bluuebunny/crossref_metadata_2025 huggingface dataset:
927. Cidofovir in the Treatment of BK Virus–Associated Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation; A Medication Use and Safety Analysis
Authors: Nazareno Ryan , Patel Dhaval , Monday Lea M
Published: November 2023

Background

BK virus hemorrhagic cystitis (BKV-HC) is a complication after allogeneic hematopoietic stem cell transplant (AlloHCT) for which optimal management is uncertain. Intravenous (IV) and intravesicular (IVES) cidofovir have been used with varying degrees of success in small case series of six to 33 patients. While some series have investigated side effects, none have examined medication errors (Fig 1).

Methods

A retrospective single-center case series of AlloHCT patients with BKV-HC given IV or IVES cidofovir (CDV) from 2018 to 2022 at an urban cancer center in Detroit, MI. Our primary objective was to determine the incidence of CDV related medication errors (ME) and perform a root cause analysis (RCA) to determine factors contributing to such events. Secondary objectives were to describe the effectiveness of CDV for BKV-HC following AlloHCT.

Results

Six AlloHCT patients were treated with CDV. Patient characteristics are shown in Table 1. Median age was 48 years (range 32-63), with most being high risk for cytomegalovirus (R+) and experiencing acute graft versus host disease. CDV and BKV-HC characteristics are shown in Table 2. BKV-HC occurred a median of 53 days post Allo-HCT (range 27-179). Four patients received IV CDV only and two received it both IV and IVES. Median number of doses was 2 (range 1-10). Median BKV-HC severity grade was 2.5, and three of six patients had BK viremia (Table 2). Five of six patients had microscopic resolution of hematuria (median time to resolution 30 days, range 1-116). However, 4 of 6 had died and 1 of 6 had recurrence of BKV-HC within 90 days. The most common CDV side effects were bladder pain/spasms (n=5) and acute kidney injury (n=4). There were 2 MEs; one near miss where CDV was incorrectly ordered IV but changed to IVES by a pharmacist, and one major safety event where an IVES dose was administered IV. RCA analysis revealed multiple contributing factors including similarity in appearance of doses and an overly simplified pump library without an option for IVES administration (Fig 2).

Conclusion

In this first case series to describe medication errors in patients treated with CDV for BKV-HC, one in three patients experienced an ME. Clinicians caring for AlloHCT patients should have a high predisposition for error when cidofovir is being prescribed.

Disclosures

All Authors: No reported disclosures
Rapid assessment of changes in phage bioactivity using dynamic light scattering
Authors: Dharmaraj Tejas , Kratochvil Michael J , Pourtois Julie D , Chen Qingquan , Hajfathalian Maryam , Hargil Aviv , Lin Yung-Hao , Evans Zoe , Oromí-Bosch Agnès , Berry Joel D , McBride Robert , Haddock Naomi L , Holman Derek R , van Belleghem Jonas D , Chang Tony H , Barr Jeremy J , Lavigne Rob , Heilshorn Sarah C , Blankenberg Francis G , Bollyky Paul L
Published: November 2023

Extensive efforts are underway to develop bacteriophages as therapies against antibiotic-resistant bacteria. However, these efforts are confounded by the instability of phage preparations and a lack of suitable tools to assess active phage concentrations over time. In this study, we use dynamic light scattering (DLS) to measure changes in phage physical state in response to environmental factors and time, finding that phages tend to decay and form aggregates and that the degree of aggregation can be used to predict phage bioactivity. We then use DLS to optimize phage storage conditions for phages from human clinical trials, predict bioactivity in 50-y-old archival stocks, and evaluate phage samples for use in a phage therapy/wound infection model. We also provide a web application (Phage-Estimator of Lytic Function) to facilitate DLS studies of phages. We conclude that DLS provides a rapid, convenient, and nondestructive tool for quality control of phage preparations in academic and commercial settings.
Intraoperative Mechanical Power and Postoperative Pulmonary Complications in Noncardiothoracic Elective Surgery Patients: A 10-Year Retrospective Cohort Study
Authors: Elefterion Bertrand , Cirenei Cedric , Kipnis Eric , Cailliau Emeline , Bruandet Amélie , Tavernier Benoit , Lamer Antoine , Lebuffe Gilles
Published: November 2023

Background

Postoperative pulmonary complications is a major issue that affects outcomes of surgical patients. The hypothesis was that the intraoperative ventilation parameters are associated with occurrence of postoperative pulmonary complications.

Methods

A single-center retrospective cohort study was conducted at the Lille University Hospital, France. The study included 33,701 adults undergoing noncardiac, nonthoracic elective surgery requiring general anesthesia with tracheal intubation between January 2010 and December 2019. Intraoperative ventilation parameters were compared between patients with and without one or more postoperative pulmonary complications (respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis) within 7 days of surgery.

Results

Among 33,701 patients, 2,033 (6.0%) had one or more postoperative pulmonary complications. The lower tidal volume to predicted body weight ratio (odds ratio per −1 ml·kgPBW
−1, 1.08; 95% CI, 1.02 to 1.14; P < 0.001), higher mechanical power (odds ratio per 4 J·min−1, 1.37; 95% CI, 1.26 to 1.49; P < 0.001), dynamic respiratory system compliance less than 30 ml·cm H2O (1.30; 95% CI, 1.15 to 1.46; P < 0.001), oxygen saturation measured by pulse oximetry less than 96% (odds ratio, 2.42; 95% CI, 1.97 to 2.96; P < 0.001), and lower end-tidal carbon dioxide (odds ratio per –3 mmHg, 1.06; 95% CI, 1.00 to 1.13; P = 0.023) were independently associated with postoperative pulmonary complications. Patients with postoperative pulmonary complications were more likely to be admitted to the intensive care unit (odds ratio, 12.5; 95% CI, 6.6 to 10.1; P < 0.001), had longer hospital length of stay (subhazard ratio, 0.43; 95% CI, 0.40 to 0.45), and higher in-hospital (subhazard ratio, 6.0; 95% CI, 4.1 to 9.0; P < 0.001) and 1-yr mortality (subhazard ratio, 2.65; 95% CI, 2.33 to 3.02; P < 0.001).

Conclusions

In the study’s population, decreased rather than increased tidal volume, decreased compliance, increased mechanical power, and decreased end-tidal carbon dioxide were independently associated with postoperative pulmonary complications.

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Implementing Workplace-Based Assessments at Scale: The SIMPL Approach
Authors: Zwischenberger Joseph B. , Hatchett Sarah P. , Rahman Naveed A. , Chadha Priyal , Sebok-Syer Stefanie S. , George Brian C.
Published: November 2023

Over the past decade, medical education has shifted from a time-based approach to a competency-based approach for surgical training. This transition presents many new systemic challenges. The Society for Improving Medical Professional Learning (SIMPL) was created to respond to these challenges through coordinated collaboration across an international network of medical educators. The primary goal of the SIMPL network was to implement a workplace-based assessment and feedback platform. To date, SIMPL has developed, implemented, and sustained a platform that represents the earliest and largest effort to support workplace-based assessment at scale. The SIMPL model for collaborative improvement demonstrates a potential approach to addressing other complex systemic problems in medical education.
Agreement between Patient-reported Pain Medication Use and Electronic Medical Record Data in Surgical Amputation Patients
Authors: Kubiak Carrie A. , Lee Jennifer C. , Hamill Jennifer B. , Kim H. Myra , Roth Randy S. , Cederna Paul S. , Geisser Michael E. , Kung Theodore A. , Kemp Stephen W. P.
Published: November 2023

Background:

Opioid misuse after surgery remains a public health crisis in the United States. Recent efforts have focused on tracking pain medication use in surgical populations. However, accurate interpretations of medication use remain quite challenging given inconsistent usage of different datasets. The purpose of this study was to investigate the agreement between electronic medical records (EMR) versus patient self-reported use of pain medications in a surgical amputation population.

Methods:

Patients undergoing major lower extremity amputation or amputation-related procedures were included in this study. Both self-reported and EMR data for pain medication intake were obtained for each patient at three time points (preoperatively, 4 months postoperatively, and 12 months postoperatively). Percentage agreement and the kappa statistic were calculated for both usage (yes/no) and dose categories.

Results:

Forty-five patients were included in this study, resulting in 108 pairs of self-reported and EMR datasets. Substantial levels of agreement (>70% agreement, kappa >0.61) for opioid use was seen at preoperative and 12 months postoperative. However, agreement dropped at 4 months postoperatively. Anticonvulsant medication showed high levels, whereas acetaminophen showed lower levels of agreements at all time points.

Conclusions:

Either self-reported or EMR data may be used in research and clinical settings for preoperative or 12-month postoperative patients with little concern for discrepancies. However, at time points immediately following the expected end of acute surgical pain, self-reported data may be needed for more accurate medication reporting. With these findings in mind, usage of datasets should be driven by study objectives and the dataset’s strength (eg, accuracy, ease, lack of bias).
Coronal, Sagittal, and Horizontal Classification of the Chest Shape and Its Role in Selection of Proper Implants
Authors: Kolasiński Jerzy , Santanelli di Pompeo Weronika , Remlein Agnieszka , Pieszko Karolina
Published: November 2023

Background:

The number of female breast correction procedures has been steadily increasing. Despite extensive literature being available on these procedures, few authors have discussed the role of preoperative chest wall analysis in relation to postoperative outcomes. To date, no comprehensive classification of chest shape has been introduced in the literature. The aim of this study was to present a novel classification of chest shapes, based on three basic planes: coronal (C), sagittal (S), and horizontal (H), hence the proposed name “CSH classification.”

Method:

In this study, a retrospective analysis of 1000 randomly selected chest and breast images was conducted by three independent nonmedical evaluators, using standardized digital images captured with the Vectra 3D body scanner. All examined patients were qualified for breast augmentation surgery.

Results:

Among 1000 randomly examined patients, 923 were classified in the coronal plane, 920 in the sagittal plane, and 627 in the horizontal plane. Other patients were excluded from the study due to insufficient quality of the images. A notable 43.2% of women have shoulder height asymmetries. A relationship between shoulder height asymmetry and chest width was confirmed by the chi-square Pearson test (P = 0.04), indicating that a higher shoulder is associated with a greater chest width on the same side. Furthermore, 84.7% of women displayed excessive upper chest projection, whereas 28.4% showed excessive lower chest projection. Additionally, 84.4% of women had chest projection asymmetries.

Conclusions:

The vast majority of the women had natural asymmetries of the breast or and chest wall. The CSH classification allows systematizing the chest shape assessment. The chest shape has a significant impact on breast implant selection and the choice of the breast surgery technique.
Congenital Nostril Stenosis with a Horseshoe-like Shape
Authors: Ueda Koichi , Sugita Naoya , Akamatsu Jun , Kawase Hiroyo , Umeda Chizuru
Published: November 2023

We report a rare case of congenital nostril stenosis because it is very interesting from the perspective of human embryo development. As we were not able to find a similar congenital case in the literature, we would like to describe it here. The patient is a 36-year-old woman who had bilateral congenital stenotic nostrils with horseshoe-like shape. Particularly, the bilateral medial crura protruded prominently. When she inhaled strongly, she could not breathe further because the action was analogous to the closure of a valve. Her elder sister had similar stenosis in the right nostril only, and parents did not have any stenotic nostrils. During the surgery, the prominent webs of the bilateral medial crura were resected, and Y-V advancement flap was inserted bilaterally to avoid restenosis. Histopathological examination revealed that the resected tissue contained cartilaginous and muscular tissue. A Koken retainer was worn throughout each entire day without washing the face or taking a bath for 3 months after surgery and was washed for keeping hygiene many times every day. After surgery, the patient can breathe well when she inhales strongly and is very satisfied with the operative results. Stenosis has not recurred 6 months after operation. Pathogenesis of this case is thought to occur at the early phase of embryo development when the medial and lateral nasal placodes form a downward-facing “horseshoe.”
Lactobacillus induced by irbesartan on spontaneously hypertensive rat contribute to its antihypertensive effect
Authors: Xiong Yanling , He Yanping , Chen Zhi , Wu Tianyuan , Xiong Yalan , Peng Yilei , Yang Xuechun , Liu Yujie , Zhou Jian , Zhou Honghao , Zhang Wei , Shu Yan , Li Xiong , Li Qing
Published: November 2023

Objective:

Hypertension is linked to gut dysbiosis. Here, the impact of the angiotensin receptor antagonist irbesartan on the gut microbiota of spontaneously hypertensive rats (SHR) were investigated. In addition, we assessed their contribution to its antihypertensive effect.

Methods:

Eight-week-old Wistar–Kyoto (WKY) rats and SHR were administered irbesartan for 8 weeks. Fecal microbiota transplantation (FMT) was performed from SHR treated with irbesartan or untreated SHR to recipient untreated SHR. The preventive effect of Lactobacillus on hypertension in SHR was evaluated. Blood pressure (BP) was calculated using a tail-sleeve sphygmomanometer. To better assess the composition of the gut microbiota, the V3–V4 region of the 16S rRNA gene was amplified while short-chain fatty acids (SCFAs) in feces were tested by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS).

Results:

Irbesartan restored gut dysbiosis, increased the abundance of Lactobacillus, and improved anti-inflammatory ability, antioxidative ability, intestinal integrity, and intestinal inflammation in SHR. The microbiota in SHR-treated irbesartan could reduce BP and improve antioxidative ability and gut integrity in SHR. Lactobacillus johnsonii (L. johnsonii) and Lactobacillus reuteri (L. reuteri) reduced BP, restored gut dysbiosis and improved anti-inflammatory ability, antioxidative ability, intestinal integrity in SHR. Most notably, irbesartan, L. johnsonii, and L. reuteri can significantly increase SCFA content in SHR feces.

Conclusion:

The current study demonstrated that irbesartan treatment ameliorated gut dysbiosis in SHR. Irbesartan induced alterations in gut microbiota, with increased prevalence of Lactobacillus.
FOXO3 longevity genotype attenuates the impact of hypertension on cerebral microinfarct risk
Authors: Nakagawa Kazuma , Chen Randi , Ross G. Webster , Donlon Timothy A. , Allsopp Richard C. , Willcox D. Craig , Morris Brian J. , Willcox Bradley J. , Masaki Kamal H.
Published: November 2023

Objective:

The G-allele of FOXO3 SNP rs2802292, which is associated with human resilience and longevity, has been shown to attenuate the impact of hypertension on the risk of intracerebral hemorrhage (ICH). We sought to determine whether the FOXO3 G-allele similarly attenuates the impact of hypertension on the risk of cerebral microinfarcts (CMI).

Methods:

From a prospective population-based cohort of American men of Japanese ancestry from the Kuakini Honolulu Heart Program (KHHP) and Kuakini Honolulu-Asia Aging Study (KHAAS) that had brain autopsy data, age-adjusted prevalence of any CMI on brain autopsy was assessed. Logistic regression models, adjusted for age at death, cardiovascular risk factors, FOXO3 and APOE-ε4 genotypes, were utilized to determine the predictors of any CMI. Interaction of FOXO3 genotype and hypertension was analyzed.

Results:

Among 809 men with complete data, 511 (63.2%) participants had evidence of CMI. A full multivariable model demonstrated that BMI [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01–1.14, P = 0.015) was the only predictor of CMI, while hypertension was a borderline predictor (OR 1.44, 95% CI 1.00–2.08, P = 0.052). However, a significant interaction between FOXO3 G-allele carriage and hypertension was observed (P = 0.020). In the stratified analyses, among the participants without the longevity-associated FOXO3 G-allele, hypertension was a strong predictor of CMI (OR 2.25, 95% CI 1.34–3.77, P = 0.002), while among those with the longevity-associated FOXO3 G-allele, hypertension was not a predictor of CMI (OR 0.88, 95% CI 0.51–1.54, P = 0.66).

Conclusion:

The longevity-associated FOXO3 G-allele mitigates the impact of hypertension on the risk of CMI.
Evaluation of Deuterium Oxide Deposition Velocity Over a Forest Environment
Authors: Viner Brian J. , Swindle Ashlee , Angelette Lucas , Langan Candace J. , Kuhne Wendy W.
Published: November 2023

Field experiments were performed to evaluate the deposition velocity of tritium oxide within a forest environment at the Savannah River Site near Aiken, SC. Field releases were designed to guide selection of deposition velocity values for use in safety-basis modeling. Six releases of deuterium oxide were conducted in 2020 and 2021 with corresponding air samples during and following each release. Samples were analyzed to determine the deuterium-to-hydrogen ratio in water and converted to concentrations of deuterium in the air during the experiment. Measurements were compared to prior model simulations to evaluate model performance and deposition velocity estimates. Field releases demonstrated vertical and horizontal mixing of a plume in a forest. Predicted deposition velocities ranged from 2.4 to 5.4 cm s−1 on average. In all cases, model simulations underpredicted deuterium concentration by 1 to 2 orders of magnitude, indicating the model does not sufficiently mix the plume into the forest. While the model underestimated the transfer of material downward through the forest, it does suggest that the model’s estimates are conservative for making downwind dose estimates because of lower plume depletion, leading to higher concentration and dose estimates. While the field releases do not cover all possible meteorological conditions, we conclude it is appropriate to use a non-zero deposition velocity when performing safety-basis modeling of tritium oxide based on conservatism within the model. A recommendation of 1.0 cm s−1 as a deposition velocity is made, which is beyond the 95th percentile value estimated from the prior modeling study.
Safety of Cidofovir Treatment for Suspected or Confirmed Adenovirus Infection in Immunocompetent Pediatric Population
Authors: Zalcman Jonatan , Pasternak Yehonatan , Kenan Dana , Dotan Miri , Gueta Itai , Kadmon Gili , Peled Orit , Bilavsky-Yarden Havatzelet
Published: November 2023

Background:

Cidofovir (CDV), a nucleoside phosphonate analogue, exhibits activity against severe cytomegalovirus and adenoviral (ADV) infection. Nevertheless, reports of elevated nephrotoxicity rates limited its use to highly vulnerable cases, mainly immunocompromised children with fulminant infection. Limited data exists regarding CDV safety in immunocompetent children.

Objective:

To evaluate CDV-related toxicity, mainly nephrotoxicity, in immunocompetent children with severe ADV/cytomegalovirus infection.

Methods:

We conducted a retrospective review of medical records for all immunocompetent children under 18 years of age treated with intravenous CDV from January 2005 to December 2019.

Results:

Among the 23 patients identified, 21 were diagnosed with severe ADV infection. Median age was 15 months. Twenty-one (91%) children were admitted to the pediatric intensive care unit. Eighteen patients (78%) received standard CDV protocol (5 mg/kg CDV weekly for 2 weeks), 4 (17%) according to nephroprotective low-dose protocol and 1 patient transitioned. The median duration of CDV treatment was 14 days (range: 1–21 days). All patients received hyperhydration and probenecid with each infusion. Acute kidney injury was recorded in 1 patient (with concurrent septic shock) during CDV treatment. Two children exhibited acute kidney injury before CDV initiation, but renal function normalized during CDV treatment. One patient developed transient neutropenia (600 cells/L), apparently as a result of sepsis. No other major adverse effects were noted. Mortality rate was 3/23 (13%), unrelated to CDV toxicity.

Conclusions:

Our findings suggest that CDV-related nephrotoxicity rate in immunocompetent children may be lower than previously reported, perhaps lower than in the severely immunocompromised population.
Efficacy and Safety of Risperidone in Patients With Delirium
Authors: Nguyen Patrick Viet-Quoc , Vu Thien Tuong Minh
Published: November 2023

Background

The cornerstone treatment of delirium is to assess and treat its underlying causes and prevent further complications. Drug therapy may be necessary to control agitation and behavioral symptoms associated with delirium. The aim of this pilot study was to evaluate the feasibility of a randomized placebo controlled trial to evaluate the efficacy and safety of risperidone in the treatment of delirium.

Methods

This was a randomized double-blinded placebo-controlled trial. Patients were enrolled in the study if they were hospitalized and 65 years or older and had a diagnosis of delirium. Delirium Rating Scale revised 98 was used to determine delirium and motor agitation.

Results

A total of 14 participants with 57% being men and having a mean age of 86 years were included. There were no statistically significant differences between the risperidone and placebo group for the Delirium Rating Scale revised 98 score. There were no severe adverse reactions reported in the study, and no patients discontinued the study for adverse reactions.

Conclusions

Risperidone at low doses (1 mg daily or less) was well tolerated for the treatment of delirium. Future large-scale trials are needed to evaluate the safety and efficacy of risperidone in the treatment of delirium. This pilot study taught us that the phase 2 RIsperDone DELirium trial will need a multicenter design with more research personnel to increase the number of participants enrolled.
COVID-19 Pandemic Effects on Clinical Outcomes of Hip Fractures Among Pediatric and Adult Patients
Authors: Roskam Justin S. , Hauser Kristine M. , DiFazio Louis T. , Rolandelli Rolando H. , Nemecz Amanda K. , Nemeth Zoltan H.
Published: November 2023

BACKGROUND:

Little is known about the distribution and outcomes of hip fractures in pediatric patients during the COVID-19 pandemic.

OBJECTIVE:

To study the clinical outcomes of both pediatric and adult patients who underwent hip fracture surgeries and determine the effects of changes surrounding the COVID-19 pandemic.

METHODS:

Both pediatric and adult surgical hip fracture cases were analyzed from the pandemic year (2020) and the control year (2019) using the American College of Surgeons National Surgical Quality Improvement Program database.

RESULTS:

Between the prepandemic (control) and pandemic years, a total of 2,438 pediatric and 28,180 adult cases were compared. Pediatric patients had similar perioperative characteristics and outcomes between the two years. Significantly fewer hip fractures were reported among adults during the pandemic (p < .001). Preoperatively, more adult patients had ventilator dependence (p = .020), transfusions (p = .029), and systemic inflammatory response syndrome (p < .001) in 2020. Adult operations were more likely to be emergent in 2020 (p < .001) and adults had more severe disease states. Length of stay (p < .001) and the time from operation to discharge (p < .001) were significantly longer for the adult cohort in 2020. Mortality was also higher for adults during the first year of the pandemic (p = .003), and superficial surgical site infections became more common (p = .036).

CONCLUSION:

Pediatric hip fracture patients had similar clinical outcomes between 2019 and 2020. Adults with hip fractures presented in more serious clinical conditions, which resulted in higher mortality in 2020. Further studies could better clarify the reasons as to why adult hip fracture patients had markedly worse clinical course during the COVID year than pediatric patients.
Geospatial Mapping to Target Injury Prevention for Older Adult Ground-Level Falls: A Feasibility Study
Authors: Cardozo-Stolberg Sara , Szydziak Elisa , Angus L. D. George , Blake Rodrigo , Marsden Daniel , Venkatesh Sinchana , Mon Nwe Oo
Published: November 2023

BACKGROUND:

Trauma centers target injury prevention efforts based on trauma registry and local epidemiological data. Identifying geographic patterns of injury through geospatial mapping has emerged as a technology to help identify at-risk individuals. Yet, the feasibility of using spatial analysis to target injury prevention efforts remains unknown.

OBJECTIVE:

This study aims to demonstrate the use of geospatial mapping of older adult ground-level falls to target injury prevention efforts.

METHODS:

This retrospective cohort analysis of ground-level falls among older adults was conducted from 2017 to 2020 at a Level I trauma center and safety net hospital. Trauma admissions, U.S. census median income, Hispanic percentage, and population density by zip codes were combined to create choropleth and heat maps to identify injury hot spots to target fall prevention classes.

RESULTS:

A total of 5,629 patients were reviewed, of which 3,002 (53%) were fall cases. Low-level falls (<10 ft) accounted for 2,224 cases; 1,449 were among older adults centered around the study hospital. Ground-level falls accounted for 1,663 patients, of whom 1,182 were older adults clustering around senior housing, assisted living facilities, nursing homes, and rehabilitation centers. As a result, our fall prevention classes are now targeted at these newly identified locations.

CONCLUSION:

Geospatial analysis provided powerful visualization of fall injury locations to target our fall prevention efforts. Geospatial analysis is a feasible tool for trauma centers to guide injury prevention strategies that effectively target the populations most in need.
Impact of a Rounding Tool and Clinical Champion on Trauma Patient Screening, Brief Intervention, and Referral to Treatment for Alcohol Use Disorder
Authors: Todd Brandon , Rahm Jordan , Kerley David , Hunt Darrell L.
Published: November 2023

BACKGROUND:

Early identification and treatment of alcohol misuse among trauma patients is the standard of care for trauma centers. Yet, trauma programs face significant barriers in adherence to sustained alcohol misuse screening.

OBJECTIVE:

This study aims to evaluate the impact of a rounding tool and clinical champion on screening, brief intervention, and referral to treatment compliance rates for alcohol use disorder in trauma patients.

METHODS:

This is a single-center, retrospective cohort design measuring the impact of a nursing rounding tool and clinical champion on screening, brief intervention, and referral to treatment for alcohol use disorder in trauma patients older than 14 years. Retrospective reviews were conducted over a 5-year period from 2017 to 2021 for all admitted trauma patients as defined by the National Trauma Data Standard.

RESULTS:

More than 5,000 trauma patients were included during the study period. The nurses' rounding tool and clinical champion intervention led to an increase in the alcohol use disorder screening rate from an average of 59% for the first 3 months of the study (May to July 2017) to 95% for the last 3 months of the study (March to May 2021).

CONCLUSION:

Our findings show that a dedicated clinical champion and nurse rounding tool increase compliance for screening, brief intervention, and referral to treatment for alcohol use disorder in trauma patients.
Escaping the Silos: Utilization of a Pediatric Trauma Escape Room to Promote Interprofessional Education and Collaboration
Authors: Hudson Ashley , Franklin Kelli , Edwards Thomas R. , Slivinski Andrea
Published: November 2023

BACKGROUND:

Millions of children are treated annually for trauma-related injuries but comprise a smaller proportion of emergency department visits than adults. As a result, emergency department teams may not have the knowledge, skills, and confidence to care for pediatric patients, and specialty teams may not interact enough as an interprofessional team to provide high-quality patient care.

OBJECTIVE:

The purpose of this project is to describe a novel interprofessional simulation-based education initiative to assist pediatric trauma team readiness.

METHODS:

An escape room was designed to provide an interactive educational environment focused on pediatric trauma education. Using an interprofessional dyad of a trauma nursing specialist and a pediatric nursing expert, the escape room was designed as a series of clues to improve pediatric skills and interprofessional collaboration between specialty teams. The escape room training was conducted (from February to March, 2023) in a large Southeastern U.S. Level II adult trauma center.

RESULTS:

Twenty-one registered nurses from different specialty teams participated in the simulation exercises with overwhelmingly positive feedback. Colleagues reported this was a unique way to deliver education that resulted in innovative team building and enriched collegiality between the specialty teams.

CONCLUSIONS:

The escape room educational format was positively received, and future events are planned across disciplines and various topics. Trauma centers with lower pediatric volumes seeking to provide engaging team-based education may use this format as a unique and innovative way to develop teams for clinical success.
Legislation, medicine, and politics: care for gender diverse youth
Authors: Preston Stephanie , Lopez Ximena
Published: November 2023

Purpose of review

A recent increase in legislation in the United States prohibiting gender-affirming care (GAC) for transgender youth follows a wave of its politicization despite support from all pertinent mainstream medical associations. This review describes the standards of GAC for transgender youth, the origins of legislation prohibiting this care, a review of current legislation in the United States and a discussion on the impact on patients, providers, and the medical field.

Recent findings

A critical evaluation of historical parallels and current organizations supporting this legislation reveals it stems not from concerns within the medical field but from political and religious interests. This intrusion sets a dangerous precedent, undermining evidence-based medicine, providers’ ability to practice according to standards of care, and patients’ and guardians’ autonomy and medical decision-making. This wave of antitrans rhetoric and legislation has resulted in threats to health providers and hospitals, ‘moral distress” in providers, and migration of providers and patients from hostile states.

Similar to antiabortion legislation, these legislative efforts will likely result in negative health outcomes and worsening disparities. The medical community must confront these forces directly through an understanding of the political and structural forces at play and adopting strategies to leverage collective power.
A comparative study on the quality of in vivo labeled red blood cell radionuclide ventriculography images employing different freeze-dried reagents
Authors: Pujatti Priscilla B. , dos Santos João Paulo G. , Gomes Maria Luisa , Cardoso Marcella A. S. , Guimarães Tiago T. , Felix Renata C. M.
Published: November 2023

Radionuclide ventriculography or Multi Gated Acquisition (MUGA) employing [99mTc]Technetium red blood cell (RBC) labeling is considered the gold standard for cardiotoxicity assessments in cancer patients undergoing chemotherapy. This in-vivo RBC labeling technique involves the reduction of [99mTc]Technetium by the stannous chloride present in freeze-dried reagent kits, with the pyrophosphate kit (PYP) being the most employed for this purpose. The literature, however, describes diethylenetriaminepentaacetic acid (DTPA) as an alternative to PYP, although a lack of comparative data from MUGA images between both reagents is noted. A retrospective cross-sectional observational study was conducted at the Brazilian National Cancer Institute Nuclear Medicine Service concerning 80 randomized MUGA images, 20 obtained employing DTPA between 2020 and 2023 and 60 obtained employing PYP between 2017 and 2020, applying the mean count per pixel (ct/pixel) and heart background (C/F) ratios as quality image indicators. Although the heart ct/pixel ratio was statistically lower in the DTPA images compared with PYP (P = 0.02), the C/F ratio was statistically similar when comparing both radiopharmaceuticals (P = 0.697). A semi-quantitative analysis of MUGA images obtained with DTPA and PYP indicates similar image quality, supporting the use of DTPA as an alternative to PYP without compromising diagnostic interpretations.
Effects of Yoga on Cancer-Related Fatigue, Psychological Distress, and Quality of Life Among Patients With Cancer Undergoing Chemotherapy and/or Radiotherapy: A Systematic Review and Meta-analysis
Authors: Ma Xing , Li Si Ni , Chan Dorothy Ngo Sheung
Published: November 2023

Background

Yoga can be considered supportive therapy for patients with cancer to alleviate cancer-related symptoms. However, there has been no meta-analysis examining yoga’s effects among patients with cancer undergoing chemotherapy and/or radiotherapy.

Objective

To synthesize the evidence regarding the effects of yoga on improving cancer-related fatigue, psychological distress, and quality of life among patients with cancer undergoing chemotherapy and/or radiotherapy.

Methods

Ten English databases and 2 Chinese databases were searched from inception to December 2022. Two independent reviewers screened studies and extracted the data. Randomized controlled trials examining the effects of yoga on cancer-related fatigue, psychological distress, and quality of life were included. Meta-analysis was conducted, and narrative synthesis was performed when meta-analysis was not applicable.

Results

Fourteen studies from 16 articles were included. The results showed that yoga reduced cancer-related fatigue (standardized mean difference [SMD], −0.75; 95% confidence interval [CI], −1.12 to −0.38;P< .001), anxiety (SMD, −0.91; 95% CI, −1.68 to −0.14;P= .02), but not depression (SMD, −0.82; 95% CI, −1.67 to 0.04;P= .06). The effects of yoga on distress and quality of life were inconclusive.

Conclusions

Yoga significantly helped reduce cancer-related fatigue and anxiety but did not reduce depression among patients with cancer undergoing chemotherapy and/or radiotherapy. Further rigorous studies are needed to identify the optimal characteristics of yoga for these patients.

Implications for Practice

It is possible to recommend yoga to patients with cancer undergoing chemotherapy and/or radiotherapy for managing cancer-related fatigue and anxiety after duly considering patients’ physical conditions and ensuring appropriate instructions are given.
Vestibular contribution to spatial orientation and navigation
Authors: Zwergal Andreas , Grabova Denis , Schöberl Florian
Published: November 2023

Purpose of review

The vestibular system provides three-dimensional idiothetic cues for updating of one's position in space during head and body movement. Ascending vestibular signals reach entorhinal and hippocampal networks via head-direction pathways, where they converge with multisensory information to tune the place and grid cell code.

Recent findings

Animal models have provided insight to neurobiological consequences of vestibular lesions for cerebral networks controlling spatial cognition. Multimodal cerebral imaging combined with behavioural testing of spatial orientation and navigation performance as well as strategy in the last years helped to decipher vestibular-cognitive interactions also in humans.

This review will update the current knowledge on the anatomical and cellular basis of vestibular contributions to spatial orientation and navigation from a translational perspective (animal and human studies), delineate the behavioural and functional consequences of different vestibular pathologies on these cognitive domains, and will lastly speculate on a potential role of vestibular dysfunction for cognitive aging and impeding cognitive impairment in analogy to the well known effects of hearing loss.
ICTV Virus Taxonomy Profile: Aoguangviridae 2023
Authors: Zhou Yifan , Wang Yongjie , Krupovic Mart
Published: November 2023

The family Aoguangviridae includes dsDNA viruses that have been associated with marine archaea. Currently, members of this virus family are known through metagenomics. Virions are predicted to consist of an icosahedral capsid and a helical tail, characteristic of members in the class Caudoviricetes. Aoguangviruses have some of the largest genomes among archaeal viruses and possess most of the components of the DNA replication machinery as well as auxiliary functions. The family Aoguangviridae includes the species Aobingvirus yangshanense. Many unclassified relatives of this virus group, referred to as ‘magroviruses’, have been discovered by metagenomics in globally distributed marine samples. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Aoguangviridae, which is available at ictv.global/report/aoguangviridae.
Implementation of national whole-genome sequencing of Mycobacterium tuberculosis, National Public Health Laboratory, Singapore, 2019—2022
Authors: Lim Ansel Yi Herh , Ang Michelle L.T. , Cho Sharol S. L. , Ng Deborah H. L. , Cutter Jeffery , Lin Raymond T. P.
Published: November 2023

The National Tuberculosis Programme (NTBP) monitors the occurrence and spread of tuberculosis (TB) and multidrug-resistant TB (MDR-TB) in Singapore. Since 2020, whole-genome sequencing (WGS) of

Mycobacterium tuberculosis

isolates has been performed at the National Public Health Laboratory (NPHL) for genomic surveillance, replacing spoligotyping and mycobacterial interspersed repetitive unit-variable number tandem repeats analysis (MIRU-VNTR). Four thousand three hundred and seven samples were sequenced from 2014 to January 2023, initially as research projects and later developed into a comprehensive public health surveillance programme. Currently, all newly diagnosed culture-positive cases of TB in Singapore are prospectively sent for WGS, which is used to perform lineage classification, predict drug resistance profiles and infer genetic relationships between TB isolates. This paper describes NPHL’s operational and technical experiences with implementing the WGS service in an urban TB-endemic setting, focusing on cluster detection and genomic drug susceptibility testing (DST). Cluster detection: WGS has been used to guide contact tracing by detecting clusters and discovering unknown transmission networks. Examples have been clusters in a daycare centre, housing apartment blocks and a horse-racing betting centre. Genomic DST: genomic DST prediction (gDST) identifies mutations in core genes known to be associated with TB drug resistance catalogued in the TBProfiler drug resistance mutation database. Mutations are reported with confidence scores according to a standardized approach referencing NPHL’s internal gDST confidence database, which is adapted from the World Health Organization (WHO) TB drug mutation catalogue. Phenotypic–genomic concordance was observed for the first-line drugs ranging from 2959/2998 (98.7 %) (ethambutol) to 2983/2996 (99.6 %) (rifampicin). Aspects of internal database management, reporting standards and caveats in results interpretation are discussed.
Long-Term Outcome after Convergent Procedure for Atrial Fibrillation
Authors: Gersak Borut , Podlogar Veronika , Kalinsek Tine Prolic , Jan Matevz
Published: November 2023

Background

The aim of this single-center retrospective study is to evaluate the long-term outcome after convergent procedure (CP) for patients with paroxysmal atrial fibrillation (AF), persistent AF and long-standing persistent AF.

Methods and results

We analyzed outcomes of patients that underwent CP from January 2009 until July 2020. 119 patients with paroxysmal AF (23.5%), persistent AF (5.9%) or long-standing persistent AF (70.6%) that attended long-term follow up were included. The outcome was assessed at 1-year after CP and at long-term follow up. At 1-year follow up rhythm and daily AF burden were assessed for patients with implantable loop recorder (61.2%). For others rhythm was assessed by clinical presentation and 12-lead ECG recording. At long-term follow up patients having sinus rhythm or unclear history of AF were monitored with 7-day ECG Holter and AF burden was determined. Long-term success was defined as freedom from AF/atrial flutter (AFL) with sinus rhythm on 12-lead ECG recording and AF/AFL burden <1% on 7-day Holter ECG. Repeat catheter ablations (RFA) prior to long-term follow up were documented.

At 1-year follow up 91.4% of patients had sinus rhythm and 76.1% of patients had AF/AFL burden <1%. At long-term follow up (8.3 ± 2.8 years) 65.5% of patients had sinus rhythm and 53.8% patients had AF/AFL burden <1% on 7-day holter ECG. Additional RFAs were performed in 32.8% of patients who had AF or AFL burden <1%. At long-term follow up age, body mass index and left atrial volume index were associated with increased risk of AF recurrence.

Conclusions

CP resulted in high long-term probability of sinus rhythm maintenance. During long-term follow-up additional RFAs were required to maintain sinus rhythm in a substantial number of patients.
Early warning system using primary healthcare data in the post-COVID-19-pandemic era: Brazil nationwide case-study
Authors: Cerqueira-Silva Thiago , Oliveira Juliane F. , de Araújo Oliveira Vinicius , Veras Florentino Pilar Tavares , Sironi Alberto , Penna Gerson O. , Pereira Ramos Pablo Ivan , Boaventura Viviane Sampaio , Barral-Netto Manoel , Marcilio Izabel
Published: November 2023

Background

Syndromic surveillance utilising primary health care (PHC) data is a valuable tool for early outbreak detection, as demonstrated in the potential to identify COVID-19 outbreaks. However, the potential of such an early warning system in the post-COVID-19 era remains largely unexplored.

Methods

We analysed PHC encounter counts due to respiratory complaints registered in the Brazilian database of the Universal Health System between January and July 2023. We applied EARS (variation C1-C2-C3) and EVI to estimate the weekly thresholds. An alarm was determined when the number of encounters exceeded the week-specific threshold. We used data on hospitalisation due to respiratory disease to classify weeks in which the number of cases surpassed predetermined thresholds as anomalies. We compared EARS and EVI’s efficacy in anticipating anomalies.

Findings

A total of 119 anomalies were identified across 116 immediate regions during the study period. The EARS-C2 presented the highest early alarm rate, with 81/119 (68%) early alarms, and C1 the lowest, with 71 (60%) early alarms. The lowest true positivity was the EARS-C1 118/1354 (8.7%) and the highest EARS-C3 99/856 (11.6%).

Conclusion

Routinely collected PHC data can be successfully used to detect respiratory disease outbreaks in Brazil. Syndromic surveillance enhances timeliness in surveillance strategies, albeit with lower specificity. A combined approach with other strategies is essential to strengthen accuracy, offering a proactive and effective public health response against future outbreaks.
Fertilizer and cultivar affect the barley rhizobiome, while domestication age only affects growth at low nutrient levels
Authors: Kindtler Nikolaj L. , Sheikh Sanea , Richardy Jesper , Krogh Emilie , Maccario Lorrie , Vestergård Mette , da Fonseca Rute R , Ekelund Flemming , Laursen Kristian H.
Published: November 2023

Modern plant breeding has provided barley cultivars that produce high yields when supplied with ample amounts of mineral fertilizer. This narrow selection criterion may have reduced key traits facilitating vital microbiome-plant interactions. Here, we investigated the performance of three old and four modern barley cultivars grown at different fertilizer regimes and assessed the root microbiome composition using 16s rRNA amplicon sequencing. The objectives were to investigate: i) nutrient availability effects on nutrient uptake and biomass production and, ii) how domestication age, cultivar, and fertilizer treatment affect the root microbiome. Without fertilizer, old cultivars outperformed modern ones in terms of biomass and had higher leaf concentration of nitrogen, potassium, sulphur, iron, zinc, and copper. This suggests that older barley cultivars retained the ability of their wild ancestor to collaborate with the soil microbiome resulting in improved nutrient acquisition in low-input systems. Interestingly, domestication age did not significantly affect the diversity of the rhizo-microbiome, which was instead dependent on individual cultivar and fertilizer treatment.

Highlight

Older barley cultivars outperform the modern ones in terms of biomass at low nutrient availability. However, the rhizo-microbial diversity depended on the individual cultivar and fertilizer regime.
Simplest Model of Nervous System. II. Evolutionary Optimization
Authors: Sinitskiy Anton V.
Published: November 2023

In this work, we build upon a simple model of a primitive nervous system presented in a prior companion paper. Within this model, we formulate and solve an optimization problem, aiming to mirror the process of evolutionary optimization of the nervous system. The formally derived predictions include the emergence of sharp peaks of neural activity (‘spikes’), an increasing sensory sensitivity to external signals and a dramatic reduction in the cost of the functioning of the nervous system due to evolutionary optimization. Our work implies that we may be able to make general predictions about the behavior and characteristics of the nervous system irrespective of specific molecular mechanisms or evolutionary trajectories. It also underscores the potential utility of evolutionary optimization as a key principle in mathematical modeling of the nervous system and offers examples of analytical derivations possible in this field. Though grounded in a simple model, our findings offer a novel perspective, merging theoretical frameworks from nonequilibrium statistical physics with evolutionary principles. This perspective may guide more comprehensive inquiries into the intricate nature of neural networks.