bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Power Delivered by Noninvasive Ventilation Contributes to Physio-Anatomical and Clinical Responses to Early Versus Late Proning in COVID-19 Pneumonia*
Authors: Musso Giovanni , Taliano Claudio , Paschetta Elena , De Iuliis Marco , Fonti Caterina , Vianou Ines Sarah , Druetta Marta , Riedo Federica , Ferraris Andrea , Tirabassi Gloria
Published: May 2023

OBJECTIVES:

To study: 1) the effect of prone position (PP) on noninvasive ventilation (NIV)-delivered mechanical power (MP) and 2) the impact of MP on physio-anatomical and clinical responses to early versus late PP in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.

DESIGN:

Nonrandomized trial with inverse probability of treatment weighted-matched groups.

SETTING:

HUMANITAS Gradenigo Sub-ICU.

PATIENTS:

One hundred thirty-eight SARS-CoV-2 pneumonia patients with moderate-to-severe acute hypoxemic respiratory failure (Pao2/Fio2ratio < 200 mm Hg) receiving NIV from September 1, 2020, to February 28, 2021 (Ethics approval: ISRCTN23016116).

INTERVENTIONS:

Early PP or late PP or supine position.

MEASUREMENTS AND MAIN RESULTS:

Respiratory parameters were hourly recorded. Time-weighted average MP values were calculated for each ventilatory session. Gas exchange parameters and ventilatory ratio (VR) were measured 1 hour after each postural change. Lung ultrasonographic scores and circulating biomarkers were assessed daily. MP delivered during the initial 24 hours of NIV (MP [first 24 hr]) was the primary exposure variable. Primary outcomes: 28-day endotracheal intubation and death. Secondary outcomes: oxygen-response, Co2-response, ultrasonographic, and systemic inflammatory biomarker responses after 24 hours of NIV. Fifty-eight patients received early PP + NIV, 26 late PP + NIV, and 54 supine NIV. Early PP group had lower 28-day intubation and death than late PP (hazard ratio [HR], 0.35; 95% CI, 0.19–0.69 and HR, 0.26; 95% CI, 0.07–0.67, respectively) and supine group. In Cox multivariate analysis, (MP [first 24 hr]) predicted 28-day intubation (HR, 1.70; 95% CI, 1.25–2.09;p= 0.009) and death (HR, 1.51; 95% CI, 1.19–1.91;p= 0.007). Compared with supine position, PP was associated with a 35% MP reduction. VR, ultrasonographic scores, and inflammatory biomarkers improved after 24 hours of NIV in the early PP, but not in late PP or supine group. A MP (first 24 hr) greater than or equal to 17.9 J/min was associated with 28-day death (area under the curve, 0.92; 95% CI, 0.88–0.96;p< 0.001); cumulative hours of MP greater than or equal to 17.9 J/min delivered before PP initiation attenuated VR, ultrasonographic, and biomarker responses to PP.

CONCLUSIONS:

MP delivered by NIV during initial 24 hours predicts clinical outcomes. PP curtails MP, but cumulative hours of NIV with MP greater than or equal to 17.9 J/min delivered before PP initiation attenuate the benefits of PP.
Efficacy of Carbapenems Compared With Noncarbapenem Broad-Spectrum Beta-Lactam Antibiotics as Initial Antibiotic Therapy Against Sepsis: A Nationwide Observational Study*
Authors: Umemura Yutaka , Yamakawa Kazuma , Tanaka Yoshihiro , Yoshimura Jumpei , Ogura Hiroshi , Fujimi Satoshi
Published: May 2023

OBJECTIVES:

As causative pathogens are not usually identified at the time of initiating antibiotics in sepsis, carbapenems are commonly used as an initial treatment. To reduce indiscriminate use of carbapenems, the efficacy of alternative empiric regimens, such as piperacillin–tazobactam and the fourth-generation cephalosporins, should be elucidated. This study aimed to evaluate survival effect associated with carbapenems as initial therapy for sepsis compared with these antibiotics.

DESIGN:

Multicenter retrospective observational study.

SETTING:

Tertiary hospitals in Japan.

PATIENTS:

Adult patients diagnosed as having sepsis from 2006 to 2019.

INTERVENTIONS:

Administration of carbapenems as initial antibiotic therapy.

MEASUREMENTS AND MAIN RESULTS:

This study used data of adult patients with sepsis extracted from a large-scale database in Japan. Patients were divided into two groups as follows: patients receiving carbapenems and patients receiving noncarbapenem broad-spectrum beta-lactam antibiotics as initial treatment. In-hospital mortality was compared between the groups by a logistic regression model adjusted by an inverse probability treatment weighting using propensity scores. To evaluate heterogeneity of effects according to patient characteristics, we also fitted logistic models in several subgroups. Among 7,392 patients with sepsis, 3,547 patients received carbapenems, and 3,845 patients received noncarbapenem agents. The logistic model showed no significant association between carbapenem therapy and lower mortality (adjusted OR 0.88, p = 0.108). Subgroup analyses suggested that there were significant survival benefits associated with carbapenem therapy in patients with septic shock, in ICUs, or with mechanical ventilation (p for effect modifications: < 0.001, 0.014, and 0.105, respectively).

CONCLUSIONS:

Compared with the noncarbapenem broad-spectrum antibiotics, carbapenems as an initial therapy for sepsis were not associated with significantly lower mortality.
Antiplatelet Versus Anticoagulation Treatment in Patients With Fontan Operation: A Systematic Review and Meta-Analysis
Authors: Kleitsioti Panagiota , Theodoridis Xenophon , Papanastasiou Christos Α. , Karvounis Haralambos , Giannopoulos Andreas , Giannakoulas George
Published: May 2023

Thromboembolism is a significant complication after the Fontan procedure because of endothelial dysfunction, abnormal blood flow, and hypercoagulability. This is the reason why it is recommended for these patients to receive thromboprophylaxis. The aim of our study was to compare the efficacy and safety of antiplatelets versus anticoagulants in patients with a history of a Fontan procedure. A systematic literature review was performed on the electronic databases PubMed, Cochrane, and Scopus, and the grey literature for retrieving studies comparing antiplatelets with anticoagulants and/or no medication on patients with Fontan circulation. We used the random effect model for synthesizing the data. A total of 26 and 20 studies were included in the qualitative and quantitative analysis, respectively. No difference was observed between antiplatelets and anticoagulants in the rate of thromboembolic events [odds ratio (OR), 1.47; 95% confidence interval (CI), 0.66–3.26]. Anticoagulants were more effective than no medication for thromboprophylaxis (OR, 0.17; 95% CI, 0.05–0.61), while comparison between antiplatelets and no medication showed no difference in thromboembolic episodes (OR, 0.25; 95% CI, 0.06–1.09). Antiplatelets were safer than anticoagulants with regards to any bleeding episodes (OR, 0.57; 95% CI, 0.34–0.95). In conclusion, no difference could be found between antiplatelets and anticoagulants in terms of efficacy. However, antiplatelets seem to be safer, as they are responsible for fewer bleeding events. Additional randomized controlled trials are needed to produce robust results.
PROSPECT guideline for haemorrhoid surgery
Authors: Bikfalvi Alexis , Faes Charlotte , Freys Stephan M. , Joshi Girish P. , Van de Velde Marc , Albrecht Eric
Published: May 2023

BACKGROUND

Haemorrhoidectomy is associated with moderate-to-severe postoperative pain.

OBJECTIVE

The aim of this systematic review was to assess the available literature and update previous PROSPECT (procedure specific postoperative pain management) recommendations for optimal pain management after haemorrhoidectomy.

DESIGN AND ELIGIBILITY CRITERIA

A systematic review utilising PROSPECT methodology was undertaken.

DATA SOURCES

Randomised controlled trials published in the English language from January 1, 2016 to February 2, 2022 assessing postoperative pain using analgesic, anaesthetic, and surgical interventions were identified from MEDLINE, EMBASE and Cochrane Database.

RESULTS

Of the 371 randomized controlled trials (RCTs) identified, 84 RCTs and 19 systematic reviews, meta-analyses met our inclusion criteria (103 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, pudendal nerve block, topical metronidazole, topical diltiazem, topical sucralfate or topical glyceryl trinitrate, and intramuscular injection of botulinum toxin.

DISCUSSION

This review has updated the previous recommendations written by our group. Important changes are abandoning oral metronidazole and recommending topical metronidazole, topical diltiazem, topical sucralfate, topical glyceryl trinitrate. Botulinum toxin can also be administered. Contemporary publications confirm the analgesic effect of bilateral pudendal nerve block but invalidate recommendations on perianal infiltration. The choice of the surgery is mostly left to the discretion of the surgeons based on their experience, expertise, type of haemorrhoids, and risk of relapse. That said, excisional surgery is more painful than other procedures.
Experiences and perspectives of adults on using opioids for pain management in the postoperative period
Authors: Aljohani Dalia Mohammed , Almalki Nabat , Adam Rosalind , Forget Patrice
Published: May 2023

OBJECTIVE

To identify and examine the available studies regarding adult perceptions and experiences of postoperative opioid pain management.

INTRODUCTION

The opioid crisis has been acknowledged as a significant clinical and social problem in many countries. Opioids are often initiated after surgery and may be continued on hospital discharge. There is no consensus on the optimal strategy for integrating patients’ views in postoperative opioid prescribing. The aim of this review is to explore the literature on adults’ experiences with postoperative opioid pain management.

INCLUSION CRITERIA

This review will consider all qualitative studies and mixed-method studies with qualitative approaches that explored adults’ opinions or concerns on opioids and/or opioid reduction, and adults’ satisfaction with pain control in this context. Participants in the studies should be adults who had undertaken any type of surgery and have had opioid prescriptions for pain management.

METHODS

This scoping review will be carried out in accordance with the Joanna Briggs Institute (JBI) methodology and will utilise the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for scoping reviews (PRISMA-ScR) reporting guideline and checklist. Searches will be conducted in Ovid MEDLINE, PsycInfo, EMBASE and CINAHL (EBSCO). Studies published in the English language will be included with no time limit. The screening and selection of studies will be carried out independently by three reviewers. Then data extraction process will be conducted by the main reviewer and the reviewer's supervisors independently. A descriptive qualitative content analysis will be utilised for data synthesis. The final report will contain a methodological quality assessment, with the findings being presented, including the knowledge gaps and recommendations for research.
Study on myocardial infarction based on nationwide inpatient sample database: a bibliometric analysis from 2000 to 2022
Authors: Zhang Tianyi , Yang Xue , Zhuang Qian , Liu Yuhua , Bai Huajuan , Liu Jianchao , Ye Zhouheng
Published: May 2023

Background

Studies on myocardial infarction (MI) based on large medical databases have become popular in recent years. The influence of the National Inpatient Sample (NIS), the largest collection of administrative healthcare data across the United States, on the field of MI has not been well investigated. This study aimed to quantify the contribution of NIS to MI research using bibliometric methods.

Methods

We searched the Web of Science Core Collection database to identify publications on MI using NIS from 2000 to 2022. Bibliometric indicators, such as the number of publications, citations, and Hirsch index (H-index), were summarized by years, authors, organizations, and journals. VOSviewer and CiteSpace software were used to analyze the keywords and trends of the hot spots.

Results

A total of 342 articles on MI based on NIS were included. A significant growth in outputs related to MI using the NIS from 2000 to 2020 was observed. The publications were mainly from the United States. The Mayo Clinic was the most prolific institution and had the most citations and the highest H-index. The American Journal of Cardiology ranked first among journals with the highest number of publications, citations, and H-index. Mortality and healthcare management are the main focuses of this field. Personalized risks and care are receiving increased attention.

Conclusion

This study suggests that NIS significantly contributes to high-quality output in MI research. More efforts are needed to improve the impact of knowledge gained from the NIS on MI.
Hirudotherapy for Venous Congestion in an Almost Completely Avulsed Earlobe without Microsurgical Repair
Authors: Vargas Nikoletta , Lieberman Benn , Hwang Lyahn , Badner Victor
Published: May 2023

Venous congestion is a frequent and challenging complication after re-attachment or replantation of avulsed tissues, body parts, and flaps. It is often the reason for failure. One of the successful therapies to prevent and/or treat venous congestion is the use of medicinal leeches. There is sound evidence for its efficacy in plastic and reconstructive surgery for avulsed body parts or flaps. However, there is not enough evidence for its use in ear reconstruction or replantation, especially regarding the fragile tissue of the earlobes. The current study is the first in the literature to describe the use of hirudotherapy for venous congestion in an almost completely avulsed earlobe without microsurgical blood vessel repair, as a last resort in an otherwise healthy 38-year-old male patient who sustained trauma due to physical assault.
Definition and Prognostic Value of Ph-like and IKZF1plus Status in Children With Down Syndrome and B-cell Precursor Acute Lymphoblastic Leukemia
Authors: Palmi Chiara , Bresolin Silvia , Junk Stefanie , Fazio Grazia , Silvestri Daniela , Zaliova Marketa , Oikonomou Athanasios , Scharov Katerina , Stanulla Martin , Moericke Anja , Zimmermann Martin , Schrappe Martin , Buldini Barbara , Bhatia Sanil , Borkhardt Arndt , Saitta Claudia , Galbiati Marta , Bardini Michela , Lo Nigro Luca , Conter Valentino , Valsecchi Maria Grazia , Biondi Andrea , te Kronnie Geertruy , Cario Gunnar , Cazzaniga Giovanni
Published: May 2023

Children with Down syndrome have an augmented risk for B-cell acute lymphoblastic leukemia (DS-ALL), which is associated with lower survival than in non-DS-ALL. It is known that cytogenetic abnormalities common in childhood ALL are less frequent in DS-ALL, while other genetic aberrancies (ie, CRLF2 overexpression and IKZF1 deletions) are increased. A possible cause for the lower survival of DS-ALL that we herewith evaluated for the first time was the incidence and prognostic value of the Philadelphia-like (Ph-like) profile and the IKZF1plus pattern. These features have been associated with poor outcome in non-DS ALL and therefore introduced in current therapeutic protocols. Forty-six out of 70 DS-ALL patients treated in Italy from 2000 to 2014 displayed Ph-like signature, mostly characterized by CRLF2 (n = 33) and IKZF1 (n = 16) alterations; only 2 cases were positive for ABL-class or PAX5-fusion genes. Moreover, in an Italian and German joint cohort of 134 DS-ALL patients, we observed 18% patients positive for IKZF1plus feature. Ph-like signature and IKZF1 deletion were associated with poor outcome (cumulative incidence of relapse: 27.7 ± 6.8% versus 13 ± 7%; P = 0.04 and 35.2 ± 8.6% versus 17 ± 3.9%; P = 0.007, respectively), which further worsens when IKZF1 deletion was co-occurring with P2RY8::CRLF2, qualifying for the IKZF1plus definition (13/15 patients had an event of relapse or treatment-related death). Notably, ex vivo drug screening revealed sensitivity of IKZF1plus blasts for drugs active against Ph-like ALL such as Birinapant and histone deacetylase inhibitors. We provided data in a large setting of a rare condition (DS-ALL) supporting that these patients, not associated with other high-risk features, need tailored therapeutic strategies.
Unraveling Heterogeneity in the Aging Hematopoietic Stem Cell Compartment: An Insight From Single-cell Approaches
Authors: Yang Fei , Nourse Craig , Helgason G. Vignir , Kirschner Kristina
Published: May 2023

Specific cell types and, therefore, organs respond differently during aging. This is also true for the hematopoietic system, where it has been demonstrated that hematopoietic stem cells alter a variety of features, such as their metabolism, and accumulate DNA damage, which can lead to clonal outgrowth over time. In addition, profound changes in the bone marrow microenvironment upon aging lead to senescence in certain cell types such as mesenchymal stem cells and result in increased inflammation. This heterogeneity makes it difficult to pinpoint the molecular drivers of organismal aging gained from bulk approaches, such as RNA sequencing. A better understanding of the heterogeneity underlying the aging process in the hematopoietic compartment is, therefore, needed. With the advances of single-cell technologies in recent years, it is now possible to address fundamental questions of aging. In this review, we discuss how single-cell approaches can and indeed are already being used to understand changes observed during aging in the hematopoietic compartment. We will touch on established and novel methods for flow cytometric detection, single-cell culture approaches, and single-cell omics.
Evaluation Strategies for Florida's Early Childhood Comprehensive Systems Impact Project
Authors: Marshall Jennifer , Hume Emma , Prieto Concha , Ade Cedrick , Delva Jennifer , Geffrard Carlene , Dias Emanuelle , Elger Rafaella Stein
Published: May 2023

Early Childhood Comprehensive Systems (ECCS) grants help states and communities improve early childhood systems to support child development, equitable access to quality services and supports, and family well-being. Truly interdisciplinary, ECCS promotes cross-sector systems change initiatives that focus on integrating health care, mental health, social services, and family support broadly and within communities with concentrated risk factors that negatively impact child health and development. Florida was 1 of 12 states funded from 2016 to 2021 to use a Collaborative Improvement and Innovation Network (CoIIN) approach to do this work. Through community-driven initiatives that focus on policy, partnerships, and practices, Florida ECCS committed to ensuring equitable opportunities for families and young children who may face barriers due to residing in disenfranchised communities. This article describes the process of evaluating this multiyear community-led, place-based initiative that leveraged cross-sector state-level support and used a variety of methods to track evolving ECCS processes and outcomes.
Providing Virtual Support to Children With Mild Developmental Delays in Response to the Pandemic
Authors: Gonzalez Melissa , Rama Catherine , Nawab Aria , Robertson Emily , Partridge Paulina Maria , Ashkenazi Arielle , Mansoor Elana , Van Weelden Julie , Peña Kristyna , Natale Ruby
Published: May 2023

The COVID-19 pandemic has had massive impacts across the globe. Children with developmental delays are an increasingly vulnerable population, highlighting the importance of ensuring they have access to high-quality virtual services during this time. The Early Discovery program currently provides therapeutic interventions for children with mild developmental delays. We sought to compare the outcomes of 2 cohorts within the Early Discovery program using different delivery approaches (n = 238 families): children who received services in person before the pandemic (n = 126) and children who received services via telehealth in the acute phase of the pandemic (n = 112). Both groups of children showed significant improvements in language skills posttreatment, and, with regard to auditory comprehension, both groups showed similar rates of improvement. However, children receiving in-person services before the pandemic showed greater improvements in expressive communication skills than children receiving telehealth services during the pandemic. Results indicate that the Early Discovery program was able to make adjustments during the pandemic that assisted families in maintaining progress in improving their child's language skills.
Distance Learning in an Inclusive Preschool Focused on Autism During the COVID-19 Pandemic
Authors: Siller Michael , Murthy Harshini , Fuhrmeister Sally
Published: May 2023

Despite the widespread use of distance learning during the coronavirus disease-2019 (COVID-19) pandemic, little is known about the developmental appropriateness of this instructional format for preschoolers, particularly when implemented in inclusive settings. The current research was implemented in a university-affiliated, state-funded inclusive preschool classroom focused on autism spectrum disorder (ASD) where parents were given the option to enroll in a full distance program (FDP) during the first 9 weeks of the 2020/21 school year. Parents of four children, including two children with ASD, selected the FDP option. Synchronous whole group, small group, and individual online sessions were recorded using screen capture and coded for children's maintained attention and directed communication. Further, parents and teachers completed exit interviews or a focus group, which were transcribed and analyzed using qualitative research methods. This is the first study to use observational methods to measure child engagement during preschool FDP sessions. Results from this mixed-method multiple case study paint a rich picture of both opportunities and limitations inherent in distance learning when implemented in inclusive preschool settings. General conclusions, future directions, and study limitations are discussed.
Preschool and Childcare Expulsion
Authors: DuShane Danielle , Yu SeonYeong
Published: May 2023

The purpose of this review is to understand what has been learned over the past 20 years of research on preschool and childcare expulsions in the United States. Our literature search identified 16 research studies on this topic. An extensive review of the identified studies was conducted to critically examine the methods used to measure expulsion, the purposes of the reviewed studies, and interventions used to mitigate expulsion rates. Results from this review revealed that researchers have examined the rates of expulsion and factors that could influence expulsion, such as predictive and risk factors (e.g., demographics, disability status), teachers' roles, teacher–family relationships, and interventions. Notably, the reviewed studies highlighted high rates of expulsion among Black male students and students with disabilities. Many teachers reported high stress, limited access to resources, and challenging relationships with administrators and parents during the process of expulsion. Although a variety of methods (e.g., survey, interview, observation) were used to measure expulsion rates, surveys were the primary method of data collection. Interventions targeting teacher well-being, mental health consultation, and classroom-wide interventions (e.g., Pyramid Model) were found to be promising methods for reducing expulsions. Based on the results, gaps in the literature and implications for future research and practice are discussed.
Risk of Major Malformations in Infants After First-Trimester Exposure to Stimulants
Authors: Szpunar Mercedes J. , Freeman Marlene P. , Kobylski Lauren A. , Rossa Ella T. , Gaccione Peter , Chitayat David , Viguera Adele C. , Cohen Lee S.
Published: May 2023

Purpose/Background

The prevalence of attention-deficit/hyperactivity disorder in adult females is 3% to 4%. Attention-deficit/hyperactivity disorder is highly comorbid with other psychiatric disorders such as mood, anxiety, and substance use disorders. For reproductive-aged women, the treatment of attention-deficit/hyperactivity disorder with stimulant medications may be considered during pregnancy or breastfeeding, although historically, data are lacking to inform these decisions. The aim of this investigation was to determine the risk of major malformations in infants after first-trimester prescription stimulant exposure in a small but rigorously characterized sample.

Methods/Procedures

The Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications systematically ascertains information from pregnant females including demographic information, medical and psychiatric history, use of prescription medications, and other information relevant to fetal outcomes. Participants provide verbal informed consent and are interviewed twice during gestation and again at approximately 3 months postpartum. The primary outcome of interest is the presence of a major malformation identified within 6 months after birth. Redacted cases of major malformations are reviewed by a dysmorphologist blinded to medication exposure.

Findings/Results

A total of N = 1988 women were eligible for this analysis, including the following exposures: n = 173 to mixed amphetamine salts; n = 40 to lisdexamfetamine; n = 45 to methylphenidate; n = 3 to dexmethylphenidate; and n = 1755 controls. The odds ratio of a major malformation among infants after first-trimester exposure to any stimulant was 0.39 (95% confidence interval, 0.09–1.61) compared with controls. There were no major malformations observed in infants exposed to lisdexamfetamine, methylphenidate, or dexmethylphenidate.

Implications/Conclusions

Although preliminary, this analysis from an ongoing pregnancy registry provides reassurance that these stimulants do not appear to have major teratogenic effects.

Trial Registration

ClinicalTrials.gov identifier: NCT01246765.
The Continuum of Severity of Functional Impairment Due to Indoor Air Symptoms
Authors: Eidstø Einar , Selinheimo Sanna , Lampi Jussi , Salmela Anniina , Pekkanen Juha
Published: May 2023

Objective

The aim of the study is to study functional impairment due to indoor air–related symptoms and associated characteristics.

Methods

A questionnaire survey of a random sample of Finnish people aged 25 to 64 years. Analyses were done using multivariate multinomial logistic regression.

Results

A total of 23.1% reported indoor air–related symptoms, 1.8% severe functional impairment due to symptoms, 5.3% moderate, 11.1% mild, and 4.9% reported no impairment. Those with severe functional impairment showed the strongest associations with comorbid diseases, for example, asthma and irritable bowel syndrome, perceived sensitivities to several environmental factors, like chemicals, and likelihood of having symptoms in multiple organs, while those with no or little functional impairment showed weak or even inverse associations. Similar results emerged with severity of indoor air–related symptoms.

Conclusions

Individuals with indoor air–related symptoms are a very heterogeneous group. This should be better considered in future research and clinical practice.
Dose Escalations Among Workers’ Compensation Claimants Using Opioid Medications—An 8 Year Postinjury Follow up Study
Authors: Lavin Robert A. , Yuspeh Larry , Kalia Nimisha , Tsourmas Nicholas F. , Leung Nina , Hunt Dan L. , Green-McKenzie Judith , Bernacki Edward J. , Tao Xuguang (Grant)
Published: May 2023

Objective

The aim of the study is to determine the morphine equivalent dose in milligrams (MED)/day escalation trend after initial utilization.

Methods

A total of 25,108 lost time claims filed between 1998 and 2007 were followed for 8 years from injury date. Claims were stratified by initial MED/day at 3 months after injury into four groups (0, 1 to < 15, 15 to < 30, and ≥30 MED/day). The slopes in MED/year of opioid dose escalation were determined for each initial MED/day group.

Results

The slopes of MED/day escalation by initial MED categories were similar (P ≥ 0.05) ranging from 5.38 to 7.76 MED annually. On average, MED/day increased in a liner pattern with a slope at 6.28 MED/year (P < 0.01).

Conclusions

Opioid MED/day increased in a linear pattern, regardless of initial MED/day dose.
Recurring Themes in Prosthetic and Orthotic Education: A Narrative Review of Prosthetic and Orthotic Education Summit Meetings
Authors: Spaulding Susan E. , Utay Joshua B. , Sachs Sheryl N.
Published: May 2023

Introduction

Prosthetic and orthotic (P&O) education summits and strategic planning meetings have been held periodically since 1970 to review the current state of practice and education and to advance the profession. These meetings typically included a panel of acknowledged experts from the ranks of educators, researchers, consumers, industry representatives, and practitioners.

Materials and Methods

A narrative review of education summit and strategic planning meeting reports was performed. The authors defined concrete aims and specific questions before conducting the review. The authors independently reviewed the reports to identify the purpose of each meeting and the perceived challenges of the time. Lastly, the authors performed a qualitative thematic analysis to clarify the findings.

Results

The recurring themes identified from the five education summit reports, joint task force report, and three National Commission on Orthotic and Prosthetic Education (NCOPE) strategic planning meeting reports include 1) workforce shortages, 2) continuous development and oversight of uniform, recognized, national academic standards, 3) sustainability of P&O academic programs, 4) development and oversight of uniform, recognized, national residency standards, 5) communication with stakeholders, including related health professionals, and 6) data collection and usage.

Conclusions

Recurring themes and challenges that existed previously in P&O education still exist today. Communication between academic programs and community partners (e.g., clinical practitioners, paraprofessionals, patients, payers, and interdisciplinary professionals) is a continuing priority to clarify the expectations of P&O professionals and to advance the profession. Use of a systematic approach could help map the patterns and needs of the profession to demonstrate progress over time and to facilitate future strategic planning.

Clinical Relevance

P&O education is designed to meet the needs of practitioners and paraprofessionals who implement P&O services (i.e., fitting, fabrication, and patient management). Maintaining communication between academia and its community partners is critical to advancing the profession.
Geographic disparities in access to liver transplantation
Authors: Yilma Mignote , Dalal Nicole , Wadhwani Sharad I. , Hirose Ryutaro , Mehta Neil
Published: May 2023

Since the Final Rule regarding transplantation was published in 1999, organ distribution policies have been implemented to reduce geographic disparity. While a recent change in liver allocation, termed acuity circles, eliminated the donor service area as a unit of distribution to decrease the geographic disparity of waitlisted patients to liver transplantation, recently published results highlight the complexity of addressing geographic disparity. From geographic variation in donor supply, as well as liver disease burden and differing model for end-stage liver disease (MELD) scores of candidates and MELD scores necessary to receive liver transplantation, to the urban-rural disparity in specialty care access, and to neighborhood deprivation (community measure of socioeconomic status) in liver transplant access, addressing disparities of access will require a multipronged approach at the patient, transplant center, and national level. Herein, we review the current knowledge of these disparities—from variation in larger (regional) to smaller (census tract or zip code) levels to the common etiologies of liver disease, which are particularly affected by these geographic boundaries. The geographic disparity in liver transplant access must balance the limited organ supply with the growing demand. We must identify patient-level factors that contribute to their geographic disparity and incorporate these findings at the transplant center level to develop targeted interventions. We must simultaneously work at the national level to standardize and share patient data (including socioeconomic status and geographic social deprivation indices) to better understand the factors that contribute to the geographic disparity. The complex interplay between organ distribution policy, referral patterns, and variable waitlisting practices with the proportion of high MELD patients and differences in potential donor supply must all be considered to create a national policy strategy to address the inequities in the system.
Influence of the Electrode Montage to Detect Ocular Vestibular Evoked Myogenic Potentials
Authors: Mat Quentin , Deggouj Naïma , Duterme Jean-Pierre , Tainmont Sophie , Lelubre Christophe , Manto Mario
Published: May 2023

Objective

To compare ocular vestibular evoked myogenic potentials (oVEMPs) obtained with three different electrode montages (infra-orbital vs belly-tendon vs chin) in a group of healthy subjects. To assess the electrical activity recorded at the level of the reference electrode in the belly-tendon and chin montages.

Study Design

Prospective study.

Setting

Tertiary referral center.

Patients

Twenty-five healthy adult volunteers.

Intervention(s)

Each ear was tested separately via air-conducted sound (500 Hz Narrow Band CE-Chirps at 100 dB nHL) for recording contralateral myogenic responses. Recording conditions were randomized.

Main Outcome Measure(s)

n1-p1 amplitudes values, interaural amplitude asymmetry ratios (ARs) and response rates.

Results

The belly-tendon electrode montage (BTEM) produced larger amplitudes than the chin (p = 0.008) and the IOEM (infra-orbital electrode montage; p < 0.001). The chin montage displayed larger amplitudes than the IOEM (p < 0.001). The interaural amplitude asymmetry ratios (ARs) were not affected by the different electrode montages (p = 0.549). In 100% of cases, oVEMPs were detected bilaterally with the BTEM which is higher than with the chin and the IOEM (p < 0.001; p = 0.020, respectively). We did not record any VEMP when placing the active electrode on the contralateral internal canthus or the chin and the reference electrode on the dorsum of the hand.

Conclusions

The BTEM increased the amplitudes recorded and response rate in healthy subjects. No positive or negative reference contamination was observed with the belly-tendon or chin montages.
Myringoplasty for Eosinophilic Otitis Media
Authors: Kikuchi Saori , Yoshida Saeko , Sugiyama Tomonori , Iino Yukiko
Published: May 2023

Objective

Surgical intervention of eosinophilic otitis media (EOM) has been considered contraindicated because middle ear surgery is associated with a risk of deafness. Myringoplasty is believed to be less invasive. Therefore, we analyzed the surgical results of myringoplasty for perforated eardrums in patients with EOM treated by biological drugs (biologics).

Study Design

Retrospective chart review.

Setting

Tertiary referral center.

Patients

Nine ears of seven patients with EOM with eardrum perforation associated with bronchial asthma were treated with add-on biologics; myringoplasty was then performed. The controls comprised 17 ears of 11 patients with EOM treated by myringoplasty without biologics.

Interventions

The EOM status of each patient of both groups was assessed using severity scores, hearing acuity, and temporal bone computed tomography scores.

Main Outcome Measures

Preoperative and postoperative changes in severity scores and hearing acuity, postoperative closure of the perforation, and relapse of EOM.

Results

Severity scores significantly decreased after the use of biologics but did not change after myringoplasty. One patient developed postoperative relapse of middle ear effusion (MEE); in the control group, however, 10 ears developed recurrence of MEE. Significant improvement of the air conduction hearing level was obtained in the biologics group. No patients showed deterioration of the bone conduction hearing level.

Conclusions

This is the first report to describe successful surgical interventions with add-on biologics for patients with EOM. In the era of biologics, surgical interventions such as myringoplasty will be indicated to improve hearing and to avoid recurrence of MEE in patients with EOM with perforated eardrums, with the use of biologics.
Anatomical Features of Children With Mondini Dysplasia: Influence on Cochlear Implantation Performance
Authors: Joo Hye Ah , Lee Dong Kyu , Lee Yun Ji , Alrehaili Bassim Mallith , AlMutawah Abdullah Ali , Kang Woo Seok , Ahn Joong Ho , Chung Jong Woo , Park Hong Ju
Published: May 2023

Objective

To analyze the long-term auditory performance after cochlear implantation (CI) and identify anatomical features of Mondini dysplasia associated with post-CI outcomes.

Study Design

Retrospective study.

Setting

Tertiary care academic center.

Patients

We enrolled 49 ears with Mondini dysplasia who underwent CI with more than 7 years of follow-up and age at CI- and sex-matched control group with radiologically normal inner ears.

Main Outcomes and Measures

The development of auditory skills after CI was evaluated using word recognition scores (WRSs). The anatomical features were measured based on temporal bone computed tomography and magnetic resonance imaging, involving the width of the bony cochlear nerve canal (BCNC), cochlear basal turn, enlarged vestibular aqueduct, cochlear height, and diameter of the cochlear nerve (CN).

Results

CI in ears with Mondini dysplasia showed comparable benefits and improvement of auditory performance to controls during the 7 years of follow-up. In Mondini dysplasia, four (8.2%) ears showed narrow BCNC (<1.4 mm) with poorer WRS (58 ± 17%) than those with normal-sized BCNC, which had WRS (79 ± 10%) comparable to that of the control group (77 ± 14%). In Mondini dysplasia, the maximum (r = 0.513, p < 0.001) and minimum (r = 0.328, p = 0.021) CN diameters had positive correlations with post-CI WRS. The maximum CN diameter (β = 48.347, p < 0.001) and BCNC width (β = 12.411, p = 0.041) were significant factors that influence the post-CI WRS in multiple regression analysis.

Conclusions

Preoperative anatomical evaluation, especially BCNC status and CN integrity, may serve as predictive markers for post-CI performance.
Exploring the Potential of Electronic Patient-Reported Outcome Measures to Inform and Assess Care in Sarcoma Centers
Authors: Geese Franziska , Kaufmann Sabine , Sivanathan Mayuri , Sairanen Kati , Klenke Frank , Krieg Andreas H. , Müller Daniel , Schmitt Kai-Uwe
Published: May 2023

Background

Electronic patient-reported outcome measures (ePROMs) are useful tools to assess care needs of patients diagnosed with cancer and to monitor their symptoms along the illness trajectory. Studies regarding the application of ePROMs by advanced practice nurses (APNs) specialized in sarcoma care and the use of such electronic measures for care planning and assessing quality of care are lacking.

Objective

To explore the potential of ePROMs in clinical practice for assessing the patient’s quality of life, physical functionality, needs, and fear of progression, as well as distress and the quality of care in sarcoma centers.

Methods

A multicenter longitudinal pilot study design was chosen. Three sarcoma centers with and without APN service located in Switzerland were included. The instruments EQ-5D-5L, Pearman Mayo Survey of Needs, the National Comprehensive Cancer Network Distress Thermometer, PA-F12, and Toronto Extremity Salvage Score were used as ePROMs. Data were analyzed descriptively.

Results

Overall, 55 patients participated in the pilot study; 33 (60%) received an intervention by an APN, and 22 (40%) did not. Patients in sarcoma centers with APN service reported overall higher scores in quality of life and functional outcome. The number of needs and distress level were lower in sarcoma centers with APN service. No differences were found with respect to patients’ fear of progression.

Conclusions

Most of the ePROMs proved to be reasonable in clinical practice. PA-F12 has shown low clinical relevance.

Implications for Practice

Using ePROMs appears to be reasonable to obtain clinically relevant patient information and to evaluate the quality of care in sarcoma centers.
Staff and Proxy Views of Multiple Family Member Involvement in Decision Making for Nursing Home Residents With Advanced Dementia
Authors: Roach Ashley , Rogers Anita Hendrix , Mitchell Susan L. , McCarthy Ellen P. , Lopez Ruth Palan
Published: May 2023

Decision making for nursing home (NH) residents with Alzheimer disease and related dementias often involves input from multiple family members and NH staff to address goals of care at the end of life. Using data from the Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life research study, a secondary analysis of qualitative data was conducted involving interviews of 144 NH staff and 44 proxies in 14 NHs to examine the perspectives of NH staff and proxies for NH residents with Alzheimer disease and related dementias on the involvement of multiple family members in decision making about end-of-life care decisions. Interviews took place between 2018 and 2021. Nursing home staff and proxies had differing perspectives of the involvement of multiple family members in decision making, with NH staff primarily viewing families as a source of conflict, whereas proxies viewed families as a source of support. Nursing home staff also had differing opinions of their role with families; some attempted to ameliorate conflict, and some did not get involved. Some NH staff felt that Black families had more conflict than White families, indicating unacceptable bias and stereotyping of Black families by NH staff. These findings suggest training and education is needed for NH staff to facilitate better communication with families and to support proxies in end-of-life decision making to address goals of care for NH residents with Alzheimer disease and related dementias.
Suicide or Homicide? A Case of Self-Inflicted Triple Gunshot Wound by Double-Barrel Shotgun
Authors: Tarozzi Ilaria , Bugelli Valentina
Published: May 2023

Differential diagnosis between suicide and homicide by firearms is still a major challenge in forensic practice, especially when multiple gunshot wounds are present. A case of self-inflicted triple wound by double-barrel shotgun is presented. A 73-year-old White male patient was found dead in a wooden area. According to investigations, he had disappeared from home the day before. The corpse was covered with clothing in a prone position on a gravel road, a short distance from a car with driver-side-door open and keys in the ignition. Next to the body, a 12-gauge double-barrel shotgun was found, with 3 fired cartridges and 1 unused in the left front pocket of the trousers. No signs of struggle were present. Two penetrating wounds in the upper torso were detected by postmortem computer tomography. Autopsy showed 2 near-contact entrance wounds in the pectoral region bilaterally, each associated with exit wounds in the omni lateral hip. Only organs of “delayed incapacitation” were injured. Death was determined to be a suicide. This uncommon case of self-inflicted triple wound by shotgun highlights the importance to integrate proper analysis of the scene with autopsy findings in order to avoid misinterpretation of a suicidal death as a homicide.
Influencing the insulin system by placebo effects in patients with diabetes type-2 and healthy controls: A randomized controlled trial
Authors: Skvortsova Aleksandrina , Veldhuijzen Dieuwke S. , van Dillen Lotte F. , Zech Hilmar , Derksen Suzanne M.J.C. , Sars Ruben H. , Meijer Onno C. , Pijl Hanno , Evers Andrea W.M.
Published: May 2023

Objective

The objective of this study was to investigate whether placebo effect induced by pharmacological conditioning with intranasal insulin can affect glucose, insulin, c-peptide, hunger and memory in patients with diabetes type-2 and healthy controls.

Methods

Placebo effect was induced by pharmacological conditioning. Thirty-two older patients (mean age = 68.3) with diabetes type-2 and age and sex matched thirty-two healthy older adults (mean age = 67.8) were randomly assigned to a conditioned or a control group. On day 1, conditioned group received 6 administrations of intranasal insulin with a CS (smell of rosewood oil) while the control group received a placebo with the CS. On day 2, both groups received a placebo spray with the CS. Glucose, insulin and c-peptide were repeatedly measured in blood. Hunger and memory were assessed with validated measures.

Results

Intranasal insulin stabilized dropping glucose levels in patients (B = 0.03, SE = 0.02, p = 0.027) and healthy men (B = 0.046, SE = 0.02, p = 0.021), and decreased C-peptide levels in healthy controls (B = 0.01, SE = 0.001, p = 0.008). Conditioning also prevented the drop of glucose levels but only in men (both healthy and patients) (B = 0.001, SE = 0.0003, p = 0.024). Conditioning significantly decreased hunger in healthy participants (B = 0.31, SE = 0.09, p < 0.001). No effects were found on other measures.

Conclusions

Placebo effect induced by conditioning with intranasal insulin modify blood glucose levels and decrease hunger in older adults but its effects depend on health status and sex. Insulin conditioning might be beneficial for groups suffering from intensive hunger but seems not be particularly suitable for blood glucose reduction.

Trial registration. Netherlands Trial Register, NL7783 (https://www.trialregister.nl/trial/7783).
Patient-Reported Quality of Life after Breast Conserving Surgery with Radiotherapy versus Mastectomy and Reconstruction
Authors: Diao Kevin , Lei Xiudong , He Weiguo , Jagsi Reshma , Giordano Sharon H. , Smith Grace L. , Caudle Abigail , Shen Yu , Peterson Susan , Smith Benjamin D.
Published: May 2023

Objective:

To compare long-term QOL outcomes in breast cancer survivors who received breast conserving surgery with radiotherapy (BCS+RT) with those who received mastectomy and reconstructive surgery (Mast+Recon) without RT and identify other important factors.

Summary Background Data:

The long-term differences in patient-reported QOL outcomes following BCS+RT and Mast+Recon are not well understood.

Methods:

We identified patients from the Texas Cancer Registry with stage 0-II breast cancer diagnosed 2009-2014 after BCS+RT or Mast+Recon without RT. Sampling was stratified by age and race and ethnicity. A paper survey was sent to 4,800 patients which included validated BREAST-Q and PROMIS modules. Multivariable linear regression models were implemented for each outcome. Minimal clinically important difference for BREAST-Q and PROMIS modules, respectively, was 4 points and 2 points.

Results:

Of 1,215 respondents (25.3% response rate), 631 received BCS+RT and 584 received Mast+Recon. The median interval from diagnosis to survey completion was 9 years. In adjusted analysis Mast+Recon was associated with worse BREAST-Q psychosocial well-being (effect size −3.80, P=0.04) and sexual well-being (effect size −5.41, P=0.02), but better PROMIS physical function (effect size 0.54, P=0.03) and similar BREAST-Q satisfaction with breasts, physical well-being, and PROMIS upper extremity function (P>0.05) compared to BCS+RT. Only the difference in sexual well-being reached clinical significance. Older (≥65) patients receiving BCS+RT and younger (<50) patients receiving autologous Mast+Recon typically reported higher QOL scores. Receipt of chemotherapy was associated with detriments to multiple QOL domains.

Conclusions:

Patients who underwent Mast+Recon reported worse long-term sexual well-being compared to BCS+RT. Older patients derived a greater benefit from BCS+RT while younger patients derived a greater benefit from Mast+Recon. These data inform preference-sensitive decision making for women with early-stage breast cancer.