bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Harm and Institutional Avoidability of Out-of-Hours Discharge From Intensive Care: An Analysis Using Mixed Methods*
Authors: Vollam Sarah , Gustafson Owen , Morgan Lauren , Pattison Natalie , Thomas Hilary , Watkinson Peter
Published: March 2022

OBJECTIVES:

Out-of-hours discharge from ICU to the ward is associated with increased in-hospital mortality and ICU readmission. Little is known about why this occurs. We map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night.

DESIGN:

This study was part of the REcovery FoLlowing intensive CarE Treatment mixed methods study. We defined out-of-hours discharge as 16:00 to 07:59 hours. We undertook 20 in-depth case record reviews where in-hospital death after ICU discharge had been judged “probably avoidable” in previous retrospective structured judgment reviews, and 20 where patients survived. We conducted semistructured interviews with 55 patients, family members, and staff with experience of ICU discharge processes. These, along with a stakeholder focus group, informed ICU discharge process mapping using the human factors–based functional analysis resonance method.

SETTING:

Three U.K. National Health Service hospitals, chosen to represent different hospital settings.

SUBJECTS:

Patients discharged from ICU, their families, and staff involved in their care.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Out-of-hours discharge was common. Patients and staff described out-of-hours discharge as unsafe due to a reduction in staffing and skill mix at night. Patients discharged out-of-hours were commonly discharged prematurely, had inadequate handover, were physiologically unstable, and did not have deterioration recognized or escalated appropriately. We identified five interdependent function keys to facilitating timely ICU discharge: multidisciplinary team decision for discharge, patient prepared for discharge, bed meeting, bed manager allocation of beds, and ward bed made available.

CONCLUSIONS:

We identified significant limitations in out-of-hours care provision following overnight discharge from ICU. Transfer to the ward before 16:00 should be facilitated where possible. Our work highlights changes to help make day time discharge more likely. Where discharge after 16:00 is unavoidable, support systems should be implemented to ensure the safety of patients discharged from ICU at night.
Role of epigenetic abnormalities and intervention in obstructive sleep apnea target organs
Authors: Ou Yanru , Zong Dandan , Ouyang Ruoyun
Published: March 2022

Obstructive sleep apnea (OSA) is a common condition that has considerable impacts on human health. Epigenetics has become a rapidly developing and exciting area in biology, and it is defined as heritable alterations in gene expression and has regulatory effects on disease progression. However, the published literature that is integrating both of them is not sufficient. The purpose of this article is to explore the relationship between OSA and epigenetics and to offer better diagnostic methods and treatment options. Epigenetic modifications mainly manifest as post-translational modifications in DNA and histone proteins and regulation of non-coding RNAs. Chronic intermittent hypoxia-mediated epigenetic alterations are involved in the progression of OSA and diverse multiorgan injuries, including cardiovascular disease, metabolic disorders, pulmonary hypertension, neural dysfunction, and even tumors. This article provides deeper insights into the disease mechanism of OSA and potential applications of targeted diagnosis, treatment, and prognosis in OSA complications.
The prevalence and outcomes of α- and β-thalassemia among pregnant women in Hubei Province, Central China
Authors: Cheng Yao , Chen Miaomiao , Ye Jiazhi , Yang Qin , Wang Ronggui , Liu Shulian , Su Rui , Song Jieping , Gao Tangxinzi , Xu Runhong , Zhao Feixia , Zhang Peili , Sun Guoqiang
Published: March 2022

There is no information concerning the prevalence of thalassemia among pregnant women in Hubei Province currently. This study is aimed to explore the prevalence of α- and β-thalassemia genotypes among pregnant women in Hubei Province, and to explore the clinically applicable screening approach, as well as to investigate the pregnancy outcomes of α- and β-thalassemia carriers.

Pregnant participants were recruited from 4 hospitals for the screening of α- and β-thalassemia mutations in Hubei Province. Polymerase Chain Reaction and flow cytometry methods were used to examine α- and β-thalassemia mutations. The hematological parameters and pregnancy outcomes of α- and β-thalassemia carriers were obtained from the hospital information system. The chi-square tests were used to evaluate the difference in hematological parameters between pregnant thalassemia carriers and the control group.

Among 11,875 participants, 414 (3.49%) were confirmed with α-thalassemia carriers, 228 (1.92%) were confirmed with β-thalassemia carriers, and 3 (0.03%) were confirmed with both α- and β-thalassemia carriers. The frequency of –α3.7 accounted for 2.05% and it was the most frequent genotype of α-thalassemia; the proportion of IVS-II-654 was 0.85% and it was the most frequent genotype of β-thalassemia in Hubei Province. Furthermore, the proportion of patients with low mean corpuscular volume (MCV) or mean cell hemoglobin (MCH) values was accounted for 36.64% and 93.97% among α-thalassemia and β-thalassemia carriers, respectively. And participants with normal MCV and MCH values were accounted for 95.07% among non-thalassemia participants. High prevalence of pregnancy-induced diabetes (16.97%), preterm birth (9.96%), pregnancy-induced hypertension (8.12%), and low birth weight (5.90%) were observed among pregnant thalassemia carriers.

MCV and MCH values were suggested to apply on the preliminary screening of pregnant β-thalassemia; however, it's unpractical on that of α-thalassemia. Furthermore, thalassemia carriers might have a high risk of negative pregnancy outcomes. These findings could be useful for the preliminary screening of thalassemia and perinatal care for the pregnant thalassemia carriers.
Intracranial Epstein-Barr virus-associated smooth muscle tumor with superimposed cryptococcal infection
Authors: Barrett Kaylyn , Tavakoli Sam , McGinity Michael , Gilbert Andrea
Published: March 2022

Rationale:

Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) are rare, virally-induced malignancies that occur almost exclusively in immunocompromised individuals. We report a very rare case of a dura-based EBV-SMT with superimposed local cryptococcal infection.

Patient concerns:

An adult male with a history of untreated acquired immunodeficiency syndrome presented to our hospital with worsening headaches, diarrhea, and diffuse myalgias.

Diagnoses:

Blood cultures were positive for methicillin-resistant Staphylococcus aureus and Cryptococcus neoformans serum antigen. Magnetic resonance imaging revealed 2 adjacent enhancing masses in the right temporal lobe, perilesional edema, and mass effect of the right lateral ventricle. Histological examination and immunohistochemical stains of the surgical specimen were consistent with EBV-SMT. Cryptococcus organisms were identified within the neoplasm.

Interventions:

The patient underwent complete tumor resection, received an extended course of amphotericin and flucytosine, and was restarted on antiretroviral therapy.

Outcomes:

The patient was discharged from the hospital with no focal neurological deficits.

Lessons:

Epstein-Barr virus associated smooth muscle tumors are rare malignancies that occur in immunocompromised patients. Prognosis is largely dependent on immune reconstitution and treatment of concomitant infections.
Normal pressure hydrocephalus
Authors: Micchia Katia , Formica Caterina , De Salvo Simona , Muscarà Nunzio , Bramanti Placido , Caminiti Fabrizia , Marino Silvia , Corallo Francesco
Published: March 2022

Idiopathic normal pressure hydrocephalus (NPH) is a syndrome that affects elderly people and is characterized by excessive accumulation of cerebrospinal fluid in the brain ventricles. Diagnosis is based on the evaluation of clinical symptoms, which consists of a classic triad (Hakim triad), gait disturbances, cognitive impairment, and urinary incontinence. However, this complete triad is not always seen; therefore, it is difficult to make the diagnosis. NPH can be divided into primary or idiopathic NPH and secondary NPH. Diagnostic criteria for NPH remain a topic of discussion; however, the development of diagnostic techniques has brought new opportunities for diagnosis. The aim of this review is to present an overview of neurophysiological and neuropsychological approaches to support the clinical evaluation of patients with NPH and contribute to the differential diagnosis of NPH and dementia, as the clinical symptoms of NPH may resemble other neurodegenerative disorders.
Treatment of refractory MALT lymphoma by lenalidomide plus bendamustine
Authors: Zhou Zhencang , Wu Pengqiang , Wang Fujue , Tao Huan , Chen Yingying , Gao Jie , Chen Dengke , Jia Yongqian
Published: March 2022

Rationale:

Marginal zone B cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) has an indolent natural course and disseminates slowly. However, there is currently no consensus regarding the optimal treatment strategy for relapsed/refractory MALT lymphomas. Lenalidomide-bendamustine may be an effective regimen for such cases.

Patient concerns:

A 48-year-old Chinese male patient with MALT lymphoma and API2/MALT received 2 courses of standard-dose rituximab, cyclophosphamide, vincristine, prednisone regimen chemotherapy combined with Helicobacter pylori eradication therapy. However, this disease was not effectively managed.

Diagnosis:

MALT lymphoma.

Interventions:

The patient received lenalidomide-bendamustine (lenalidomide 25 mg on days 1–21 and bendamustine 90 mg/m2 on days 1–2) for 6 courses.

Outcomes:

Lenalidomide-bendamustine was a safe and effective chemotherapy. No serious adverse events occurred during the treatment period. Ultrasound gastroscopy revealed that the tumor gradually shrank and eventually disappeared to complete remission.

Lessons:

The lenalidomide-bendamustine scheme might be a potentially effective option for patients with refractory or relapsed MALT lymphoma.
Efficacy of Yiqi Wenyang Huoxue method in treating adult bronchial asthma
Authors: Yu Qiangqiang , Bao Mengjie , Yu Tao , Zhang Yuanbing , Xiang Shuangdi , Li Tao , Sun Peng , Ye Chao , Shen Jianli , Yu Jianwei , Xue Hanrong
Published: March 2022

Background:

Bronchial asthma (BA) is a chronic inflammatory disease of the airway, which has the characteristics of recurrent attacks and difficult to cure. Glucocorticoid and bronchodilator are the primary treatment drugs for asthma. Although the treatment has made some progress, the control status is still not ideal. According to clinical reports, the Yi-qi Wen-yang Huo-xue method (YQWYHXM) of Traditional Chinese Medicine (TCM) is safe and effective in the treatment of BA, but there is not enough evidence to prove it. Based on it, we conducted this systematic evaluation.

Methods:

Eight databases and Clinical trial registries (Embase, Cochrane, PubMed, CNKI, CBM, Wanfang, VIP, China Clinical Trial Registry and Clinical Trails) were searched from the establishment of those until January 22, 2021 with the following terms for retrieval: BS, TCM, Chinese medicinal herb, Chinese herbal medicine and randomized controlled trial. Data analysis was performed by 2 researchers using RevMan 5.3 and SATA 16.0 separately from the Cochrane Collaboration.

Results:

This study will be able to provide definitive evidence to clarify all the suspicions we seek, confirming the effectiveness of YQWYHXM in the treatment of adults with BA.

Conclusion:

This study will prove that YQWYHXM is a safe and effective TCM adjuvant therapy for BA.

Registration:

Efficacy of Yiqi Wenyang Huoxue method in Treating Adult Bronchial Asthma.

Asthma:

A protocol for Systematic Review and Meta-Analysis of Randomized Controlled Trials. PROSPERO 2021 CRD42021256791. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256791.
Effectiveness of tocilizumab in the treatment of hospitalized adults COVID-19
Authors: Zhang Jing , Chen Chun , Yang Yi , Yang Jin
Published: March 2022

Background:

Since December 2019, the coronavirus disease (COVID-19) has spread worldwide, leading to a global health threat. This study aimed to investigate the effectiveness of tocilizumab in COVID-19 patients.

Methods:

We systematically searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and World Health Organization International Clinical Trials Registry Platform to March 10, 2021 for randomized controlled trials in which patients were randomly assigned to receive tocilizumab plus usual care or usual care alone in hospitalized adults with COVID-19. A random-effects meta-analysis model was used to pool studies. All data analyses were performed using Review Manager version 5.4.

Results:

Eleven studies with 6579 patients were included in our meta-analysis, of which 3406 and 3173 were assigned to tocilizumab and control groups, respectively. Tocilizumab significantly reduced the 28 to 30-day mortality (relative risk [RR] = 0.89, 95% confidence interval [CI] 0.80-0.99, P = .04), incidence of mechanical ventilation (MV) (RR = 0.79, 95% CI 0.71-0.89, P < .001), composite outcome of MV or death (RR = 0.81, 95% CI 0.72-0.90, P < .001), time-to-hospital discharge (hazard ratio = 1.30, 95% CI 1.16-1.45, P < .001), intensive care unit admission (RR = 0.64, 95% CI 0.47-0.88, P = .006), serious infection (RR = 0.61, 95% CI 0.40-0.94, P = .02), and number of serious adverse events (RR = 0.64, 95% CI 0.47-0.86, P = .004).

Conclusion:

Tocilizumab reduced short-term mortality, incidence of MV, composite outcome of death or MV, intensive care unit admission, serious infection, serious adverse events, and time-to-hospital discharge in hospitalized COVID-19 patients. Further studies are required to determine the optimal dose.
Effects of heavy metals in acute ischemic stroke patients
Authors: Yen Cheng-Chang , Chen Hsin-Hung , Hsu Yi-Ting , Tseng Ching-Jiunn , Lin Ching-Huang
Published: March 2022

Cerebrovascular disease is the second commonest cause of mortality globally and among the commonest causes of disability. However, research executed to probe the heavy metal exposure–stroke incidence relationship is scarce. Accordingly, we executed our study to probe the relationship of heavy metal concentrations (ie, concentrations of lead [Pb], mercury [Hg], cadmium [Cd], and arsenic) in the serum and urine of acute ischemic stroke (AIS) patients with several patient variables.

For enrollment, we chose patients who had a first AIS within 7 days after the onset of a stroke. Thus, 33 newly diagnosed patients with AIS were recruited. We determined the aforementioned metals’ concentrations by executing inductively coupled plasma mass spectrometry. We also gauged the association between such metal concentrations and patient variables by employing Spearman correlation coefficient. To examine the differences in metal concentrations between the different variables, we implemented an independent Mann–Whitney U test.

In our cohort analysis, we noted serum Pb and Cd concentrations to be positively correlated with serum creatinine and hemoglobin. Serum and urine Cd concentrations had a negative correlation with impaired HbA1c in AIS patients. Urine Hg had a positive correlation with C-reactive protein in the participants. Participants who smoked or consumed alcohol had significantly higher Pb and Cd levels in serum than did those who neither smoked nor drank. Patients with AIS who smoked or consumed alcohol had high levels of serum Pb and serum Cd than did those who did not. Patients with AIS who consumed alcohol had significantly higher Pb and Hg urine concentrations than did those who did not.

Our study indicated that serum Cd and Pb elevation increased the AIS risk in southern Taiwan patients.
Internal carotid artery occlusion related to poorly controlled rheumatoid arthritis presenting with continuous hand shaking
Authors: Chien Ching-Fang , Tsai Chun-Yi , Wu Meng-Ni , Lai Chiou-Lian , Liou Li-Min
Published: March 2022

Rationale:

Limb-shaking syndrome is a special manifestation of transient ischemic attack, resulting from internal carotid artery (ICA) occlusion. Extra-articular manifestations of rheumatoid arthritis (RA) are likely to occur in patients with severe or active RA. RA may accelerate atherosclerotic processes through inflammation. Here, we present a case of ICA occlusion related to poorly controlled RA that presented with continuous hand shaking.

Patient concerns:

A 73-year-old man with a history of poorly controlled RA developed total occlusion of the right ICA in recent 4 months. He presented with 2 days of continuous and rhythmic left-hand shaking before admission.

Diagnosis:

The patient was suspected to have transient ischemic attack resulting from ICA occlusion.

Interventions:

Antiplatelets and antiepileptic drugs were used for continuous nonepileptic focal myoclonus. A disease-modifying antirheumatic drug-based regimen for RA was developed to prevent further atherosclerosis.

Outcomes:

Following the initial intervention, continuous hand shaking subsided on hospital day 7. Prednisolone was titrated as an active RA control. At the 6-month follow-up visit, neither painful wrist swelling nor recurrent shaking of the hand was noted.

Lessons:

Continuous hand shaking (nonepileptic focal myoclonus) can be the initial presentation of ICA occlusion in patients with poorly controlled RA. Every patient with RA should be treated aggressively with anti-rheumatic agents since RA is an independent risk factor for stroke. Additionally, every patient with RA should be surveyed for ICA stenosis, especially in those with poor control.
Differences in the diagnosis and treatment of hematologic malignancies attributable to health insurance coverage
Authors: Song Eun Young , Shin Sue , Park Hyunwoong , Kim Namhee , Yoon Jong Hyun , Roh Eun Youn
Published: March 2022

Medical care should be equally provided to the public regardless of their financial capability. In the real world, expenditures directly out from the patient sector decide the medical journey, even in a country with national health insurance. The aim of this study was to investigate whether there are differences in the diagnostic and treatment processes in hematologic malignancies based on patient characteristics, such as health insurance status.

Through the review of 5614 “CBCs with differential count” results with abnormal cells from 358 patients from January 2010 to June 2017, 238 patients without past medical histories of hematologic malignancies were enrolled. Excluding reactive cases, 206 patients with hematologic malignancy were classified into 8 disease categories: acute leukemia, myelodysplastic syndrome, myeloproliferative neoplasm (MPN), myelodysplastic syndrome/MPN, lymphoid neoplasm, plasma cell neoplasm, r/o hematologic malignancy, and cancer.

The patients’ age, sex, disease categories and follow-up durations showed associations with the clinical course. The “refusal of treatment” group was the oldest and had a relatively higher percentage of females, whereas those who decided to transfer to a tertiary hospital were younger. The age, clinical course, and follow-up durations were different across health insurance statuses. The medical aid group was the oldest, and the group whose status changed from a medical insurance subscriber to a medical aid beneficiary during treatment was the youngest. The majority of patients who refused treatment or wished to be transferred to a tertiary hospital were medical insurance subscribers. The percentage of patients who were treated in this secondary municipal hospital was higher in the medical-aid beneficiaries group than in the medical insurance group. Follow-up durations were longest in the status change group and shortest in the medical insurance group.

Almost all medical aid beneficiaries with hematologic malignancies opted to continue treatment at this secondary/municipal hospitals, indicating that this category of medical institutions provides adequate levels and qualified healthcare services to those patients. The secondary municipal hospital provides qualified healthcare services for medical aid beneficiaries with hematologic malignancies.
Associations Between Demographic, Clinical, and Symptom Characteristics and Stress in Oncology Patients Receiving Chemotherapy
Authors: Stacker Tara , Kober Kord M. , Dunn Laura , Viele Carol , Paul Steven M. , Hammer Marilyn , Conley Yvette P. , Levine Jon D. , Miaskowski Christine
Published: March 2022

Background

Patients undergoing cancer treatment experience global stress and cancer-specific stress. Both types of stress are associated with a higher symptom burden.

Objective

In this cross-sectional study, we used a comprehensive set of demographic, clinical, and symptom characteristics to evaluate their relative contribution to the severity of global and cancer-specific stress.

Methods

Patients (N = 941) completed study questionnaires before their second or third cycle of chemotherapy.

Results

Consistent with our a priori hypothesis, we found both common and distinct characteristics associated with higher levels of global stress and cancer-specific stress. A significant proportion of our patients had scores on the Impact of Event Scale-Revised suggestive of subsyndromal (29.4%) or probable (13.9%) posttraumatic stress disorder. Four of the 5 stepwise linear regression analyses for the various stress scales explained between 41.6% and 54.5% of the total variance. Compared with various demographic and clinical characteristics, many of the common symptoms associated with cancer and its treatments uniquely explained a higher percentage of the variance in the various stress scales. Symptoms of depression made the largest unique contribution to the percentage of total explained variance across all 5 scales.

Conclusion

Clinicians need to assess for global stress, cancer-specific stress, and depression in patients receiving chemotherapy.

Implications for Practice

Patients may benefit from integrative interventions (eg, mindfulness-based stress reduction, cognitive behavioral therapy, acupuncture) that simultaneously address stress and symptoms commonly associated with cancer and its treatments.
Perceived Participation in Decision-Making on Primary Surgery and Associated Factors Among Early Breast Cancer Patients
Authors: Tang Han , Dong Shiqi , Wang Shang , Du Ruofei , Yang Xiao , Cui Panpan , Liu Wei , Chen Changying
Published: March 2022

Background

Breast cancer patients wish to participate in the treatment decision-making, but the perceived participation was inconsistent with the willingness, leading to poor patient outcomes.

Objective

The aims of this study were to explore the perceived participation in the primary surgery decision-making among Chinese patients with early-stage breast cancer (BCa) and to analyze the relationships of demographic and clinical factors, participation competence, self-efficacy, social support, and doctors’ promotion of participation with the guidance of the capability, opportunity, motivation-behavior system (the COM-B system).

Methods

Paper surveys were used to collect data from 218 participants. The participation competence, self-efficacy, social support, and the doctor facilitation of involvement were evaluated to measure factors related to perceived participation among early-stage BCa.

Results

Perceived participation was low, and participants with a high level of participation competence, self-efficacy, and social support and who were employed and had a higher education level and higher family income perceived higher participation in primary surgery decision-making.

Conclusions

Perceived participation was low and may be facilitated by patients’ internal and external factors during the decision-making process. Health professionals should be aware that patient participation in decision-making is a type of self-care health behavior, and targeted decision support interventions should be provided to facilitate participation.

Implications for Practice

Patient-perceived participation may be evaluated from the perspective of self-care management behaviors among BCa patients. Nurse practitioners should emphasize their important roles in providing information, patient education, and psychological support to better contribute to the course of the treatment decision-making process for BCa patients who faced primary surgery.
Effects of a Caregiver Educational Program on Interactions between Family Caregivers and Patients with Advanced COPD
Authors: Vagharseyyedin Seyyed Abolfazl , Arbabi Mahdi , Rahimi Hossein , Moghaddam Sayyed Gholamreza Mortazavi
Published: March 2022

The quality of family caregiver–patient interaction plays a crucial role in the context of chronic conditions. This study investigated the effects of a caregiver educational program on interactions between family caregivers and patients with advanced chronic obstructive pulmonary disease (COPD). In this trial, 92 pairs of family caregivers and patients in a subspecialty lung care clinic located in Birjand, Iran were allocated into intervention and control groups (n = 46 per group). The intervention consisted of eight sessions, including three educational sessions on COPD, two educational sessions on coping strategies, as well as three peer support sessions. The Dyadic Relationship Scale was completed at baseline, posttest, and follow-up (2 months after intervention). For caregivers in the intervention group, positive dyadic interaction improved significantly from baseline to follow-up and from posttest to follow-up in comparison with the control group (p < 0.05). Also, for these caregivers, negative dyadic strain enhanced significantly from baseline to posttest and from baseline to follow-up as compared with those in the control group (p < 0.05). Finally, in patients of the intervention group, negative dyadic strain from baseline to follow-up and from posttest to follow-up significantly improved when compared with that of control patients (p < 0.05).
Is ANTT Achievable in the Home Healthcare Setting?
Authors: Rowley Stephen , Clare Simon
Published: March 2022

At the heart of infection prevention in the home care setting is aseptic technique, a generic term for the clinical competency of ensuring asepsis during invasive clinical procedures and the maintenance of invasive medical devices. Variable terminology has resulted in confused education and clinical practice. Ambiguity has played out in all care environments, but especially in the home, where the challenge of providing effective aseptic technique is complicated by unique environmental and logistical factors. This has led some to conclude that aseptic technique is not possible in the home, or that it is not required at all in certain situations. This article challenges these assumptions and outlines the Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, that is used widely internationally. Through a thematic analysis of focus group discussions with home care nurses (n = 107) in the United Kingdom and the United States, opinions about aseptic practice in the home care setting were examined. Three main polarizing themes were identified and used to discuss theory and practice applications of aseptic technique for home healthcare nurses. Specific challenges in performing aseptic technique in home-based settings are exacerbated by ambiguity between what constitutes “clean,” “aseptic,” or so-called “sterile” technique, and are perpetuated by a lack of competency-based training that doesn't reflect the critical importance of aseptic technique to patient safety. Rather than continuing an endless debate about the definition of aseptic technique, ANTT has redefined aseptic technique education and clinical practice, with a comprehensive clinical practice framework and associated clinical governance better supporting patient safety.
Implementing Home-based Prevention Physical Therapy
Authors: Wilson Christopher M. , Arena Sara K. , Deel Courteney , Flasher Emet , Romolino Nicole , Morris Emili , Boright Lori E.
Published: March 2022

The purpose of this study was to conduct a scoping review of the available service delivery models related to home-based fall prevention programs led by rehabilitation professionals and to describe the path to launching one such program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). Topics of review included: Medicare and private billing structures available for current prevention programs and traditional rehabilitation, the Affordable Care Act and its application to reimbursement of preventive services and direct access care models, and a comparative review of CMS' Patient Driven Group Model (PDGM) home health benefit and Medicare Part B billing and reimbursement. Additionally, a path to launch one prevention-focused program, HOP-UP-PT, is described. There is emerging evidence that upstreaming fall prevention programs can help reduce falls and have money-saving downstream effects. A reimbursement model for this type of programming must be established in order ensure long-term sustainability. Although there is evidence that home-based prevention programs such as HOP-UP-PT can reduce falls and fall-risk metrics among an older adult population, there is not a clear and sustainable payment pathway, which limits proliferation of similar programs. Therefore, this preventative care model which has emerging evidence of cost savings will require reimbursement restructuring beyond what is available with existing payment models.
High-Frequency Utilization of the PICU*
Authors: Heneghan Julia A. , Akande Manzilat , Goodman Denise M. , Ramgopal Sriram
Published: March 2022

OBJECTIVES:

To describe the demographic, clinical, outcome, and cost differences between children with high-frequency PICU admission and those without.

DESIGN:

Retrospective, cross-sectional cohort study.

SETTING:

United States.

PATIENTS:

Children less than or equal to 18 years old admitted to PICUs participating in the Pediatric Health Information System database in 2018.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We assessed survivors of PICU admissions for repeat PICU admissions within a year of their index visit. Children with greater than or equal to 3 PICU admissions within a year were classified as high-frequency PICU utilization (HFPICU). We compared demographic, clinical, outcome, and cost characteristics between children with HFPICU and those with only an index or two admissions per year (nHFPICU). Of 95,465 children who survived an index admission, 5,880 (6.2%) met HFPICU criteria. HFPICU patients were more frequently younger, technology dependent, and publicly insured. HFPICU patients had longer lengths of stay and were more frequently discharged to a rehabilitation facility or with home nursing services. HFPICU patients accounted for 24.8% of annual hospital utilization costs among patients requiring PICU admission. Time to readmission for children with HFPICU was 58% sooner (95% CI, 56–59%) than in those with nHFPICU with two admissions using an accelerated failure time model. Among demographic and clinical factors that were associated with development of HFPICU status calculated from a multivariable analysis, the greatest effect size was for time to first readmission within 82 days.

CONCLUSIONS:

Children identified as having HFPICU account for 6.2% of children surviving an index ICU admission. They are a high-risk patient population with increased medical resource utilization during index and subsequent ICU admissions. Patients readmitted within 82 days of discharge should be considered at higher risk of HFPICU status. Further research, including validation and exploration of interventions that may be of use in this patient population, are necessary.
A Comparison of Complications in Therapeutic versus Contralateral Prophylactic Mastectomy Reconstruction: A Paired Analysis
Authors: Sergesketter Amanda R. , Marks Caitlin , Broadwater Gloria , Shammas Ronnie L. , Greenup Rachel A. , Clancy Sharon , Plichta Jennifer K. , Hollenbeck Scott T. , Phillips Brett T.
Published: March 2022

Background:

Although breast reconstruction after bilateral mastectomies including a contralateral prophylactic mastectomy is known to have a higher overall complication profile, whether reconstructive complication rates differ between the therapeutic mastectomy and contralateral prophylactic mastectomy sides remains unclear.

Methods:

Women undergoing bilateral mastectomies with autologous or implant-based breast reconstruction for a unilateral breast cancer at a single institution were identified (2009 to 2019). Postoperative complications were stratified by laterality (therapeutic mastectomy versus contralateral prophylactic mastectomy). Paired data were analyzed to compare the risks of complications between prophylactic and therapeutic reconstruction sides in the same patient.

Results:

A total of 130 patients (260 reconstructions) underwent bilateral autologous or implant-based reconstruction. Although most women underwent a simple mastectomy, a higher proportion of therapeutic mastectomies were modified radical mastectomies including axillary lymph node dissections compared to contralateral prophylactic mastectomies (15.4 percent versus 0 percent). Forty-four percent of women completed postmastectomy radiation therapy of the therapeutic side before definitive reconstruction. Overall, both therapeutic and prophylactic reconstructions had a similar incidence of reconstructive failure (p = 0.57), return to the operating room (p = 0.44), mastectomy skin flap necrosis (p = 0.32), seroma (p = 0.82), fat necrosis (p = 0.16), wound infection (p = 0.56), and cellulitis (p = 0.56). Nearly one-fifth of patients experienced complications limited to the prophylactic side [contralateral prophylactic mastectomy reconstruction complications, n = 26 (20.0 percent); therapeutic mastectomy reconstruction complications, n = 15 (11.5 percent)].

Conclusion:

Despite a history of local radiation therapy and more extensive oncologic surgery on the therapeutic side, there are no significant differences in the incidence of postsurgical complications on the therapeutic mastectomy and contralateral prophylactic mastectomy sides after bilateral reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Defining Mastectomy Skin Flap Necrosis: A Systematic Review of the Literature and a Call for Standardization
Authors: Oleck Nicholas C. , Gu Cindy , Pyfer Bryan J. , Phillips Brett T.
Published: March 2022

Background:

Mastectomy skin flap necrosis following breast reconstruction may lead to wound dehiscence, infection, implant exposure, and reconstructive failure. The absence of a standardized definition for it has led to variation in estimated incidence, from as low as 2 percent to greater than 40 percent. The authors systematically reviewed the literature on mastectomy skin flap necrosis to characterize existing definitions and provide a framework for future classification.

Methods:

A systematic review of the PubMed and Cochrane databases identified studies reporting a discrete definition of mastectomy skin flap necrosis and corresponding outcomes in breast reconstruction. Provided definitions were extracted, categorized, and comparatively analyzed.

Results:

Fifty-nine studies met inclusion criteria, with a combined total of 14,368 patients and 18,920 breasts. Thirty-four studies (57.6 percent) reported mastectomy skin flap necrosis solely as a function of total breasts, and 11 (18.6 percent) reported mastectomy skin flap necrosis solely as a function of total patients. Only 14 studies (23.7 percent) provided two separate rates. The overall rate of mastectomy skin flap necrosis was 10.4 percent (range, 2.3 to 41.2 percent) and 15.3 percent (range, 4.7 to 39.0 percent), when reported per breast or per patient, respectively. Studies were categorized by mastectomy skin flap necrosis definition, including intervention (n = 33), depth (n = 20), area (n = 4), and timing (n = 2). Mastectomy skin flap necrosis rates were highest in studies defining necrosis by depth (15.1 percent), followed by intervention (9.6 percent), timing (6.4 percent), and area (6.3 percent). Necrosis rates among studies defining mastectomy skin flap necrosis by intervention, depth, and area were found to be statistically different (p < 0.001)

Conclusions:

Reported mastectomy skin flap necrosis definitions and outcomes vary significantly in the existing literature. For accurate characterization and quantification, a clear, simplified, consensus definition must be adopted.
New testing guidelines for community-acquired pneumonia
Authors: Losier Ashley , Dela Cruz Charles S.
Published: March 2022

Purpose of review

The purpose of this article is to review diagnostic testing recommendations outlined in the current American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) community-acquired pneumonia (CAP) guideline and the 2021 ATS guideline for noninfluenza respiratory viruses.

Recent findings

Diagnostic testing in CAP with gram stain, lower respiratory and blood cultures, Streptococcal and Legionella urinary antigens are not routinely recommended unless identified as severe CAP or with risk factors for Methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa infection. Influenza virus testing remains a strong recommendation during periods of community viral spread.

An additional 2021 ATS clinical practice guideline reviewed the use of molecular testing for noninfluenza viral pathogens in adults with suspected CAP and recommended testing in those hospitalized with severe CAP and/or various immunocompromising conditions.

Diagnostic testing remains an important component of confirming and treating CAP. The CAP guideline includes recommendations surrounding diagnostic testing with lower respiratory gram stain and culture, blood cultures, Legionella and Pneumococcal urinary antigen, influenza viral testing and serum procalcitonin.

There is a strong recommendation to obtain influenza virus testing during periods of community spread. However, the use of other diagnostics such as gram stain, lower respiratory and blood culture, and urinary antigen testing are dependent on severity of illness and whether a patient has been identified as having strong risk factors for MRSA or P. aeruginosa infection. The 2021 ATS clinical practice document did not routinely recommend testing noninfluenza respiratory viruses unless identified as having severe CAP and/or various immunocompromising conditions.
Cranioplasty Outcomes From 500 Consecutive Neuroplastic Surgery Patients
Authors: Belzberg Micah , Mitchell Kerry-Ann , Ben-Shalom Netanel , Asemota Anthony O. , Wolff Amir Y. , Santiago Gabriel F. , Shay Tamir , Huang Judy , Manson Paul N. , Brem Henry , Gordon Chad R.
Published: March 2022

Background:

Cranioplasty is critical to cerebral protection and restoring intracranial physiology, yet this procedure is fraught with a high risk of complications. The field of neuroplastic surgery was created to improve skull and scalp reconstruction outcomes in adult neurosurgical patients, with the hypothesis that a multidisciplinary team approach could help decrease complications.

Objective:

To determine outcomes from a cohort of cranioplasty surgeries performed by a neuroplastic surgery team using a consistent surgical technique and approach.

Methods:

The authors reviewed 500 consecutive adult neuroplastic surgery cranioplasties that were performed between January 2012 and September 2020. Data were abstracted from a prospectively maintained database. Univariate analysis was performed to determine association between demographic, medical, and surgical factors and odds of revision surgery.

Results:

Patients were followed for an average of 24 months. Overall, there was a reoperation rate of 15.2% (n = 76), with the most frequent complications being infection (7.8%, n = 39), epidural hematoma (2.2%, n = 11), and wound dehiscence (1.8%, n = 9). New onset seizures occurred in 6 (1.2%) patients.

Several variables were associated with increased odds of revision surgery, including lower body mass ratio, 2 or more cranial surgeries, presence of hydrocephalus shunts, scalp tissue defects, large-sized skull defect, and autologous bone flaps. importantly, implants with embedded neurotechnology were not associated with increased odds of reoperation.

Conclusions:

These results allow for comparison of multiple factors that impact risk of complications after cranioplasty and lay the foundation for development of a cranioplasty risk stratification scheme. Further research in neuroplastic surgery is warranted to examine how designated centers concentrating on adult neuro-cranial reconstruction and multidisciplinary collaboration may lead to improved cranioplasty outcomes and decreased risks of complications in neurosurgical patients.
National Network of Depression Centers' Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy
Authors: Zandi Peter P. , Morreale Michael , Reti Irving M. , Maixner Daniel F. , McDonald William M. , Patel Paresh D. , Achtyes Eric , Bhati Mahendra T. , Carr Brent R. , Conroy Susan K. , Cristancho Mario , Dubin Marc J. , Francis Andrew , Glazer Kara , Ingram Wendy , Khurshid Khurshid , McClintock Shawn M. , Pinjari Omar F. , Reeves Kevin , Rodriguez Nelson F. , Sampson Shirlene , Seiner Stephen J. , Selek Salih , Sheline Yvette , Smetana Roy W. , Soda Takahiro , Trapp Nicholas T. , Wright Jesse H. , Husain Mustafa , Weiner Richard D.
Published: March 2022

Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.
Aliidiomarina halalkaliphila sp. nov., a haloalkaliphilic bacterium isolated from a soda lake in Inner Mongolia Autonomous Region, China
Authors: Yang Ming , Xue Qiong , Zuo Zhenqiang , Zhou Jian , Zhang Shengjie , Li Ming , Zhou Heng , Zhang Manqi , Kumar Sumit , Li Wei , Chen Guiying , Zhao Dahe , Xiang Hua
Published: March 2022

A haloalkaliphilic strain (IM 1326T) was isolated from brine sampled at a soda lake in the Inner Mongolia Autonomous Region, China. Cells of the strain were rod-shaped and motile. Strain IM 1326T was able to grow at 4–42 °C (optimum, 37 °C) with 0–13.0 % (w/v) NaCl concentrations (optimum at 4.0–6.0 %) and at pH 7.5–11.0 (optimum at 9.0–10.0). The 16S rRNA gene phylogenetic analysis revealed that the isolate belongs to the genus

Aliidiomarina

and is closely related to the type strains of

Aliidiomarina sanyensis

(95.8 % sequence similarity),

Aliidiomarina shirensis

(95.7 %),

Aliidiomarina iranensis

(95.4 %) and

Aliidiomarina haloalkalitolerans

(95.3 %). The whole genome of strain IM 1326T was sequenced, and the genomic DNA G+C content was 49.7 mol%. Average nucleotide identity, average amino acid identity and digital DNA–DNA hybridization values between the isolate and the related

Aliidiomarina

species were 68.1–84.9 %, 76–78 % and 18.4–20.4 %, respectively. The respiratory quinone was ubiquinone-8. The polar lipid profile included diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine and one unidentified aminophospholipid. The predominant cellular fatty acids were summed feature 9 (10-methyl-C16 : 0/iso-C17 : 1 ω9c, 22.2 %), iso-C15 : 0 (16.1 %) and iso-C17 : 0 (13.1 %). Based on the results of phylogenetic analysis, genome relatedness, and the physiological and chemotaxonomic properties of the isolate, strain IM 1326T is considered to represent a novel species of the genus

Aliidiomarina

, for which the name Aliidiomarina halalkaliphila sp. nov. is proposed (type strain IM 1326T=CGMCC 1.17056T=JCM 34227T).
Analyzing county-wide trends in Tennessee Covid-19 rates, Median Household Income, and Presence of Hospital
Authors: Brahmbhatt Viraj
Published: March 2022

The Covid-19 pandemic has caused millions of deaths and infections worldwide. Recent studies suggest that Covid-19 may be disproportionately affecting certain groups. The Tennessee Department of Health regularly publishes data on Covid infections and vaccinations. This data alongside data published from the 2010 census was used to analyze trends in Covid-19 rates for the State of Tennessee. The census data for the average household income of each county was cross-referenced with the covid data. A positive correlation between population of the county and the number of new cases reported on January 3rd, 2022, appeared when observing the data. A regression analysis (ANOVA) revealed that the data on population and covid rate was significant (P-value: 2.69E-10). The results from comparing the covid rates in a county with a hospital and a county without a hospital seemed to be the most significant. The data reported by the Sycamore institute on the Tennessee counties without a hospital was used to identify trends unique to these counties. The counties lacking a hospital were compared with counties with a similar population. 7 hospital-less counties were used for comparison, 6 counties (Fayette, Grainger, Haywood, Chester, Sequatchie, Clay) reported a greater number of cases than counties of a similar population. Of the 20 counties lacking a hospital, 16 fell within the bottom 50% of median household incomes, with 9 in the bottom 25% and 4 in the bottom 10%. Healthcare sites in rural areas may lack fundamental infrastructure. These areas may require unique interventions to address the healthcare concerns present.