bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical spectrum of and outcomes for Indian children with deficiency of adenosine deaminase 2 (DADA2): a multicentric study
Authors: Kumar Sathish , Chugh Akagri , Kumar Samantha Cheryl , Punnen Anu , Bhat Chandrika , Patra Pratap , Viswanathan Vijay , Gupta Aditya , Aggarwal Mukul , Nayak Amiya Ranjan , Lingappa Lokesh , Sharma Jyoti , Gupta Neerja , Naranje Priyanka , Jana Manisha , Bagri Narendra Kumar , Hari Pankaj , Ramanan Athimalaipet V
Published: September 2024

Objectives

Deficiency of adenosine deaminase-2 (DADA2) is a monogenic disorder closely resembling PAN and can present to physicians across various specialties. Through this case series, we aimed to study and describe the clinical spectrum of and outcomes for Indian children with DADA2.

Methods

The de-identified data from all participating centres were entered in an Excel spreadsheet, and the coordinating centre (All India Institute of Medical Sciences, New Delhi) screened the data for accuracy and completeness.

Results

We enrolled 16 children (11 females) in the study; the mean (s.d.) age at the time of onset of symptoms for males and females was 46.2 (47) and 73.6 (50.4) months, respectively. The most common clinical features in this cohort were fever and rash in 80% of patients. More than half of the children, n (%) [8, (53%)] had a CNS stroke. The other clinical features were hypertension [5(33%)], anaemia [3 (20%)] and arthralgia/arthritis in 4 (26%). These children were managed with various immunomodulators: steroids [13, (86%)], anti-TNF agents [12, (80%)], CYC [2 (13%)] and MMF [3 (20%)]. The median [interquartile range (IQR)] duration of follow-up for this cohort was 17 (10, 29) months. Fourteen children achieved remission, and none had recurrent strokes after the initiation of anti-TNF drugs.

Conclusion

DADA-2 closely resembles PAN; early age of onset and CNS stroke are striking differentiating features from classic PAN. Most children respond well to anti-TNF agents without serious adverse events being observed during short-term follow-up.
Perceived income inequality, perceived unfairness and subjective social status in Europe
Authors: Hajdu Gábor
Published: September 2024

This article examines the relationship between perceived income inequality, the perceived unfairness of income distribution (discrepancy between an individual’s perceived and preferred levels of income inequality) and subjective social status. Using four waves of the ‘Social Inequality’ module of the International Social Survey Programme (28 European countries, 70 000 individuals) and an empirical strategy that controls for a rich set of objective measures of social status and the objective level of income inequality, the results show that both perceived inequality and perceived unfairness are negatively associated with subjective social status. Moreover, perceived unfairness moderates the relationship between perceived inequality and subjective social status. Specifically, the negative effects are larger for individuals who perceive high levels of unfairness than for those with lower levels of perceived unfairness. The analysis also provides evidence that the association between perceived inequality and subjective social status is stronger for individuals with lower income, lower education, and those living in Eastern European countries.
Historical drivers of HCV Subtypes 1b and 3a in Thailand and 6f in Phetchabun, an HCV endemic area of the country
Authors: Wasitthankasem Rujipat , Aiewsakun Pakorn , Lapchai Sutthinee , Raksayot Maneerat , Keeratipusana Chantisa , Jarupund Pakawat , Nakhonsri Vorthunju , Pimsing Napaporn , Tongsima Sissades , Poovorawan Yong
Published: September 2024

The World Health Organization has set a target to eliminate viral hepatitis as a public threat by 2030. In pursuit of this goal, Thailand initiated a hepatitis C virus (HCV) microelimination project targeting Phetchabun province, a well-recognized high-burden HCV endemic area. However, the historical transmission dynamics of HCV in Phetchabun, and in Thailand in general, remain unclear. This study investigates the epidemic histories of HCV in Phetchabun, focusing on Subtypes 1b, 3a, and 6f, and their relationship with HCV in other regions of Thailand, using molecular phylogenetic analyses. Our results reveal nationwide the presence of Subtypes 1b and 3a, while Subtype 6f is mainly confined to Phetchabun. The initial spread of Subtype 1b was inferred to coincide with World War II and the period of suboptimal medical and hygienic standards in Thai blood transfusion services, suggesting a correlation between the two. The early expansion of Subtype 3a was, on the other hand, found to correlate with the epidemic of intravenous drug use in Thailand during the time of Vietnam War. The early expansion of Subtype 6f, in contrast, appears to coincide with the period of severe regional political conflict and social and economic instability. All these findings suggest the complex interplay between social determinants of health and HCV transmission. Post the mid-1990s/early 2000s, all subtypes showed significantly reduced population growth rates, aligning with improvements in blood transfusion safety standards, the nationwide “War on Drugs” policy, and enhanced accessibility to public healthcare and HCV treatments. These combined efforts likely have contributed to curbing the spread of HCV in Thailand. Nevertheless, our analyses reveal that the prevalence of HCV in Thailand remains high overall, emphasizing the need for further research and a nationwide approach to more effectively reduce the HCV burden in Thailand.
PAs and NPs in liver transplantation
Authors: Nargiso Sarah , Lo Mary , Ramos Leyda , Bolaños Amarilis , Lee Evelyn , Sher Linda
Published: September 2024

Objectives:

This study assessed the use and perceptions of physician associates/assistants (PAs) and NPs at liver transplant centers and sought to determine their financial effect.

Methods:

Leaders of liver transplant programs performing 25 or more transplants in 2020 were contacted to complete an 11-question survey about the role and effect of PAs and NPs in liver transplant. A single-center retrospective analysis compared length of stay (LOS) and readmission rates for primary liver transplants and simultaneous liver-kidney transplants before and after a dedicated PA team was established. Chi-square and t-test analyses were performed.

Results:

The survey achieved a 77% response rate, and 98% of institutions reported using PAs and NPs. The single-center study found the mean LOS post-transplant was significantly shorter in the post-PA cohort (P = .0005). No significant difference was found in 30-day readmission rates.

Conclusions:

PAs and NPs are used broadly across the post-liver transplant care continuum. Using LOS as a surrogate financial marker suggests that a dedicated PA and NP team may contribute to cost savings.
Giving Your Preceptors What They Need
Authors: McMullan Susan P. , Woodfin Kaitlen O. , Richey Ryan , Yerdon Amy
Published: September 2024

Advanced practice registered nursing (APRN) educational programs require students to complete many hours of clinical education to prepare them for their role. This article outlines the process of developing a novel nurse anesthesia preceptor training program that could be implemented by any graduate APRN program. Preceptors’ requests for specific information about how to best educate students served as a catalyst to develop a customized preceptor training program tailored to the needs of the program, the preceptors, and students to optimize clinical education and improve quality of care.
Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia
Authors: Campbell Amber , Jacoby Mackenzie , Hernandez Nadia
Published: September 2024

Purpose of review

The purpose of this article is to provide an update of regional anesthesia and its applications in the critical care patient population.

Recent findings

Regional anesthesia including blocks of the abdomen and thorax, head and neck, as well as upper and lower extremities can be used to alleviate pain and assist in managing life-threatening conditions such as cerebral vasospasm and ventricular storm in the ICU population. There have been many advances in these techniques including ultrasound-guidance with innovative approaches that allow for more superficial procedures that are safer for critically ill patients. Regional anesthesia can decrease hospital length of stay (LOS), prevent ICU admission, shorten ICU LOS, and increase ventilator free days and may have mortality benefits.

Pain management in the ICU is an important and sometimes challenging aspect of patient care. Regional anesthetic techniques have more indications and are safe, versatile tools that should be incorporated into care of critically ill patients.
EP-0108A is a moderation selectively BRD4 BD2 inhibitor with potential AML tumor suppression
Authors: Li Li , Zhu Hui , Liu Shuang
Published: September 2024

Acute myeloid leukemia is the most common type of acute leukemia in adults. The epigenetic molecule BRD4 is a member of the bromodomain and extra-terminal family and plays an important role in the occurrence and development of tumors. BRD4 is essential for oncogene expression, including c-Myc. So, BRD4 inhibition is considered as an effective strategy for the treatment of hematological and solid malignancies. In recent years, several small molecule inhibitors targeting BRD4 have been developed. However, these inhibitors had excessive hematological toxicity due to the lack of specific binding to BD1 and BD2 domains of BRD4, while other inhibitors with high selectivity lose their antitumor efficacy. To balance the relationship between efficacy and safety, we developed EP-0108A, a BRD4 inhibitor with moderate selectivity for the BD2 domain over BD1 domain of BRD4. Our results show that EP-0108A has antitumor effects in MV4-11 and Kasumi-1 cell line-derived xenograft mouse models without significant effects on heart or breathing safe in rats and Beagle dogs. In repeated dose toxicity studies, EP-0108A showed reversible hematological and gastrointestinal toxicity in both rats and dogs. Our findings indicate that EP-0108A has the potential to be a new therapeutic agent for the treatment of cancer.
Development and Validation of a Deep Learning Model for Prediction of Adult Physiological Deterioration
Authors: Shashikumar Supreeth P. , Le Joshua Pei , Yung Nathan , Ford James , Singh Karandeep , Malhotra Atul , Nemati Shamim , Wardi Gabriel
Published: September 2024

BACKGROUND:

Prediction-based strategies for physiologic deterioration offer the potential for earlier clinical interventions that improve patient outcomes. Current strategies are limited because they operate on inconsistent definitions of deterioration, attempt to dichotomize a dynamic and progressive phenomenon, and offer poor performance.

OBJECTIVE:

Can a deep learning deterioration prediction model (Deep Learning Enhanced Triage and Emergency Response for Inpatient Optimization [DETERIO]) based on a consensus definition of deterioration (the Adult Inpatient Decompensation Event [AIDE] criteria) and that approaches deterioration as a state “value-estimation” problem outperform a commercially available deterioration score?

DERIVATION COHORT:

The derivation cohort contained retrospective patient data collected from both inpatient services (inpatient) and emergency departments (EDs) of two hospitals within the University of California San Diego Health System. There were 330,729 total patients; 71,735 were inpatient and 258,994 were ED. Of these data, 20% were randomly sampled as a retrospective “testing set.”

VALIDATION COHORT:

The validation cohort contained temporal patient data. There were 65,898 total patients; 13,750 were inpatient and 52,148 were ED.

PREDICTION MODEL:

DETERIO was developed and validated on these data, using the AIDE criteria to generate a composite score. DETERIO’s architecture builds upon previous work. DETERIO’s prediction performance up to 12 hours before T0 was compared against Epic Deterioration Index (EDI).

RESULTS:

In the retrospective testing set, DETERIO’s area under the receiver operating characteristic curve (AUC) was 0.797 and 0.874 for inpatient and ED subsets, respectively. In the temporal validation cohort, the corresponding AUC were 0.775 and 0.856, respectively. DETERIO outperformed EDI in the inpatient validation cohort (AUC, 0.775 vs. 0.721; p < 0.01) while maintaining superior sensitivity and a comparable rate of false alarms (sensitivity, 45.50% vs. 30.00%; positive predictive value, 20.50% vs. 16.11%).

CONCLUSIONS:

DETERIO demonstrates promise in the viability of a state value-estimation approach for predicting adult physiologic deterioration. It may outperform EDI while offering additional clinical utility in triage and clinician interaction with prediction confidence and explanations. Additional studies are needed to assess generalizability and real-world clinical impact.
Predictors of ICU Surrogates’ States of Concurrent Prolonged Grief, Posttraumatic Stress, and Depression Symptoms*
Authors: Wen Fur-Hsing , Prigerson Holly G. , Chuang Li-Pang , Chou Wen-Chi , Huang Chung-Chi , Hu Tsung-Hui , Tang Siew Tzuh
Published: September 2024

OBJECTIVES:

Scarce research explores factors of concurrent psychologic distress (prolonged grief disorder [PGD], posttraumatic stress disorder [PTSD], and depression). This study models surrogates’ longitudinal, heterogenous grief-related reactions and multidimensional risk factors drawing from the integrative framework of predictors for bereavement outcomes (intrapersonal, interpersonal, bereavement-related, and death-circumstance factors), emphasizing clinical modifiability.

DESIGN:

Prospective cohort study.

SETTING:

Medical ICUs of two Taiwanese medical centers.

SUBJECTS:

Two hundred eighty-eight family surrogates.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Factors associated with four previously identified PGD-PTSD-depressive-symptom states (resilient, subthreshold depression-dominant, PGD-dominant, and PGD-PTSD-depression concurrent) were examined by multinomial logistic regression modeling (resilient state as reference). Intrapersonal: Prior use of mood medications correlated with the subthreshold depression-dominant state. Financial hardship and emergency department visits correlated with the PGD-PTSD-depression concurrent state. Higher anxiety symptoms correlated with the three more profound psychologic-distress states (adjusted odds ratio [95% CI] = 1.781 [1.562–2.031] to 2.768 [2.288–3.347]). Interpersonal: Better perceived social support was associated with the subthreshold depression-dominant state. Bereavement-related: Spousal loss correlated with the PGD-dominant state. Death circumstances: Provision of palliative care (8.750 [1.603–47.768]) was associated with the PGD-PTSD-depression concurrent state. Surrogate-perceived quality of patient dying and death as poor-to-uncertain (4.063 [1.531–10.784]) correlated with the subthreshold depression-dominant state, poor-to-uncertain (12.833 [1.231–133.775]), and worst (12.820 [1.806–91.013]) correlated with the PGD-PTSD-depression concurrent state. Modifiable social-worker involvement (0.004 [0.001–0.097]) and a do-not-resuscitate order issued before death (0.177 [0.032–0.978]) were negatively associated with the PGD-PTSD-depression concurrent and the subthreshold depression-dominant state, respectively. Apparent unmodifiable buffering factors included surrogates’ higher educational attainment, married status, and longer time since loss.

CONCLUSIONS:

Surrogates’ concurrent bereavement distress was positively associated with clinically modifiable factors: poor quality dying and death, higher surrogate anxiety, and palliative care—commonly provided late in the terminal-illness trajectory worldwide. Social-worker involvement and a do-not-resuscitate order appeared to mitigate risk.
Comparative performance of pharmacogenetics-based warfarin dosing algorithms in Chinese population: use of a pharmacokinetic/pharmacodynamic model to explore dosing regimen through clinical trial simulation
Authors: Shi Keli , Deng Jiexin
Published: September 2024

Objective

Warfarin has a narrow therapeutic window and large variability in dosing that are affected by clinical and genetic factors. To help guide the dosing of warfarin, the Clinical Pharmacogenetics Implementation Consortium has recommended the use of pharmacogenetic algorithms, such as the ones developed by the International Warfarin Pharmacogenetics Consortium (IWPC) and by Gage et al. when genotype information is available.

Methods

In this study, simulations were performed in Chinese cohorts to explore how dosing differences between Western (by IWPC and Gage et al.) and Chinese algorithms (by Miao et al.) would mean in terms of anticoagulation effect in clinical trials. We first tried to replicate a published clinical trial comparing genotype-guided dosing to routine clinical dosing in Chinese patients. We then made simulations where Chinese cohorts received daily doses recommended by Gage, IWPC, and Miao algorithms.

Results

We found that in simulation conditions where dosing specifications were strictly followed, genotype-guided dosing by IWPC and Lenzini formulae was more likely to overshoot the upper limit of the therapeutic window by day 15, and thus may have a lower % time in therapeutic range (%TTR) than that of clinical dosing group. Also, in comparing Gage, IWPC, and Miao algorithms, we found that the Miao dosing cohort has the highest %TTR and the lowest risk of over-anticoagulation by day 28.

Conclusion

In summary, our results confirmed that algorithms developed based on data from local patients may be more suitable for achieving therapeutic international normalized ratio window in Chinese population.
Recent updates on the influence of iron and magnesium on vascular, renal, and adipose inflammation and possible consequences for hypertension
Authors: Connolly Benjamin J. , Saxton Sophie N.
Published: September 2024

The inflammatory status of the kidneys, vasculature, and perivascular adipose tissue (PVAT) has a significant influence on blood pressure and hypertension. Numerous micronutrients play an influential role in hypertension-driving inflammatory processes, and recent reports have provided bases for potential targeted modulation of these micronutrients to reduce hypertension. Iron overload in adipose tissue macrophages and adipocytes engenders an inflammatory environment and may contribute to impaired anticontractile signalling, and thus a treatment such as chelation therapy may hold a key to reducing blood pressure. Similarly, magnesium intake has proven to greatly influence inflammatory signalling and concurrent hypertension in both healthy animals and in a model for chronic kidney disease, demonstrating its potential clinical utility. These findings highlight the importance of further research to determine the efficacy of micronutrient-targeted treatments for the amelioration of hypertension and their potential translation into clinical application.
Long-term exposure to antihypertensive drugs and the risk of cancer occurrence: evidence from a large population-based study
Authors: Franchi Matteo , Torrigiani Ginevra , Kjeldsen Sverre Erik , Mancia Giuseppe , Corrao Giovanni
Published: September 2024

Objective:

Available data on the association between antihypertensive drugs and cancer are characterized by a few years follow-up. Our aim has been to evaluate the association between long-term exposure to antihypertensive drugs and the risk of cancer occurrence.

Methods:

Using the healthcare utilization databases of the Lombardy region (Italy), individuals aged 40–85 years who had no previous history of cancer and were newly dispensed with at least one antihypertensive drug from the major drug classes between 2009 and 2011 were followed from the first drug dispensation to December 31, 2020. Data were analyzed according to the first drug used and the intention to treat principle, but also via an “as treated” approach, that is, by considering changes of and exposure to drugs during follow-up. The association between the duration of exposure to each drug class and the risk of cancer occurrence was evaluated using the adjusted Cox regression models.

Results:

The study cohort included 338 910 new drug users (median age, 59 years; 49.5% males). During a median follow-up of 10.2 years, 36 556 cancers occurred. There was no consistent significant association between the risk of cancer occurrence and angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, or thiazides. A progressive, weak increase in cancer occurrence was associated with progressive exposure to calcium channel blockers and, limited to long-term exposure, to beta-blockers. A modest progressive increase in risk was observed also for thiazide-like and loop diuretics in the as treated, although not in the intention to treat approach.

Conclusions:

Long-term evaluation of exposure to antihypertensive drugs did not show consistent associations between thiazides, angiotensin-receptor blockers, or angiotensin-converting-enzyme inhibitors and the risk of cancer occurrence. A weak association was observed between cancer and the duration of exposure to calcium channel blockers and beta-blockers.
Ocular manifestations of West Nile virus
Authors: Dossett James P. , Clavell Christine I. , Ghorayeb Ghassan
Published: September 2024

Purpose of review

Over the past two decades, the ophthalmic manifestations of West Nile virus have been more clearly established in the literature. This review aims to summarize its diagnosis and pathogenesis, with a focus on its clinical appearance, characteristic imaging features, and management.

Recent findings

Ocular manifestations of West Nile virus present early in the disease course and are more common in cases with severe neurological involvement. The use of optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), fundus autofluorescence (FAF), fluorescein angiogram (FA), and indocyanine green angiography (ICGA) can aid in its diagnosis and management.

West Nile virus infection may present with ocular findings that include anterior uveitis, vitritis, retinitis, chorioretinitis, and optic neuropathy; visual prognosis can range from excellent to poor depending on severity of involvement and the presence of secondary complications, such as occlusive vasculitis and macular ischemia. Diagnosis may be aided by multimodal imaging assessment. The ophthalmologist should have a high clinical suspicion for ocular involvement in cases of severe systemic disease.
Ethical considerations for large language models in ophthalmology
Authors: Kalaw Fritz Gerald P. , Baxter Sally L.
Published: September 2024

Purpose of review

This review aims to summarize and discuss the ethical considerations regarding large language model (LLM) use in the field of ophthalmology.

Recent findings

This review of 47 articles on LLM applications in ophthalmology highlights their diverse potential uses, including education, research, clinical decision support, and surgical assistance (as an aid in operative notes). We also review ethical considerations such as the inability of LLMs to interpret data accurately, the risk of promoting controversial or harmful recommendations, and breaches of data privacy. These concerns imply the need for cautious integration of artificial intelligence in healthcare, emphasizing human oversight, transparency, and accountability to mitigate risks and uphold ethical standards.

The integration of LLMs in ophthalmology offers potential advantages such as aiding in clinical decision support and facilitating medical education through their ability to process queries and analyze ophthalmic imaging and clinical cases. However, their utilization also raises ethical concerns regarding data privacy, potential misinformation, and biases inherent in the datasets used. Awareness of these concerns should be addressed in order to optimize its utility in the healthcare setting. More importantly, promoting responsible and careful use by consumers should be practiced.
Novel artificial intelligence for diabetic retinopathy and diabetic macular edema: what is new in 2024?
Authors: Vujosevic Stela , Limoli Celeste , Nucci Paolo
Published: September 2024

Purpose of review

Given the increasing global burden of diabetic retinopathy and the rapid advancements in artificial intelligence, this review aims to summarize the current state of artificial intelligence technology in diabetic retinopathy detection and management, assessing its potential to improve care and visual outcomes in real-world settings.

Recent findings

Most recent studies focused on the integration of artificial intelligence in the field of diabetic retinopathy screening, focusing on real-world efficacy and clinical implementation of such artificial intelligence models. Additionally, artificial intelligence holds the potential to predict diabetic retinopathy progression, enhance personalized treatment strategies, and identify systemic disease biomarkers from ocular images through ‘oculomics’, moving towards a more precise, efficient, and accessible care. The emergence of foundation model architectures and generative artificial intelligence, which more clearly reflect the clinical care process, may enable rapid advances in diabetic retinopathy care, research and medical education.

This review explores the emerging technology of artificial intelligence to assess the potential to improve patient outcomes and optimize personalized management in healthcare delivery and medical research. While artificial intelligence is expected to play an increasingly important role in diabetic retinopathy care, ongoing research and clinical trials are essential to address implementation issues and focus on long-term patient outcomes for successful real-world adoption of artificial intelligence in diabetic retinopathy.
Artificial intelligence in myopia in children: current trends and future directions
Authors: Ng Yin Ling Clarissa , Zhu Xiangjia , Ang Marcus
Published: September 2024

Purpose of review

Myopia is one of the major causes of visual impairment globally, with myopia and its complications thus placing a heavy healthcare and economic burden. With most cases of myopia developing during childhood, interventions to slow myopia progression are most effective when implemented early. To address this public health challenge, artificial intelligence has emerged as a potential solution in childhood myopia management.

Recent findings

The bulk of artificial intelligence research in childhood myopia was previously focused on traditional machine learning models for the identification of children at high risk for myopia progression. Recently, there has been a surge of literature with larger datasets, more computational power, and more complex computation models, leveraging artificial intelligence for novel approaches including large-scale myopia screening using big data, multimodal data, and advancing imaging technology for myopia progression, and deep learning models for precision treatment.

Artificial intelligence holds significant promise in transforming the field of childhood myopia management. Novel artificial intelligence modalities including automated machine learning, large language models, and federated learning could play an important role in the future by delivering precision medicine, improving health literacy, and allowing the preservation of data privacy. However, along with these advancements in technology come practical challenges including regulation and clinical integration.
Microbiome contributions to pain: a review of the preclinical literature
Authors: Pratt McKenna L. , Plumb Ashley N. , Manjrekar Aditi , Cardona Lucia M. , Chan Cheri K. , John Juanna M. , Sadler Katelyn E.
Published: September 2024

Over the past 2 decades, the microbiome has received increasing attention for the role that it plays in health and disease. Historically, the gut microbiome was of particular interest to pain scientists studying nociplastic visceral pain conditions given the anatomical juxtaposition of these microorganisms and the neuroimmune networks that drive pain in such diseases. More recently, microbiomes both inside and across the surface of the body have been recognized for driving sensory symptoms in a broader set of diseases. Microbiomes have never been a more popular topic in pain research, but to date, there has not been a systematic review of the preclinical microbiome pain literature. In this article, we identified all animal studies in which both the microbiome was manipulated and pain behaviors were measured. Our analysis included 303 unique experiments across 97 articles. Microbiome manipulation methods and behavioral outcomes were recorded for each experiment so that field-wide trends could be quantified and reported. This review specifically details the animal species, injury models, behavior measures, and microbiome manipulations used in preclinical pain research. From this analysis, we were also able to conclude how manipulations of the microbiome alter pain thresholds in naïve animals and persistent pain intensity and duration in cutaneous and visceral pain models. This review summarizes by identifying existing gaps in the literature and providing recommendations for how to best plan, implement, and interpret data collected in preclinical microbiome pain experiments.
Association of Novel Ventricular Assist Device Self-report Measures With Overall Health-Related Quality of Life
Authors: Grady Kathleen L. , Burns James L. , Allen Larry A. , Stehlik Josef , Teuteberg Jeffrey , McIlvennan Colleen K. , Kirklin James K. , Beiser David G. , Lindenfeld JoAnn , Denfeld Quin E. , Lee Christopher S. , Kiernan Michael , Cella David , Klein Liviu , Walsh Mary Norine , Ruo Bernice , Adler Eric , Rich Jonathan , Pham Duc Thinh , Yancy Clyde , Murks Catherine , Bedjeti Katy , Hahn Elizabeth A.
Published: September 2024

Background

Few study authors examined factors influencing health-related quality of life (HRQOL) early after left ventricular assist device (LVAD) implantation.

Objective

The purpose of this study was to determine whether 5 novel self-report measures and other variables were significantly associated with overall HRQOL at 3 months after LVAD surgery.

Methods

Patients were recruited between October 26, 2016, and February 29, 2020, from 12 US sites. Data were collected before LVAD implantation and at 3 months post LVAD implantation. Overall HRQOL measures included the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) overall summary score (OSS) and EuroQol 5-dimension- 3L visual analog scale. Potential factors associated with overall HRQOL included 5 novel self-report measures (Satisfaction with Treatment, Being Bothered by VAD Self-care and Limitations, VAD Team Communication, Self-efficacy regarding VAD Self-care, and Stigma), and demographic and clinical characteristics. Statistics included regression analyses.

Results

Of enrollees, 242 completed self-report measures at baseline, and 142 completed measures 3 months postoperatively. Patients were 55 ± 13 years old, with 21% female, 24% non-White, 39% high school or lower educated, and 47% destination therapy. Using the KCCQ-12 OSS, higher Satisfaction with Treatment was associated with a higher KCCQ-12 OSS; Being Bothered by VAD Self-care and Limitations, high school or lower education, chest incision pain, cardiac dysrhythmias within 3 postoperative months, and peripheral edema were associated with a worse KCCQ-12 OSS (R
2 = 0.524). Factors associated with a worse 3-month EuroQol 5-dimension-3L visual analog scale were female sex, adverse events within 3 months post implantation (cardiac dysrhythmias, bleeding, and venous thrombosis), and chest incision pain (R
2 = 0.229). No factors were associated with a higher EuroQol 5-dimension-3L visual analog scale score at 3 months.

Conclusions

Two novel measures, demographics, postimplantation adverse events, and symptoms were associated with post-LVAD KCCQ-12 OSS early after surgery.
Ultrasound-Guided Percutaneous Ultrasonic Tenotomy for Refractory Patellar Tendinopathy in High-Level Athletes: A Case Series
Authors: Omodani Toru , Saito Masayoshi , Ikuta Futoshi
Published: September 2024

Objective:

To elucidate the clinical outcomes and return-to-sport status of high-level athletes with refractory patellar tendinopathy treated with ultrasound-guided percutaneous ultrasonic tenotomy (PUT).

Design:

Case series study.

Setting:

Single orthopaedic clinic.

Patients:

Five cases involving 8 knees from athletes (average age: 22 years, range: 17-30 years) who presented with refractory patellar tendinopathy and underwent PUT between 2022 and 2024. Conservative treatments had previously been attempted without sufficient pain relief or return to sports.

Interventions:

All patients underwent ultrasound-guided PUT using the TX-2 device from Tenex Health. Jogging was resumed 1 month after surgery, and a return to competitive sports was permitted as early as 3 months postsurgery.

Main Outcome Measures:

Preoperative and postoperative Victorian Institute of Sport Assessment (VISA) scores and Numerical Rating Scale (NRS) scores for pain. Time to return to full training and competitive sports, and presence of postoperative infection signs.

Results:

The VISA score significantly improved from a preoperative average of 43.1 to a postoperative average of 77.1 (P = 0.0004). The NRS significantly decreased from a preoperative average of 6.4 to a postoperative average of 2.8 (P = 0.0005). Four cases involving 6 knees fully returned to sports, with an average return time of 3 months and 19 days (range: 3 months to 4 months and 13 days). One case involving 2 knees did not show sufficient pain improvement and the patient could not return to sports. No signs of infection were observed in any case.

Conclusions:

PUT for refractory patellar tendinopathy in high-level athletes generally results in favorable treatment outcomes and successful return to sports. This study provides novel insights into the effectiveness of PUT for patellar tendinopathy in athletes, highlighting the need for future studies with larger sample sizes to validate these findings and explore factors associated with poor outcomes.
Point of care ultrasound for triage of critically ill patients in the emergency department
Authors: Kinni Harish , Garcia Samuel , Clark Christopher
Published: September 2024

Point of care ultrasound (POCUS) has been a constantly evolving and growing tool utilized by emergency medicine and intensive care practitioners. Ultrasound use for the assessment and management of critically ill patients has been available for several decades with the focused assessment with sonography in trauma (FAST) exam being one of the first widely adopted POCUS protocols. This along with other established protocols has made an impact on the care delivered to critically ill patients. This narrative review will cover some of the history of POCUS in the emergency department, brief considerations for machines and infrastructure, and current uses including in trauma, shock/hypotension, cardiac arrest, dyspnea, abdomen, vascular, and procedural guidance. Furthermore, it will provide a review of the evidence supporting its efficacy in managing critically ill patients and future directions.
Social and humanitarian issues in nephrology and hypertension
Authors: Abdellatif Dina A.
Published: September 2024

Purpose of review

Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease.

Recent findings

Undoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering.

It is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.
Increased PRIM2 Expression Associated With Poor Prognosis in Patients With Pancreatic Ductal Adenocarcinoma
Authors: Yin Jingyang , Guo Shixiang , Yang Jiali , Xia Renpei , Wang Huaizhi
Published: September 2024

Objectives

To explore the association between PRIM2 expression and prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) from multiclinic centers.

Materials and Methods

Samples from PDAC patients were collected and processed to tissue microarray (TMA). PRIM2 expression was detected by immunohistochemistry (IHC) of in 127 enrolled PDAC patients who underwent surgical resection from January 2012 to December 2018, were with complete follow-up, and were enrolled and grouped by PRIM2 stain level into 2 groups. The expression differences, the association to clinicopathologic features, and the survival were evaluated by the groups. Data of RNA/protein expression and clinical features from public databases were used for validation.

Results

PRIM2 was highly expressed in PDAC patients and associated with poor prognosis in patients with PDAC. Association was found between increased PRIM2 levels and pathology grade (P = 0.050). Moreover, in multivariate analysis of survival, the highly expression of PRIM2 was identified as an independent risk factor for poor survival (HR, 1.78; P = 0.031). Analysis on public databases validated above results.

Conclusions

High expression of PRIM2 was associated with poor prognosis in PDAC patients, and PRIM2 could be used as an independent risk indicator.
Patient and Family Input to Determine Experiences and Research Interests in Pediatric Pancreatitis
Authors: Cress Gretchen A. , Scudiero Karen T. , Wang Fuchenchu , Patrick Vanessa B. , Wood Phoebe M. , Yuan Ying , Lowe Mark E. , Uc Aliye
Published: September 2024

Objective

The aim of this study was to determine patient-reported burdensome experiences and research interests in children with acute recurrent pancreatitis or chronic pancreatitis and their families.

Materials and Methods

Children with pancreatitis and their families completed a web-based survey. Subject prioritized rankings of symptoms or quality of life issues and topics for future research were assessed. Data are presented as family and children scores.

Results

Among 80 participants, 18 were children with pancreatitis and 62 were family members. Top 5 ranked symptoms or quality of life issues were as follows: 1) pain, 2) fatigue, 3) missing school, 4) upset stomach, and 5) not knowing when an attack will occur. Top 5 ranked future research topics were as follows: 1) how to prevent a pancreatitis attack, 2) how pancreatitis affects other parts of the body, 3) ways to treat or handle pain, 4) what is the cause of pancreatitis, and 5) teach doctors about pancreatitis.

Conclusions

This study highlights the importance of patient and family input in caring for children with pancreatitis. The most bothersome symptoms were pain, fatigue, and upset stomach. Children with pancreatitis and families would like future research to primarily focus on prevention of pancreatitis attacks, pain therapy, and complications of pancreatitis.
Reflections on the Journey to Improve Medical Education in Nutrition
Authors: Kolasa Kathryn M. , Eliot Kathrin , Craven Kay
Published: September 2024

The landscape of nutrition education within the US healthcare system has a rich history, although the impact remains limited. This article explores various change drivers to address the need for increased value for incorporating knowledge of food and nutrition into health professions education. Key initiatives discussed include the 2022 White House National Strategy on Hunger, Nutrition, and Health; the 2023 Medical Education in Nutrition Summit; and recent 2024 Food Is Medicine Summits, which have contributed to reshaping healthcare priorities. This article also underscores the relevance of value-based care and interprofessional collaboration in addressing the nation’s nutrition-related challenges. With acknowledgement of persistent barriers to the effective integration of nutrition education across the medical curricula continuum, the article recognizes the historical perspectives that have contributed to today’s landscape. It also explores strategies proposed to enhance medical nutrition education, including funding sources, curriculum development, competency frameworks, culinary medicine programs, and legislation. The authors emphasize the need for sustained advocacy, innovative and intentional curriculum design, and interprofessional collaboration to equip healthcare professionals with the knowledge and skills needed to effectively address the mounting burden of diet-related diseases today.
Influence of age and race on axial elongation in myopic children: A systematic review and meta-regression
Authors: Brennan Noel A. , Shamp Wright , Maynes Elizabeth , Cheng Xu , Bullimore Mark A.
Published: September 2024

PURPOSE

Axial elongation is the basis of progression in primary myopia and the preferred metric to monitor its evolution. We conducted a meta-regression to model axial elongation and its associated factors in children with low to moderate myopia.

METHODS

A comprehensive electronic systematic search was performed using Ovid Medline, EMBASE, and Cochrane Central Register of Controlled Trials of studies conducted up until October 2021. The mean rate of axial elongation was analyzed using a multivariate linear mixed-effects meta-regression model, with backward stepwise elimination of nonsignificant covariates. The model included three levels of random effects, allowing both prediction and confidence intervals to be estimated.

RESULTS

A total of 64 studies with 83 subpopulations and 142 evaluations of mean axial change from baseline met our inclusion criteria and had no missing significant covariates in the final model. A separate analysis including all populations with axial length data (202 evaluations) but missing variance or covariate data produced a similar model to that for the analysis with complete data. The mean axial elongation is 38% greater in Asian children (95% confidence interval, 19 to 61%; p<0.01) compared with non-Asians, but both groups show a 15% decline per year as age increases (95% confidence interval, 12 to 17% p<0.0001). Prediction intervals indicate substantial variability around the axial elongation estimates.

CONCLUSIONS

This analysis provides mean values of axial elongation for evaluation of efficacy of myopia control. The broad prediction intervals emphasize the large range of individual axial elongation rates in the population, illustrating the challenge in managing individual children. Interpretation of the analysis is limited by the use of aggregated data rather than individual subject data.
The Role of Professional Development and Technical Assistance in Supporting Implementation of COVID-19 Prevention Strategies in K-12 Schools
Authors: Skelton-Wilson Syreeta , Lee Sarah , Potts Jessica , Chung Chloe , Pitt-Barnes Seraphine , Fahrenbruch Melissa , Ogunyankin Forest , Keener Mast Dana
Published: September 2024

Context:

Schools vary in their capacity to implement recommended strategies to prevent infectious diseases, such as COVID-19. Professional development (PD) and technical assistance (TA) are well-established tools used to strengthen school capacity and infrastructure for healthier school environments.

Objective:

The authors examined the relationship between PD and TA received by districts and schools and their implementation of COVID-19 prevention strategies during the 2020-2021 school year.

Design and Setting:

We conducted a descriptive analysis of survey responses collected during Spring 2021 from selected districts and schools in 9 participating states. The survey assessed the implementation of 10 COVID-19 prevention strategies recommended by the Centers for Disease Control and Prevention and whether district or school staff received PD and/or TA on topics related to COVID-19 during the same year.

Participants:

Survey responses were received from designated contacts in 310 districts and 931 schools across 9 states.

Main Outcome Measures:

The dependent variable was the number of COVID-19 prevention strategies that were reported as “in place” by each district and school ranging from 0 to 10.

Results:

On average, districts and schools reported implementing 7 of 10 recommended COVID-19 prevention strategies during the 2020-2021 school year. Schools that received PD on at least 1 of 12 topics reported implementing 7.61 COVID-19 prevention strategies, whereas schools that did not receive PD reported implementing 6.34 strategies. Similarly, schools that received TA on at least 1 topic reported higher COVID-19 implementation scores (7.51) than schools that did not receive any TA (7.20).

Conclusions:

Findings reveal a positive relationship between receiving PD and/or TA and implementation of COVID-19 prevention strategies in school settings.