bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Evaluation of a Novel Patient-Reported Outcome Implementation Process in a Student-Led Pro Bono Clinic: Acceptability and Adoption
Authors: Staples Trevor , Beran-Maryott Gillian , Brinkerhoff Alan , Bradford Misha , Ward R. Scott , Thackeray Anne
Published: May 2021

Background and Purpose.

Although patient-reported outcomes (PROs) are increasingly implemented to inform care and demonstrate the value of care across disciplines and settings, no previous reports have assessed PRO implementation and acceptability to student clinicians in a pro bono physical therapy clinic. The purpose of this case report was to describe the development and evaluation of an implementation process for an electronically administered PRO in a pro bono physical therapy clinic.

Case Description.

A student-faculty team used the consolidated framework for implementation research to identify barriers to PRO implementation in one student-run pro bono clinic and develop strategies to address identified barriers. The change management theoretical framework was used to develop an implementation process that addressed all general and local contextual needs. Acceptability and adoption of the Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF) computer adaptive test to student clinicians were assessed to evaluate implementation effectiveness.

Outcomes.

Implementation barriers included rotating student teams, limited knowledge, need for workflow modifications, and PRO translation to Spanish. Student clinician training, workflow adaptation, and use of English and Spanish versions of PROMIS PF addressed all barriers, general and local contextual needs. Student clinician responses suggested that implementation strategies were acceptable, citing increase efficiency and simplicity. Patient-Reported Outcome Measurement Information System Physical Function adoption was 81% (per month range = 47–100%) over the 6-month implementation period.

Discussion and Conclusion.

Acceptance and adoption rates by student clinicians indicate that implementation of PROMIS PF was successful at improving PRO collection and influencing student clinician education about PROs.
A Novel Physical Therapy Learning Experience in Pediatrics Via Telehealth: A Qualitative Case Analysis
Authors: Fergus Andrea , Hartsook Katherine , Smith Julianna , Hale Mary , Kellar Daniel
Published: May 2021

Background and Purpose.

While the integration of experiential learning with patients and clients into the physical therapy (PT) curriculum is beneficial to student learning particularly in the area of pediatrics, the implementation of such experiences can be extremely challenging. Telehealth is rapidly expanding given the emerging technology, health care needs for individuals in remote settings, and the current pandemic situation. The purpose of the present evaluation was to examine the perspectives of the students, supervising PTs and the caregiver on a method/model for the telehealth delivery of pediatric PT, and the collaborative experiential learning experience in this setting using a qualitative grounded theory approach.

Method/Model Description.

A 24-month-old boy with spastic hemiplegia was treated for 6 weeks in his home via Zoom videoconferencing in a collaborative clinical education experience. Interventions included constraint-induced movement therapy, bimanual training, dynamic balance training, and facilitation of postural control. Caregiver education was provided throughout. The chat and recording features were used throughout each session to provide direction, feedback, and education while minimizing the distraction during sessions. Semi-structured interviews were completed with the 2 PTs, 6 students, and mother after the experience. Interviews were transcribed and theme coded until saturation was achieved. A concept map was developed through consensus.

Outcomes.

Themes emerged for telehealth and telehealth learning experiences. Considerations included the home environment, technology, lack of physical contact and importance of verbal communication, preparation, instantaneous feedback, and active participation. The active participation of the caregiver seemed to empower the family and provide them with a therapeutic viewpoint. Communication via the chat feature provided a means for instantaneous feedback that was considered less disruptive to the student–family interaction resulting in student empowerment, confidence, and skill development.

Discussion and Conclusion.

The telehealth delivery of service seems to enhance the empowerment and buy-in of the patient/caregiver resulting in improved outcomes and carryover for PT. Telehealth PT experiential learning provides a venue for collaborative learning and enhanced student autonomy resulting in improved confidence while fostering student analytical skills, communication skills, and creativity. Telehealth PT provides unique opportunities for growth and learning in a collaborative learning experience and may also serve as a venue for clinical education experiences.
Examining Demographic and Preadmission Factors Predictive of First Year and Overall Program Success in a Public Physical Therapist Education Program
Authors: Mitchell Katy , Ellison Jennifer , Schaumberg Elke , Gleeson Peggy , Bickley Christina , Naiki Anna , Travis Severin
Published: May 2021

Introduction.

Despite an increase in the rigor of entry-level Doctor of Physical Therapy (DPT) program admission, programs still struggle with student retention and success. The purpose of this study was to examine demographic and preadmission factors predictive of first year and overall program success in an entry-level public physical therapist education program.

Subjects.

Retrospective data from 473 DPT students at the Texas Woman’s University in Houston, TX, who entered the program between 2010 and 2018.

Methods.

This study included the following predictor variables: last 60 hours undergraduate (UG) grade point average (GPA), UG math/science GPA, overall UG GPA, science/nonscience major, Graduate Record Examination (GRE) component scores, GRE summed score (GRE-S), size and type of UG institution (dichotomized), gender, age, and personal grit score. Success in the program was measured by first-semester GPA, cumulative third-semester GPA, final program GPA, three-tiered ranking of academic and clinical education (CE) standing, completion of first-year program, and completion of the entire 3-year program.

Results.

First-year program success (first-semester GPA, cumulative third-semester GPA, and first-year completion) was predicted by age, overall UG GPA, GRE-S, and all GRE components. GRE scores and UG GPA when entered together predicted 45.8% of the first-year GPA. Overall program success was predicted by UG GPA, GRE-S, and all GRE components. GRE-S and UG GPA when entered together predicted 34.8% of final program GPA. Academic standing was predicted by multiple predictors, whereas CE performance was only predicted by 2 components of the GRE and GRE-S. When comparing students who completed the program versus those who did not, significant differences were found in all GRE components and overall UG GPA. Receiver-operating-characteristics analysis was used to determine cutoff scores for the GRE and overall UG GPA, which best predict first-year and program retention.

Conclusion.

Admissions committees of DPT should analyze their program-specific data to better guide their admissions decisions. Overall UG GPA and GRE continue to be strong predictors of physical therapist program success. In order to increase retention rates, DPT programs should consider additional resources for students who may be at risk.
Use of fibrin monomer and D-Dimer in assessing overt and nonovert disseminated intravascular coagulation
Authors: Zheng Xiaohe , Chen Shaoqian , Zhang Fan , Ye Manman , Chen Jianlong , Zhang Shihong
Published: May 2021

Introduction

Early diagnosis of disseminated intravascular coagulation (DIC) before its progression to an overt stage is beneficial for its treatment and prognosis.

This retrospective study aimed to evaluate the diagnostic performance of D-dimer and fibrin monomer in the early stage of DIC.

A total of 707 patients suspected of having DIC, 302 healthy people were enrolled and divided into four groups: overt DIC, nonovert DIC, non-DIC based on the International Society of Thrombosis and Hemostasis scoring for overt DIC and the modified nonovert DIC criteria, healthy people as control group. Quantitative determination was done by immunoturbidimetry for D-dimer and fibrin monomer.

The median of fibrin monomer in overt, nonovert and non-DIC was 41.65, 26.89 and 8.68 μg/ml, respectively. The median of D-dimer in overt, nonovert and non-DIC was 9.69, 3.98 and 3.08 μg/ml, respectively. D-dimer and fibrin monomer values were higher in overt DIC than other groups, but there was no difference between nonovert DIC and non-DIC in D-dimer. Unlike D-dimer, statistically significant differences were found in fibrin monomer between nonovert and non-DIC. At receiver operator characteristic curve–generated cutoff values, fibrin monomer had much excellent predictive performance compared with D-dimer for distinguishing nonovert DIC from non-DIC. D-dimer and fibrin monomer had same diagnostic performance in distinguishing overt DIC from non-DIC.

Fibrin monomer is a better indicator compared with D-dimer in distinguishing patients with nonovert DIC from non-DIC. Hence, it might serve as an excellent negative exclusion marker to provide a reference for early clinical diagnosis and intervention through more studies.
Effect of bariatric surgery on blood pressure response to exercise in a severely obese population
Authors: Sénéchal-Dumais Isabelle , Auclair Audrey , Leclerc Jacinthe , Poirier Paul
Published: May 2021

Background

Exaggerated blood pressure response to exercise is a cardiovascular risk factor associated to higher morbidity and mortality. Severely obese patients have an increased risk of exercise-induced hypertension (EIH). We aimed to assess the blood pressure response to exercise in patients with severe obesity who underwent bariatric surgery as well as the main determinants of this response.

Methods

We used data from the ACTIVE clinical trial, in which 60 severely obese patients who underwent bariatric surgery were enrolled. Anthropometric measurements, abdominal and mid-thigh computed tomography scans and maximal exercise testing were performed before bariatric surgery, as well as 3 and 6 months post-surgery. EIH was defined as a maximal SBP ≥210 mmHg for men and ≥190 mmHg for women.

Results

At baseline, 62% of patients had EIH. At 6 months, we observed an EIH resolution rate of 39%. The main determinant of EIH resolution was sex. Actually, patients with EIH resolution were mostly women without resting hypertension and a lower amount of visceral adipose tissue.

Conclusion

These results suggest that bariatric surgery is efficient to resolve EIH, particularly in women with initially a better anthropometric profile.
Monitoring muscle mass using ultrasound: a key role in critical care
Authors: van Ruijven Isabel M. , Stapel Sandra N. , Molinger Jeroen , Weijs Peter J.M.
Published: May 2021

Purpose of review

The loss of muscle mass in critically ill patients contributes to morbidity and mortality, and results in impaired recovery of physical functioning. The number of publications on the topic is increasing. However, there is a lack of consistent methodology and the most optimal methodology remains unclear, hampering its broad use in clinical practice.

Recent findings

There is a large variety of studies recently published on the use of ultrasound for assessment of muscle mass. A selection of studies has been made, focusing on monitoring of muscle mass (repeated measurements), practical aspects, feasibility and possible nutrition and physical therapy interventions. In this review, 14 new small (n = 19–121) studies are categorized and reviewed as individual studies.

The use of ultrasound in clinical practice is feasible for monitoring muscle mass in critically ill patients. Assessment of muscle mass by ultrasound is clinically relevant and adds value for guiding therapeutic interventions, such as nutritional and physical therapy interventions to maintain muscle mass and promote recovery in critically ill patients.
Type 2 diabetes and the risk of colorectal polyps
Authors: Hsu Po-Ke , Huang Jing-Yang , Su Wei-Wen , Wei James Cheng-Chung
Published: May 2021

The incidence rates of type 2 diabetes mellitus (T2DM) and colorectal polyps have been increasing over the last decades. However, direct associations between T2DM and colorectal polyps have not been extensively reported. We will explore the relationship between T2DM and colorectal polyps.

In the retrospective study, we classified DM and NonDM groups (control) from 993,516 people in Taiwan nationwide population insurance database from the period of 2000 to 2013. We collected data on income and comorbidities through the international classification of diseases, ninth revision—clinical modification (ICD-9-CM) codes.

The T2DM group had a higher incidence rate of colorectal polyps (31.97%, 95% confidence interval [CI] = 30.97–33.28) than the control group (25.9%, 95% CI = 25.1–26.72), and the crude incidence ratio was 1.235 (95% CI = 1.174–1.300). In 13 years of follow-up (2000–2013), T2DM was linked to a significantly higher cumulative probability of colorectal polyps (log-rank test: P = .0001).

Patients with T2DM had a 1.23-fold higher risk of new colorectal polyps than control patients in 13 years of follow-up. We explain the T2DM increases incidence for colorectal polyps in long term follow-up.
Evaluating the conversion to extended-release tacrolimus from immediate-release tacrolimus in liver transplant recipients
Authors: Choi David , Thaker Sarang , West-Thielke Patricia , Elmasri Annesti , Chan Christine
Published: May 2021

Background

A new formulation of once daily extended-release tacrolimus (LCP-tac, Envarsus XR) was approved for use in the USA for kidney transplant recipients in 2015. There are limited data regarding real-world observations with conversion to LCP-tac in liver transplant recipients.

Methods

We performed a retrospective analysis of liver transplant recipients treated with LCP-tac. Data collection included (1) reasons for switching to LCP-tac; (2) conversion ratio used; (3) kidney function at time of conversion and 3 months after; (4) outcomes of conversion [acute cellular rejection rates and cytomegalovirus (CMV) viremia] within 3 months of conversion.

Results

Average conversion ratio used to achieve therapeutic drug level without further dose adjustment was 1:0.73 (SD 0.11). Median time after transplant was 508 days (IQR 736). Common reasons patients were switched to LCP-tac were from fluctuations in tacrolimus levels (44%) and adverse effect of tremor (32%). Among patients who were switched due to tremors 88% noted significant improvement. There was no difference in serum creatinine (P = 0.55) or glomerular filtration rate (P = 0.64) from baseline to 3 months postconversion. There were no episodes of acute cellular rejections or CMV viremia postconversion.

Conclusion

This observational study demonstrated that conversion of immediate-release tacrolimus to LCP-tac in liver transplant recipients was well tolerated and effective.
Transjugular intrahepatic portosystemic shunt with transhepatic portal vein puncture guided by ultrasound: a technical alternative
Authors: Rêgo Heloísa M.C. , Medronha Eduardo F. , Junior Enio Ziemiecki , Tovo Cristiane V. , de Mattos Angelo A.
Published: May 2021

Objective

Evaluation of an alternative technique to perform transjugular intrahepatic portosystemic shunt (TIPS), using abdominal ultrasound to guide portal puncture.

Methods

Retrospective analysis of TIPS performed from January 2014 to December 2018 in an interventional radiology service. TIPS were performed according to the classic technique, except at the moment of portal branch puncture, when abdominal ultrasound was used to guide it, visualized its path within the parenchyma in real-time. Qualitative and quantitative variables were analyzed considering a 95% confidence interval and application of the Student’s t-test with a significance level of P < 0.05.

Results

Forty-one TIPS were performed. The technical success rate of ultrasound guidance in portal puncture was 100.0%. After its performance, a reduction in the portosystemic pressure gradient was observed, with an initial gradient average of 18.8 mmHg (12–25 ± 3.6 mmHg) and a final gradient of 9.2 mmHg (5–14 ± 2.4 mmHg). The mean values for the TIPS execution time, fluoroscopy time and the radiation dose, verified through the dose area product, were 65.2 ± 46.7 min, 25 ± 14.1 min and 85.6 ± 70 Gy cm2, respectively. There were no complications related to the inadvertent puncture of nontarget structures or deaths due to complications resulting from TIPS.

Conclusion

The results demonstrate that the portal transhepatic puncture guided by the abdominal ultrasound is an effective and safe procedure and results in time of execution, time of fluoroscopy and radiation dose below the current reference values of the conventional procedure.
Trends and outcomes of infective endocarditis in cirrhosis: a propensity-matched national study
Authors: Garg Rajat , Aggarwal Manik , Ahuja Keerat R. , Singh Amandeep , Sanaka Madhusudan R. , McCullough Arthur
Published: May 2021

Background

Cirrhosis is the most common cause of liver-related death and bacterial infection is a common comorbidity in cirrhosis. We aimed to study the trends and outcomes of infective endocarditis in cirrhosis.

Methods

A propensity-matched analysis of the National Inpatient Sample database was performed to assess outcomes of infective endocarditis in adult patients (>18 years) from 2004–2013 with and without cirrhosis. Various outcomes were assessed for outcomes of infective endocarditis in cirrhosis. Multivariate regression analysis was performed for predictors of mortality in infective endocarditis.

Results

There has been no significant change in incidence (3.3–3.6%, P = 0.27) and overall mortality (6.3–8.6%, P = 0.42) of infective endocarditis in cirrhosis. After propensity matching, patients with cirrhosis had significantly higher in-hospital mortality (15 vs. 10.6%, P < 0.001) and acute kidney injury (AKI) (31.8 vs. 28.5%, P < 0.001) as compared to no cirrhosis. Microbiological analysis revealed significantly higher rates of streptococci (35.3 vs. 31.9%, P < 0.001) and fungal infective endocarditis (0.03 vs. 0%, P < 0.001) and lower incidence of Gram-negative infective endocarditis (3.9 vs. 6.3%, P < 0.001) in cirrhosis. Cirrhosis patients had significantly less surgical intervention (10.2 vs. 30.3%, P < 0.001) along with overall total cost and length of stay as compared to no cirrhosis. On multivariate analysis, advanced age, AKI, shock and mechanical ventilation were positive predictors of mortality in infective endocarditis patients with cirrhosis patients.

Conclusions

Cirrhosis is an independent predictor of mortality in infective endocarditis with worse outcomes and less surgical intervention. Gram-negative infective endocarditis is lower in cirrhosis, whereas streptococci and fungal infective endocarditis are higher than noncirrhotic patients.
Who are the patients with Crohn’s disease unsuitable to receive an anti-TNFα therapy? Results from a survey of Italian physicians and literature review
Authors: Caprioli Flavio , Daperno Marco , Bravatà Ivana , Brigido Alessia , Frigerio Daniela , Secchi Ottavio , Rispo Antonio
Published: May 2021

Objectives

Anti-TNFα agents have been a staple of Crohn’s disease treatment for 20 years, but they have weaknesses. New treatments have more recently become available. The aim of this paper is to examine the Crohn’s disease patient population for whom anti-TNF treatments are not preferred and where new mechanisms of action should be considered.

Methods

A representative sample of 100 Italian physicians with documented expertise with biological treatment of moderate-to-severe Crohn’s disease were interviewed. A literature review on Crohn’s disease treatment was also conducted to identify patient populations for whom anti-TNFs are unsuitable.

Results

On the basis of the interviewed physicians, about 9% of moderate-to-severe Crohn’s disease patients were noneligible to anti-TNFα due to contraindication or possible risk of intolerance, while 11% had discontinued anti-TNFα treatment due to complications or intolerance/hypersensitivity. Patients with severe heart disease and at high risk of infections were more frequently considered unsuitable. The proportion of patients considered unsuitable among elderly patients and in those with recurrent infections, cancer, and other comorbidities ranged between 40 and 60%.

Conclusions

We provided additional quantitative and qualitative information to help identify patients who are less suitable to anti-TNF agents, who could benefit from newer biologic agents with different mechanisms of action.
Can 68Ga-PSMA PET/CT-derived prostate-specific membrane antigen expression parameters predict prostate-specific antigen response to enzalutamide treatment?
Authors: Karyağar Savaş , Güven Osman , Karyağar Sevda Sağlampinar , Arici Serdar , Selvi Oğuzhan , Geredeli Çağlayan , Özülker Filiz
Published: May 2021

Objective

In patients with metastatic castration-resistant prostate cancer (mCRPCa), enzalutamide is administered when docetaxel treatment fails. The purpose of the study was to evaluate the relationship between prostate-specific antigen (PSA) response and metabolic parameters obtained from 68Ga-PSMA PET/CT before treatment in this patient group.

Methods

From February 2018 to May 2020, 34 patients with mCRPCa were enrolled in this study. The association between PSA response (at least 50% decrease compared to the pretreatment value) and quantitative prostate-specific membrane antigen (PSMA) expression parameters such as SUVmax, SUVmean, PSMA-TV (PSMA receptor-expressing tumor volume) and TL-PSMA (total lesion PSMA receptor expression) were evaluated.

Results

Mean SUVmax, SUVmean, PSMA receptor-expressing tumor volume (PSMA-TV) and total lesion PSMA receptor expression (TL-PSMA) values were 33.66 ± 20.42; 8.82 ± 5.03; 319.85 ± 615.12 cm3; and 2894.76 ± 5195.13, respectively. In the posttreatment 12th week, 22 patients (64.7%) had PSA response, while 12 patients (35.3%) were nonresponders. In patients with PSA response, PSMA-TV values were significantly lower than nonresponders (78.37 ± 80.99 cm3 vs. 451.58 ± 734.61 cm3; P = 0.028). But there was no significant difference between responders and nonresponders in terms of age, ISUP grade, SUVmax, SUVmean, TL-PSMA, pretreatment PSA values, presence of local recurrence or metastases at any site.

Conclusion

PSMA-TV values on 68Ga-PSMA PET/CT imaging before starting enzalutamide treatment following docetaxel failure can predict PSA response in patients with mCRPCa.
Multifocal Osteonecrosis in a 3-Year-old Child With Sickle Beta Plus Thalassemia
Authors: Bhasin Neha , Price Nathan , Desoky Sarah M.
Published: May 2021

Sickle beta+thalassemia is considered to be a mild form of sickle cell disease. However, some patients with mild disease can present with osteonecrosis. Here, we present a rare 3-year-old male who presented with acute pain, a baseline hemoglobin of 13 g/dL, who acutely developed multifocal osteonecrosis, and improved with partial exchange transfusion and hydroxyurea therapy.
Extraneural Metastases of Diffuse Midline Glioma, H3 K27M-Mutant at Diagnosis: Case Report, Review of the Literature, and Identifying Targetable Alterations
Authors: Lazow Margot A. , Leach James L. , Trout Andrew T. , Breneman John C. , Fouladi Maryam , Fuller Christine
Published: May 2021

Extraneural metastases are rare in pediatric high-grade gliomas and little is known about the genomic profiles of tumors that disseminate beyond the central nervous system. We describe a pediatric patient with H3 K27M-mutant diffuse midline glioma of the brain and spine with biopsy-confirmed osseous metastases present at diagnosis and suspected metastatic parenchymal pulmonary disease. Several potentially clinically and/or therapeutically relevant genomic alterations were identified, including H3F3A and TP53 mutations as well as MET, CDK6, EMSY, and PIK3CG amplifications. Sequencing is critical to improve our understanding of the molecular drivers of distant metastases and discover therapeutic targets that penetrate all disease sites.
Skilled Home Healthcare Clinician and Staff Perspectives on Communication With Physicians
Authors: Norton Jonathan D. , Nkodo Amelie , Nangunuri Bhavana , Arbaje Alicia I. , Pierotti Danielle M. , Carl Kimberly , Boyd Cynthia M. , Leff Bruce , Sheehan Orla C.
Published: May 2021

Communication between physicians who order, and clinicians who provide skilled home healthcare (SHHC), is critical to well-coordinated care. The views of SHHC staff on communication with physicians have not been well studied. The objective of this study was to explore how SHHC staff view the communication processes with physicians who order SHHC services. Using purposive and snowball sampling, we conducted semistructured interviews with 22 SHHC staff across multiple regions of the United States. Qualitative thematic content analysis was used to analyze the data. SHHC staff experienced significant barriers to effective communication with physicians, including not being able to communicate in a timely manner when necessary for patient care, and challenges identifying the correct physician to coordinate care and sign SHHC orders. Key strategies to enhance communication focused on creating standardized processes to streamline communication, setting expectations for response times in communication, and improving the Centers for Medicare & Medicaid Services Home Health Certification and Plan of Care form (commonly referred to as the “CMS-485”/Plan of Care). SHHC staff experience significant communication challenges with physicians who order SHHC services that can compromise care coordination and delivery. Modifications to workflows are urgently needed to improve efficiency and quality of communication, care coordination, and quality of care.
Incorporating Virtual Visits Into the Home Health Plan of Care
Authors: Hinck Susan M.
Published: May 2021

Virtual visits, using 2-way real-time remote communication between the patient and the home health clinician, are a valuable adjunct to in-person visits to advance the prescribed plan of care. This article defines virtual visits within the larger context of telehealth and describes how to balance and integrate assessment and teaching modalities across in-person and virtual visits. Protection of patients' rights and privacy and facilitation of face-to-face visits with practitioners are also discussed.
Increasing Home Healthcare Referrals and Access to Community Resources in Response to High Emergency Department Utilization
Authors: Leonard Christina , Dumayas-Booth Grace Lea , Zomorodi Meg , Lashley Tonisha , Sullivan Tonya
Published: May 2021

The goal of this interprofessional quality initiative project was to decrease emergency department (ED) visits for nonemergency health problems by referring superutilizers to home healthcare or connecting them with existing community resources. An interprofessional team of students from schools of nursing, public health, and occupational therapy collaborated on a community assessment, investigated and gathered community resources, and interviewed key stakeholders at a rural ED to identify the root causes of high utilization. Using these data, we designed an algorithm for ED clinicians that provided an organized community resource collection and electronic resources for ED staff. We focused on encouraging an increase in the evaluation of patients for eligibility to receive home healthcare services.
The Impact of Dedicated Education Model on Nursing Students' Outcomes
Authors: Musallam Eyad , Ali Abeer Alhaj , Nicely Stephanie
Published: May 2021

Background

Dedicated education units (DEUs) provide an approach to clinical redesign in nursing education. However, the evidence supporting the application of the DEU model has not been systematically reviewed to assess the impact of this model on students' learning outcomes.

Purpose

This integrative review analyzed the evidence on the relationship between the DEU model and nursing students' learning outcomes.

Methods

Electronic databases were searched for articles published between 1998 and 2019. Search terms used were dedicated education unit, academic collaboration, academic-practice partnership, and outcomes. A total of 24 articles informed this review.

Results

Four categories emerged: clinical self-efficacy and confidence, teamwork and collaboration, knowledge and competency, and students' satisfaction.

Conclusion

The main findings support a positive relationship between the DEU model and students' learning outcomes. Research is still needed to investigate the impact of DEU models on students' problem-solving and clinical judgment.
Learning-by-Teaching and Service Learning to Promote Bleeding Control Education
Authors: Courville Katheryn A. , Lowe Anita , Dannelley Brittany , Sellers Jonathan , Deal Belinda
Published: May 2021

Background:

Stop the Bleed is a free 1-hour class that teaches laypersons to identify and treat life-threatening bleeding. The training requires a 1:10 instructor-to-participant ratio, which creates a resource drain on volunteer instructors. Nursing students are eligible to assist instructors.

Problem:

Our State Legislature mandated that public schools equip themselves with bleeding control kits resulting in thousands of school staff needing training.

Approach:

Our nursing school used a service learning model to aid schools. Nursing students coordinated the program, and student learning occurred through a learning-by-teaching strategy.

Outcomes:

We trained 656 community members, taught in 5 counties, and students received 320 clinical hours. If not for COVID-19 (coronavirus disease 2019), numbers would have been doubled. We developed a sustainable relationship with school nurses. Students rated the program highly with respect to meeting course objectives and preparation for professional practice.

Conclusions:

The program met its goals and will continue.
Detecting Progression in Advanced Glaucoma: Are Optical Coherence Tomography Global Metrics Viable Measures?
Authors: Thenappan Abinaya , Tsamis Emmanouil , Zemborain Zane Z. , La Bruna Sol , Eguia Melvi , Joiner Devon , De Moraes Carlos Gustavo , Hood Donald C.
Published: May 2021

SIGNIFICANCE

Optical coherence tomography (OCT) summary measures have been suggested as a way to detect progression in eyes with advanced glaucoma. Here, we show that these measures have serious flaws largely due to segmentation errors. However, inspection of the images and thickness maps can be clinically useful.

PURPOSE

This study aimed to test the hypothesis that recently suggested global OCT measures for detecting progression in eyes with advanced progression are seriously affected by segmentation mistakes and other errors that limit their clinical utility.

METHODS

Forty-five eyes of 38 patients with a 24-2 mean deviation worse than −12 dB had at least two spectral domain OCT sessions (0.8 to 4.4 years apart) with 3.5-mm circle scans of the disc and cube scans centered on the fovea. Average (global) circumpapillary retinal nerve fiber layer thickness, G
cRNFL, and ganglion cell plus inner plexiform layer thickness, G
GCLP, were obtained from the circle and cube scan, respectively. To evaluate progression, ΔG
cRNFL was calculated for each eye as the G
cRNFL value at time 2 minus the value at time 1, and ΔG
GCLP was calculated in a similar manner. The b-scans of the six eyes with the highest and lowest ΔG
cRNFL and ΔG
GCLP values were examined for progression as well as segmentation, alignment, and centering errors.

RESULTS

Progression was a major factor in only 7 of the 12 eyes with the most negative values of either ΔG
cRNFL or ΔG
GCLP, whereas segmentation played a role in 8 eyes and was the major factor in all 12 eyes with the largest positive values. In addition, alignment (one eye) and other (three eyes) errors played a secondary role in four of the six eyes with the most negative ΔG
cRNFL values.

CONCLUSIONS

For detecting the progression of advanced glaucoma, common summary metrics have serious flaws largely due to segmentation errors, which limit their utility in clinical and research settings.
Improving Compliance with Dyslipidemia Screening Guidelines in a Single-center U.S. Outpatient Pediatric Cardiology Clinic
Authors: Pradhan Sarah , Dodgen Andrew L. , Snyder Christopher S.
Published: May 2021

Introduction:

The development of atherosclerotic cardiovascular disease begins in childhood. The American Academy of Pediatrics (AAP) endorsed guidelines recommending universal hyperlipidemia screening of children ages 9–11 and again at 17–21 years. An AAP Periodic Survey of Fellows demonstrated less than half of pediatricians report adherence to these guidelines. This quality improvement initiative’s objective was to improve compliance with AAP hyperlipidemia guidelines in an outpatient pediatric cardiology clinic at a single academic center to 80% over a 2-month time frame.

Methods:

We report the results of an IRB-approved chart review at a single-center outpatient pediatric cardiology practice. We defined pediatric cardiologists’ compliance as documented prior lipid screening, ordering a lipid panel, or documented recommendation for follow-up screening. Two plan-do-study-act (PDSA) cycles were undertaken. The first intervention included an informational session to provide pediatric cardiologists with AAP recommendations. The second intervention involved weekly email reminders and a statement for physicians in the electronic medical record.

Results:

We collected data from 600 individual charts of patients seen over 35 clinic days. We received charts before the first PDSA intervention. Baseline compliance with outpatient hyperlipidemia screening was 0%. After the first PDSA cycle, the average screening rate improved to 49%. After the second PDSA cycle, the average screening rate improved to 89%, and there was a centerline shift in the data, indicating improvement.

Conclusion:

We improved the pediatric cardiologists’ compliance with the AAP-recommended hyperlipidemia screening guidelines from 0% to 89% through 2 intervention cycles. Further efforts may be required to sustain this change.
Training the Trainers in Ultrasound-guided Access to Improve Peripheral Intravenous Catheter Placement among Children Presenting for Anesthesia
Authors: O’Reilly-Shah Vikas N. , Franz Amber , Groenewald Cornelius B. , Collins Michael , Patak Lance S.
Published: May 2021

Introduction:

Factors predicting difficult peripheral intravenous (PIV) catheter placement in children are known. Ultrasound guidance can decrease the number of attempts required for difficult PIV placement. However, the uptake of this technique among attending anesthesiologists at our institution remained low. This study aimed to reduce the incidence of PIV placement requiring greater than 3 attempts and reduce time to PIV placement by providing training in ultrasound guidance.

Methods:

We implemented an evidence-based difficult IV algorithm and ultrasound-guided PIV placement training for attending pediatric anesthesiologists at a tertiary academic pediatric institution. The algorithm outlined risk factors for difficult IV access, established a goal of 3 or fewer attempts, and recommended early ultrasound use after 1 unanticipated attempt and the first attempt for anticipated difficult IV. Group sessions, including instruction and simulated practice, preceded a period of individual training in the operating room using a punch card to monitor each trainee’s progress while also serving to motivate continued engagement.

Results:

We performed a cross-sectional analysis of consecutive cases from December 1, 2015, to September 30, 2019, comparing a 22-month baseline period (n = 12,581) with the training period (n = 6,725) and the following year (n = 6,557). Cases requiring more than 3 attempts decreased from 4.0% to 2.7% overall and from 10% to 6.2% among patients 24 months or less of age. The time required to establish PIV access was unchanged. Factors associated with increased attempts were identified.

Conclusions:

Implementing a difficult IV algorithm and training among attending pediatric anesthesiologists in ultrasound-guided PIV placement reduced attempts but not the time required to establish PIV access.
Psychological aspects of pain prevention
Authors: Fisher Emma , Eccleston Christopher
Published: May 2021

How to prevent the onset, maintenance, or exacerbation of pain is a major focus of clinical pain science. Pain prevention can be distinctly organised into primary, secondary, and tertiary prevention. Primary prevention describes avoiding hurt or pain, secondary prevention describes reducing pain when pain is unavoidable, and tertiary prevention describes preventing or reducing ongoing negative consequences such as high functional disability or distress due to chronic pain. Each poses separate challenges where unique psychological factors will play a role. In this short review article, we highlight psychological factors important to primary, secondary, and tertiary prevention and provide direction for the field. We present 2 case studies on secondary prevention in children and adolescents and tertiary prevention in adults with chronic pain. Finally, we provide research directions for progression in this field, highlighting the importance of clear theoretical direction, the identification of risk factors for those most likely to develop pain, and the importance of treatment.
Pediatric Trainee Perspectives on the Decision to Disclose Medical Errors
Authors: Lin Matthew , Horwitz Leora , Gross Rachel S. , Famiglietti Hannah , Caplan Arthur
Published: May 2021

Purpose

The aim of the study was to describe factors that may impact pediatric trainees’ willingness to disclose medical errors using clinical vignettes.

Methods

A single-center cross-sectional anonymous survey of pediatric residents and fellows at a large urban medical center in 2019 was conducted. Trainees were provided with clinical vignettes depicting an error resulting in a serious safety event (SSE), minor safety event (MSE), and near miss safety event (NMSE) and were asked to classify the type of safety event and rate and explain their agreement or disagreement with disclosure. Survey items also evaluated trainees’ personal experiences with errors and disclosure. Descriptive and correlational analyses were used to characterize responses. Qualitative content from open-ended survey questions was analyzed using the constant comparative method.

Results

Of 126 trainees, 42 (33%) completed the survey. All agreed with disclosing the hypothetical error presented in the vignette resulting in an SSE (100%), with rates falling for the MSE (95%) and NMSE (7%). There were no significant associations between disclosure agreement for the vignettes and trainee demographic features, knowledge of safety events, prior personal experiences with errors, and disclosure. Four themes that emerged from qualitative analysis of trainees’ rationales for disclosure or nondisclosure of the vignette errors are harm, parental preferences, ethical principles, and anticipatory guidance.

Conclusions

Trainees had high rates of disclosure for the vignette errors cases that depicted SSEs and MSEs but lower rates for NMSEs. Trainees considered the type and level of harm caused, parental preferences, upholding ethical principles, and the need for anticipatory guidance in their rationales for disclosure or nondisclosure of the vignette errors.
Collaborative Case Review: A Systems-Based Approach to Patient Safety Event Investigation and Analysis
Authors: Lacson Ronilda , Khorasani Ramin , Fiumara Karen , Kapoor Neena , Curley Patrick , Boland Giles W. , Eappen Sunil
Published: May 2021

Objectives

The aims of the study were to assess a system-based approach to event investigation and analysis—collaborative case reviews (CCRs)—and to measure impact of clinical specialty on strength of action items prescribed.

Methods

A fully integrated CCR process, co-led by radiology and an institutional patient safety program, was implemented on November 1, 2017, at our large academic medical center for evaluating adverse events involving radiology. Quality and safety teams performed reviews for events identified with other departments who maintained their existing processes. This institutional review board–approved study describes the program, including percentage of CCR from an institutional Electronic Safety Reporting System, percentage of CCR per specialty, and action item completion rates and strength (e.g., stronger) based on a Veterans Administration–designed hierarchy. χ2 analysis assessed impact of clinical specialty on strength of action prescribed.

Results

Seventy-three CCR in 2018 generated 260 action items from 10 specialties. Seventy percent (51/73) were adverse events identified through Electronic Safety Reporting System. The specialty most frequently associated with CCR was radiology (16/73, 22%). Most action items (204/260, 78%) were completed in 1 year; stronger action items were completed in 71 (27%) of 260. Radiology was responsible for 61 action items; 25 (41%) of 61 were strong versus all other specialties with strong action items in 46 (23%) of 199 (P < 0.01).

Conclusions

An integrated multispecialty CCR co-led by the radiology department and an institutional patient safety program was associated with a higher proportion of CCR, stronger action items, and higher action item completion rate versus other hospital departments. Active engagement in CCR can provide insights into addressing adverse events and promote patient safety.
An Agitated Patient With COVID-19 Infection and Early-onset Alzheimer Disease
Authors: Sykora Daniel , Stonnington Cynthia M. , Jain Neeta
Published: May 2021

Encephalopathy, delirium, and agitation are documented symptoms of coronavirus disease (COVID-19) infection, but research into the management of agitation in the setting of COVID-19 and pre-existing neuropsychiatric disease is ongoing. We present a 55-year-old male patient with early-onset Alzheimer disease and deteriorating mental and functional status who presented to our institution with agitation and persistent COVID-19 positivity on polymerase chain reaction testing. His agitation was improved through pharmacologic optimization including the avoidance of benzodiazepines and initiation of clonidine and prazosin, which temporally coincided with the resolution of his nearly 2-month long COVID-19 positivity.
The Efficacy of Memantine for the Treatment of Migraine: A Meta-Analysis of Randomized Controlled Studies
Authors: Xu Zhili , Chen Linglong , Jin Shuang , Chen Xinguo , Yang Baohua
Published: May 2021

Introduction

The efficacy of memantine for migraine remains controversial. We conduct a systematic review and meta-analysis to explore the influence of memantine versus placebo on treatment in migraine patients.

Methods

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through February 2020 for randomized controlled trials assessing the effect of memantine versus placebo on treatment efficacy in migraine patients. This meta-analysis is performed using the random-effect model.

Results

Three randomized controlled trials are included in the meta-analysis. Overall, compared with control group in migraine patients, memantine treatment is associated with substantially reduced monthly attack frequency (mean difference [MD], −2.14; 95% confidence interval [CI], −2.83 to −1.46; P < 0.00001), number of migraine days (MD, −4.17; 95% CI, −6.40 to −1.93; P = 0.0003) and Migraine Disability Assessment (MD, −5.63; 95% CI, −6.46 to −4.79; P < 0.00001), but demonstrates no obvious influence on acute pain medications (MD, −1.23; 95% CI, −4.63 to 2.17; P = 0.48).

Conclusions

Memantine treatment may benefit to the control of migraine.
The Use of Motor-Evoked Potentials in Clinical Trials in Multiple Sclerosis
Authors: Fernández Victoria
Published: May 2021

Motor-evoked potentials (MEPs) can be used to assess the integrity of the descending corticospinal tract in the laboratory. Evoked potentials (EPs) have been widely used in the past for the diagnosis of multiple sclerosis (MS), but they are now becoming more useful in assessing the prognosis of the disease. Motor-evoked potentials have been included in EP scales that have demonstrated good correlations with clinical disability. Soon after the onset of MS, it is possible to detect an ongoing process of neurodegeneration and axonal loss. Axonal loss is probably responsible for the disability and disease progression that occurs in MS. Given the good correlations of EPs in detecting disease progression in MS, they have been used to monitor the effects of drugs used to treat the disease. Several clinical trials used MEPs as part of their EP evaluation, but MEPs have never been used as a measure of efficacy in clinical trials testing neuroprotective agents, although MEPs could be a very promising tool to measure neuroprotection and remyelination resulting from these drugs. To be used in multicenter clinical trials, MEP readings should be comparable between centers. Standardized multicenter EP assessment with central reading has been demonstrated to be feasible and reliable. Although MEP measurements have been correlated with clinical scores and other measures of neurodegeneration, further validation of MEP amplitude measurements is needed regarding their validity, reliability, and sensitivity before they can be routinely used in clinical drug trials in MS.
Effect of storage conditions on SARS-CoV-2 RNA quantification in wastewater solids
Authors: Simpson Adrian , Topol Aaron , White Bradley , Wolfe Marlene K. , Wigginton Krista , Boehm Alexandria B.
Published: May 2021

SARS-CoV-2 RNA in wastewater settled solids is associated with COVID-19 incidence in sewersheds and therefore, there is a strong interest in using these measurements to augment traditional disease surveillance methods. A wastewater surveillance program should provide rapid turn around for sample measurements (ideally within 24 hours), but storage of samples is necessary for a variety of reasons including biobanking. Here we investigate how storage of wastewater solids at 4°C, -20°C, and -80°C affects measured concentrations of SARS-CoV-2 RNA. We find that short term (7-8 d) storage of raw solids at 4°C has little effect on measured concentrations of SARS-CoV-2 RNA, whereas longer term storage at 4°C (35-122 d) or freezing reduces measurements by 60%, on average. We show that normalizing SARS-CoV-2 RNA concentrations by concentrations of pepper mild mottle virus (PMMoV) RNA, an endogenous wastewater virus, can correct for changes during storage as storage can have a similar effect on PMMoV RNA as on SARS-CoV-2 RNA. The reductions in SARS-CoV-2 RNA in solids during freeze thaws is less than those reported for the same target in liquid influent by several authors.