to make cataract surgery safer and to promote amblyopia therapy.
Development of a Predictive Model for Individualized Hearing Aid Benefit
Authors: Suresh Krish , Franck Kevin , Arenberg Julie G. , Song Yohan , Lee Daniel J. , Crowson Matthew G.
Published: November 2022

Objectives

To develop a model to predict individualized hearing aid benefit. To provide interpretations of model predictions on global and individual levels.

Methods

We compiled a data set of patients with hearing loss who trialed hearing aids and completed the Client Oriented Scale of Improvement (COSI) questionnaire, a validated patient-reported outcome measure of hearing aid benefit. Features included demographic, medical, and audiological measures. The outcome was the COSI score for change in listening ability with hearing aids, scaled from 1 to 5. Model development was performed using fivefold cross-validation repeated three times with hyperparameter tuning. Model performance was assessed using the root mean squared error (RMSE) of the COSI scores. Model interpretation was performed using Shapley Additive Explanations.

Results

The data set comprised 1,286 patients across 3,523 listening situations. The best performing model was random forest with an RMSE of 0.80, found to be significantly better than the next best model (eXtreme gradient boosting with RMSE of 0.85, p < 0.01). The most important features in predicting hearing aid benefit were shorter duration of hearing aid use, higher pure-tone average in the better hearing ear, and younger age.

Conclusion

We have developed a predictive model for hearing aid benefit that can also provide individualized explanations of model predictions. Predictive modeling could be a useful tool in assessing a patient's candidacy and predicted benefit from hearing aids.
Postoperative Constipation Incidence and Effects of Selected Risk Factors on Constipation Development in Elderly Patients With Hip Fracture
Authors: Celik Buket , Bilik Özlem
Published: November 2022

Constipation is a common problem in the general population and is particularly prevalent among hospitalized elderly patients with hip fracture due to lack of mobility, medications, and lack of privacy associated with hospitalization. This study aimed to determine the incidence of postoperative constipation and the effects of selected risk factors on constipation development in elderly patients with hip fracture. The study used a descriptive, cross-sectional, and prospective design. Data were collected on the second postoperative day and upon discharge. The study sample included 150 patients. The constipation incidence rate was found to be 77.70%. Of all the patients developing constipation, 87.70% did not have a normal bowel movement even upon discharge. A significant difference was found between constipation development and the total score for constipation risk assessment, postponing defecation, psychological or behavioral barriers to defecation in the hospital environment, preservation of privacy for defecation, and return to normal bowel movement upon discharge. Based on the results, nurses should determine the risk factors for constipation unique to each patient in the postoperative period and conduct appropriate preventive interventions.
Effects of a Fall Prevention Program Based on Goal Attainment Theory for Homebound Older Adults With Osteoarthritis of the Lower Extremities
Authors: Lee Chunhee , Park Heeok
Published: November 2022

This study implemented and evaluated a community-based fall prevention program based on goal attainment theory that targeted older adults with osteoarthritis. The program included education, exercise, and one-on-one counseling during which the participant and the provider set individual fall prevention goals. This study used a nonequivalent control group pre-/posttest design. Participants were older adults in senior centers with lower extremity osteoarthritis. A fall prevention program in the experimental group included group (70 minutes, once/week; education and exercise) and individual counseling (10 minutes, twice/week; emotional support and goal setting). Data analysis was conducted using SPSS/WIN 22.0 with the χ
2 test, Fisher's exact test, independent t test, and Mann–Whitney U test. The experimental group experienced significantly fewer falls, less stiffness, less difficulty performing activity; more muscular strength, walking ability, and balance; as well as less fear of falling and higher falls efficacy in comparison with the control group. However, pain did not improve in either of the two groups. Fall prevention programs need to include the active involvement of carers in ensuring environmental changes to reduce fall risks. In addition, health professionals who care for community patients with osteoarthritis could strengthen interactions and exchanges to prevent falls and actively modify home hazards.
Osteoporosis
Authors: Patel Khyati , Salama Shereen , Cottreau Jessica
Published: November 2022

Osteoporosis is a bone disease characterized by decreased new bone formation, increased bone resorption, or both processes occurring simultaneously. This disease affects more than 10 million individuals older than 50 years in the United States. If this disease is left untreated, it can result in fragility fractures, which are currently seen in more than 1 million people in the United States. New agents have been developed to add to the list of treatment options that can be used to treat this disease. This article summarizes two specific agents that were approved by the Food and Drug Administration within the last few years: abaloparatide (Tymlos) and romosozumab (Evenity). This article also highlights the crucial role that nursing staff may play in the management of osteoporosis.
Association between Gestational Age, Birth Weight, Parental Age at Childbirth, Mode of Delivery, and Infantile Esotropia
Authors: Huang Junting , Zheng Qianwen , Nie Kailai , Wei Hong , Liu Longqian
Published: November 2022

SIGNIFICANCE

This study investigated the potential perinatal risk factors associated with infantile esotropia in a Chinese population, including advanced parental age at childbirth and mode of delivery. The findings may be significant in developing better intervention strategies for infantile esotropia.

PURPOSE

This study aimed to investigate the associations between gestational age, birth weight, parental age at childbirth, mode of delivery, family history of strabismus, and infantile esotropia in the Chinese population.

METHODS

Ninety-nine patients with infantile esotropia and 117 control subjects were enrolled between March 2018 and March 2021. Detailed questionnaires were administered to parents to collect relevant information. Univariate and multivariate logistic regression models were used to identify possible risk factors of infantile esotropia. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

RESULTS

Infantile esotropia was associated with low birth weight (<2500 g; OR, 4.235; 95% CI, 1.460 to 12.287; P = .008) and emergency cesarean delivery (OR, 2.230; 95% CI, 1.127 to 4.413; P = .02).

CONCLUSIONS

The findings suggest that low birth weight and emergency cesarean deliveries are risk factors for infantile esotropia, highlighting a need for collaborative care between obstetricians, pediatricians, and vision care providers.
Assessing the Impact of Prophylactic Eculizumab on Renal Graft Survival in Atypical Hemolytic Uremic Syndrome
Authors: Glover Emily K. , Smith-Jackson Kate , Brocklebank Vicky , Wilson Valerie , Walsh Patrick R. , Montgomery Emma K. , Wong Edwin K.S. , Johnson Sally , Malina Michal , Kavanagh David , Sheerin Neil S. ,   UK aHUS Transplant Consortium
Published: November 2022

Background

Atypical hemolytic uremic syndrome (aHUS) is a rare cause of end-stage kidney disease and associated with poor outcomes after kidney transplantation from early disease recurrence. Prophylactic eculizumab treatment at the time of transplantation is used in selected patients with aHUS. We report a retrospective case note review describing transplant outcomes in patients with aHUS transplanted between 1978 and 2017, including those patients treated with eculizumab.

Methods

The National Renal Complement Therapeutics Centre database identified 118 kidney transplants in 86 recipients who had a confirmed diagnosis of aHUS. Thirty-eight kidney transplants were performed in 38 recipients who received prophylactic eculizumab. The cohort not treated with eculizumab comprised 80 transplants in 60 recipients and was refined to produce a comparable cohort of 33 transplants in 32 medium and high-risk recipients implanted since 2002. Complement pathway genetic screening was performed. Graft survival was censored for graft function at last follow-up or patient death. Graft survival without eculizumab treatment is described by complement defect status and by Kidney Disease: Improving Global Outcomes risk stratification.

Results

Prophylactic eculizumab treatment improved renal allograft survival (P = 0.006) in medium and high-risk recipients with 1-y survival of 97% versus 64% in untreated patients. Our data supports the risk stratification advised by Kidney Disease: Improving Global Outcomes.

Conclusions.

Prophylactic eculizumab treatment dramatically improves graft survival making transplantation a viable therapeutic option in aHUS.