bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster 162: Time to Achievement of Clinically Significant Outcomes Following Revision Rotator Cuff Repair
Authors: Mirle Vikranth , Gamsarian Vahram , Tashjian Michelle , Chang Joshua , Khazi-Syed Daanish , Brusalis Christopher , Yanke Adam , Cole Brian , Verma Nikhil , Nicholson Gregory , Garigues Grant , Forsythe Brian
Published: October 2024

Objectives:

To define the time required to achieve outcomes (CSOs) following revision rotator cuff repair (RCR). The main outcome was to identify an evidence-based timepoint for functional recovery, including the time needed to attain minimally clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for revision RCR.

Methods:

Patients who underwent rotator cuff repair between 2016 and 2022 were collected. Those with completed preoperative and at least 1 post-operative (3-month, 6-month, 1 year, and 2 years) Patient-Reported Outcome Measures (PROMs), including American Shoulder and Elbow Surgeons (ASES), or Single Assessment Numeric Evaluation (SANE) were included. Exclusion criteria included patients with significant concomitant procedures, or primary rotator cuff repairs. MCID and PASS for each PROM were identified from prior literature and utilized as a threshold needed to attain functional recovery. The time needed to achieve CSO was then calculated and plotted using Kaplan-Meier survival analysis.

Results:

The average patient was 58.8 years old, male (66%), and white (72%). Of the 99 included patients, 48 patients had completed SANE forms, and 52 had completed ASES forms. Patients attained SANE achievement rates of 68.8% for MCID and 35.5% for PASS, and ASES achievement rates of 75% for MCID and 38.5% for PASS. Median achievement time across both surveys ranged between 4.3 – 5.01 months for MCID, and between 5.01 – 5.72 months for PASS. Averages for achievement time for MCID ranged from 5.2 – 5.6 months, and for PASS from 6.3-9.2 months, respectively. (Figure 1)

Conclusions:

When comparing the mean time to CSO of revision RCR to primary RCR in previously published literature, the results are not only similar, but illustrate a slightly earlier time to CSO in revision cases. However, the overall percentage of MCID and PASS attainment are significantly reduced. This can potentially inform clinicians, that while a lower percentage of the revision cases will attain clinically significant outcomes compared to primary patients, those who do attain CSO will have a similar post-operative course. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving revision RCR.
Poster 261: The Influence of Slope Reducing Osteotomy on Patella Height in Patients Undergoing Revision ACL Reconstruction: An Evaluation of a Tibial Tubercle-Sparing Anterior Closing-Wedge Osteotomy Technique
Authors: Saithna Adnan , Guy Sylvain , Ferreira Alexandre , Carrozzo Alessandro , Vieira Thais Dutra , Ollivier Matthieu , Sonnery-Cottet Bertrand
Published: October 2024

Objectives:

The purpose of this study was to evaluate the effect of tibial tubercle-sparing anterior closing-wedge osteotomy on patellar height in revision ACL reconstructions (ACLR).

Methods:

Patients who underwent arthroscopic revision ACLR combined with retro-tibial tubercle anterior closing wedge high tibial osteotomy (ACW-HTO) from 01/01/2016 to 31/03/2021 were assessed for eligibility. Patellar height was measured on full weightbearing lateral x-rays according to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) or frontal x-rays using the Femoral Patellar Height Index (FPHI). The PTS was evaluated using the proximal anatomic axis of the tibia on standard short lateral x-rays. The delta (post-operative - preoperative) and the ratio (pre-operative / post-operative) of the three patellar height indices and PTS were calculated. Preoperative to postoperative patellar height were compared using independent t tests for each index. It was also investigated whether patients changed patellar height category (baja, norma, or alta).

Results:

Among 475 revision ACLR, 47 tibial tubercle-sparing ACW-HTOs were performed. No significant difference in patellar height was found between pre- and postoperative x-rays regardless of the index (ISI P = .1729, CDI P = .4034, FPHI P = .5130). Despite the lack of a statistically significant difference, 15 patients (31.9%) exhibited a post-operative change in their patellar height category when measured by the ISI (6 moved up a category, 9 moved down a category) and 18 (38.3%) patients changed category according to the CDI (10 moved up a category, 8 moved down a category).

Conclusions:

Although a statistically significant difference between pre- and postoperative patella height was not observed, changes in patellar height category were common after tibial tubercle-sparing anterior closing-wedge high tibial osteotomy, in patients undergoing revision ACL reconstruction. The clinical impact of these changes is unknown and further study is needed to investigate whether they may result in patellofemoral symptoms.
Poster 305: Redislocation After Medial Patellofemoral Ligament Reconstruction is Correlated with Preoperative Measurements and Intraoperative Instability Measurements
Authors: Phillips Andrew , Haneberg Erik , Elias Tristan , Sachdev Divesh , Kaplan Daniel , Wang Zachary , Credille Kevin , Chahla Jorge , Forsythe Brian , Verma Nikhil , Cole Brian , Yanke Adam
Published: October 2024

Objectives:

Medial patellofemoral ligament reconstruction is performed to address cases of patellar instability. Historically, this is a well-tolerated procedure though complications, including redislocation and recurrent instability can occur. While risk factors for redislocation following MPFLR have been proposed, there remains no agreed upon consensus. This is even more true in setting of isolated MPFL reconstruction, as concomitant procedures may naturally exclude certain anatomic risk factors. The purpose of this study was to correlate demographic, anatomical, and clinical risk factors to redislocation following isolated medial patellofemoral ligament reconstruction (MPFLR).

Methods:

A retrospective review of patients who underwent isolated MPFLR for recurrent patellar instability at a single institution between December 2015-June 2021 was performed. Included patients had a minimum of 2 years of follow-up data available. Demographic, pre-operative radiographic, surgical, and clinical data was compared between those who had a dislocation event after surgery and those who did not. Subluxation and subjective instability were not considered dislocation events. Independent samples T-test and univariate binary logistic regression was performed.

Results:

This study included 126 patients with a mean age of 21.74 ± 9.20 and a mean BMI of 25.93 ± 6.36. Of these, 67.5% were female and 61.9% of operations were on the left knee. In total, 8.7% (11/126) of patients experienced a redislocation event with a mean time to redislocation of 19.11 months after surgery (range 5 – 32 months). On preoperative magnetic resonance imaging (MRI), greater trochlear bump height measured to bone (p=0.032) and measured to cartilage (p=0.033) was associated with redislocation (Table 1). Additionally, patients who redislocated were found to have a wider sulcus angle (p=0.022). On examination under anesthesia, a greater flexion instability resolution angle – the angle of knee flexion at which the patella no longer dislocates – was found to be associated with redislocation (p=0.041) (Figure 1). These variables all retained significance during univariate regression.

Conclusions:

MPFLR is associated with a high level of success with a redislocation rate of 8.7% in this study. On pre-operative MRI, wide sulcus angle and increased bump height measured to bone and to cartilage were risk factors for redislocation. Additionally, redislocation was associated with a greater flexion instability resolution angle (IRA).
Poster 347: Return to Sports of ACL Primary Repair Versus Autograft ACL Reconstruction at 2-year Follow-Up
Authors: Rilk Sebastian , DiFelice Gregory , van der List Jelle , Vermeijden Harmen Daniel , Goodhart Gabriel , O'Brien Robert
Published: October 2024

Objectives:

To evaluate the psychological readiness to return to sports (RTS), and assess the rates of RTS at preinjury level in patients undergoing anterior cruciate ligament (ACL) primary repair (ACLPR) with suture versus autograft ACL reconstruction (ACLR) at minimum 2-year follow-up (FU).

Methods:

Consecutive patients <50 years old and a preinjury Tegner score of ≥5, undergoing either ACLPR or ACLR by a single surgeon, between January 2018 and April 2021, were considered for eligibility. Surgical indication for either ACLPR with suture augmentation or autograft ACLR (58% hamstring- and 42% quadriceps tendon graft) was based on intra-operatively determined ACL tear type and tissue quality. ACLPR was performed in all patients with proximal type I or II types and good to excellent tissue quality, whereas ACLR was only performed when tear characteristics contraindicated ACL repair. To evaluate success of RTS, activity level (Tegner Activity Scale), psychological readiness to RTS (ACL-Return to Sport After Injury [RSI] score) and instrumented anterior-tibial translation side-to-side difference (ATT-SSD) were evaluated at minimum 2-year FU.

Results:

A total of 181 patients (100 ACLPR, 81 ACLR), were evaluated at final FU (mean ± SD (range), 3.2 ± 0.9 (2 to 5) years). A significantly greater number of patients undergoing ACLPR returned to their preinjury activity level (73% vs. 47%, p < .001), and further presented significantly better ACL-RSI scores (75.3 ± 22.2 vs. 66.6 ±24.2, p = .023) at minimum 2-year FU. Instrumented knee laxity revealed similar results for both treatment groups (ACLPR, 0.80 ±1.2 mm vs. ACLR, 0.97 ± 1.2 mm, p = .449).

Conclusions:

Patients undergoing ACLPR demonstrate greater return to preinjury activity level and greater confidence in their operated knee when performing their respective sport at 2-year FU compared to ACLR.
Poster 399: The 10-Year Decreasing Trend of Youth Soccer Concussions Presenting to U.S. Emergency Departments
Authors: Chun Alex , Snyder Eli , Obana Kyle , Ashinsky Beth , Parisien Robert , Bottiglieri Thomas , Ahmad Christopher , Trofa David
Published: October 2024

Objectives:

Soccer is one of the most popular youth sports with nearly 3 million annual participants in the United States alone. Importantly, concussion incidence and awareness in youth soccer has prompted implementation of various protective measures. Despite these interventions, no studies have investigated the prevalence of youth soccer concussions over time. The purpose of this study is to analyze trends and etiologies of youth soccer concussions presenting to United States emergency departments (EDs).

Methods:

Data from National Electronic Injury Surveillance System were analyzed for soccer players 2 to 18 years old sustaining concussions from January 2013 to December 2022. Patient data collected included age, sex, mechanism of injury, diagnosis, loss of consciousness, and disposition. Raw data were used to calculate national estimates based on assigned statistical sample weight of each hospital.

Results:

182,462 youth soccer concussions were diagnosed in US EDs (52.6% male). Most common mechanism of injury was head to ball (29%). Between 2013 and 2022, concussions decreased 28%. Overall concussions decreased by 1,449 per year (95% CI: -2383 to -515, p=0.007). Not specified concussions decreased by 340 per year (95% CI: -501 to -180, p=0.001), head to body by 378 per year (95% CI: -527 to -229, p<0.001), head to ground by 275 per year (95% CI: -463 to -87, p=0.01), and other mechanisms by 56 per year (95% CI: -109 to -3, p=0.04). There were no changes in head to ball or head-to-head mechanisms. Exclusion of years 2020 and 2021 due to COVID demonstrated decreases in not specified concussions by 256 per year (95% CI = -394 to -118, p=0.004), head to body by 314 per year (95% CI: -431 to -196, p=0.001), and head to ground by 182 per year (95% CI: -331 to -33, p=0.02).

Conclusions:

There is a decreasing trend in youth soccer concussions from 2013 to 2022. Although concussion risk is greatest from contact with the ball, there was no decrease in head to ball concussions during the study period despite implementation and utilization of protective gear. This study contributes to growing literature regarding concussions in youth soccer athletes.
Opioids for the palliation of symptoms in people with serious respiratory illness: a systematic review and meta-analysis
Authors: Smallwood Natasha E. , Pascoe Amy , Wijsenbeek Marlies , Russell Anne-Marie , Holland Anne E. , Romero Lorena , Ekström Magnus
Published: October 2024

Background

People living with serious respiratory illness experience a high burden of distressing symptoms. Although opioids are prescribed for symptom management, they generate adverse events, and their benefits are unclear.

Methods

We examined the efficacy and safety of opioids for symptom management in people with serious respiratory illness. Embase, MEDLINE and the Cochrane Central Register of Controlled Trials were searched up to 11 July 2022. Reports of randomised controlled trials administering opioids to treat symptoms in people with serious respiratory illness were included. Key exclusion criteria included <80% of participants having a nonmalignant lung disease. Data were extracted regarding study characteristics, outcomes of breathlessness, cough, health-related quality of life (HRQoL) and adverse events. Treatment effects were pooled using a generic inverse variance model with random effects. Risk of bias was assessed using the Cochrane Risk of Bias tool version 1.

Results

Out of 17 included trials, six were laboratory-based exercise trials (n=70), 10 were home studies measuring breathlessness in daily life (n=788) and one (n=18) was conducted in both settings. Overall certainty of evidence was “very low” to “low”. Opioids reduced breathlessness intensity during laboratory exercise testing (standardised mean difference (SMD) −0.37, 95% CI −0.67– −0.07), but not breathlessness measured in daily life (SMD −0.10, 95% CI −0.64–0.44). No effects on HRQoL (SMD −0.42, 95% CI −0.98–0.13) or cough (SMD −1.42, 95% CI −3.99–1.16) were detected. In at-home studies, opioids led to increased frequency of nausea/vomiting (OR 3.32, 95% CI 1.70–6.51), constipation (OR 3.08, 95% CI 1.69–5.61) and drowsiness (OR 1.37, 95% CI 1.01–1.86), with serious adverse events including hospitalisation and death identified.

Conclusions

Opioids improved exertional breathlessness in laboratory exercise studies, but did not improve breathlessness, cough or HRQoL measured in daily life at home. There were significant adverse events, which may outweigh any benefits.
Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report
Authors: Cao Yangming
Published: October 2024

Background

Pseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.

Case presentation

A 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.

Investigation

I was repeatedly reassured that the lab’s manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians’ suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians’ recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.

Conclusions

Pseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.
Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention
Authors: Schou-Juul Frederik , Ferm Lucca-Mathilde Thorup , Kinch Simon , Skov Sofie Smedegaard , Ritz Christian , Lauridsen Sigurd
Published: October 2024

Background

Interventions targeting healthcare professionals’ confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.

Methods

Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.

Results

While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.

Conclusions

The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.
Implementing a Medicines at Transitions Intervention (MaTI) for patients with heart failure: a process evaluation of the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) cluster randomised controlled trial
Authors: Powell Catherine , Ismail Hanif , Breen Liz , Fylan Beth , Alderson Sarah L , Gale Chris P , Gardner Peter , Silcock Jonathan , Cundill Bonnie , Farrin Amanda , Mason Ellen , Moreau Lauren , Alldred David P ,   ISCOMAT Programme Management Team, Armitage Gerry , Blenkinsopp Alison , Turner Robert , Taylor Andrew , Kellar Ian , Hartley Suzanne , Bojke Chris , Wright John
Published: October 2024

Background

Heart failure is a major global health challenge incurring a high rate of mortality, morbidity and hospitalisation. Effective medicines management at the time of hospital discharge into the community could reduce poor outcomes for people with heart failure. Within the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) programme, the Medicines at Transitions Intervention (MaTI) was co-designed to improve such transitions, with a cluster randomised controlled trial to test effectiveness. The MaTI includes a patient toolkit and transfer of discharge medicines information to community pharmacy. This paper aims to determine the degree to which the intervention was delivered, and identify barriers and facilitators experienced by staff for the successful implementation of the intervention.

Methods

The study was conducted in six purposively selected intervention sites. A mixed-methods design was employed using hospital staff interviews, structured and unstructured ward observations, and routine trial data about adherence to the MaTI. A parallel mixed analysis was applied. Qualitative data were analysed thematically using the Framework method. Data were synthesised, triangulated and mapped to the Consolidated Framework for Implementation Research (CFIR).

Results

With limited routines of communication between ward staff and community pharmacy, hospital staff found implementing community pharmacy-related steps of the intervention challenging. Staff time was depleted by attempts to bridge system barriers, sometimes leading to steps not being delivered. Whilst the introduction of the patient toolkit was often completed and valued as important patient education and a helpful way to explain medicines, the medicines discharge log within it was not, as this was seen as a duplication of existing systems. Within the CFIR the most applicable constructs were identified as ‘intervention complexity’ and ‘cosmopolitanism’ based on how well hospitals were networked with community pharmacies, and the availability of hospital resources to facilitate this.

Conclusion

The MaTI was generally successfully implemented, particularly the introduction of the toolkit. However, implementation involving community pharmacy was more challenging and more effective communication systems are needed to support wider implementation.

Trial registration

11/04/2018 ISRCTN66212970. https://www.isrctn.com/ISRCTN66212970.
Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study
Authors: Gupte Samriddhi S , Sachdeva Ashish , Kabra Aman , Singh Bhanu Pratap , Krishna Ashish , Pathni Anupam Khungar , Sharma Bhawna , Moran Andrew , Mamindla Amarendar Reddy , Kannuri Nanda Kishore , Deo Sarang
Published: October 2024

Hypertension poses a critical threat to health in India, being the predominant risk factor for mortality and disability. With over 70% of outpatient care being provided by the private sector, our study investigated the practices and incentives of private health providers in screening, diagnosing, treating, monitoring, and counseling hypertension patients in rural and peri-urban India. Conducted from April 2020 to February 2021, the qualitative study involved 46 participants, including various healthcare professionals and patients in three Telangana state districts. Analysis revealed a lack of recognition of hypertension’s gravity among private providers in these areas, leading to inconsistent screening practices and varied diagnostic thresholds, particularly among rural medical practitioners. Both formal and informal providers lacked standardized protocols and follow-up mechanisms, with limited technical knowledge about hypertension observed, especially among rural practitioners who were often the first point of contact. Drug effectiveness, and incentives from pharmaceutical sales representatives influenced prescribing practices. Diagnostic labs also offered financial incentives for patient referrals. Thus, aligning providers’ objectives with patient preferences and public health goals is crucial. To encourage evidence-based hypertension care, the government and NGOs could implement strategies such as tailored incentives, financial rewards, tax benefits, accreditation, and recognition for private healthcare providers. Professional bodies in the private sector should establish programs emphasizing quality assurance and certifications. Future research should focus on designing and testing new models for private sector hypertension service delivery, coupled with targeted interventions to enhance care in rural and peri-urban settings.
Inflammation scores based on C-reactive protein and albumin predict mortality in hospitalized older patients independent of the admission diagnosis
Authors: Di Rosa Mirko , Sabbatinelli Jacopo , Giuliani Angelica , Carella Miriam , Magro Daniele , Biscetti Leonardo , Soraci Luca , Spannella Francesco , Fedecostante Massimiliano , Lenci Federica , Tortato Elena , Pimpini Lorenzo , Burattini Maurizio , Cecchini Sara , Cherubini Antonio , Bonfigli Anna Rita , Capalbo Maria , Procopio Antonio Domenico , Balistreri Carmela Rita , Olivieri Fabiola
Published: October 2024

Systemic inflammation significantly increases the risk of short- and long-term mortality in geriatric hospitalized patients. To predict mortality in older patients with various age-related diseases and infections, including COVID-19, inflammatory biomarkers such as the C-reactive protein (CRP) to albumin ratio (CAR), and related scores and indexes, i.e. Glasgow Prognostic Score (GPS), modified GPS (mGPS), and high sensitivity (hs)-mGPS, have been increasingly utilized. Despite their easy affordability and widespread availability, these biomarkers are predominantly assessed for clinical purposes rather than predictive applications, leading to their underutilization in hospitalized older patients.

In this study, we investigated the association of CAR, GPS, mGPS, and hs-mGPS with short-term mortality in 3,206 geriatric hospitalized patients admitted for acute conditions, irrespective of admission diagnosis. We observed that unit increases of CAR, and the highest classes of GPS, mGPS, and hs-mGPS were significantly associated with a two- to threefold increased risk of death, even adjusting the risk for different confounding variables. Interestingly, a hs-mGPS of 2 showed the highest effect size. Furthermore, gender analysis indicated a stronger association between all CRP-albumin based parameters and mortality in men, underscoring the gender-specific relevance of inflammation-based circulating parameters in mortality prediction.

In conclusion, scores based on serum CRP and albumin levels offer additional guidance for the stratification of in-hospital mortality risk in older patients by providing additional information on the degree of systemic inflammation.
Diagnostic value of syndecan-1 for coronary artery lesions and correlation analysis of laboratory indicators in Kawasaki disease patients
Authors: Dai Ling , Zhang Lingbo , He Jie , Huang Rui , Tang Wenwen , Guo Huan , Shang Xiaoke
Published: October 2024

Background

To explore the application value of syndecan-1 (SDC-1) in the diagnosis of coronary artery lesions (CALs) in Kawasaki disease (KD) patients and the correlation of multiple laboratory indicators in KD patients.

Methods

86 pediatric Kawasaki disease (KD) patients and 52 healthy controls admitted from January 2018 to December 2023 were retrospectively analyzed. Venous blood samples from KD patients were analyzed for white blood cells (WBC), platelets (PLT), C-reactive protein (CRP), interleukin-6 (IL-6), syndecan-1 (SDC-1), coagulation parameters, and lipid profiles. Correlations between these laboratory indicators were assessed. Receiver operating characteristic (ROC) curve analysis determined the diagnostic value of SDC-1 for coronary artery lesions (CALs) in KD patients. SDC-1 levels were further compared across different CAL severity groups.

Results

The levels of ALT, AST, WBC, PLT, CRP, IL-6, and SDC-1 in the KD group were significantly higher than those in the control group (P < 0.05). Coagulation function analysis showed that APTT, TT and FIB levels were significantly increased in the KD group compared with the control group (P < 0.05). Lipid profile analysis revealed that TC, HDL-C, and ApoA1 were significantly decreased, whereas TG, LDL-C, and ApoB100 were significantly increased in the KD group (P < 0.05). Refractory KD patients exhibited significantly higher levels of ALT, AST, SDC-1, CRP, WBC, and TG compared to responsive KD patients (P < 0.05). Correlation analysis indicated a strong positive correlation between PLT and LDL-C (r = 0.227, P = 0.035) and between IL-6 and TG (r = 0.491, P = 0.000), while CRP was negatively correlated with ApoA1 (r = -0.265, P = 0.014). Among the 86 KD patients, 41 (47.67%) developed CALs, with 19 classified as mild, 15 as moderate, and 7 as severe. For predicting CALs among KD patients, the threshold of SDC-1 was identified as 5.5 ng/ml, with a sensitivity of 70.7%, specificity of 64.4%, positive predictive value of 65.91%, negative predictive value of 69.05%, and an AUC of 0.762 (95% confidence interval 0.662–0.861, P < 0.001). SDC-1 levels significantly differed among the CAL severity groups (P = 0.008), with higher levels observed in moderate compared to mild CALs, and in severe compared to moderate CALs.

Conclusion

In conclusion, SDC-1 has strong clinical value in the diagnosis of CALs in KD patients, and there is a close relationship between the levels of inflammatory factors, coagulation function and lipid levels in KD patients.
Characterizing humpback whale behavior along the North-Norwegian coast
Authors: Ytterhus Utengen Ingvild , Vogel Emma F. , Biuw Martin , Van Ruiten Meghan , Rikardsen Audun H.
Published: October 2024

Background

Studying movement patterns of individual animals over time can give insight into how they interact with the environment and optimize foraging strategies. Humpback whales (Megaptera novaeangliae) undertake long seasonal migrations between feeding areas in polar regions and breeding grounds in tropical areas. During the last decade, several individuals have had up to a 3-month stop-over period around specific fjord-areas in Northern Norway to feed on Norwegian spring-spawning (NSS-) herring (Culpea harengus L.). Their behavioral patterns during this period are not well understood, including why some whales seemingly leave the fjords and then later return within the same season.

Methods

To investigate whale behavior during this seasonal stopover, we classified humpback whale tracks into five distinct movement modes; ranging, encamped, nomadic, roundtrip and semi-roundtrip. A behavioral change point analysis (BCPA) was used to select homogeneous segments based on persistence velocity. Then, net squared displacement (NSD) over time was modeled to differentiate movement modes. This study also manually identified longer roundtrips away from the fjords that lasted several days and examined movement modes within these.

Results

Inside the fjord systems, encamped mode was most prevalent in December–January, suggesting the whales were mainly foraging on overwintering NSS-herring in this area. During the same winter seasons, half of the whales left the fjords and then returned. We hypothesize that these trips serve as ‘searching trips’ during which the whales seek better feeding opportunities outside the fjords. If better foraging conditions are not found, they return to the fjords to continue their feeding. The overall most common mode was ranging (54%), particularly seen during the start of their southwards migration and in areas outside the fjord systems, indicating that the whales mainly moved over larger distances in the offshore habitat.

Conclusions

This study serves as a baseline for future studies investigating both the searching trip theory and humpback whale behavior in general, and confirms that this method could be useful to analyze local scale movement patterns of satellite tagged whales.
Survey self-report of rheumatoid arthritis and treatments versus specialist clinician confirmation
Authors: Jugnundan Shamil , Schmajuk Gabriela , Trupin Laura , Blanc Paul D.
Published: October 2024

Objective

To assess agreement between patient survey report and physician recorded arthritic conditions and medication use in order to validate population-based epidemiologic approaches to auto-immune arthritic conditions.

Methods

Rheumatologists in the U.S. Appalachian region recruited men 50 years or older with a confirmed rheumatoid arthritis (RA) diagnosis. For each participating patient, the treating specialist completed a brief chart abstraction that included rheumatic diagnosis and corresponding treatment. Patients participated in a telephone interview using the same questionnaire as applied in a larger random digit dial survey that queried arthritis diagnosis and treatment. We assessed patient-clinician agreement with the Prevalence Adjusted and Biased Adjusted Kappa (PABAK) statistic.

Results

We included 36 patient-clinician dyads in this analysis. All clinicians and patients concurred in the RA diagnosis (PABAK = 1). For concomitant systemic lupus and scleroderma, we observed generally concordant responses (PABAK 0.89 and 1, respectively). For medication use, for hydroxychloroquine or sulfasalazine was associated with the lowest PABAK (0.39), intermediate values for methotrexate and for the “other conventional synthetic DMARDs” category (0.67), and with the highest agreement PABAK value for the “biologic DMARD or JAK 2 inhibitor” category (0.89).

Conclusion

Survey-based self-report of RA offers a useful approach in epidemiological investigation. This is particularly relevant to population-based approaches to autoimmune arthritis related to occupational and environmental factors.
Impact of resilience policies on cape town's water-food nexus: A system dynamics approach
Authors: Hofmann Viola S. , Egieya Jafaru M. , Parker Yumna , Gorgens Johann , Goosen Neill J.
Published: October 2024

Background

Climate change is increasingly affecting the supply of resources such as water and food. From 2015 to 2018, Cape Town endured its most severe drought on record. Yet, resource management often occurs in isolation, which contrasts with the holistic perspective provided by the nexus concept that recognizes the interdependence of resource sectors. This study employs system dynamics modeling, to examine the City of Cape Town’s (CoCT) water-food trade-offs and interactions using qualitative and quantitative approaches. It assesses various policies proposed by the CoCT, to improve system resilience and to boost future water supplies, examining their efficacy and potential drawbacks. These policies are tested against future scenarios including population growth and climate change predictions of different severities.

Results

The simulation results show an increase in food demand, which is mainly linked to population growth and a significant decrease in water availability. Without intervention, the CoCT is expected to experience serious water shortages within the 40-year simulation period.

Conclusions

The findings indicate that the CoCT’s strategies will effectively secure adequate water for its expanding population. However, a major concern was found to be the proposed intensification of aquifer exploitation. The model predicts that such an approach could lead to overabstraction of some aquifers, compromising their sustainability.
Proximity predicament: a rare case of hydatid cyst in the porta hepatis region
Authors: Raheem Abdul , Arsal Syed Ali , Ali Syed Muhammad Sinaan , Areeba Syeda , Ahmed Suhaib , Kumar Ashish
Published: October 2024

Hydatid cysts near the porta hepatis present notable medical challenges due to their intricate positioning and potential influence on crucial structures within the liver and its vicinity. While relatively rare, their presence can lead to intricate medical scenarios because of their proximity to vital liver and bile duct structures, but their occurrence can present complex medical situations due to their proximity to critical structures in the liver and bile ducts. We present an unusual case of a 33-year-old male with no known comorbidities presented to the outpatient department of general surgery with pain, insidious in onset and gradually progressive, in the right hypochondrial region for the past 3 months, along with mild fever, reduced appetite, and weight loss of 3 kg. Managing hepatic cysts, especially when near the porta hepatis, poses significant diagnostic challenges. Imaging scans revealed multiple hypodense lesions suggestive of hepatic cysts, with the largest one measuring 5 cm × 8 cm in segment VI. Native post-contrast lesions were also observed in the right lower lobe. Although hepatic duct dilation was not observed, the presence of a cyst near the porta hepatis an atypical site for hydatid cyst, complicated potential PAIR procedures (puncture, aspirate, injection, re-aspirate), raising concerns about the risk of damaging vital structures like the hepatic artery or major bile duct. A multidisciplinary approach engaged interventional radiology to evaluate PAIRS feasibility. PAIRS was performed successfully, except for the cyst near the porta hepatis to avoid complications. Despite this, the patient continued to experience abdominal discomfort post-operation, although liver function tests improved in the postop period. This case underscores the uncommon occurrence of hydatid cysts near the porta hepatis and highlights the need for additional research to comprehend its prevalence and causes. Further investigation is crucial to enhance our understanding of the epidemiology and optimal management strategies involving PAIRS in such challenging cases.
Correlation between parental willingness to pay, health-related quality of life, and satisfaction with physiotherapy services in Nigeria: a cross-sectional study
Authors: Fatoye Francis , Mbada Chidozie Emmanuel , Adebayo Mutiat Adewumi , Gebrye Tadesse , Fatoye Clara Toyin , Ademoyegun Adekola Babatunde , Oyewole Olufemi Oyeleye , Ogundele Abiola Oladele , Okonji Adaobi Margaret
Published: October 2024

Background

Being a parent of a child with a disability requiring many clinic visits is burdensome. Therefore, understanding the willingness-to-pay (WTP) for physiotherapy for children with disability is important to facilitating access to care and for policy-making. This study aimed to investigate patterns and correlates of parental WTP for physiotherapy.

Methods

A total of 65 parents of children with disability receiving physiotherapy as outpatients were recruited from selected tertiary hospitals in Nigeria. A WTP questionnaire, SF-12 health survey, and Physiotherapy Satisfaction Questionnaire were used to assess the WTP, health-related quality of life (HRQoL), and satisfaction with physiotherapy respectively. Descriptive statistics of mean, standard deviation, frequency, and percentages were used to summarize the data. Chi-square and regression analysis were also used to test the association and determinants of WTP from each of the socio-demographic factors, satisfaction with physiotherapy, and health-related quality of life, respectively.

Results

A majority (49.2%) of the respondents were in the 21–35 years age category. There was 30.8% “no WTP” for physiotherapy among parents of children with disability. A significant association was observed between socio-economic status and WTP for all treatment modalities (p < 0.05). The majority of the respondents had above-average levels of physical and mental health domain of SF-12. No significant association was observed between WTP and each satisfaction with physiotherapy and HRQoL (p > 0.05).

Conclusion

There was a high rate of ‘no WTP’ for physiotherapy among parents of children with disability. Level of satisfaction with physiotherapy and health-related quality of life was not significantly associated with parental WTP for physiotherapy.
Relationship Between Radiation Oncology Department National Institutes of Health Funding and Institutional Community Inclusion/Investment
Authors: Awobayiku Oluwatomiwa O. , Sun Yilun , McClelland Shearwood
Published: October 2024

PURPOSE

Disparities in health care access and funding allocation persist among racial minorities and low-income populations. Radiation oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear.

METHODS

Radiation oncology departments awarded NIH funding from 2019 to 2021 were studied using the 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity to assess the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding.

RESULTS

Twenty-two radiation oncology departments were analyzed in this study. A significant positive correlation was identified between the NIH research funding these departments received and their institutional rankings for overall community benefit (tau = 0.38;
P
< .034). Additionally, there was a trend toward significance for the relationship between NIH funding and institutional rankings for community investment spending (tau = 0.497;
P
< .053). No significant correlation was observed for other variables, including institutional rankings for charity care spending, Medicaid as a portion of patient revenue or services provided to patients from minoritized groups, low-income backgrounds, or those with lower levels of education.

CONCLUSION

Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit (measured by spending on financial assistance, community investment, and Medicaid). This suggests that departments receiving NIH funding may be incentivized to allocate resources toward initiatives aimed at improving community health outcomes extending beyond direct patient care.
Successful Retirement Planning for Endocrinologists
Authors: Becker Carolyn B , Friday Karen E , Rogol Alan D , Carroll William F , Santen Richard J
Published: October 2024

The Endocrine Society formally addressed the issue of retirement for its members for the first time in a Workshop held on June 4 at ENDO 2024 in Boston, Massachusetts. Preparation for the workshop included 4 steps: (1) completion of a survey; (2) advice from a retirement expert; (3) extensive literature review; and (4) multiple pre-workshop discussions among the presenters. The survey found that retired endocrinologists are involved in a wide variety of professional and nonprofessional activities. The retirement expert and the literature review outlined several concepts underlying a successful retirement and the questions and decisions needed during the planning process. The presenters described several illustrative examples of retirement activities. A “Piece of My Mind” essay in the Journal of the American Medical Association written by the moderator (C.B.) expressed ethical considerations made feasible by the independence of her retirement status. The first presenter (A.R.) noted that the time available during retirement allowed mentorship, teaching in foreign countries and other institutions, and participation on international committees. The second speaker (K.F.) commented that expertise gained during practice of Endocrinology can be used for expert legal, pharmaceutical, and financial opinions. She also noted that volunteering for professional or nonprofessional groups provides an avenue for “giving back” to others. The final presenter (R.S.) stated that retirement provides an opportunity to embark on new clinical endeavors, such as managing patients via telemedicine in rural underserved areas. In summary, retirement is an important phase of a career and can be highly rewarding and enjoyable.
A Randomized Clinical Trial Comparing 2 Levothyroxine Regimens During Ramadan Fasting in Thyroidectomized Patients
Authors: Alzahrani Ali S , Mukhtar Noha , Alhammad Zahrah , Alobaid Lulu , Hakami Abdulrhman Jaber , Alsagheir Osamah , Mohamed Gamal , Hameed Maha , Almahfouz Abdulraof
Published: October 2024

Context

For Muslim patients on levothyroxine (L-T4) therapy, the best approach for L-T4 intake during Ramadan fasting remains unclear.

Objective

We compared 2 practical approaches for L-T4 intake during Ramadan.

Methods

We randomly assigned 69 patients (21 males, 48 females, median age 44 years) with differentiated thyroid cancer (DTC) who underwent thyroidectomy in the past and are on stable LT4 doses to 2 arms. Arm A (33 patients) ingested their pre-Ramadan L-T4 dose at the evening meal and ate immediately. Arm B (36 patients) increased their pre-Ramadan dose by 25 µg if their regular L-T4 dose was ≤150 µg/day or by 50 µg if their pre-Ramadan dose was >150 µg/day and ate immediately.

Results

At the beginning of Ramadan (baseline), the median thyrotropin (TSH) level and the numbers of patients in euthyroidism, subclinical hyperthyroidism (Shyper), or subclinical hypothyroidism (Shypo) were comparable between the 2 arms (P = .69 and P = .65, respectively). At the end of Ramadan, in arm A there were 17 (51.5%), 3 (9.1%), and 13 (39.4%) patients in euthyroidism, Shyper, and Shypo compared with 17 (47.2%), 14 (38.9%), and 5 (13.9%) patients, respectively, in arm B (P = .005). The mean ± SD TSH levels in arms A and B at the end of Ramadan were 5.6 ± 6.0 mU/L and 1.67 ± 2.6 mU/L, respectively (P = .0001).

Conclusion

No overt thyroid dysfunction developed but there were more cases of Shypo in arm A and Shyper in arm B. Arm B achieved desirable levels of TSH (normal or slightly suppressed) in 86% of cases and might be a preferable approach, especially for patients who need TSH suppression (eg, DTC).
A Randomized Controlled Trial Comparing Effectiveness of Different Fibrinogen Preparations in Restoring Clot Firmness
Authors: Baryshnikova Ekaterina , Aloisio Tommaso , Di Dedda Umberto , Anguissola Martina , Barbaria Alessandro , Caravella Giuseppe , Ranucci Marco
Published: October 2024

BACKGROUND:

Different preparations of fibrinogen concentrate are currently available. Two in vitro studies demonstrated the superiority of FibCLOT (LFB) in increasing clot firmness with respect to RiaSTAP (CSL Behring). The present trial involved a clinical model to test the hypothesis of superiority, with the increase in clot firmness as the primary end point.

METHODS:

Forty cardiac surgery patients were randomly allocated to receive a dose of 30 mg/kg FibCLOT or RiaSTAP after protamine administration in the presence of microvascular bleeding and a FIBTEM maximum clot firmness (MCF) <10 mm. Viscoelastic parameters were measured before and after fibrinogen supplementation: FIBTEM MCF, EXTEM MCF, and EXTEM clotting time (CT).

RESULTS:

The mean increase in FIBTEM MCF was 4 ± 1.2 mm (mean and standard deviation) in the FibCLOT group and 4 ± 1.6 mm in the RiaSTAP group (P = 1.000); the mean decrease in CT was 11. 2 ± 12.2 (mean and standard deviation) seconds in the FibCLOT group and 14. 8 ± 13 seconds in the RiaSTAP group (P = .372). In both groups, fibrinogen supplementation induced a significant (P = .001) increase in the FIBTEM MCF and EXTEM CT. The proportions of patients who did not experience an increase of 4 mm in the RiaSTAP group and the FibCLOT group were not statistically significantly higher (35% vs 20%, respectively, relative risk 2.15, 95% confidence interval 0.52–9.00, P = .288).

CONCLUSIONS:

In contrast to previous in vitro studies, we found that the effect of FibCLOT on MCF and CT was not significantly greater than that of RiaSTAP in cardiac surgery patients. Further studies in other clinical settings are warranted.