bluuebunny/crossref_metadata_2025 huggingface dataset:
Root Cause Analysis
Authors: Contreras Joemart
Published: March 2021

In the summer of 2020, a patient at a major Veteran Affairs medical center in the western United States experienced an unwitnessed fall in their telemetry patient ward. This incident resulted in the patient receiving a fracture in his/her C5 cervical spine area. This eventually led to his/her death the following day. After determining a Safety Assessment Code score of 3, the patient safety manager determined that an immediate root cause analysis (RCA) was required. After assembling an interdisciplinary team and providing training on the VA's RCA policies and processes, an initial timeline of the sequence of the events was created. After identifying the gaps, personnel were interviewed, and using triage questions, the full flow diagram of the incident was created. By understanding what had occurred, the team was able to find the root causes of key events within the timeline. Four root causes were determined. One was the lack of an immobilization protocol for patients who sustained injuries from a fall. The second was the misinterpretation of the restraint policy by the nursing staff. The third was failing to identify risk factors associated with a patient's Morse fall risk score. Finally, the last root cause was the improper patient bed configuration of using a mattress from a different vendor. All these root causes received action plans that seek to reduce future problems from occurring. Although I had limited time with the overall RCA project, I learned a lot about the VA process and how important and valuable a good RCA is in preventing issues from occurring again and ensuring patient safety is held to the highest priority for a hospital and healthcare system.
A Chart Audit Study of Clozapine Utilization in Early Psychosis
Authors: Leclerc Louis-David , Demers Marie-France , Bardell Andrea , Bilodeau Isabelle , Williams Richard , Tibbo Phil , Roy Marc-André
Published: March 2021

Purpose

This study aimed to document the treatment trajectories and clozapine use in first-episode psychosis patients and to document the underlying reasons for using or not using clozapine in patients not achieving psychosis remission.

Methods

We conducted a retrospective chart audit of patients aged 18 to 30 years having DSM-5 diagnoses of schizophrenia spectrum psychotic disorders treated in 3 Canadian early intervention programs for psychosis. The severity of the patient's illness (using the Clinical Global Impression Severity [CGI-S] scale) and remission of psychosis were rated before and after each antipsychotic trial.

Results

One hundred and forty-seven patients were included in the study. There were 19.7% patients exposed to clozapine after an average of 2.4 antipsychotic trials and a mean delay of 470.8 days. There were 75.9% patients who improved their CGI-S score (mean improvement, 2.5) after the clozapine trial and 62.1% achieved a CGI-S score ≤3. Full remission of psychosis on clozapine was achieved in 69.0% of the patients. Clozapine was successfully used for some patients with a nonadherent profile in our sample (eg, personality disorder, substance use disorder). Although the mean duration of clozapine trials during the observation period was 688.6 days, no patient discontinued clozapine because of adherence issues.

Conclusions

Clozapine use in these early intervention programs were at a rate consistent to what is expected from the literature and allowed a majority of patients to achieve remission of psychosis and to experience a robust improvement of severity of illness.
Design and outcomes of a nurse practitioner preceptor development program
Authors: Hallas Donna , Haber Judith , Biesecker Babette , Hartnett Erin , Toft Klar Robin , Djukic Maja , Apold Susan , Vetter Mary Jo , McMillan Adrienne , Brilliant Maria , Baldyga Julie A. , Waingortin Ryan , Fletcher Jason
Published: March 2021

Nurse practitioners (NPs) are educated to provide high-quality patient- and family-centered care to underserved, culturally diverse, medically complex populations. Nurse practitioner faculty plan curricular activities that challenge NP students to critically assess individuals and populations with the goal of preparing NP students to be “practice-ready” upon graduation. Nurse practitioner clinical training occurs in practice settings with NP preceptors, with specific areas of clinical expertise. However, there is a lack of NP clinical preceptors educationally prepared to clinically teach and evaluate NP students. This article presents the design, implementation, evaluation, and outcomes from a 3-year grant funded by the United States Human Resources and Administration Services that featured a web-based Primary Care Nurse Practitioner Preceptor Development Program. Ninety percent of NPs who precepted NP students completed all web-based learning modules. Preceptors with educational preparation via online modules to guide NP student learning in clinical settings are a critical resource for faculty to prepare NP students to be practice-ready upon graduation. This web-based learning platform for online NP preceptor education may be a successful approach for expanding and improving the NP preceptor pool nationwide.
Lepidopterism caused by the puss caterpillar
Authors: Koehler Alexandra W. , Zaveri Kiran G.
Published: March 2021

Lepidopterism is a term inclusive of cutaneous and systemic reactions resulting from moths, butterflies, and larva. The puss caterpillar is the larval form of the southern flannel moth, Megalopyge opercularis. A case presentation is reviewed and treatment options presented for contact with puss caterpillars and other stinging caterpillars encountered in the primary care setting. Contact with the puss caterpillar causes a characteristic rash and can produce extreme symptoms of pain for its victims. Accurate and early diagnosis can expediate treatment to alleviate symptoms and decrease morbidity in those affected and aid in differential diagnosis of various stinging caterpillars.
Usefulness and feasibility of repeated tail artery cannulations in the rat
Authors: Kumagai Kosuke , Toyooka Terushige , Otsuka Yohei , Horikawa Masahiro , Yamada Kentaro , Tomiyama Arata , Takeuchi Satoru , Kurihara Koichi , Wada Kojiro
Published: March 2021

Rat ventral caudal artery (VCA, tail artery) cannulation for blood pressure monitoring and blood sampling is essential for maintaining consistent procedures in rat models. Double or triple insults are sometimes necessary, but repeated VCA cannulations have not been compared with repeated femoral artery cannulations. In addition, the collateral system for resistance to ischemia in the rat tail is unclear. Our present study revealed that repeated VCA cannulations on different days was a better technique than repeated femoral artery cannulations in terms of surgical time, postsurgical weight loss and ischemic complications. Furthermore, the lateral caudal arteries and the segmental anastomosing vessels were important for resistance to ischemic complications after VCA occlusion.
Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR)
Authors: Balci Cafer , Eşme Mert , Sümer Fatih , Asil Serkan , Yavuz Bünyamin , Tuna Rana , Özsürekci Cemile , Çalişkan Hatice , Ünsal Pelin , Şengül Ayçiçek Gözde , Halil Meltem , Cankurtaran Mustafa , Doğu Burcu Balam
Published: March 2021

Objectives

Masked hypertension, defined as nonelevated clinic blood pressure with elevated out of clinic blood pressure, has been associated with increased cardiovascular events, mortality and cognitive impairment. No evidence exists regarding the effect of treating masked hypertension. In this study, we followed-up the patients in the G-MASH-cog study for 1 year and aimed to examine the effect of the management of masked hypertension on cognitive functions.

Methods

The G-MASH-cog study participants were followed-up for 1 year. In masked hypertensive individuals, lifestyle modification and antihypertensive treatment (perindopril or amlodipine) were initiated for blood pressure control. Measurements of cognitive tests and ambulatory blood pressure monitoring at baseline and at 1-year follow-up were compared.

Results

A total of 61 patients (30 in masked hypertension group; 31 in normotensive group) were included. Mean age was 72.3 ± 5.1 and 59% of the participants were female. Compared with baseline ambulatory blood pressure measurement results, patients with masked hypertension had significantly lower ambulatory blood pressure measurement results after 1-year follow-up. The quick mild cognitive impairment test (Q-MCI-TR) score increased with antihypertensive treatment (Q-MCI score at baseline = 41(19–66.5), at 1 year = 45.5 (22–70), P = 0.005) in masked hypertensive patients. In the final model of the mixed-effects analysis, when adjusted for covariates, interaction effect of the masked hypertension treatment with time was only significant in influencing the changes in Q-MCI scores over time in patients aged between 65 and 74 years (P = 0.002).

Conclusions

Treatment of masked hypertension in older adults was associated with improvement in cognitive functions.
The Validity of Somatic Symptom Disorder in Patients With Gastrointestinal Complaints
Authors: Berens Sabrina , Schaefert Rainer , Ehrenthal Johannes C. , Baumeister David , Gauss Annika , Eich Wolfgang , Tesarz Jonas
Published: March 2021

Background and Goal:

The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD−) along sociodemographic, clinical, and psychological characteristics.

Study:

This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD−) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD− patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD− patients.

Results:

About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits.

Conclusions:

Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.
Roux-en-Y Gastric Bypass Is Associated With Increased Hazard for De Novo Alcohol-related Complications and Liver Disease
Authors: Kim Hannah P. , Jiang Yue , Farrell Timothy M. , Peat Christine M. , Hayashi Paul H. , Barritt Alfred Sidney
Published: March 2021

Goal:

The goal of this study was to determine if bariatric surgeries are associated with de novo alcohol-related complications.

Background:

Bariatric surgery is associated with an increased risk of alcohol use disorders. The effect of bariatric surgeries on other alcohol-related outcomes, including liver disease, is understudied.

Materials and Methods:

Using the IMS PharMetrics database, we performed a cohort study of adults undergoing bariatric surgery or cholecystectomy, excluding patients with an alcohol-related diagnosis within 1 year before surgery. The primary outcome was any alcohol-related diagnosis after surgery. We fit a multivariable Cox proportional hazards model to determine independent associations between bariatric surgeries [Roux-en-Y gastric bypass (RYGB); adjustable gastric band; sleeve gastrectomy] versus cholecystectomy and the development of de novo alcohol-related outcomes. We further fit complication-specific models for each alcohol-related diagnosis.

Results:

RYGB was significantly associated with an increased hazard of any de novo alcohol-related diagnosis [adjusted hazard ratio (AHR)=1.51, 95% confidence interval (CI): 1.40-1.62], while adjustable gastric band (AHR=0.55, 95% CI: 0.48-0.63) and sleeve gastrectomy (AHR=0.77, 95% CI: 0.64-0.91) had decreased hazards. RYGB was associated with a 2- to 3-fold higher hazard for alcoholic hepatitis (AHR=1.98, 95% CI: 1.17-3.33), abuse (AHR=2.05, 95% CI: 1.88-2.24), and poisoning (3.14, 95% CI: 1.80-5.49).

Conclusions:

RYGB was associated with higher hazards of developing de novo alcohol-related hepatitis, abuse, and poisoning compared with a control group. Patients without a history of alcohol use disorder should still be counseled on the increased risk of alcohol use and alcohol-related complications, including alcohol-related liver disease, following RYGB, and should be monitored long term for the development of alcohol-related complications.
Intracystic Glucose Levels in Differentiating Mucinous From Nonmucinous Pancreatic Cysts
Authors: Mohan Babu P. , Madhu Deepak , Khan Shahab R. , Kassab Lena L. , Ponnada Suresh , Chandan Saurabh , Facciorusso Antonio , Crino Stefano F. , Barresi Luca , McDonough Stephanie , Adler Douglas G.
Published: March 2021

Background:

Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant transformation. Nonsurgical methods of differentiating mucinous and nonmucinous pancreatic cysts are challenging and entail a multi investigational approach. Low intracystic glucose levels have been evaluated in multiple studies for its accuracy in differentiating mucinous from nonmucinous cysts of the pancreas.

Methods:

Multiple databases were searched and studies that reported on the utility of intracystic glucose levels in diagnosing mucinous pancreatic cysts were analyzed. Meta-analysis was conducted using the random-effects model, heterogeneity was assessed by I
2%, and pooled diagnostic test accuracy values were calculated.

Results:

Seven studies were included in the analysis from an initial total of 375 citations. The pooled sensitivity of low glucose in differentiating mucinous pancreatic cyst was 90.5% [95% confidence interval (CI): 88.1-92.5; I
2=0%] and the pooled specificity was 88% (95% CI: 80.8-92.7; I
2=79%). The sensitivity at a glucose cut-off of 50 was 90.1% (95% CI: 87.2-92.5; I
2=0%) and the specificity was 85.3% (95% CI: 76.8-91.1; I
2=76%). The sensitivity of glucose levels in pancreatic cyst fluid taken by endoscopic ultrasound guided fine-needle aspiration was 90.8% (95% CI: 87.9-93.1; I
2=0%) and the specificity was 90.5% (95% CI: 81.7-95.3; I
2=83%). The sensitivity of point-of-care glucometers was 89.5% (95% CI: 87.9-93.1; I
2=0%) and specificity was 83.9% (95% CI: 68.5-92.6; I
2=43%).

Conclusions:

Low glucose level at a cut-off of 50 mg/dL on fluid samples collected by endoscopic ultrasound guided fine-needle aspiration and analyzed by point-of-care glucometer achieves excellent diagnostic accuracy in differentiating mucinous pancreatic cysts.
Identifying Advanced Fibrosis in NAFLD Using Noninvasive Tests
Authors: Noorian Shaya , Patel Ankur , Ashkar Carina , Saab Sammy
Published: March 2021

Background:

The utility of noninvasive tests (NITs) for the diagnosis of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD) is limited by indeterminate results and modest predictive values (PVs). Algorithms of sequential NITs may overcome these shortcomings. Thus, we sought to systematically review the accuracy of sequential algorithms for assessing advanced fibrosis in NAFLD.

Methods:

A systematic review was performed following guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A literature search of PubMed and Embase was performed in July of 2020 to identify studies that evaluated diagnostic characteristics of sequential NIT algorithms in NAFLD.

Results:

Among 8 studies meeting inclusion criteria, 48 algorithms were studied in 6741 patients. The average sensitivity, specificity, positive PV, negative PV, and proportion of indeterminate values for included algorithms were 72%, 92%, 88%, 82%, and 25%, respectively. Six algorithms achieved sensitivities in the top quartile (≥86.3%) with <25% indeterminate values. Four algorithms achieved specificities in the top quartile (≥98.7%) with <25% indeterminate values. The aforementioned algorithms included combinations of Fibrosis-4, NAFLD fibrosis score, and vibration-controlled transient elastography.

Conclusions:

Sequential NIT algorithms may reduce indeterminate results while achieving sensitivities comparable to single NITs. Sequential algorithms may also augment the specificities of single NITs, though resulting positive PVs may not be high enough to obviate the need for liver biopsy. Available evidence supports the use of Fibrosis-4, NAFLD fibrosis score, and vibration-controlled transient elastography within sequential algorithms to achieve diagnostic accuracy for advanced fibrosis in NAFLD.
Differential Bile Acid Detection in Refractory GERD Patient Saliva Using a Simple and Sensitive Liquid Chromatography Tandem Mass Spectrometry Approach
Authors: Perez Nisha , Chambert Kimberly , Ribadeneira Maria , Currie Mark G. , Chen Yan , Kessler Marco M.
Published: March 2021

Goals:

The aim was to measure bile acids in human saliva using a sensitive ultraperformance liquid chromatography tandem mass spectrometry analysis method to distinguish quantitative differences in refractory gastroesophageal reflux disease (GERD) patients as compared with proton pump inhibitor (PPI) controlled GERD patients and healthy volunteers.

Study:

Human saliva samples were analyzed from 2 separate studies. The first a meal-controlled pilot, in which premeal and postmeal saliva samples were analyzed from 20 healthy subjects and 20 patients with GERD symptoms controlled by PPIs. In a subsequent exploratory study, saliva was collected from 34 patients with continuing GERD symptoms despite PPI treatment (refractory GERD), 30 healthy subjects, and 30 PPI-controlled GERD patients at ≥4 hours postmeal.

Results:

In the meal-controlled pilot study, both healthy subjects and patients with PPI-controlled GERD, had total saliva bile acid increase for the first hour after consumption of a meal and returned to baseline levels 4 hours later. There was no difference in bile acid levels between the 2 groups. In the exploratory study, the saliva from patients with refractory GERD had statistically significant higher levels of total bile acid concentration compared with those of healthy volunteers and patients with PPI-controlled GERD (P=0.0181).

Conclusions:

Bile acids can be detected and accurately quantitated in human saliva using a sensitive ultraperformance liquid chromatography tandem mass spectrometry assay. Increases above threshold could indicate an underlying disease.

This method could potentially be used to evaluate biliary reflux as an underlying pathophysiology of refractory GERD.
Occurrence and clinical characteristics of occult hepatitis C virus infection in hemodialysis units at Ismailia, Egypt
Authors: Serwah Mohamed A. , Omar Seham A. , Khedr Mohamed S. , Abdel-hamid Alaa Eldein S.
Published: March 2021

Background and aims

Occult hepatitis C infection is defined as the presence of hepatitis C virus RNA in peripheral blood mononuclear cells (PBMC) ± hepatocytes in the absence of HCV-RNA in serum. It has been a lot of debate and controversy in recent years and not discussed well. This issue has not been discussed or investigated in Egypt, especially in patients on hemodialysis in Ismailia. This study is the first one to investigate the prevalence of occult HCV infection in large populations of chronic hemodialysis (CHD) patients in Ismailia, Egypt.

Methods

Our study is cross-sectional analytic and included 204 CHD patients; who are negative for HCV infection. Sensitive commercial real-time assay was used to detect HCV-RNA in PBMC. In our study, the presence of genomic HCV-RNA in PBMCs of all these patients was detected by real-time PCR. On the other hand, 22 patients on hemodialysis with an established diagnosis of chronic hepatitis C virus infection were included as a control group and examined by real-time PCR was used to evaluate HCV infection.

Results

Occult HCV infection is defined as the presence of HCV-RNA in PBMNCs in patients on chronic hemodialysis, and it was found in 14/204 (7%) of the patients. Patients who were on CHD for a longer time are susceptible to occult HCV infection, and their mean alanine aminotransferase levels are significantly higher during the last 3 months before study entry. In comparison, chronic HCV patients have elevated bilirubin, aspartate transferase and alanine transferase than occult HCV infection.

Conclusions

The prevalence of occult HCV infection was 7% in our CHD patients. No available data are showing the virulence of this form of virus. However, further studies in other geographic populations with high HCV endemicity are needed to clarify the significance of occult HCV infection in these patient groups, in addition to test for the presence of negative antigenomic strand to confirm or disconfirm the reliability of occult HCV.
Macro- and micronutrients in metabolic (dysfunction) associated fatty liver disease: association between advanced fibrosis and high dietary intake of cholesterol/saturated fatty acids
Authors: Guveli Hakan , Kenger Emre Batuhan , Ozlu Tugce , Kaya Eda , Yilmaz Yusuf
Published: March 2021

Background and aim

There is still no approved pharmacotherapy for metabolic (dysfunction) associated fatty liver disease (MAFLD). Although dietary and lifestyle modifications for weight loss remain the mainstay for disease management, the association between macro- and micronutrients and fibrosis stage in patients with MAFLD remains unclear. This study was undertaken to address this issue.

Methods

This is a retrospective analysis of prospectively collected data from patients in whom MAFLD was diagnosed with vibration controlled transient elastography. Steatosis was defined by a controlled attenuation parameter ≥238 dB/m, whereas a liver stiffness measurement ≥11 kPa was considered to indicate advanced fibrosis.

Results

The study sample consisted of 106 patients with MAFLD (mean age 49 ± 10 years, 52 men and 54 women). Among the different micro- and macronutrients tested, only the dietary intake of cholesterol and saturated fatty acid (SFA) was independently associated with the presence of advanced fibrosis.

Conclusion

Our findings suggest that cholesterol/SFA-restricted dietary regimens – as exemplified by the traditional Mediterranean diet – may reduce the risk of advanced fibrosis in patients with MAFLD.
Frailty is strongly associated with self-reported symptom burden among patients with cirrhosis
Authors: Deng Lisa X. , Bischoff Kara E. , Kent Dorothea S. , O’Riordan David L. , Pantilat Steven Z. , Lai Jennifer C.
Published: March 2021

Objectives

Although patients with cirrhosis often experience debilitating symptoms, few are referred for palliative care. Frailty is increasingly incorporated in liver transplantation evaluation and has been associated with symptom burden in other populations. We hypothesized that frail patients with cirrhosis are highly symptomatic and thus are likely to benefit from palliative care.

Methods

Patients with cirrhosis undergoing outpatient liver transplantation evaluation completed the Liver Frailty Index (grip strength, chair stands and balance) and a composite of validated measures including the Edmonton Symptom Assessment Scale, distress and quality of life (QOL) measures.

Results

Of 233 patients (median age 61 years, 43% women), 22% were robust, 59% prefrail and 19% frail. Overall, 38% of patients reported ≥1 severe symptoms based on preestablished Edmonton Symptom Assessment Scale criteria. Higher frailty categories were associated with increased prevalence of pain, dyspnea, fatigue, nausea, poor appetite, drowsiness, depression and poor well-being (test for trend, all P < 0.05). Frail patients were also more likely to report psychological distress and poor QOL (all P < 0.01). In univariate analysis, each 0.5 increase in liver frailty index was associated with 44% increased odds of experiencing ≥1 severe symptoms [95% confidence interval (CI), 1.2–1.7, P < 0.001], which persisted (odds ratio, 1.3, 95% CI, 1.0–1.6, P = 0.004) even after adjusting for Model for End Stage Liver Disease-Sodium, ascites, hepatic encephalopathy and age.

Conclusion

In patients with cirrhosis, frailty is strongly associated with physical/psychological symptoms, including pain and depression and poor QOL. Frail patients with cirrhosis may benefit from palliative care co-management to address symptoms and improve QOL.
The prognostic impact of different stages of acute kidney injury in patients with decompensated cirrhosis: a prospective cohort study
Authors: Leão Gabriel S. , de Mattos Angelo A. , Picon Rafael V. , Schacher Fernando C. , John Neto Guilherme , Jotz Raquel F. , Chiesa Talita , Bombassaro Isadora Z. , Possebon João Pedro P. , Coral Gabriela P. , Tovo Cristiane V. , de Mattos Ângelo Z.
Published: March 2021

Aim

To assess the impact of the different stages of acute kidney injury (AKI) on the prognosis of patients hospitalized with decompensated cirrhosis.

Methods

This was a prospective cohort study of consecutive patients admitted in two tertiary hospitals in southern Brazil. Participants were considered eligible if they were admitted for acute decompensation of cirrhosis. The main exposure factor was the onset of AKI. AKI stages were defined according the European recommendations. The outcomes evaluated were survival time and death rates at 28 and 90 days from hospital admission. A χ2 test was used to compare mortality between groups. Kaplan–Meier survival analyses were undertaken assessing time to event as days from AKI diagnosis to death or liver transplant.

Results

Two hundred and five patients were included in the study, and 121 met the criteria for AKI. Patients with AKI 1b, AKI 2 and AKI 3 had higher 90-day mortality than patients without AKI (P = 0.008, P < 0.001 and P < 0.001, respectively). However, there was no difference in 90-day mortality when patients with AKI 1a were compared with those without AKI (P = 0.742). The mean survival of patients without AKI was higher than that of patients with AKI 1b (591.4 and 305.4 days, respectively, P = 0.015), while there was no significant difference between the mean survival of patients without AKI and that of patients with AKI 1a (591.4 and 373.6 days, respectively, P = 0.198).

Conclusion

Only AKI ≥1b seems to substantially impact mortality of patients hospitalized for acute decompensation of cirrhosis.
Successful Management of Massive Congenital Hepatic Hemangioma and Systemic Hypertension With Sirolimus
Authors: Moon So Jung , Baek Hee Jo , Kim Bo Ram , Park Woo Jin , Kim Joheon , Lee Yun Young , Cho Hwa Jin , Kook Hoon
Published: March 2021

Congenital hepatic hemangioma (CHH) is a common benign vascular tumor of the liver, seen in infancy. The clinical manifestations vary from incidental findings to life-threatening complications. The authors present here a case of an infant with massive CHH who developed systemic hypertension because of compression of the right renal artery by the CHH and did not respond to other lines of treatment. After sirolimus therapy, the CHH size decreased and antihypertensive drugs were no longer necessary. In a critical situation, if the embolization and/or steroids do not seem to control the situation, then adding sirolimus may be considered as secondary therapy with good additive effects.
Magnet® and Pathway: Partners for Nursing Excellence
Authors: Lal M. Maureen , Pabico Christine G.
Published: March 2021

This month's Magnet® Perspectives column examines American Nurses Credentialing Center's Magnet Recognition Program® and Pathway to Excellence® Program as partners for nursing excellence. We explore the differences between the programs, how they complement one another, and how they can be combined to impact a host of key measures, including nurse engagement, interprofessional collaboration, and patient safety. Nursing leaders at 2 dual-designated hospitals share their decision to pursue both credentials and ways in which the combined designation adds value for nurses and the patient care environment. They discuss how the essential elements of a Magnet and Pathway culture contributed to a nimble, innovative response to the COVID-19 pandemic and strategies nursing leaders can employ to create and sustain an environment where change flourishes and nurses thrive.
A Study Looking at a Lower Cost Option for Cultural Competence Education
Authors: Shelley Alexandra N. , O'Brien Gufarotti Jessica , Kendrioski Natasha , Lanza-Bisciello Ann Marie , Xuereb Kevin , Stoerger Lauren , Sun Carolyn
Published: March 2021

To meet the growing demands in the US healthcare system caused by multiculturalism and the expansion of health inequities, due diligence must be given to testing the efficacy of tools used in teaching nurses to provide culturally competent care. This project assessed the utility of a free US government–developed training module. The team found an improved trend in nurse-patient communication scores and improved willingness to ask for help with cultural issues for the intervention unit. The use of no-cost, publicly available resources may be a cost-effective option for training materials.
Exploring Strategies to Build Resiliency in Nurses During Work Hours
Authors: Mintz-Binder Ronda , Andersen Susan , Sweatt Laura , Song Huaxin
Published: March 2021

OBJECTIVE

This pilot study investigated increasing nurse resiliency utilizing a toolkit of stress-reducing interventions on medical-surgical units at 4 hospitals.

BACKGROUND

Resiliency-building activities are time consuming and undertaken outside work hours. Although the activities show a positive impact on resilience, researchers investigated whether similar results could be achieved where nurses experience work stress.

METHODS

This quasi-experimental pretest and posttest interventional study used a within-subjects design. Provided toolkits included written instructions to carry out the study. Nurses completed surveys at baseline, at 10 time points over a 6-week period, and at study conclusion.

RESULTS

The Connor-Davidson Resilience Scale-10 scores increased significantly at follow-up (P < .02). Self-reported stress levels decreased over the 10 shifts with continued use of the interventions.

CONCLUSION

Using stress-reducing interventions during work decreased stress and increased resiliency, thereby offering nurse leaders additional options to promote a healthy workforce at the bedside.
Effect of a Nurse-Led, Patient-Centered, Gratitude Intervention on Patient Hospitalization Experience
Authors: Lindauer Cathleen , Speroni Karen Gabel , Godinez Kim , Lurz Taylor , Oakley Rossana , Zakes April
Published: March 2021

OBJECTIVE

Objectives were to evaluate patient perceptions of a nurse-led, patient-centered gratitude intervention and if nurses identified actionable items to improve patient's hospitalization experience.

BACKGROUND

Research demonstrates positive effects of gratitude and caring interventions on patient health and well-being. Evidence is sparse regarding nurse-led gratitude interventions improving hospitalized patient's experiences.

METHODS

In this pilot study, 91 adult medical patients completed gratitude forms twice daily for up to 6 shifts and a study discharge form documenting intervention perceptions. In response to the patients' gratitude-related feedback, RNs recorded patient experience–related actions they and interprofessional teams could implement.

RESULTS

On average, patients perceived the nurse-led gratitude intervention as helpful (4.2) (1 = very unhelpful, 5 = very helpful) and improved hospitalization experiences (4.3) (1 = seldom, 5 = never). Most of the time actions were required or to be taken, based on patient gratitude intervention responses.

CONCLUSIONS

Patient perceptions of nurse-led gratitude intervention demonstrated helpfulness and improved hospitalization experience.
Prone Team
Authors: Wells Celia , Zhang Ziya , Huelskamp Stephen , Hughes Ellen , Aguila Dorothy , Sevillano Maria , Garrett Lisa , Acquah Samuel , Chan Christy , Kohli-Seth Roopa
Published: March 2021

AIM

To identify strategies to improve time to prone in ICUs during the coronavirus disease 2019 (COVID-19) pandemic for patients meeting the criteria for prone position ventilation.

BACKGROUND

Healthcare systems worldwide experienced an influx of COVID-19 patients, especially in critical care. COVID-19 patients are at risk of acute respiratory distress syndrome (ARDS). Prone position ventilation is the standard of care for mechanically ventilated patients with moderate to severe ARDS. Prone maneuvers in and of itself are time-consuming and labor-intensive, posing additional risks to patients.

APPROACH

Our academic medical center developed a travel proning team to address the rapid increase in COVID-19 patients with ARDS necessitating prone positioning.

EVALUATION

Over a period of 30 days, 420 ICU patients were intubated, 131 had moderate to severe ARDS and underwent prone positioning. Patients were placed in prone position or returned to supine position more than 834 times over 38 days. At the highest point, 37 procedures were done in 24 hours.

CONCLUSION

This quality initiative demonstrated that utilization of a traveling proning team provides efficiency in time to prone. Developing a travel prone team allowed for efficiency in time to prone, supported the ICU clinical teams, and enhanced interdisciplinary collaboration, which is essential during times of crisis.
Gastric Venous Congestion After Total Pancreatectomy is Frequent and Dangerous
Authors: Loos Martin , Mehrabi Arianeb , Ramouz Ali , Contin Pietro , Strobel Oliver , Müller-Stich Beat P. , Mihaljevic Andre L. , Diener Markus K. , Schneider Martin , Berchtold Christoph , Al-Saeedi Mohammed , Goeppert Benjamin , Mayer Philipp , Feisst Manuel , Hinz Ulf , Weigand Markus A. , Hackert Thilo , Büchler Markus W.
Published: March 2021

Objective:

The aim of this study was to determine the role of GVC in mortality after TP.

Background:

Data from a nationwide administrative database revealed that TP is associated with a 23% mortality rate in Germany.Methods: A total of 585 consecutive patients who had undergone TP (n = 514) or elective completion pancreatectomy (n = 71) between January 2015 and December 2019 were analyzed. Univariable and multivariable analyses were performed to identify risk factors for GVC and 90-day mortality. Results: GVC was observed in 163 patients (27.9%) requiring partial or total gastrectomy. Splenectomy (odds ratio 2.14, 95% confidence interval 1.253.80, P = 0.007) and coronary vein resection (odds ratio 5.49,95% confidence interval 3.19–9.64, P < 0.001) were independently associated with GVC. The overall 90-day mortality after TP was 4.1% (24 of 585 patients), 7.4% in patients with GVC and 2.8% in those without GVC (P = 0.014). Of the 24 patients who died after TP, 12 (50%) had GVC.

Conclusion:

GVC is a frequent albeit not well-known finding after TP, especially when splenectomy and resection of the coronary vein are performed. Adequate decision making for partial gastrectomy during TP is crucial. Insufficient gastric venous drainage after TP is life-threatening.
Thinking Beyond Giant Cell Arteritis in COVID-19 Times
Authors: Au Benjamin Wai Yin , Ku Dominic J. , Sheth Shivanand J.
Published: March 2021

Background:

The coronavirus disease 2019 has displayed multi-system manifestations since its first presentation. This article highlights an unusual presentation of COVID-19 that was reviewed by our instituition's otolaryngology and ophthalmology team.

Methods:

We present 2 cases of COVID-19 which presented with unilateral otalgia and ipsilateral pulsatile headaches involving the temporal area. They were referred to the otolaryngology team for assessment of otalgia and subsequently referred to the ophthalmology team for possible giant cell arteritis (GCA). Both patients had no jaw claudication, scalp pain, or tenderness.

Results:

Serology testing showed raised C-reactive protein (CRP) but normal platelets and erythrocyte sedimentation rate. Case 1 was tested for COVID-19 as part of a preoperative workup which returned positive. With a marked similarity in presentation, Case 2 was tested for COVID-19 which also returned positive.

Conclusions:

These 2 cases highlight another set of symptoms that COVID-19 patients may present with. In the context of a COVID-19 pandemic, if a patient presents symptoms similar to GCA but with isolated CRP, it should prompt consideration for COVID testing.
Closed genome sequences of Staphylococcus lloydii sp. nov. and Staphylococcus durrellii sp. nov. isolated from captive fruit bats (Pteropus livingstonii)
Authors: Fountain Kay , Gibbon Marjorie J. , Loeffler Anette , Feil Edward J.
Published: March 2021

The increasing availability of whole genome sequencing of bacteria has accelerated the discovery of novel species which may not have been easy to discriminate using standard phenotypic or single gene methods. Phylogenomic analysis of genome sequences from a collection of coagulase-negative staphylococcal species isolated from captive fruit bats revealed two clusters which were close to

Staphylococcus kloosii

. To assess the relatedness of the strains we used digital DNA–DNA hybridization (dDDH) and two methods for average nucleotide identity (ANI) computation which predicted two novel species having dDDH less than 70 % and ANI less than 95%. We propose these species as Staphylococcus lloydii sp. nov. (type strain 23_2_7_LYT=NCTC 14453T=DSM 111639T) and Staphylococcus durrellii sp. nov (type strain 27_4_6_LYT=NCTC 14454T=DSM 111640T).
Muricauda amphidinii sp. nov., a novel marine bacterium isolated from the phycosphere of dinoflagellate Amphidinium carterae
Authors: Chen Yuerong , Hu Zhong , Wang Hui
Published: March 2021

A Gram-stain-negative, aerobic, rod-shaped and non-motile bacterium was isolated from a liquid culture of dinoflagellate Amphidinium carterae and further designated as LMIT004T. Optimal growth was observed at 25 °C, pH 7.0 and in the presence of 2 % (w/v) NaCl. Oxidase and catalase were positive. Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain LMIT004T showed high similarities to type strains

Muricauda nanhaiensis

SM17004T (96.77 %) and

Muricauda aquimarina

JCM11811T (95.60 %) but formed a separate branch in the genus

Muricauda

. The G+C content of strain LMIT004T was 39.0 mol%. The dominant fatty acids were iso-C15 : 0 and iso-C15 : 1 G. The polar lipids mainly contained phosphatidylethanolamine, five unidentified phospholipids and five unidentified polar lipids. The sole respiratory quinone was menaquinone-6 (MK-6). The draft genome of the type strain was 3.88 Mbp. The average nucleotide identity values between strain LMIT004T and the two reference strains

M. nanhaiensis

SM17004T and

M. aquimarina

JCM11811T were 77.47 and 73.49 %, respectively. Based on the polyphasic analysis, strain LMIT004T is suggested to represent a novel specie in the genus of

Muricauda

, for which the name Muricauda amphidinii sp. nov. is proposed. The type strain is LMIT004T (=CICC 24871T=KCTC 72948T).
The Influence of Covid-19 Vaccine on Daily Cases, Hospitalization, and Death Rate in Tennessee: A Case Study in the United States
Authors: Roghani Ali
Published: March 2021

The COVID-19 outbreak highlights the vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the whole population to be vaccinated immediately. Therefore, policies have adopted a strategy to vaccinate the elderly and vulnerable population while delaying others. This study uses the Tennessee official statistic from the onset of COVID vaccination (17th of December 2021) to understand how age-specific vaccination strategies reduce daily cases, hospitalization, and death rate. The result shows that vaccination strategy can significantly influence the numbers of patients with COVID-19 in all age groups and lower hospitalization and death rates just in older age groups. The Elderly had a 95% lower death rate from December to March; however, and no change in the death rate in other age groups. The Hospitalization rate was reduced by 80% in this study cohort for people aged 80 or older, while people who were between 50 to 70 had almost the same hospitalization rate. The study indicates that vaccination targeting older age groups is the optimal way to avoid higher transmissions and reduce hospitalization and death rate for older groups.
The single-cell epigenetic regulatory landscape in mammalian perinatal testis development
Authors: Liao Jinyue , Suen Hoi Ching , Rao Shitao , Luk Alfred Chun Shui , Zhang Ruoyu , Lee Annie Wing Tung , Chan Ting Hei Thomas , Cheung Man Yee , Chu Ho Ting , So Hon Cheong , Hobbs Robin M. , Lee Tin-Lap
Published: March 2021

Spermatogenesis depends on an orchestrated series of developing events in germ cells and full maturation of the somatic microenvironment. To date, the majority of efforts to study cellular heterogeneity in testis has been focused on single-cell gene expression rather than the chromatin landscape shaping gene expression. To advance our understanding of the regulatory programs underlying testicular cell types, we analyzed single-cell chromatin accessibility profiles in more than 25,000 cells from mouse developing testis. We showed that scATAC-Seq allowed us to deconvolve distinct cell populations and identify cis-regulatory elements (CREs) underlying cell type specification. We identified sets of transcription factors associated with cell type-specific accessibility, revealing novel regulators of cell fate specification and maintenance. Pseudotime reconstruction revealed detailed regulatory dynamics coordinating the sequential developmental progressions of germ cells and somatic cells. This high-resolution data also revealed putative stem cells within the Sertoli and Leydig cell populations. Further, we defined candidate target cell types and genes of several GWAS signals, including those associated with testosterone levels and coronary artery disease. Collectively, our data provide a blueprint of the ‘regulon’ of the mouse male germline and supporting somatic cells.
De novotranscriptome sequencing of the northern fowl mite,Ornithonyssus sylviarum, shed light into parasitiform poultry mites evolution and its chemoreceptor repertoires
Authors: Bhowmick Biswajit , Chen Huaqing , Lozano-Fernandez Jesus , Vizueta Joel , Ignell Rickard , Han Qian
Published: March 2021

The poultry red mite (PRM),Dermanyssus gallinae(De Geer), and the northern fowl mite (NFM),Ornithonyssus sylviarum(Canestrini and Fanzago), are the most serious pests of poultry, both of which have an expanding global prevalence. Research on NFM has been constrained by a lack of genomic and transcriptomic data. Here, we report and analyze the first transcriptome data for this species. A total of 28,999 unigenes were assembled, of which 19,750 (68.10%) were annotated using seven functional databases. The biological function of these unigenes was predicted using the GO, KOG, and KEGG databases. To gain insight into the chemosensory receptor-based system of parasitiform mites, we furthermore assessed the gene repertoire of gustatory receptors (GRs) and ionotropic receptors (IRs), both of which encode putative ligand-gated ion channel proteins. While these receptors are well characterized in insect model species, our understanding of chemosensory detection in mites and ticks is in its infancy. To address this paucity of data, we identified 9 IR/iGluRs and 2 GRs genes by analyzing transcriptome data in the NFM, while 9 GRs and 41 IR/iGluRs genes were annotated in the PRM genome. Taken together, the transcriptomic and genomic annotation of these two species provide a valuable reference for studies of parasitiform mites, and also helps to understand how chemosensory gene family expansion/contraction events may have been reshaped by an obligate parasitic lifestyle compared with their free-living closest relatives. Future studies should include additional species to validate this observation, and functional characterization of the identified proteins as a step forward in identifying tools for controlling these poultry pests.
Single-cell dynamics reveal a stress-induced decision between cardiomyocyte hypertrophy and apoptosis
Authors: Chun Bryan , Ngo Lavie , Saucerman Jeffrey J.
Published: March 2021

Cardiomyocyte hypertrophy and apoptosis underlie cardiomyopathies and heart failure. While previous studies have described hypertrophy or apoptosis at the level of cell populations, how individual cells commit to these distinct yet co-regulated fates is unclear. We developed a high-content microscopy approach to track single-cell hypertrophy and apoptosis dynamics, revealing new features and unique subpopulation responses. The catecholamine isoproterenol induced both analog hypertrophy and digital apoptosis. While high-dose isoproterenol induced mixed hypertrophy and apoptosis at the population level, we found that individual cells that hypertrophy are more likely to survive. Likewise, phenylephrine-induced hypertrophy was associated with survival at the single-cell level. Inhibiting caspase-3 reduced apoptosis and increased a cell’s likelihood of hypertrophy. Multinomial log-linear models demonstrate that a cell’s initial size and DNA content predict its susceptibility to hypertrophy or apoptosis. These data support a “grow or die” conceptual model for cardiomyocyte decisions. This work develops a single-cell profiling method to reveal that while hypertrophy and apoptosis often coincide at the population level, single cells that hypertrophy are protected from death.
Disruption of origin chromatin structure by helicase activation in the absence of DNA replication
Authors: Hoffman Rachel A. , MacAlpine David M.
Published: March 2021

Prior to initiation of DNA replication, the eukaryotic helicase, Mcm2-7, must be activated to unwind DNA at replication start sites in early S-phase. To study helicase activation within origin chromatin, we constructed a conditional mutant of the polymerase α subunit Cdc17 (or Pol1) to prevent priming and block replication. Recovery of these cells at permissive conditions resulted in the generation of unreplicated gaps at origins, likely due to helicase activation prior to replication initiation. We used micrococcal nuclease (MNase)-based chromatin occupancy profiling under restrictive conditions to study chromatin dynamics associated with helicase activation. Helicase activation in the absence of DNA replication resulted in the disruption and disorganization of chromatin which extends up to one kilobase from early, efficient replication origins. The CMG holo-helicase complex also moves the same distance out from the origin, producing single-stranded DNA that activates the intra-S-phase checkpoint. Loss of the checkpoint did not regulate the progression and stalling of the CMG complex, but rather resulted in the disruption of chromatin at both early and late origins. Finally, we found that the local sequence context regulates helicase progression in the absence of DNA replication, suggesting that the helicase is intrinsically less processive when uncoupled from replication.