bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractional Erbium-Doped Yttrium Aluminum Garnet Laser in the Treatment of Primary Cutaneous Amyloidosis
Authors: Fawzy Marwa M. , Kamel Marwa M. , El Maadawi Zeinab , Abdel Hady Rehab , Osman Mai Abdelraouf
Published: March 2021

BACKGROUND

Although various treatments are currently available for primary cutaneous amyloidosis (PCA), there is no entirely satisfactory treatment. Recently, fractional ablative lasers are claimed to have therapeutic effects for PCA.

OBJECTIVE

To evaluate the efficacy and safety of fractional Er:YAG laser for the treatment of PCA.

METHODS AND MATERIALS

Ten patients with macular and lichen amyloidosis received 4 treatment sessions with 4-week intervals. The outcome was assessed clinically (degree of pigmentation, rippling, lichenification, and itching) through photographs and histologically (amount of amyloid, melanin, epidermal thickness, and depth of rete ridges) through biopsy specimens stained with hematoxylin–eosin, Congo red, and Fontana–Masson stain. Patients were followed up for 3 months after the final treatment.

RESULTS

At 3-month follow-up, fractional Er:YAG laser exhibited a significant clinical and histological improvement. Patient satisfaction concurred with physicians' evaluations. Recurrence was detected in 1 patient.

CONCLUSION

In light of the authors' findings, fractional Er:YAG laser offered a great clinical and histological efficacy with excellent safety profile. Careful laser selection based on making a compromise between efficacies and safeties may improve outcome.
A Point-of-Care Algorithm to Guide Proper Device Selection for Ambulatory Electrocardiography
Authors: Farasat Morteza , Sanchez Jose M. , West J. Jason , Burke Joseph M. , Prouse Andrew F. , Gore M. Odette , Salame Gerard A. , Keach Joseph Walker , Trent Stacey A. , Haigney Mark C. P. , Hogan Shea E. , Peterson Pamela N. , Stauffer Brian L. , Holland Matthew R. , Krantz Mori J.
Published: March 2021

In the outpatient setting, ambulatory electrocardiography is the most frequently used diagnostic modality for the evaluation of patients in whom cardiac arrhythmias or conduction abnormalities are suspected. Proper selection of the device type and monitoring duration is critical for optimizing diagnostic yield and cost-effective resource utilization. However, despite guidance from major professional societies, the lack of systematic guidance for proper test selection in many institutions results in the need for repeat testing, which leads to not only increased resource utilization and cost of care, but also suboptimal patient care. To address this unmet need at our own institution, we formed a multidisciplinary panel to develop a concise, yet comprehensive algorithm, incorporating the most common indications for ambulatory electrocardiography, to efficiently guide clinicians to the most appropriate test option for a given clinical scenario, with the goal of maximizing diagnostic yield and optimizing resource utilization. The algorithm was designed as a single-page, color-coded flowchart to be utilized both as a rapid reference guide in printed form, and a decision support tool embedded within the electronic medical records system at the point of order entry. We believe that systematic adoption of this algorithm will optimize diagnostic efficiency, resource utilization, and importantly, patient care and satisfaction.
Tectonic Mini-DSAEK Facilitates Closure of Corneal Perforation in Eyes With Healthy Endothelium
Authors: Seifelnasr Mohamed , Roberts Harry W. , Moledina Malik , Myerscough James
Published: March 2021

Purpose:

The purpose of this study was to report a surgical technique for closure of a traumatic corneal perforation in a patient with healthy endothelium.

Methods:

A 69-year-old male patient presented to Southend University Hospital with a 2.5 mm round temporal corneal perforation caused by a metallic foreign body from an industrial accident. Best-corrected visual acuity at presentation was 6/36. The patient received a tectonic small diameter Descemet stripping automated endothelial keratoplasty (mini-DSAEK) to close the perforation. The patient subsequently developed traumatic cataract and underwent cataract surgery 8 months later. Clinical outcomes at 1 week, 1 month, 3 months, 6 months, and 9 months were evaluated. The primary outcomes of interest were successful sustained closure of the perforation and surgical complications, with secondary outcomes of best-spectacle corrected visual acuity (BSCVA, Snellen) and keratometric astigmatism (KA, Pentacam).

Results:

The anterior chamber was reformed by the graft, restoring the globe's mechanical integrity. The bare stroma reepithelized by 1 week. Neither intraoperative nor postoperative surgical complications were reported. The anterior chamber remained deep and formed during subsequent follow-ups through 9 months. At the 9-month follow-up, final best spectacle-corrected visual acuity was 6/6-1 (Snellen fraction). Keratometric astigmatism was 1.1 diopters.

Conclusions:

Tectonic mini-Descemet stripping automated endothelial keratoplasty is a safe technique in the management of corneal perforations too large for tissue adhesives, with a low astigmatic profile and rapid visual recovery.
Effects of Vectored Thermal Pulsation on Objective Tear Film Measures
Authors: Fallah Shamis , Loer Christopher J.
Published: March 2021

Purpose:

To assess the effect of vectored thermal pulsation treatment for meibomian gland dysfunction on objective measures of lipid layer thickness (LLT) and tear osmolarity.

Methods:

One hundred patients with meibomian gland dysfunction diagnosis were recruited to participate. At their initial visit, baseline study parameters were recorded, and vectored thermal pulsation treatment was administered. At the 2- to 3-month follow-up visit, the study parameters were reevaluated. Subjective symptoms were evaluated using the Ocular Surface Disease Index questionnaire. LLT was measured using an ocular surface interferometer. Tear osmolarity was calculated using impedance measurement of tear fluid collected from the eyelid margin.

Results:

Ninety-six patients (192 eyes) completed the follow-up. Mean improvement in Ocular Surface Disease Index was 5.6 points (95% confidence interval [CI], −9.0 to −2.1, P = 0.002). There was no significant change in tear osmolarity (mean change −1.6 mOsm/L, 95% CI, −4.7 to +1.3 mOsm/L, P = 0.3). There was no significant change in LLT (mean change −4.3 nm, 95% CI, −9.1 to +0.5 nm, P = 0.08).

Conclusions:

The hypothesis that vectored thermal pulsation treatment would decrease tear osmolarity and increase LLT was not substantiated. Although we detected significant improvement in subjective symptoms, the improvement was smaller than the improvements reported in previous studies. Our results suggest that the current understanding of the effects of vectored thermal pulsation treatment is incomplete.
Posterior lamellar keratoplasty: techniques, outcomes, and recent advances
Authors: Yeu Elizabeth , Gomes José A.P. , Ayres Brandon D. , Chan Clara C. , Gupta Preeya K. , Beckman Kenneth A. , Farid Marjan , Holland Edward J. , Kim Terry , Starr Christopher E. , Mah Francis S. ,   for the ASCRS Cornea Clinical Committee
Published: March 2021

Over the past 2 decades, posterior lamellar keratoplasty (PLK) has emerged as an alternative to penetrating keratoplasty in the treatment of corneal endothelial disorders. The reasons for this trend include the search for a safer procedure to replace diseased endothelium that provides faster and better visual rehabilitation and reduces the need for postoperative care. Different surgical techniques, surgical instruments, devices, and lasers have been introduced to overcome technical difficulties, thus improving clinical outcomes. Yet, surgeons and eye banks must address the complications and limitations that arise during the transition to these new techniques. This review discusses the most significant aspects of the evolution of PLK, including a detailed description of current techniques and the direction of future treatment for corneal endothelial disease with the use of laser-assisted surgery, bioengineered corneas, cell therapy, and new pharmacologic therapy.
Trifocal intraocular lens implantation in eyes with previous corneal refractive surgery for myopia and hyperopia
Authors: Cobo-Soriano Rosario , Ortega-Usobiaga Julio , Rodríguez-Gutiérrez Beatriz , Tejerina Víctor , Llovet Fernando , Casco Bruno , Baviera Julio
Published: March 2021

Purpose:

To evaluate the visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic and hyperopic corneal refractive laser surgery.

Setting:

Clinica Baviera-AIER-Eye group, Spain.

Design:

Retrospective comparative case series.

Methods:

The series was divided into 2 groups according to the type of corneal laser refraction (myopic and hyperopic). The main visual and refractive outcome measures included corrected distance visual acuity (CDVA) and uncorrected distance and near visual acuity, safety, efficacy, and predictability. The secondary outcome measures were percentage of enhancement and Nd:YAG capsulotomy and influence of prelaser magnitude of myopia and hyperopia on the outcome of trifocal IOL implantation.

Results:

The sample comprised 868 eyes (543 patients): myopic, n = 319 eyes (36.7%); and hyperopic, n = 549 eyes (63.2%). Three months postoperatively, visual outcomes were poorer in the hyperopic group than those in the myopic group for mean CDVA (0.06 ± 0.05 vs 0.04 ± 0.04, P < .01) and safety (21% vs 12% of CDVA line loss, P < .05) outcomes. However, precision outcomes were worse in the myopic group than those in the hyperopic group, with a mean spherical equivalent of −0.38 ± 0.3 vs −0.17 ± 0.3 (P < .01). Stratification by magnitude of primary laser treatment revealed poorer visual and safety results in the high hyperopia subgroup (>+3.0 diopters [D]) and poorer precision in the high myopia subgroup (<−5.0 D).

Conclusions:

Trifocal IOL implantation after photorefractive surgery in eyes previously treated with myopic ablation achieved good visual outcomes but less predictability in the high myopia subgroup. However, eyes with a previous hyperopic corneal ablation achieved excellent precision but worse visual and safety outcomes in the high hyperopia subgroup.
Identifying Prosthetic Capabilities That Define Functionality of Individuals With Amputation
Authors: Bell Elizabeth M. , Carrignan Jessica , Collier Douglas Kurt , Yang Ji Seung , Shim Jae Kun
Published: March 2021

Introduction

Although the physical abilities associated with activity, exercise, and fitness within the general population of individuals without disabilities have been well established, it is unclear if these abilities define the physical function of individuals with lower-limb amputations (LLAs) who use a prosthesis. A multidimensional definition of the physical function of people with LLA must consider what abilities are necessary and relevant.

Objectives

This literature review aimed to identify common abilities used to evaluate the physical function of people with LLA. A secondary aim was to evaluate if each identified ability had been indirectly addressed by existing questionnaires and performance-based tests.

Study Design

Literature Review.

Methods

Ten common physical abilities associated with measuring the physical function of LLA were identified through literature review. These identified abilities were used to assess what aspects had been indirectly addressed by existing questionnaires and performance-based evaluations of LLA physical function.

Results and Conclusions

Abilities identified through literature review included agility, balance, comfort, endurance, flexibility, load, maneuverability, power, strength, and symmetry. These 10 abilities are important and commonly used as outcome measures associated with the physical function of people with LLA. Although each ability was addressed by multiple assessments, no assessment addressed all 10 identified abilities. The Prosthetic Limb Users Survey of Mobility, Prosthetic Profile of the Amputee, Rivermead Mobility Index, and the Amputee Mobility Predictor addressed most (8–9 of 10) of the identified abilities. There were clear differences and gaps in the abilities addressed by current assessments, possibly because they rely on an incomplete definition of what is required for LLA physical function. We propose that these 10 abilities are unique and underlie the definition of LLA physical function. However, future work must assess the validity of this proposed framework.

Clinical Relevance

A multidimensional definition of LLA physical function is necessary to enable more appropriate prosthetic design, prescription, and use. Promoting greater mobility and physical activity levels within this population will improve health of people with LLA.
Effect of Transtibial Prosthesis Mass Alteration on Metabolic Activity and Outcomes
Authors: Seth Mayank , Warren Kelly A. , Lamberg Eric M.
Published: March 2021

Introduction

The loss of a lower limb is a traumatic life-changing event. It imposes restrictions on an individual's mobility and adversely affects his/her personal and social life. The gait of an individual with transtibial amputation (TTA) is less efficient, as evidenced by the higher metabolic cost during walking compared with individuals without amputation. The mass of a prosthetic leg may influence the metabolic cost of the user and potentially impact his/her activity. Currently, however, limited evidence is available on transtibial prosthesis mass. Hence, the purpose of this study was to explore the effects of prosthesis mass alterations on metabolic cost, function, satisfaction, and health-related quality of life of individuals with TTA after 7 days of acclimation.

Materials and Methods

A repeated-measures study involving three testing sessions (each 1 week apart) was conducted, during which three load conditions were examined. At the end of the first two sessions, participant's prosthesis mass was increased by adding either 30% (light load) or 50% (heavy load) of the total mass difference between both legs to a proximal location on the prosthesis. Data collection during each session comprised a 6-minute walk test (during which metabolic activity was also acquired) and completion of questionnaires from the Orthotics and Prosthetics Users' Survey.

Results

Increasing prosthesis mass with the light and heavy load conditions did not significantly increase the net metabolic cost and walking economy of the participants. Participant function (performance and self-reported) and satisfaction were not significantly affected by the mass increase. However, while using the light load condition, participants reported a significant improved health-related quality of life.

Conclusions

Increasing prosthesis mass did not result in the worsening of metabolic activity and other selected outcomes among people with TTA.
Development of postgraduate training in critical care medicine for nurse practitioners and physician assistants
Authors: Zhou Christine Y. , Pathak Vikas
Published: March 2021

Nurse practitioners (NPs) and physician assistants (PA) are increasingly providing care to the critically ill patients in the intensive care unit. We structured a 4-month training program for our existing NPs and PAs and assessed their knowledge and skill pre and post training. The program was composed of blended didactic in critical care medicine topics, critical care simulations in simulation laboratory, and supervised critical care procedures. Formal knowledge and skill assessments were performed before and after the program to assess success in meeting predefined learning objectives. The mean preintervention medical knowledge assessment score was 3.37 ± 0.56 SD, which significantly improved to 3.86 ± 0.46 SD (p < .00001). For clinical skills for critical care procedures, the mean preintervention score was 3.10 ± 0.86 SD, which improved to 3.61 ± 0.92 SD (p < .00001). The overall knowledge (including medical knowledge and clinical skills) improved from mean 3.30 ± 0.86 SD to 3.80 ± 0.42 SD. The improvement was seen regardless of the duration of experience in critical care medicine. We concluded that structured didactics with supervised procedural training along with dedicated training in simulation laboratories, even for a short period, improves the overall knowledge and clinical skills required to work in a critical care setting.
Associations of Habitual Dietary Intake With Fecal Short-Chain Fatty Acids and Bowel Functions in Irritable Bowel Syndrome
Authors: Calderon Gerardo , Patel Chirag , Camilleri Michael , James-Stevenson Toyia , Bohm Matthew , Siwiec Robert , Rogers Nicholas , Wo John , Lockett Carolyn , Gupta Anita , Xu Huiping , Shin Andrea
Published: March 2021

Background & Goals:

Diet may contribute to symptoms of irritable bowel syndrome (IBS) and luminal production of putative IBS biomarkers including short-chain fatty acids (SCFAs). Study aims were to to assess relationships of habitual fiber or starch intake with fecal SCFAs in patients with IBS and healthy volunteers (HVs).

Study:

In 18 HVs and 30 patients with IBS (13 constipation-predominant [IBS-C] and 17 diarrhea-predominant [IBS-D]), habitual diet using a food frequency questionnaire; bowel functions using a validated bowel diary; and fecal SCFAs by HPLC-mass spectrometry were assessed. Associations of fiber and starch with SCFAs were analyzed using Spearman (r

s
) and Pearson (R) correlations. Relationships between other dietary endpoints, SCFAs, and bowel functions were explored.

Results:

Habitual fiber or starch intakes were not significantly correlated with SCFAs or bowel functions in all participants or HVs nor with SCFAs in IBS. Starch was negatively correlated (R=−0.53; P=0.04) with complete evacuation in IBS-D. Fiber (r

s
=0.65; P=0.02) and starch (r

s
=0.56; P=0.05) were correlated with ease of passage in IBS-C. Stool form, frequency, and ease of passage were positively correlated with total SCFAs (all P<0.05), acetate (all P<0.01), propionate (all P<0.05), and butyrate (form P=0.01; ease of passage P=0.05) among all participants, but not in IBS. Complete evacuation was negatively correlated with propionate (R=−0.34; P=0.04) in all participants. Total (P=0.04) and individual SCFAs (all P<0.05) were positively correlated with stool form in HVs.

Conclusions:

Habitual fiber and starch intake does not influence fecal SCFAs but may influence bowel functions in IBS. Fecal SCFAs correlate with bowel functions among all participants including HVs.
Photodynamic Therapy (PDT), Radiofrequency Ablation (RFA) With Biliary Stents in Palliative Treatment of Unresectable Extrahepatic Cholangiocarcinoma
Authors: Mohan Babu P. , Chandan Saurabh , Khan Shahab R. , Kassab Lena L. , Ponnada Suresh , Artifon Everson L.A. , Otoch Jose P. , McDonough Stephanie , Adler Douglas G.
Published: March 2021

Background and Aim:

Extrahepatic unresectable cholangiocarcinoma carries a dismal prognosis. In addition to biliary drainage by stent placement; photodynamic therapy (PDT) and radiofrequency ablation (RFA) have been tried to prolong survival. In this meta-analysis, we appraise the current known data on the use of PDT, RFA in the palliative treatment of extrahepatic unresectable cholangiocarcinoma.

Methods:

We searched multiple databases from inception through July 2020 to identify studies that reported on PDT and RFA. Pooled rates of survival, stent patency, 30-, 90-day mortality, and adverse events were calculated. Study heterogeneity was assessed using I
2% and 95% prediction interval.

Results:

A total of 55 studies (2146 patients) were included. A total of 1149 patients underwent treatment with PDT (33 studies), 545 with RFA (22 studies), and 452 patients with stent-only strategy. The pooled survival rate with PDT, RFA, and stent-only groups was 11.9 [95% confidence interval (CI): 10.7-13.1] months, 8.1 (95% CI: 6.4-9.9) months, and 6.7 (95% CI: 4.9-8.4) months, respectively. The pooled time of stent patency with PDT, RFA, and stent-only groups was 6.1 (95% CI: 4.2-8) months, 5.5 (95% CI: 4.2-6.7) months, and 4.7 (95% CI: 2.6-6.7) months, respectively. The pooled rate of 30-day mortality with PDT was 3.3% (95% CI: 1.6%-6.7%), with RFA was 7% (95% CI: 4.1%-11.7%) and with stent-only was 4.9% (95% CI: 1.7%-13.1%). The pooled rate of 90-day mortality with PDT was 10.4% (95% CI: 5.4%-19.2%) and with RFA was 16.3% (95% CI: 8.7%-28.6%).

Conclusion:

PDT seemed to demonstrate better overall survival and 30-day mortality rates than RFA and/or stent-only palliation.
Association Between Chronic Hepatitis C Virus Infection and Esophageal Cancer
Authors: Ponvilawan Ben , Rittiphairoj Thanitsara , Charoenngam Nipith , Rujirachun Pongprueth , Wattanachayakul Phuuwadith , Tornsatitkul Surapa , Ungprasert Patompong
Published: March 2021

Background:

Chronic hepatitis C virus (HCV) infection is associated with increased risk of hepatobiliary tract cancer. However, whether chronic HCV infection is also associated with elevated risk of other types of cancer is still unknown. This systematic review and meta-analysis was conducted in order to investigate whether chronic HCV infection is positively associated with esophageal cancer.

Methods:

A systematic review was conducted using Embase and MEDLINE databases from inception to November 2019, with a search strategy that comprised the terms for “hepatitis C virus” and “cancer.” Eligible studies were cohort studies consisting of patients with chronic HCV infection and comparators without HCV infection, and followed them for incident esophageal cancer. Hazard risk ratio, incidence rate ratio, relative risk or standardized incidence ratio of this association were extracted from each eligible study along with their 95% confidence intervals and were combined to calculate the pooled effect estimate using the random effect, generic inverse variance method.

Results:

A total of 20,459 articles were identified using this search strategy. After 2 rounds of independent review, 7 studies satisfied the inclusion criteria and were included in the meta-analysis. Chronic HCV infection was significantly associated with a higher incidence of esophageal cancer with the pooled relative risk of 1.61 (95% confidence interval: 1.19-2.17; I
2=39%). The funnel plot was relatively symmetric which was not suggestive of publication bias.

Conclusion:

This systematic review and meta-analysis demonstrated that there is a modest association between chronic HCV and incident esophageal cancer. However, more studies are needed to investigate the causality of this association.
Positioning biologics in the management of moderate to severe Crohn's disease
Authors: Hashash Jana G. , Mourad Fadi H.
Published: March 2021

Purpose of review

Since there is a lack of head-to-head randomized controlled trials, little direction is provided from guidelines on the positioning of biologics for the treatment of Crohn's disease (CD). This review utilizes comparative effectiveness and safety results from real-world data and network meta-analyses to inform clinical practice for positioning of biological therapies in the treatment of moderate-to-severe CD.

Recent findings

We summarize the results of studies pertaining to the identification of predictors for response to biologics in CD. Recently published studies about the management of moderate-to-severe CD are discussed and a positioning algorithm is proposed for the therapeutic approach of these patients.

Different classes of biologics are comparable with regards to safety and almost similar in effectiveness in the management of CD. There are certain clinical scenarios in which one biologic is more effective than another. For instance, patients with a more aggressive disease phenotype such as fistulizing disease would benefit from infliximab over other biologics, whereas in older patients at a higher risk for infectious complications, it may be more appropriate to use ustekinumab or vedolizumab over the anti-tumor necrosis factor (TNF) agents. More data pertaining to identifying predictors of response to the different available therapies and head-to-head comparison trials are needed to personalize our therapeutic approach of CD patients.
Therapeutic Leukapheresis in Pediatric Leukemia: Utilization Trend and Early Outcomes in a US Nationwide Cohort
Authors: Takahashi Takuto , Turcotte Lucie M. , Gordon Peter M. , Johnson Andrew D. , Rubin Nathan , Spector Logan G.
Published: March 2021

Leukapheresis (LA) in pediatric leukemia is performed for leukostasis, a life-threatening emergency in the setting of extremely increased blast cell counts. The authors aimed to assess the epidemiology of pediatric leukemia who received LA. The authors reviewed US nationally representative admission records of patients less than 20 years of age in the Kids’ Inpatient Database for the years 2000, 2003, 2006, 2009, 2012, and 2016. Incidence of new leukemia cases who underwent LA were calculated for the years 2009, 2012, and 2016. Cox and logistic regression analyses were performed to ascertain the risk factors for adverse outcomes. There were 526 admissions for pediatric patients with acute lymphoblastic leukemia (ALL) (n=328), acute myeloid leukemia (AML) (n=124), or chronic myeloid leukemia (CML) (n=74) who underwent LA over the study period. The incidence of leukemia cases that required LA was lower in 2016 than in 2009 or 2012 (1.4%, 2.2%, and 2.7%, respectively; P=0.001). In-hospital mortality was higher in AML than ALL (hzard ratio, 3.2; 95% confidence interval, 1.1-9.1). None with CML died during admission. This first population-based study of LA in pediatric leukemia showed a decreased utilization of LA over recent years. The higher inpatient mortality in AML, as compared with ALL or CML, warrant further investigations.
Women RISE
Authors: Zimbro Kathie S. , Maduro Ralitsa S. , Haimani Olivia F. , Hahn Donna S. , Morgan Merri K.
Published: March 2021

Background:

The Women RISE program, educating women and health care providers along with technology support, may reduce opioid use.

Local Problem:

Opioid use presented health concerns for women in Virginia's Central Shenandoah Valley.

Methods:

We evaluated the impact of Women RISE on self-management of chronic pain and opioid use, provider prescribing practices, and opioid reduction within our community.

Interventions:

We implemented the Chronic Pain Self-Management Program (CPSMP), educated women and providers, and streamlined access to the Prescription Management Program. Opioid best practice alerts informed providers about their prescribing practices.

Results:

The CPSMP was beneficial in improving women's coping skills, knowledge about opioid use, and overall quality of life. Opioid prescriptions were reduced 34%. We also reduced unneeded opioid analgesics within our community.

Conclusions:

Women were better able to manage chronic pain and stressors impacting opioid misuse. Opioid prescribing practices improved, limiting opioid availability in our community.
An Integrative Review of the Barriers and Facilitators to Nurse Engagement in Quality Improvement in the Clinical Practice Setting
Authors: Alexander Catherine C. , Tschannen Dana , Hays Deana , Clouse Morgan , Zellefrow Cindy , Amer Kim Siarkowski , Lambert-Davis Jacquelyn , Watson Tressa Honaas , Tovar Elizabeth G. , Milner Kerry A.
Published: March 2021

Background:

Nurse engagement in quality improvement (QI) improves health care quality and outcomes but is typically low in clinical settings.

Purpose:

An integrative review was conducted to identify facilitators and barriers of nurse engagement in QI.

Methods:

This integrative review was conducted using an electronic search of databases with search terms specific to nursing engagement in QI. The Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide was used to rate quality and level of evidence.

Results:

Nine articles met the criteria for review. Top barriers were leadership, education and training, resource constraints, data, culture, and time. Top facilitators were leadership, education and training, culture, mentors, and champions.

Conclusion:

High-quality literature exploring barriers and facilitators of nurse engagement in QI is lacking. Research is needed to examine the degree to which these barriers and facilitators impact engagement and how they can be addressed to increase it.
Today’s Advanced Practice Leader
Authors: Kapu April , Dubree Marilyn
Published: March 2021

This month's column highlights organizational, practice, and patient care advantages to adding advanced practice leaders to health systems' leadership teams and ideal characteristics of effective, executive advanced practice leaders.
Development and Implementation of a Brief Healthcare Professional Support Program Based in Gratitude, Mindfulness, Self-compassion, and Empathy
Authors: Victorson David , Sauer Christina , Horowitz Bruriah , Wolf-Beadle Julie
Published: March 2021

OBJECTIVE

To highlight the development, implementation, and initial findings of a brief healthcare professional support program called “GRACE.”

BACKGROUND

Healthcare professionals face significant work-related stressors that when left unmanaged can negatively affect their overall well-being and contribute to burnout.

METHODS

Over a 2-year period, the GRACE program was delivered to 8 clinical units at a midsized southwestern hospital. Questionnaires were administered at baseline and 1 month.

RESULTS

Program participants were 36 years old on average, female (81%), and White (68%) and mostly employed as nurses (66%). Attendees reported increased knowledge, understanding, and confidence and found the program to be acceptable. One month after training, participants demonstrated significant improvements in self-compassion. Medical units that received GRACE training saw significantly greater increases in patient satisfaction scores compared with units that did not receive training.

CONCLUSIONS

The GRACE program was feasible and acceptable to deliver, and initial proof-of-concept evidence was supported.
Academic-Practice Partnership in Rural Maryland: Opportunities for Advanced Practice Registered Nurse Training and Employment
Authors: Akintade Bimbola , Idzik Shannon , Gourley Bridgitte , Montgomery Kathryn Lothschuetz , Indenbaum-Bates Keisha , Novak Kristy , Hicks Gary N. , Appleby Tonya
Published: March 2021

This case study describes how an innovative, triple-win, academic-practice partnership model can be used to deepen the clinical expertise of advanced practice registered nurse (APRN) students and improve rural Americans' access to quality patient care. It features the experience and strategies used by a school of nursing and a local rural hospital system collaborating to provide clinical experiences for APRN students pursuing doctor of nursing practice degrees.
T2 Hepatocellular Carcinoma Exception Policies That Prolong Waiting Time Improve the Use of Evidence-based Treatment Practices
Authors: Durkin Claire , Kaplan David E. , Bittermann Therese
Published: March 2021

Background.

A United Network for Organ Sharing policy change in 2015 created a 6-mo delay in the receipt of T2 hepatocellular carcinoma exception points. It was hypothesized that the policy changed locoregional therapy (LRT) practices and explant findings because of longer expected waiting time.

Methods.

Patients transplanted with a first T2 hepatocellular carcinoma exception application between January 1, 2010 and December 31, 2014 (prepolicy; N = 6562), and those between August 10, 2015 and December 2, 2019 (postpolicy; N = 2345), were descriptively compared using data from United Network for Organ Sharing.

Results.

Median time from first application to transplantation was more homogenous across the US postpolicy, due to greater absolute increases in Regions 3, 6, 10, and 11 (>120 d). During waitlisting, postpolicy candidates received more LRT overall (P < 0.001), with more notable increases in previously short-wait regions. Postpolicy explants were overall more likely to have ≥1 tumor with complete necrosis (23.9 versus 18.4%; P < 0.001) and less likely have ≥1 tumor with no necrosis (32.6% versus 38.5%; P < 0.001). Significant geographic variability in explant treatment response was observed prepolicy with recipients in previously short-wait regions having more frequent tumor viability at transplant. Postpolicy, there were no differences in the prevalence of recipients with ≥1 tumor with 100% or 0% necrosis across regions (P = 0.9 and 0.2, respectively).

Conclusions.

The 2015 T2 exception policy has led to reduced geographic variability in the use of pretransplant LRT and in less frequent tumor viability on explant for recipients in previously short-waiting times.
Ex Situ Arterial Reconstruction During Normothermic Perfusion of the Liver
Authors: Nasralla David , Lembach Hanns , Mergental Hynek , Mirza Darius , Friend Peter , Muiesan Paolo , Perera MTPR
Published: March 2021

Background.

Aberrant hepatic arterial anatomy may be seen in up to 30% of liver grafts, and reconstruction prolongs the cold ischemic time or the arterialization times. If normothermic machine preservation (NMP) is used to preserve liver grafts, the presence of aberrant arterial anatomy poses a challenge. Dual arterial cannulation is a temporary solution to enable effective perfusion, until optimal circumstances are met for arterial reconstruction, without compromising ischemia time. To date the technical and logistical feasibility of arterial reconstruction ex situ and during NMP has not been reported.

Methods.

Series of 5 cases from the Consortium for Organ Preservation in Europe randomized controlled trial in which grafts with arterial anatomic variations were reconstructed while organs were perfused on NMP.

Results.

One donor after cardiac death and 4 donor after brain death livers with arterial anatomical variations reconstructed while on NMP were included. All patients survived transplantation, spending 1–7 d in intensive care unit and discharged home after 5–15 d. None of the cases developed early allograft dysfunction or any early technical complications. At follow-up, there were no late hepatic artery thrombosis, stenosis, or any other vascular–related complication. Four of 5 patients underwent magnetic resonance cholangiopancreatography at 6 mo with no evidence of ischemic cholangiopathy.

Conclusions.

The case series described above suggests that ex vivo arterial reconstruction surgery on liver grafts while on board the NMP device is feasible, safe, and effective.
Need for Pretransplant Midodrine Does Not Negatively Impact Simultaneous Liver-kidney Transplant Outcomes
Authors: Barman Pranab M. , King Lindsay Y. , Berg Carl L. , Parish Alice , Niedzwiecki Donna , Barbas Andrew S. , McElroy Lisa , Patel Yuval A.
Published: March 2021

Background.

Midodrine is often needed pretransplant to improve hemodynamics in simultaneous liver-kidney transplant candidates. Previous research has shown that patients requiring midodrine before kidney transplant alone have increased posttransplant risk for delayed allograft function, graft failure, and death. However, the impact of pretransplant midodrine use on outcomes after simultaneous liver-kidney transplant is unknown.

Methods.

We performed a retrospective study of all adult (age ≥18 y) simultaneous liver-kidney transplant recipients from a single academic transplant center from February 1, 2002, to June 30, 2019.

Results.

Sixty-four simultaneous liver-kidney transplants were performed in our institution during this time period, of which, 43 were not on midodrine before transplant, 17 were on midodrine alone, and 4 were on intravenous (IV) vasopressor therapy. Despite the midodrine group having a higher MELD-Na at listing, higher MELD-Na at transplant, and being older, there were no significant differences in key outcomes including delayed renal allograft function, estimated glomerular filtration rate at transplant discharge, and estimated glomerular filtration rate at 1 y after transplant compared with the nonmidodrine group. There was no significant difference in graft failure or survival at last follow-up.

Conclusions.

Our study suggests that need for pretransplant midodrine should not be a barrier to simultaneous liver-kidney transplant.
A National Survey of Hepatocellular Carcinoma Surveillance Practices Following Liver Transplantation
Authors: Aggarwal Avin , Te Helen S. , Verna Elizabeth C. , Desai Archita P.
Published: March 2021

Background.

Recurrence of hepatocellular carcinoma (HCC) is an important predictor of survival after liver transplantation (LT). Recent studies show that early diagnosis, aggressive treatment, and surveillance may improve outcomes after HCC recurrence. We sought to determine the current practices and policies regarding surveillance for HCC recurrence after LT.

Methods.

We conducted a web-based national survey of adult liver transplant centers in the United States to capture center-specific details of HCC surveillance post-LT. Responses were analyzed to generate numerical and graphical summaries.

Results.

Of 101 eligible adult liver transplant centers, 48 (48%) centers across the United States responded to the survey. Among the participating centers, 79% stratified transplant recipients for HCC recurrence risk, while 19% did not have any risk stratification protocol. Explant microvascular invasion (mVI) was the most common factor used in risk stratification. Use of pretransplant serum biomarkers such as alpha-fetoprotein (AFP) was variable, with only 48% of the participating centers reporting specific “cutoff” values. While a majority of centers (88%) reported having a routine imaging protocol for HCC recurrence surveillance, there was considerable heterogeneity in terms of frequency and duration of such surveillance. Of the centers that did risk stratify patients to identify those at higher risk of HCC recurrence, about 50% did not change their surveillance protocol.

Conclusions.

Our study affirms significant variability in center practices, and our results reflect the need for high-quality studies to guide risk stratification and surveillance for HCC recurrence.
A Program of Research to Evaluate the Impact of Deceased Organ Donation Legislative Reform in Nova Scotia: The LEADDR Program
Authors: Weiss Matthew J. , Krmpotic Kristina , Cyr Tim , Dhanani Sonny , Dieudé Mélanie , Dirk Jade S. , Hartell David , Isenor Cynthia , James Lee , Lucas Amanda , Patriquin Chelsea , Simpson Christy , Sullivan Victoria L. , Tennankore Karthik K. , Thurlow Jennifer , Urquhart Robin , Vorster Hans , Beed Stephen D.
Published: March 2021

Background.

This is the first time deemed consent, where the entire population of a jurisdiction is considered to have consented for donation unless they have registered otherwise, will be implemented in North America. While relatively common in other regions of the world—notably Western Europe—it is uncertain how this practice will influence deceased donation practices and attitudes in Canada.

Methods.

We describe a Health Canada funded program of research that will evaluate the implementation process and full impact of the deceased organ donation legislation and the health system transformation in Nova Scotia that includes opt-out consent.

Results.

There is a need to evaluate the impact of these changes to inform not only Nova Scotia and Atlantic Canada, but also other provincial, national, and international stakeholders.

Conclusions.

We establish a rigorous academic framework that we will use to evaluate this significant health system transformation.
Sulfurovum indicum sp. nov., a novel hydrogen- and sulfur-oxidizing chemolithoautotroph isolated from a deep-sea hydrothermal plume in the Northwestern Indian Ocean
Authors: Xie Shaobin , Wang Shasha , Li Dengfeng , Shao Zongze , Lai Qiliang , Wang Yejian , Wei Mingcong , Han Xiqiu , Jiang Lijing
Published: March 2021

A novel mesophilic, hydrogen-, and sulfur-oxidizing bacterium, designated strain ST-419T, was isolated from a deep-sea hydrothermal vent plume on the Carlsberg Ridge of the Northwestern Indian Ocean. The isolate was a Gram-staining-negative, non-motile and coccoid to oval-shaped bacterium. Growth was observed at 4–50 °C (optimum 37 °C), pH 5.0–8.6 (optimum pH 6.0) and 1.0–5.0 % (w/v) NaCl (optimum 3.0 %). ST-419T could grow chemlithoautotrophically with molecular hydrogen, sulfide, elemental sulfur and thiosulfate as energy sources. Molecular oxygen, nitrate and elemental sulfur could be used as electron acceptors. The predominant fatty acids were C16 : 1ω7c, C18 : 1ω7c and C16 : 0. The major polar lipids were phosphatidylethanolamine, diphosphatidylglycerol and phosphatidylglycerol. The respiratory quinone was menaquinone MK-6 and the G+C content of the genomic DNA was 42.4 mol%. Phylogenetic analysis based on 16S rRNA gene sequences revealed that ST-419T represented a member of genus

Sulfurovum

and was most closely related to

Sulfurovum riftiae

1812ET, with 97.6 % sequence similarity. The average nucleotide identity (ANI) and digital DNA–DNA hybridization (dDDH) values between ST-419T and

S. riftiae

1812ET were 74.6 and 19.6 %, respectively. The combined genotypic and phenotypic data indicate that ST-419T represents a novel species within the genus

Sulfurovum

, for which the name Sulfurovum indicum sp. nov. is proposed. The type strain is ST-419T (=MCCC 1A17954T=KCTC 25164T).
Epigenetic drift association with cancer risk and survival, and modification by sex
Authors: Yu Chenglong , Wong Ee Ming , Joo Jihoon Eric , Hodge Allison M. , Makalic Enes , Schmidt Daniel , Buchanan Daniel D. , Severi Gianluca , Hopper John L. , English Dallas R. , Giles Graham G. , Southey Melissa C. , Dugué Pierre-Antoine
Published: March 2021

To investigate age- and sex-specific DNA methylation alterations related to cancer risk and survival, we used matched case-control studies of colorectal (N=835), gastric (N=170), kidney (N=143), lung (N=332), prostate (N=869) and urothelial (N=428) cancers, and mature B-cell lymphoma (N=438). Linear mixed-effects models were conducted to identify age-, sex- and age-by-sex-associated methylation markers using a discovery (controls) - replication (cases) strategy. Replication was further examined using summary statistics from Generation Scotland (GS). Associations between replicated markers and risk of and survival from cancer were assessed using conditional logistic regression and Cox models (hazard ratios [HR]), respectively. We found 32,659, 23,141 and 48 CpGs with replicated associations for age, sex and age-by-sex, respectively. The replication rates (GS summary data) for these CpGs were 94%, 86% and 91%, respectively. Significant signals for cancer risk and survival were identified at some individual age-related CpGs. There was a strong negative trend in the association between epigenetic drift and risk of colorectal cancer. Two CpGs overlapping TMEM49 and ARX genes were associated with survival of overall (HR=0.91, P=7.7×10−4) and colorectal (HR=1.52, P=1.8×10−4) cancer, respectively, with significant age-by-sex interaction. Our results may provide markers for cancer early detection and prognosis prediction.

Simple Summary

Ageing is the strongest cancer risk factor, and men and women exhibit disparate risk profiles in terms of incidence and survival. DNA methylation is known to strongly vary by age and sex. Epigenetic drift refers to age-related DNA methylation changes and the tendency for increasing discordance between epigenomes over time, but it remains unknown to what extent the epigenetic drift might contribute to cancer risk and survival. The aims of this study were to identify age-associated, sex-associated and sexually dimorphic age-associated (age-by-sex-associated) DNA methylation markers and investigate whether age- and age-by-sex-associated markers are associated with cancer risk and survival. Our study, which used a total of 3,215 matched case-control pairs with DNA methylation in pre-diagnostic blood, is the first large study to examine the association between sex-specific epigenetic drift and cancer development and progression. The results may be useful for cancer early diagnosis and prediction of prognosis.
Genetic variability associated withOAS1expression in myeloid cells increases the risk of Alzheimer’s disease and severe COVID-19 outcomes
Authors: Magusali Naciye , Graham Andrew C. , Piers Thomas M. , Panichnantakul Pantila , Yaman Umran , Shoai Maryam , Reynolds Regina H. , Botia Juan A. , Brookes Keeley J. , Guetta-Baranes Tamar , Bellou Eftychia , Bayram Sevinc , Sokolova Dimitra , Ryten Mina , Frigerio Carlo Sala , Escott-Price Valentina , Morgan Kevin , Pocock Jennifer M. , Hardy John , Salih Dervis A.
Published: March 2021

Genome-wide association studies of late-onset Alzheimer’s disease (AD) have highlighted the importance of variants associated with genes expressed by the innate immune system in determining risk for AD. Recently, we and others have shown that genes associated with variants that confer risk for AD are significantly enriched in transcriptional networks expressed by amyloid-responsive microglia. This allowed us to predict new risk genes for AD, including the interferon-responsive oligoadenylate synthetase 1 (OAS1). However, the function ofOAS1within microglia and its genetic pathway are not known. Using genotyping from 1,313 individuals with sporadic AD and 1,234 control individuals, we confirm that theOAS1variant, rs1131454, is associated with increased risk for AD and decreasedOAS1expression. Moreover, we note that the same locus was recently associated with critical illness in response to COVID-19, linking variants that are associated with AD and a severe response to COVID-19. By analysing single-cell RNA-sequencing (scRNA-seq) data of isolated microglia fromAPPNL-G-Fknock-in and wild-type C57BL/6J mice, we identify a transcriptional network that is significantly upregulated with age and amyloid deposition, and contains the mouse orthologueOas1a, providing evidence thatOas1aplays an age-dependent function in the innate immune system. We identify a similar interferon-related transcriptional network containingOAS1by analysing scRNA-seq data from human microglia isolated from individuals with AD. Finally, using human iPSC-derived microglial cells (h-iPSC-Mg), we see thatOAS1is required to limit the pro-inflammatory response of microglia. When stimulated with interferon-gamma (IFN-γ), we note that cells with lowerOAS1expression show an exaggerated pro-inflammatory response, with increased expression and secretion of TNF-α. Collectively, our data support a link between genetic risk for AD and susceptibility to critical illness with COVID-19 centred onOAS1and interferon signalling, a finding with potential implications for future treatments of both AD and COVID-19, and the development of biomarkers to track disease progression.