bluuebunny/crossref_metadata_2025 huggingface dataset:
Arc Crust Formation of Lesser Antilles Revealed by Crustal Xenoliths from Petit St. Vincent
Authors: Melekhova Elena , Camejo-Harry Michal , Blundy Jon , Wallis Simon R , Annen Catherine , Kunz Barbara E , Jenner Frances E , Thirlwall Matthew
Published: April 2022

The Lesser Antilles volcanic arc is known for its magmatic diversity and unusually abundant plutonic xenoliths. Xenoliths from Petit St. Vincent (Grenadines’ archipelago) are particularly interesting because of their textural and petrogenetic range. Here we combine petrographic observations, Electron Backscatter Diffraction (EBSD) analysis, major and trace element chemistry of xenoliths and lavas and geochemical and thermal modelling to explore the construction of arc crust beneath Petit St. Vincent. Petit St. Vincent xenoliths are dominated by calcic plagioclase, clinopyroxene and amphibole, and can be divided into two main categories, igneous and meta-igneous. Igneous xenoliths typically have cumulate textures; meta-igneous xenoliths range texturally from those that preserve vestiges of primary magmatic fabrics to intensely deformed varieties characterised by grain-size reduction and foliation development. Meta-igneous xenoliths also contain the most calcic plagioclase (An98–100). The presence of both meta-igneous and igneous xenoliths provides evidence for reworking of older arc crust and antecedent igneous intrusions. The latter have a protolith composition similar to high-MgO, low-Sr picrites and high-Ca, high-Sr ankaramites from the neighbouring islands of Petite Martinique and Grenada. The meta-igneous xenoliths derive from older, mafic arc crust present at the onset of subduction. Trace element chemistry and EBSD analyses of meta-igneous xenoliths are consistent with a complex history of re-melting and deformation mediated by chlorine-bearing H2O rich fluids (including melts). Thermal modelling supports crustal reworking through repeated magma intrusions and indicates that the observed thermal structure and thickness of crust beneath Petit St. Vincent could have developed on a timescale of approximately 4 million years at rates compatible with the regional arc magma flux. Based on evidence from thermodynamic models and exhumed ancient arc crust sections, Collins et al. (Nature Geoscience, 13, 331–338, 2020) have proposed that water-fluxed melting may be an important aspect of deep arc crust sections world-wide. Textures and mineralogy of xenoliths from Petit St. Vincent, including their characteristic high-An plagioclase, testify to such a process beneath an active, intra-oceanic arc.
High-sensitivity cardiac troponin, a cardiac marker predicting death in patients with kidney disease: a dose–response meta-analysis of cohort studies
Authors: Yuan L , Chen C , Feng Y , Yang X J , Li Y , Wu Y , Hu F , Zhang M , Li X , Hu H , Zhang J , Li T , Liu Y , Sun X , Zhao Y , Hu D
Published: April 2022

Patients with kidney disease are at increased risk of adverse mortality events. Numerous studies have demonstrated the positive association of high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) with all-cause and cardiovascular (CV) mortality in patients with kidney disease; however, the dose–response meta-analysis has not been reported. We therefore performed this study to evaluate the dose–response associations of hs-cTn with risk of all-cause and CV mortality to improve risk stratification. We searched three databases (PubMed, Embase and Web of Science) to identify relevant prospective cohort studies published up to 12 January 2021. Random-effects models were used to summarize relative risks (RRs) and 95% confidence intervals (CIs) of all-cause and CV mortality. Restricted cubic splines were used to fit the dose–response associations. For each 10 ng/l increase in hs-cTnT and hs-cTnI, the risk increased by 14% (RR = 1.14, 95% CI, 1.10–1.18) and 19% (RR = 1.19, 95% CI, 1.09–1.31) for all-cause mortality, 25% (RR = 1.25, 95% CI, 1.13–1.38) and 19% (RR = 1.19, 95% CI, 1.10–1.29) for CV mortality. A linear trend was found between hs-cTnT and all-cause mortality, whereas a non-linear trend was found in hs-cTnI. Additionally, both hs-cTnT and hs-cTnI were shown to have linear trends with CV mortality. Our meta-analysis suggests that hs-cTn had high sensitivity in predicting mortality events. All dose–response trends were rising rather than falling, conferring that any increase in the levels of hs-cTn may possibly predict a death prognosis among chronic kidney disease patients.
Richard Hader Visionary Leader Award 2021 Visionary Leader Runner-up Brandon “Kit” Bredimus
Authors: Tye Joe
Published: April 2022

The following manuscript is one of the runner-up entries submitted to Nursing Management for the Visionary Leader Award in recognition of Brandon “Kit” Bredimus, DNP, RN, the CNO and vice president for nursing at Midland Memorial Hospital in Midland, Tex.
Clinical communication
Authors: Collins Rhonda
Published: April 2022

Four tools to keep nurses safe beyond the next crisis
Heart failure readmission reductions during the COVID-19 pandemic
Authors: Hamilton Brielle , Yadav Charul , Gomez Deanna , Book Karyn A. , Motavalli Lisa , Gronczewski Craig , Kempf Sheila , Giordano Nicholas , Mastro Kari A.
Published: April 2022

Behaviors, treatments, and self-management strategies used by patients and caregivers at home
Recognizing Our Biases, Understanding the Evidence, and Responding Equitably
Authors: McCarty Dana B.
Published: April 2022

Background:

Implicit bias permeates beliefs and actions both personally and professionally and results in negative health outcomes for people of color—even in the neonatal intensive care unit (NICU). NICU clinicians may naïvely and incorrectly assume that NICU families receive unbiased care. Existing evidence establishing associations between sex, race, and neonatal outcomes may perpetuate the tendency to deny racial bias in NICU practice.

Evidence Acquisition:

Using the socioecological model as a framework, this article outlines evidence for racial health disparities in the NICU on multiple levels—societal, community, institutional, interpersonal, and individual. Using current evidence and recommendations from the National Association of Neonatal Nurses Position Statement on “Racial Bias in the NICU,” appropriate interventions and equitable responses of the NICU clinician are explored.

Results:

Based on current evidence, clinicians should reject the notion that the social construct of race is the root cause for certain neonatal morbidities. Instead, clinicians should focus on the confluence of medical and social factors contributing to each individual infant's progress. This critical distinction is not only important for clinicians employing life-saving interventions, but also for those who provide routine care, developmental care, and family education—as these biases can and do shape clinical interactions.

Implications for Practice and Research:

Healthcare practitioners have an ethical and moral responsibility to maintain up-to-date knowledge of new evidence that impacts our clinical practice. The evidence demonstrates the importance of recognizing the enduring role of racism in the health and well-being of people of color and the need to adjust care accordingly.
Does Interbody Cage Lordosis and Position Affect Radiographic Outcomes After Single-level Transforaminal Lumbar Interbody Fusion?
Authors: DiMaria Stephen , Karamian Brian A. , Siegel Nicholas , Lambrechts Mark J. , Grewal Lovy , Jeyamohan Hareindra R. , Robinson William A. , Patel Akul , Canseco Jose A. , Kaye Ian David , Woods Barrett I. , Radcliff Kris E. , Kurd Mark F. , Hilibrand Alan S. , Kepler Chris K. , Vaccaro Alex R. , Schroeder Gregory D.
Published: April 2022

Study Design:

This was a retrospective cohort study.

Objective:

The objective of this study was to determine if the degree of interbody cage lordosis and cage positioning are associated with changes in postoperative sagittal alignment after single-level transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data:

Ideal sagittal alignment and lumbopelvic alignment have been shown to correlate with postoperative clinical outcomes. TLIF is one technique that may improve these parameters, but whether the amount of cage lordosis improves either segmental or lumbar lordosis (LL) is unknown.

Methods:

A retrospective review was performed on patients who underwent single-level TLIF with either a 5-degree or a 12-degree lordotic cage. LL, segmental lordosis (SL), disk height, center point ratio, cage position, and cage subsidence were evaluated. Correlation between center point ratio and change in lordosis was assessed using the Spearman correlation coefficient. Secondary analysis included multiple linear regression to determine independent predictors of change in SL.

Results:

A total of 126 patients were included in the final analysis, with 51 patients receiving a 5-degree cage and 75 patients receiving a 12-degree cage. There were no differences in the postoperative minus preoperative LL (∆LL) (12-degree cage: −1.66 degrees vs. 5-degree cage: −2.88 degrees, P=0.528) or ∆SL (12-degree cage: −0.79 degrees vs. 5-degree cage: −1.68 degrees, P=0.513) at 1-month follow-up. Furthermore, no differences were found in ∆LL (12-degree cage: 2.40 degrees vs. 5-degree cage: 1.00 degrees, P=0.497) or ∆SL (12-degree cage: 1.24 degrees vs. 5-degree cage: 0.35 degrees, P=0.541) at final follow-up. Regression analysis failed to show demographic factors, cage positioning, or cage lordosis to be independent predictors of change in SL. No difference in subsidence was found between groups (12-degree cage: 25.5% vs. 5-degree cage: 32%, P=0.431).

Conclusion:

Lordotic cage angle and cage positioning were not associated with perioperative changes in LL, SL, or cage subsidence after single-level TLIF.

Level of Evidence:

Level III.
Instrumentation Across the Cervicothoracic Junction Does Not Improve Patient-reported Outcomes in Multilevel Posterior Cervical Decompression and Fusion
Authors: Toci Gregory R. , Karamian Brian A. , Lambrechts Mark J. , Mao Jennifer , Mandel Jenna , Darrach Tallulah , Canseco Jose A. , Kaye I. David , Woods Barrett I. , Rihn Jeffrey , Kurd Mark F. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: April 2022

Study Design:

This was a retrospective cohort.

Objective:

The objective of this study was to determine if instrumentation across the cervicothoracic junction (CTJ) in elective multilevel posterior cervical decompression and fusion (PCF) is associated with improved patient-reported outcome measures (PROMs).

Summary of Background Data:

Fusion across the CTJ may result in lower revision rates at the expense of prolonged operative duration. However, it is unclear whether constructs crossing the CTJ affect PROMs.

Materials and Methods:

Standard Query Language (SQL) identified patients with PROMs who underwent elective multilevel PCF (≥3 levels) at our institution. Patients were grouped based on anatomic construct: crossing the CTJ (crossed) versus not crossing the CTJ (noncrossed). Subgroup analysis compared constructs stopping at C7 or T1. Independent t tests and χ2 tests were utilized for continuous and categorical data, respectively. Regression analysis controlled for baseline demographics. The α was set at 0.05.

Results:

Of the 160 patients included, the crossed group (92, 57.5%) had significantly more levels fused (5.27 vs. 3.71, P<0.001), longer operative duration (196 vs. 161 min, P=0.003), greater estimated blood loss (242 vs. 160 mL, P=0.021), and a decreased revision rate (1.09% vs. 10.3%, P=0.011). Neither crossing the CTJ (vs. noncrossed) nor constructs spanning C3–T1 (vs. C3–C7) were independent predictors of ∆PROMs (change in preoperative minus postoperative patient-reported outcomes) on regression analysis. However, C3–C7 constructs had a greater revision rate than C3–T1 constructs (15.6% vs. 1.96%, P=0.030).

Conclusion:

Crossing the CTJ in patients undergoing elective multilevel PCF was not an independent predictor of improvement in PROMs at 1 year, but they experienced lower revision rates.

Level of Evidence:

Level III.
Modified Graft Loop Technique Augmented With Nonabsorbable Suture Tape for Chronic Elbow Dislocation
Authors: Sachinis Nikolaos P. , Vasiadis Ioannis , Yiannakopoulos Christos K. , Givissis Panagiotis
Published: April 2022

The task of achieving a good clinical outcome on patients with chronic elbow dislocation is arduous. Any stabilization method used should be robust enough in order to allow for early elbow motion. Immobilization of the elbow for a prolonged time period may lead to stiffness and heterotopic ossification. Several methods of ligament reconstruction have tried to address the global instability that is present in such scenarios. We describe a technique of reconstructing both bands of the medial ligament, and the lateral ulnar collateral ligament of the elbow, by using a looped tendon graft and reinforcing the lateral side with nonabsorbable tape and anchors. The graft is passed as a loop once through the humerus and ulna, recreating the anterior portion of the medial collateral ligament and the lateral ulnar collateral ligament. Then the lateral side is augmented with the tape and anchors and the loop is fixed. Lastly, the medial tail of the graft is used in order to recreate the posterior part of the medial ligament. This technique uses a single graft along with nonabsorbable tape and anchors to make a robust construct that will withstand early range of motion, without jeopardizing elbow stability. Potential complications include damage to the ulnar nerve, infection, elbow stiffness, or persistent instability in complex cases with bone involvement.
Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals
Authors: Saab Mohamad M. , O’Driscoll Michelle , Sahm Laura J. , Leahy-Warren Patricia , Noonan Brendan , FitzGerald Serena , Kilty Caroline , O’Malley Maria , Lyons Noreen , Hegarty Josephine
Published: April 2022

Objective

This systematic review described the effect of interventions aimed at helping Healthcare Professionals refer high-risk individuals for lung cancer screening. Primary outcomes included: lung cancer detection, screening for lung cancer, lung cancer treatments received and lung cancer mortality. Healthcare professionals’ knowledge and awareness of lung cancer screening served as secondary outcomes.

Methods

Experimental studies published between January 2016 and 2021 were included. The search was conducted in MEDLINE, CINAHL, ERIC, PsycARTICLES, PsycInfo and Psychology and Behavioral Sciences Collection. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool and the level of evidence was assessed using the Scottish Intercollegiate Guidelines Network grading system.

Results

Nine studies were included. Nurse navigation, electronic prompts for lung cancer screening and shared decision-making helped improve patient outcomes. Specialist screenings yielded more significant incidental findings and a higher percentage of Lung-RADS 1 results (i.e. no nodules/definitely benign nodules), while Primary Care Physician screenings were associated with higher numbers of Lung-RADS 2 results (i.e. benign nodules with a very low likelihood to becoming malignant). An increase in Healthcare Professionals’ knowledge and awareness of lung cancer screening was achieved using group-based learning compared to lecture-based education delivery.

Conclusions

The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making, as well as a structured, clear and well-understood referral processes supported by the use of electronic system-incorporated prompts.
Development and Validation of a Dried Blood Spot Assay Using UHPLC-MS/MS to Identify and Quantify 12 Antihypertensive Drugs and 4 Active Metabolites: Clinical Needs and Analytical Limitations
Authors: Peeters Laura E. J. , Bahmany Soma , Dekker Tim , Aliawi Aya , van Domburg Bart , Versmissen Jorie , Koch Birgit C. P.
Published: April 2022

Purpose:

As nonadherence to antihypertensive drugs (AHDs) can increase the risk of cardiovascular events, hospitalization, and higher costs, there is a need for a reliable, objective, and easy method to assess nonadherence in patients. The dried blood spot (DBS) sampling method used to measure drug concentrations meets these requirements. For detecting nonadherence, identification is more important than quantification. Owing to their use in clinical practice, it is important to measure multiple AHDs with a single method. Therefore, we developed and validated a single DBS method for 17 commonly used AHDs and 4 active metabolites using ultrahigh performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS).

Methods:

Analytical validation of the DBS assay was performed in accordance with the guidelines on bioanalytical method validation of the European Medicines Agency and US Food and Drug Administration as well as the International Association of Therapeutic Drug Monitoring and Clinical Toxicology guidelines.

Results:

We validated 12 of the 17 AHDs according to the European Medicines Agency and Food and Drug Administration requirements for bioanalytical method validation. Eleven AHDs were validated for both identification and quantification of drug concentrations, whereas nifedipine was only validated for identification. However, 5 of the 17 AHDs were excluded due to suboptimal validation results. Lercanidipine was excluded due to nonlinearity, and all 4 AHDs measured in the negative mode of UHPLC-MS/MS were not in accordance with one or more of the acceptance criteria and were therefore excluded.

Conclusions:

The described method accurately measured AHDs in DBS and can be used to determine nonadherence in patients. However, method validation revealed a challenging balance between analytical limitations and clinical needs when analyzing multiple drugs using the same method.
High-Sensitivity and High-Throughput Quantification of Everolimus in Human Whole Blood Using Ultrahigh-Performance Liquid Chromatography Coupled With Tandem Mass Spectrometry
Authors: Miyagi Chika , Tanaka Ryota , Hirata Kenshiro , Watanabe Takuma , Tatsuta Ryosuke , Miyamura Shigeyuki , Itoh Hiroki
Published: April 2022

Background:

Rigorous dose adjustment by therapeutic drug monitoring (TDM) is recommended when everolimus (EVR) is administered for immunosuppression. In this study, the authors developed a highly sensitive ultrahigh-performance liquid chromatography coupled with the tandem mass spectrometry (UHPLC-MS/MS) method for measuring EVR concentrations in whole blood using a high-throughput solid-phase extraction method for sample pretreatment. Furthermore, the blood EVR concentrations in routine TDM samples from patients who underwent renal transplantation measured using the established UHPLC-MS/MS method were compared with those measured using the latex agglutination turbidimetric immunoassay (LTIA).

Methods:

Blood samples were pretreated by solid-phase extraction using a 96-well HLB µElution plate. The clinical application of the newly developed method was evaluated using 87 blood samples from 19 patients who underwent kidney transplant.

Results:

The calibration curve showed good linearity over a wide range of 0.1–50 ng/mL, with relative error ≤15% obtained from the back calculation of calibrators, and ≤20% for the lower limit of quantification. Within-batch and batch-to-batch accuracies and precisions fulfilled the acceptance criteria of the US Food and Drug Administration guidelines for bioanalytical method validation. The extraction recovery rates were good (≥65.2%), and almost no matrix effects were found in any of the quality control samples. Blood EVR concentrations measured by UHPLC-MS/MS were positively correlated with those measured by LTIA. A Bland–Altman plot indicated that the UHPLC-MS/MS method yielded better measurements than the LTIA method, regardless of the concentration.

Conclusions:

Therefore, the authors succeeded in developing a novel high-sensitivity and high-throughput method for measuring blood EVR concentration by UHPLC-MS/MS using a µElution plate for sample pretreatment.
Depressive Symptoms After Acute Myocardial Infarction and Its Association With Low Functional Capacity and Physical Activity
Authors: Lee Sanghee , Kim Won-Seok
Published: April 2022

Purpose:

Depressive symptoms after acute myocardial infarction (AMI) are related with adverse health outcomes. However, the risk factors and course of depressive symptoms after AMI have not been widely investigated, especially in Asian populations. We aimed to evaluate changes in the prevalence of depressive symptoms and the associated risk factors at 3 mo after AMI. We also investigated the associations among functional capacity, physical activity (PA), and depressive symptoms.

Methods:

This cross-sectional study was conducted for 1545 patients who were admitted for AMI and referred to cardiac rehabilitation (CR) between August 2015 and March 2019. Of these patients, 626 patients completed the Patient Health Questionnaire-9 (PHQ-9), the Korean Activity Scale Index (KASI), and the International Physical Activity Questionnaire (IPAQ) 3 mo following AMI. A PHQ-9 score of ≥5 was considered to indicate depressive symptoms.

Results:

The prevalence of depressive symptoms was 30% at baseline and decreased to 12% at 3 mo after AMI. Depressive symptoms were significantly associated with low functional capacity (OR = 2.20, P = .004) and unemployment status (OR = 1.82, P = .023). After adjusting for variables including functional capacity, depressive symptoms exhibited a significant relationship with low PA after AMI (OR = 1.80, P = .023).

Conclusion:

Systematic screening and treatment for depressive symptoms and efforts to promote CR may help to improve PA and functional capacity in Korean patients with AMI. Such efforts may aid in reducing the depressive symptoms and related adverse outcomes.
AIR VERSUS SULFUR HEXAFLUORIDE GAS TAMPONADE IN VITRECTOMY FOR UNCOMPLICATED RETINAL DETACHMENT WITH INFERIOR BREAKS
Authors: Uemura Akinori , Mihara Naohisa , Yamakiri Keita , Santo Kyoko , Hamada Takuto , Sakamoto Taiji
Published: April 2022

Purpose:

To compare surgical outcomes of filtered air and sulfur hexafluoride (SF6) as an internal tamponade in patients undergoing primary 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment with inferior breaks.

Methods:

Patients with uncomplicated rhegmatogenous retinal detachment associated with inferior breaks (between 4 and 8 o'clock positions) who were undergoing primary pars plana vitrectomy were enrolled. All eyes underwent pars plana vitrectomy and complete drainage of subretinal fluid, followed by filtered air or 20% SF6 tamponade. The main outcome measures included single-surgery anatomical success rates and final visual recovery.

Results:

Overall, 116 eyes of 116 patients (81 men and 35 women with a mean age of 55.2 years) were assessed. Air was used in 52 eyes (air group) and gas in 64 eyes (gas group). Single-surgery anatomical success was achieved in 50 (96.2%) and 60 (93.8%) eyes in the air and gas groups, respectively (P= 0.69), and final anatomical success was achieved in all eyes. The mean final Snellen visual acuity was similar in the air (20/23) and gas groups (20/21;P= 0.13).

Conclusion:

No significant differences were observed in single-surgery anatomical success rates and final visual recovery when comparing air with SF6 gas tamponade in pars plana vitrectomy for primary uncomplicated rhegmatogenous retinal detachment with inferior breaks.
Risk factors for pneumothorax and pulmonary hemorrhage following computed tomography-guided transthoracic core-needle biopsy of subpleural lung lesions
Authors: Chiu Jui-Han , Chang Ying-Yueh , Weng Ching-Yao , Lee Ying-Chi , Yeh Yi-Chen , Chen Chun-Ku
Published: April 2022

Background:

Identifying the risk factors for complications may alert the physicians and help them adjust their plans before performing computed tomography–guided lung biopsies. Reportedly, a pleura-nodule distance longer than 2.0 cm is a strong predictor for pneumothorax and pulmonary hemorrhage. However, the rate and risk factors of biopsy-associated complications in subpleural lesions have not been assessed. This study aimed to identify the risk factors for pneumothorax and pulmonary hemorrhage in subpleural lesions ≤2.0 cm in depth.

Methods:

Altogether, 196 patients (196 subpleural lesions, lesion depth: 0.1–2.0 cm) who underwent computed tomography–guided transthoracic core-needle biopsies between March 2017 and November 2017 were retrospectively analyzed. Univariate analysis of risk factors including patient-related, lesion-related, and procedure-related characteristics was performed for pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm after the biopsy. Multivariate logistic regression analysis was performed to identify the independent risk factors.

Results:

Pneumothorax ≥1 cm and pulmonary hemorrhage ≥2 cm were identified in 35 (17.9%) and 32 (16.3%) cases, respectively. In the multivariate analysis, a longer needle path (odds ratio [OR], 1.976; 95% confidence interval [CI], 1.113−3.506; p = 0.020) and low attenuation along the biopsy tract (OR, 3.080; 95% CI, 1.038−9.139; p = 0.043) were predictors of pneumothorax ≥ 1 cm. Ground-glass lesions (OR, 2.360; 95% CI, 1.009–5.521; p = 0.048) and smaller needle-pleura angle (OR, 0.325; 95% CI, 0.145−0.728; p = 0.006) were associated with pulmonary hemorrhage ≥2 cm.

Conclusion:

For subpleural lesions ≤2.0 cm in depth, a puncture route having a shorter needle path and passing through the lung parenchyma with higher attenuation may reduce the risk of biopsy-associated pneumothorax ≥1 cm. A higher needle-pleura angle may reduce the risk of pulmonary hemorrhage ≥2 cm in the short axis.
Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses’ Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors
Authors: Allison M. Kathryn , Curran Geoffrey M. , Walsh Wendy A. , Dworkin Emily R. , Zielinski Melissa J.
Published: April 2022

Introduction

Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as “teleSANE”) during sexual assault examinations is a promising new practice to address this issue.

Purpose

The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs.

Methods

Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs.

Results

Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover.

Discussion

Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.
Improving the Forensic Documentation of Injuries Through Alternate Light: A Researcher–Practitioner Partnership
Authors: Scafide Katherine N. , Ekroos Rachell A. , Mallinson R. Kevin , Alshahrani Abeer , Volz Jessica , Holbrook Debra S. , Hayat Matthew J.
Published: April 2022

An alternate light source (ALS) is a practitioner-driven technology that can potentially improve the documentation of injuries among victims of interpersonal violence. However, evidence-based guidelines are needed to incorporate and document an ALS skin assessment into a forensic medical examination that accurately reflects the science, context of forensic nursing practice, trauma-informed responses, and potential impact on criminal justice stakeholders. This article introduces the forensic nursing community to a current translation-into-practice project focused on developing and evaluating an ALS implementation program to improve the assessment and documentation of bruises among adult patients with a history of interpersonal violence. Our researcher–practitioner collaboration uses theory-based approaches that consider both the developed program's practice context and stakeholder impact. The goal is to provide evidentiary support for adult victims of violence and a more equitable forensic nursing practice that benefits diverse patient populations.
Short-term Endoscopic Outcomes of Balloon and Rigid Bronchoplasty in the Management of Benign Subglottic and Tracheal Stenosis
Authors: Di Felice Christopher , Alraiyes Abdul H. , Gillespie Colin , Machuzak Michael , Gildea Thomas R. , Sethi Sonali , Cicenia Joseph , Mehta Atul C. , Almeida Francisco A.
Published: April 2022

Background:

Endoscopic therapies are firmly established in the management algorithm of benign subglottic and tracheal stenosis (SGTS). The optimal dilation strategy, however, has yet to be elucidated. The objective of this study was to compare the efficacy and safety of balloon versus rigid bronchoplasty in the treatment of benign SGTS.

Methods:

De novo cases of benign SGTS at our institution over a 9-year period were retrospectively identified. Patients were divided into 2 groups based on the initial dilation strategy of balloon or rigid bronchoplasty. Demographics, clinical findings, concurrent interventions, lesion characteristics, and complications were analyzed. Two reviewers independently assigned an index and follow-up endoscopic stenosis grade for each case. The mean stenosis grade at follow-up in both groups was then calculated and compared.

Results:

Sixty-three patients with benign SGTS were included. Most stenoses in the rigid (80%) and balloon (63%) bronchoplasty groups were complex (P=0.174). In addition, 94% (59/63) of index stenoses were classified as Cotton Myer Grade 3. At follow-up, no significant difference was found in the mean stenosis grade between dilation strategies (1.97 vs. 2.2, P=0.287). Furthermore, no procedural-related complications were observed in either group.

Conclusion:

Balloon and rigid bronchoplasty are safe and effective endoscopic tools in the early management of benign SGTS. A multimodality approach centered around mucosal sparing techniques remains vitally important to the overall and likely long-term success of treating this challenging disease entity.
Adaptation of a Lean Tool Across Surgical Units to Improve Patient Experience
Authors: Salinas Brianna
Published: April 2022

Background:

High reliability organizations (HROs) sustain consistently excellent outcomes over time. Health care systems need to eliminate major quality failures to become reliable.

Local Problem:

Practice variations, unstructured leader rounds, and unfavorable patient experience outcomes with Responsiveness of Hospital Staff prompted leaders to adopt Kamishibai cards (K-cards).

Methods:

Evidence-based practices (EBPs) such as timeliness of answering call lights, purposeful rounding, communication, and engaging patients were used to develop Responsiveness K-cards.

Interventions:

Responsiveness K-cards established standard work for staff responsiveness and audited process compliance. Findings determined what areas needed improvement, and leaders engaged frontline staff in practice changes.

Results:

Percentile rank for Responsiveness of Hospital Staff had a sustained increase. Four of 6 hospital units using Responsiveness K-cards achieved 80% rank or better in every patient experience domain for the entire fiscal year.

Conclusions:

K-cards use HRO principles to standardize practice and improve outcomes. They encourage continuous improvement, which supports the sustainability of EBPs.
Auditory Verbal Hallucinations in Schizophrenia, Part II
Authors: Yttri Janne-Elin , Urfer-Parnas Annick , Parnas Josef
Published: April 2022

Hallucination is defined in the diagnostic systems as an experience resembling true perception without causal stimulus. In this second report from an in-depth phenomenological study of schizophrenia patients experiencing auditory verbal hallucinations (AVHs), we focused on the phenomenological qualities of AVHs. We found that a substantial proportion of patients could not clearly distinguish between thinking and hallucinating. The emotional tone of the voices increased in negativity. AVHs became more complex. Spatial localization was ambiguous and only 10% experienced only external hallucinations. There was an overlap with passivity phenomena in one third of the cases. The patients occasionally acted upon the content of AVHs. In the discussion section, we criticize the perceptual model of AVHs. We conclude that the definition of AVH in schizophrenia is misleading and exerts negative consequences on the clinical work and empirical research.
Hepatic Adenomas in Patients 60 and Older Are Enriched forHNF1AInactivation and Malignant Transformation
Authors: Yasir Saba , Chen Zongming E. , Jain Dhanpat , Kakar Sanjay , Wu Tsung-Teh , Yeh Matthew M. , Torbenson Michael S.
Published: April 2022

Hepatic adenomas occur most commonly in women between the ages of 20 and 40 years, but rarely they occur in older aged persons, including those 60 years of age or older. This group of adenomas, however, has not been systemically examined. Twenty-six hepatic adenomas in persons 60 years of age or older were studied, along with a control group of 50 hepatic adenomas in persons aged 30 to 39. Hepatic adenomas in persons 60 or more years of age were found in 21 women and 5 men, while the control group had 44 women and 6 men. Subtyping the adenomas in persons 60 years or older showed the following results: 18HNF1A-inactivated adenomas (69%), 4 inflammatory adenomas (15%), and 4 unclassified adenomas (15%). In contrast, the control group showed a significantly different pattern (P=0.003), with a greater percentage of inflammatory adenomas (28, 56%), fewerHNF1A-inactivated adenomas (8, 16%), and more unclassified adenomas (14, 28%). Atypia and malignant transformation within the hepatic adenomas was studied next. Of the hepatic adenomas in persons age 60 or greater, 3 (12%) showed atypical histologic features, and 6 (23%) had a malignant transformation. In contrast, for hepatic adenomas in the control group, only 4 (8%) adenomas showed atypical histologic features, and 3 (6%) had undergone malignant transformation. In addition, the hepatic adenomas that were atypical or showed early malignant transformation were less likely to have beta-catenin activation in patients over 60 (2/9 cases) compared with those between 30 and 39 years (5/7 cases). Myxoid change and heavy lipofuscin deposition were also more common in adenomas in older aged persons. In conclusion, hepatic adenomas in persons 60 years of age or older are enriched forHNF1A-inactivated adenomas and have a higher frequency of malignant transformation. Malignant transformation, however, is less likely to develop through activation of the beta-catenin pathway.
Time of Observation in Xenobiotic Ingestions in Children
Authors: Capua Maya , Amlicke Maire , Esposito Emily , Belfer Joshua , Bellis Mitchell , Falkowitz Daria , Teng David
Published: April 2022

Objectives

Children endure a prolonged observation after xenobiotic ingestions, despite low associated morbidity and mortality. The primary objective was to describe the management and outcomes of acute xenobiotic exposures in asymptomatic pediatric patients presenting to the emergency department (ED). A secondary objective was to explore the impact of vital signs on the patients' management and outcomes.

Methods

We conducted a retrospective review of asymptomatic children (younger than 18 years) presenting to a pediatric ED after a toxic ingestion from 2014 to 2018. Ingestions of hydrocarbons, acetaminophen, salicylates, sulfonylureas, caustic, and/or extended release agents were excluded. Demographic and clinical data were abstracted.

Results

Of 2817 charts, we identified 109 asymptomatic patients with a mean age of 4.7 years. The average observation from registration to disposition was 4.06 hours. Five patients were admitted and were subsequently discharged within 24 hours. Of the discharged patients, 2 returned within 72 hours and were subsequently discharged home. A total of 321 asymptomatic patients presented with ≥1 abnormal vital signs (mean age, 6.6 years) and were observed in the ED for an average of 4.54 hours. They had a higher percentage of ingestions related to suicide attempts (odds ratio, 6.8). Twenty-two were admitted. Of those discharged home, 11 returned to the ED within 72 hours; all were subsequently discharged home.

Conclusions

Prolonged observations may not be necessary after ingestions in asymptomatic children. Vital sign abnormalities at presentation did not impact disposition. Prospective studies are needed to determine the safety and efficacy of this shortened observation.
Changes in the Pattern of Superficial Lymphatic Drainage of the Abdomen after Abdominoplasty
Authors: Bassalobre Milena , Liebano Richard Eloin , da Silva Milla Pompilio , Castiglioni Mário Luiz Vieira , Sadala Adria Yared , Ferreira Lydia Masako , Nahas Fabio Xerfan
Published: April 2022

Background:

The changes in the pattern of lymphatic drainage of the superficial abdominal wall after abdominoplasty are still unknown. These changes may increase the risk of numerous complications, including seroma formation. Depending on the alterations, the manual lymphatic drainage technique should be modified in postoperative patients. The aim of this study was to map the pattern of lymphatic drainage of the superficial infraumbilical abdominal wall after abdominoplasty.

Methods:

Twenty women with indications for abdominoplasty were selected in the Plastic Surgery Division of the Federal University of São Paulo. Intradermal lymphoscintigraphy with dextran 500–99m-technetium was performed in 20 female patients in the preoperative phase and 1 and 6 months after abdominoplasty to evaluate superficial lymphatic drainage of the abdominal wall.

Results:

Before surgery, all patients presented with abdominal lymphatic drainage toward the inguinal lymph nodes. One and 6 months after abdominoplasty, only 15 percent exhibited the same drainage pathway. Drainage toward the axillary lymph node chain occurred in 65 percent of the patients, 10 percent displayed a drainage pathway toward both the axillary and inguinal lymph nodes, and lymphatic drainage was indeterminate in 10 percent of the cases.

Conclusions:

A significant change in lymphatic drainage pathway occurred in the infraumbilical region after abdominoplasty. The axillary drainage path was predominant after the operation, in contrast to the inguinal path observed in the preoperative period. However, 35 percent of cases exhibited alternative drainage. No significant changes were documented between 1 and 6 months postoperatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Versatility of the Fixed-Mobile Septal Extension Graft for Nasal Tip Reshaping
Authors: Rohrich Rod J. , Chamata Edward S. , Alleyne Brendan , Bellamy Justin L.
Published: April 2022

Key goals of nasal tip reshaping include precise control of tip shape and position, along with restoration of proper structural support. Unfortunately, traditional techniques attempting to address these goals have yielded unpredictable results. In this article, the authors detail their surgical technique and discuss the numerous aesthetic and functional benefits of this graft, along with its applicability to a wide variety of patient populations and nasal deformities. The authors’ technique utilizing the fixed-mobile septal extension graft has demonstrated reliability in establishing proper tip positioning through precise adjustments to tip rotation and projection, while simultaneously providing a stable structure for maintaining tip support. While fixed at the anterior septal angle, this graft also proves beneficial in maintaining natural tip mobility because of its anterior extension past the septum. The fixed-mobile septal extension graft is versatile and reliable when used for tip reshaping and support.
Occupational Prevention of COVID-19 Among Healthcare Workers in Primary Healthcare Settings: Compliance and Perceived Effectiveness of Personal Protective Equipment
Authors: Abed Alah Muna Talal Theyab , Abdeen Sami , Selim Nagah , Tayar Elias , Bougmiza Iheb
Published: April 2022

Objectives

It is crucial for healthcare workers (HCWs) to comply with infection prevention and control precautions such as the appropriate use of personal protective equipment (PPE) for their safety and the safety of patients. In this study, we aimed to assess HCWs’ compliance with the appropriate use of PPE in primary healthcare settings in Qatar along with its associated factors and explore their perceived effectiveness of different PPE items in protecting against COVID-19 infection.

Methods

A Web-based survey was conducted between November 2020 and January 2021 targeting all clinical HCWs under the umbrella of Primary Health Care Corporation.

Results

A total of 757 HCWs completed the survey, and most were between 30 and 39 years of age (50.2%), females (62.7%), and nurses (35.3%). Eighty eight percent of participants believed that PPE could provide high or very high protection against COVID-19. About one-half (53%) were found to be fully compliant with PPE use during patient interactions with suspected or confirmed COVID-19 cases, whereas three-quarters (76.3%) were fully compliant while performing aerosol-generating procedures. Healthcare workers’ age, nationality, health center region, area of work, clinical experience, frequency of interaction with suspected or confirmed COVID-19 cases, and the perceived effectiveness of PPE were significant predictors of full compliance with PPE. Shortage of PPE was the commonest reported barrier to appropriate use.

Conclusions

Despite HCWs’ high perceived effectiveness for PPE in protecting against COVID-19 infection, their full compliance rate with using PPE was moderate and needs further improvement.
Comparing Hospital Length of Stay Risk-Adjustment Models in US Value-Based Physician Payments
Authors: Ghosh Arnab K. , Ibrahim Said , Lee Jennifer , Shapiro Martin F. , Ancker Jessica
Published: April 2022

Backgroung and Objectives:

Under the Affordable Care Act, the US Centers for Medicare & Medicaid Services created Physician Value-Based Payment Modifier Program and its successor the Merit-Based Incentive Payment System to tie physician payments to quality and cost. The addition of hospital length of stay (LOS) to these value-based physician payment models reflects its increasing importance as a metric of health care cost and efficiency and its association with adverse health outcomes. This study compared the Centers for Medicare & Medicaid Services–endorsed LOS risk-adjustment methodology with a novel methodology that accounts for pre-hospitalization clinical, socioeconomic status (SES), and admission-related factors as influential factors of hospital LOS.

Methods:

Using the 2014 New York, Florida, and New Jersey State Inpatient Database, we compared the observed-to-expected LOS of 2373102 adult admissions for 742 medical and surgical diagnosis-related groups (DRGs) by 3 models: (a) current risk-adjustment model (CRM), which adjusted for age, sex, number of chronic conditions, Elixhauser comorbidity score, and DRG severity weight, (b) CRM but modeling LOS using a generalized linear model (C-GLM), and (c) novel risk-adjustment model (NRM), which added to the C-GLM covariates for race/ethnicity, SES, discharge destination, weekend admission, and individual intercepts for DRGs instead of severity weights.

Results:

The NRM disadvantaged physicians for fewer medical and surgical DRGs, compared with both the C-GLM and CRM models (medical DRGs: 0.49% vs 13.17% and 10.89%, respectively; surgical DRGs: 0.30% vs 13.17% and 10.98%, respectively). In subgroup analysis, the NRM reduced the proportion of physician-penalizing DRGs across all racial/ethnic and socioeconomic groups, with the highest reduction among Whites, followed by low SES patients, and the lowest reduction among Hispanic patients.

Conclusions:

After accounting for pre-hospitalization socioeconomic and clinical factors, the adjusted LOS using the NRM was lower than estimates from the current Centers for Medicare & Medicaid Services–endorsed model. The current model may disadvantage physicians serving communities with higher socioeconomic risks.
Automated Detection, Segmentation, and Classification of Pleural Effusion From Computed Tomography Scans Using Machine Learning
Authors: Sexauer Raphael , Yang Shan , Weikert Thomas , Poletti Julien , Bremerich Jens , Roth Jan Adam , Sauter Alexander Walter , Anastasopoulos Constantin
Published: April 2022

Objective

This study trained and evaluated algorithms to detect, segment, and classify simple and complex pleural effusions on computed tomography (CT) scans.

Materials and Methods

For detection and segmentation, we randomly selected 160 chest CT scans out of all consecutive patients (January 2016–January 2021, n = 2659) with reported pleural effusion. Effusions were manually segmented and a negative cohort of chest CTs from 160 patients without effusions was added. A deep convolutional neural network (nnU-Net) was trained and cross-validated (n = 224; 70%) for segmentation and tested on a separate subset (n = 96; 30%) with the same distribution of reported pleural complexity features as in the training cohort (eg, hyperdense fluid, gas, pleural thickening and loculation). On a separate consecutive cohort with a high prevalence of pleural complexity features (n = 335), a random forest model was implemented for classification of segmented effusions with Hounsfield unit thresholds, density distribution, and radiomics-based features as input. As performance measures, sensitivity, specificity, and area under the curves (AUCs) for detection/classifier evaluation (per-case level) and Dice coefficient and volume analysis for the segmentation task were used.

Results

Sensitivity and specificity for detection of effusion were excellent at 0.99 and 0.98, respectively (n = 96; AUC, 0.996, test data). Segmentation was robust (median Dice, 0.89; median absolute volume difference, 13 mL), irrespective of size, complexity, or contrast phase. The sensitivity, specificity, and AUC for classification in simple versus complex effusions were 0.67, 0.75, and 0.77, respectively.

Conclusion

Using a dataset with different degrees of complexity, a robust model was developed for the detection, segmentation, and classification of effusion subtypes. The algorithms are openly available at https://github.com/usb-radiology/pleuraleffusion.git.
Hepatic Angiosarcoma With Diffuse Increased 18F-FDG Uptake on PET/CT
Authors: Zhou Ziang , Lu Xia , Wang Wei , Yang Jigang
Published: April 2022

A 51-year-old woman was diagnosed with fulminant hepatic failure based on laboratory indexes. Contrast-enhanced CT demonstrated numerous, widespread lesions in all segments of the liver. 18F-FDG PET/CT showed the abundant foci of increased 18F-FDG uptake in the enlarged liver. The liver transplantation was performed due to fulminant hepatic failure. Postoperative pathology demonstrated diffused hepatic angiosarcoma, which should be included in the differential diagnosis of diffuse 18F-FDG uptake hepatic lesions on PET/CT.