bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidural abscess formation with an atypical pathogen following epidural steroid injection: A case report
Authors: Lee Jae Young , Kim Jun Woo , Na Yong Jae , Kim Taikon , Han Seung Hoon
Published: September 2022

Rationale:

Subcutaneous and epidural abscesses following epidural injection are a serious but rare complication. Epidural abscesses are typically caused by Staphylococcus aureus bacterial infection. In this case presented here, the causative bacterium was Enterococcus faecalis.

Patient concerns:

A 67-year-old woman having chronic lower back and right leg pain with past history of 20 years of rheumatoid arthritis, diabetes mellitus, and osteoporosis (T-score: −2.7) visited the outpatient pain clinic. Magnetic resonance imaging (MRI) revealed L4-5 right central disc extrusion with inferior migration. We performed a continuous epidural block for 7 days without complications. After 10 days, she presented with worsened low back pain, erythematous skin change on the lower back, chilling, and elevated serum acute phase reactants.

Diagnosis:

The diagnosis was subsequently confirmed by MRI suggesting subcutaneous and epidural abscess. Blood and pus cultures showed the growth of E. faecalis.

Interventions:

Pigtail catheter drainage was performed and intravenous antibiotics (ampicillin-sulbactam) targeting E. faecalis were applied for 3 weeks. Oral antibiotics (amoxicillin/potassium clavulanate) were applied for 6 weeks after discharge.

Outcomes:

At the 2-month follow-up, improvement in both the clinical condition and serum acute phase reactants levels were noted.

Lessons:

Epidural injection can lead to a subcutaneous abscess that is further extended into the epidural space. One of the key factors is the presence of comorbid conditions, including diabetes mellitus and prolonged steroid usage due to rheumatoid arthritis.
Effects of high-intensity statin combined with telmisartan versus amlodipine on glucose metabolism in hypertensive atherosclerotic cardiovascular disease patients with impaired fasting glucose: A randomized multicenter trial
Authors: Lee Chan Joo , Sung Jung-Hoon , Kang Tae-Soo , Park Sungha , Lee Sang-Hak , Kim Jong-Youn , Kim Byeong-Kuek
Published: September 2022

Background:

There is lacking evidence that telmisartan can improve insulin resistance in patients on high-intensity statins. This study compared the effects of telmisartan and amlodipine on glucose metabolism in hypertensive atherosclerotic cardiovascular disease (ASCVD) patients with impaired fasting glucose (IFG) requiring high-intensity rosuvastatin therapy.

Methods:

Ninety-nine patients were randomly assigned to 2 groups [telmisartan-statin group (n=48) and amlodipine-statin group (n=51)] as add-on therapy to high-intensity rosuvastatin therapy (20 mg). The primary endpoint was to assess insulin resistance using the homeostatic model assessment (HOMA-IR) value at week 24. The secondary endpoint was the change in glucose metabolism indices from baseline to week 24.

Results:

The HOMA-IR at week 24 (2.4 [interquartile range, 1.8–3.8] versus 2.7 [1.7–3.7]; P = .809) and changes in the HOMA-IR from baseline to week 24 (−7.0 [−29.0 to 21.0] versus −5.5 [−53.3 to 27.3]; P = .539) were not significantly different between 2 groups. However, the fasting glucose level at week 24 was significantly lower in the telmisartan-statin group than in the amlodipine-statin group (107.7 ± 13.4 mg/dL versus 113.3 ± 12.4 mg/dL; P = .039) and significantly decreased in the telmisartan-statin group (−3.2 ± 8.6% versus 3.8 ± 13.2%; P = .003). The proportion of patients with fasting glucose ≥100 mg/dL (71.1% versus 89.6%; P = .047) or new-onset diabetes mellitus (12.5% versus 31.4%, P = .044) at week 24 was also significantly lower in the telmisartan-statin group than in the amlodipine-statin group.

Conclusion:

In comparison to amlodipine, telmisartan did not decrease the HOMA-IR. However, telmisartan preserved insulin secretion, led to a regression from IFG to euglycemia and prevented new-onset diabetes mellitus in ASCVD patients with IFG requiring high-intensity statins.
The benefit of radiotherapy in distant metastatic small-cell lung cancer: A retrospective study based on propensity score matching (PSM)
Authors: Qie Shuai , Shi Hongyun , Wang Fang , Liu Fangyu , Zhang Xin , Sun Xiaoyue
Published: September 2022

Due to extensive tumor spread, systemic chemotherapy is the main treatment for distant metastatic small-cell lung cancer (DM-SCLC). It is still unclear whether adding local radiotherapy (RT) on the basis of chemotherapy can improve the long-term survival of patients with DM-SCLC. This study aims to explore the population with DM-SCLC who can benefit from RT. Patients with metastatic SCLC with complete data were collected from the Surveillance, Epidemiology, and End Results database and divided into 2 groups according to whether RT was given or not. The propensity score matching method was used to balance the covariate differences between the RT group and the non-RT group. Lasso Cox regression model and Cox proportional hazards regression analyses were used to identifying independent risk factors affecting survival. Kaplan–Meier method was used to calculate the survival rate. P < .05 was considered statistically significant. After matching, there were 3150 patients in both groups. Sex, tumor size, N stage, RT, chemotherapy, brain metastasis, liver metastasis, age, and site metastasis were independent factors of survival in DM-SCLC. The 1- and 2-year survival rates were 24.5% and 5.8% in the RT group and 14.8% and 2.3% in the non-RT group (P < .001). The median survival time of the RT group was 9 months, and that of the non-RT group was 7 months, and the difference was statistically significant (P < .001). RT improved survival in all sex subgroups, any N stage subgroup, any tumor size subgroup, no brain metastases subgroup, no liver metastases subgroup, any age subgroup, and 1-2 organ metastases subgroup. RT improves 1- and 2-year survival in DM-SCLC.
Alberta Stroke Program Early CT Score applied to hyperdense lesion on noncontrast CT immediately post-thrombectomy is a predictor of poor outcome in acute ischemic stroke: A case-control study
Authors: Yuan Zhengzhou , Yang Yuan , Luo Ying , Chen Xiu , Luo Hua , Li Jinglun , Meng Renliang , Xie Yang , Jiang Li , Lv Zhiyu , Rong Benbing , Li Zuoxiao
Published: September 2022

We aimed to evaluate whether Alberta Stroke Program Early CT Score (ASPECTS) applied to hyperdense lesion on noncontrast CT obtained immediately post-thrombectomy (post-ASPECTS) is useful for predicting poor outcome. We retrospectively reviewed patients who underwent noncontrast CT (NCCT) immediately after mechanical thrombectomy between January 2017 and July 2020 in our comprehensive stroke center. We collected baseline NCCT and post-ASPECTS score. The sensitivity, specificity, and positive and negative predictive values of the post-ASPECTS in predicting clinical outcome were calculated. A total of 223 patients were included. The hyperdense lesion on NCCT immediately after endovascular thrombectomy presented in 85.7% (191/223) patients, poor clinical outcome was in 56.1% (112/191) of hyperdense lesion patients. Low post-ASPECTS was associated with poor outcome (OR 0.390; 95% CI 0.258-0.589; P = .001), with an AUCROC curve of 0.753 (95% CI 0.684–0.822), while baseline NCCT-ASPECTS was not (OR 0. 754; 95% CI 0. 497-1.144; P = .185). A score ≤ 7 in post-ASPECTS was the best cut-off to poor clinical outcome (sensitivity 84.8%; specificity 52.7%; positive predictive value 68.4%; negative predictive value 73.8%). Our results point to the proportion of patients who present hyperdense lesion on NCCT is very high, post-ASPECTS could predict poor clinical outcomes in patients with stroke treated with endovascular mechanical thrombectomy, and post-ASPECTS may achieved better predictive value than baseline ASPECTS.
The influence of marital status on survival in patients with nasopharyngeal carcinoma: A surveillance, epidemiology, and end results database analysis
Authors: Yu Bin , Lin Fei , Duan Jie , Ning Hong
Published: September 2022

Background:

To assess the influence of marital status on the survival of patients with nasopharyngeal carcinoma (NPC), we used the Surveillance, Epidemiology, and End Results (SEER) database to analyze 5477 patients who were diagnosed with NPC from 2004 to 2016.

Methods:

Kaplan–Meier survival analysis and Cox proportional hazard regression were used to analyze the influence of marital status on cause-specific survival (CSS) and overall survival (OS). Subgroup analyses was used to assess the influence of marital status on CSS based on different factors.

Results:

For the 5477 patients, 61.5%, 22.4%, and 16.1% were married, single/unmarried, and separated/widowed/divorced, respectively. The separated/widowed/divorced group was more likely to be female (P < .001), had the highest proportion of elderly subjects (P < .001), were mostly Caucasian (P < .001), had pathological grade I/II (P < .001), were likely to undergo surgery (P = .032), and were registered in the northeast, north-central, and south (P < .001) regions. The 5-year CSS rates were 92.6%, 92.4%, and 85.1% in the married, single/unmarried, and separated/widowed/divorced groups, respectively (P < .001), and the 5-year OS rates were 60.7%, 54.6%, and 40.1%, respectively (P < .001).

Conclusion:

Marital status is an independent prognostic factor of NPC. Separated/widowed/divorced patients had a significantly increased risk of NPC-related death (hazard ratio [HR] = 2.180, 95% confidence interval [CI] 1.721–2.757, P < .001) compared to married patients. The single/unmarried (P = .355) group had a CSS similar to that of the unmarried group. Marital status is an independent prognostic factor of survival in NPC patients. Separated/widowed/divorced status increases the risk of NPC mortality.
Posterior reversible encephalopathy in a pregnant woman without preeclampsia or eclampsia: A case report
Authors: Zhang Yi , Liang Bing , Zhao Cuiping , Zhou Yi , Yan Chuanzhu
Published: September 2022

Background:

We report a case of a pregnant woman who presented posterior reversible encephalopathy syndrome (PRES) without pre-eclampsia, eclampsia, or any other common causes of PRES.

Methods:

A 32-year-old primigravida at 25 weeks and 4 days of gestation was admitted to neurology department because of suffering intermittent headache, hearing loss, memory loss with mental and behavioral disorder, and blurred vision for 1 month. She was healthy before without hypertension, migraine, or other medical or family history. Brain magnetic resonance imaging (MRI) revealed diffuse symmetrical high-signal intensity lesions in the white matter, medulla oblongata, without enhancement. After completely multidisciplinary discussion and with the family of the patient, she accepted termination of pregnancy.

Results:

After the operation, the patient improved symptomatically. The follow-up MRI showed a decrease of the white matter lesion after 3 months and complete recovery at postoperative 6 months. The patient returned to work without any neurological sequelae.

Conclusion:

It might widen the cause spectrum of PRES that pregnancy itself without pre-eclampsia, eclampsia, or any other known risk factors could cause PRES. Pregnancy with acute or subacute leukoencephalopathy should be screened related causes and risk factors carefully. Hormonal fluctuations during the pregnancy might account for pregnancy-related PRES.
Prognostic factors for mobility in children with osteogenesis imperfecta
Authors: Sawamura Kenta , Kitoh Hiroshi , Kaneko Hiroshi , Kitamura Akiko , Hattori Tadashi
Published: September 2022

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by bone fragility. Although the disease severity is known to influence the ability to walk, little is known about how children with severe OI can achieve practical ambulation (PA). This study aimed to determine the early predictors of future mobility in children with OI. Thirty OI patients with an average age of 12.1 years were classified into the PA group (22 patients) and nonambulator group (NA group: 8 patients) on the basis of the Hoffer classification. Various clinical parameters related to mobility were compared between the PA and NA groups. Therapeutic interventions were also compared between the 2 groups. The mean age at diagnosis and initial fracture were significantly lower in the NA group than in the PA group. The height was significantly smaller in the NA group than in the PA group at all ages examined (at birth, 3 years, and 6 years). The number of patients with respiratory failure was significantly higher in the NA group than in the PA group. The age at initial corrective osteotomy of the lower extremities in the PA group was significantly lower than that in the NA group, although there was no significant difference in the disease severity in infancy between the groups. Height during infancy, age at initial fracture, and neonatal respiratory status could be prognostic factors for mobility in OI. Surgical interventions at an early age may influence walking ability in children with moderate OI.
Predictive value of combining maternal peripheral blood count indicators for early-onset sepsis in preterm infants: A retrospective cohort study
Authors: Yan Yiwei , Jiang Lian , Li Mei , Zhang Wenhao , Yu Lingjuan , Zhang Yuansu
Published: September 2022

To assess the early predictive value of maternal parameters for early-onset sepsis (EOS) in preterm infants, especially including the maternal neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV). The retrospective cohort study examined a total of 231 preterm infants (69 with EOS) from May 2017 to October 2021 of the Fourth Hospital of Hebei Medical University, randomly divided (7:3) into the training set group (n = 162) and validation set group (n = 69). Thirteen clinical variables (including MPV, NLR, and PLR) were included as the research objects. By logistic regression, the factors significantly associated with EOS were distinguished. Additionally, a nomogram was constructed based on the independent risk factors, the validation of which relied on the concordance index, calibration curves, receiver operating characteristic curves, and decision curve analyses. Multivariate logistic regression proved that NLR (OR = 1.67, 95% CI = 1.18–2.36, P = .004), PLR (OR = 1.03, 95% CI = 1.01–1.04, P = .001), and MPV (OR = 1.75, 95% CI = 1.15–2.66, P = .009) were independent risk factors for EOS. The AUC of the nomogram for the training set group was 0.872 (0.814, 0.931) and 0.889 (0.843, 0.935) in the validation set group. The P values of Hosmer–Lemeshow test for the training set and validation set groups were .903 and .752, respectively. The decision curve analyses outcome indicated good clinical practicability. The C-index for the training set and validation set groups were 0.872 and 0.889, respectively. The maternal NLR, PLR, and MPV levels had good predictive value for EOS in premature infants. The nomogram in our study could help clinicians predict the occurrence of EOS.
Leiomyomatosis peritonealis disseminata with low-grade malignant change: A case report
Authors: Ye Zhongxue , Chen Lu
Published: September 2022

Background:

Leiomyomatosis peritonealis disseminata (LPD) is a rare disease characterized by multiple leiomyomas spread all over the peritoneal cavity. It is commonly described as benign in women of reproductive age. Malignant LPD is much rarer.

Methods:

We present a case of LPD with low potential malignant change in a 43-year-old female, who felt a lump in her abdomen after laparoscopic myomectomy 10 years ago and laparoscopic hysterectomy 8 years ago. The patient underwent exploratory laparotomy and salpingectomy, greater omentectomy, and pelvic and abdominal mass resection were performed during the surgery. The pathological findings revealed LPD with low potential malignant change, with strong expression of estrogen receptor and progesterone receptor. The patient refused oophorectomy and chose gonadotropin-releasing hormone agonists injection postoperatively.

Results:

No recurrence was found during the follow-up to date.

Conclusion:

Surgery is the main treatment for LPD, and endocrine therapy is another choice. Although it is reported mostly benign, we need to be alert to the possibility of malignancy.
Daily output measures of Emergency Department in association with seasonality and day of the week: A retrospective cohort observational study
Authors: Gabbay Uri , Drescher Michael J
Published: September 2022

To evaluate the daily output measures of the emergency department (ED) in association with seasonality and the day of the week. A retrospective cohort of ED visits to tertiary medical centers between 2016 and 2020. The research unit was each day during the study period. The independent variables were season and day of the week. The dependent variables were ED visits, admission and dropout rates, and duration of ED discharge. The comparison of means was evaluated using ANOVA. Statistical significance was set at P < .05. There were 1826 days, 792 thousand visits, 58% were female. Admission rate 28%, duration to discharge 3.8 h, dropout rate 2%. The average daily visits by season ranged from 101% of the overall average in autumn to 97% in spring. Average daily visits by day of the week were significantly different, with the highest on Sunday (Israel’s first working day of the week), 124% of the overall daily average, and the lowest on Saturday (weekly day off) with 70%. Saturdays had the highest admission rate of 30% and 28% of the overall rate. There was a moderate dependency between the ED duration and discharge, with a dropout rate of r
2 = 0.19. The average daily visits were not affected by season but differed considerably by day of the week. Admission rates varied slightly by season but were similar by day of the week apart from Saturdays. This may be attributable to the case mix on Saturdays or less restriction to admit when the number of visits is low. We recommended each Emergency Department to evaluate its daily output measures dependency with seasonality and day of the week for operational optimization.
Identification of a predictive gene signature related to pyroptosis for the prognosis of cutaneous melanoma
Authors: Shi Zhaoyang , Gu Jiaying , Yao Yi , Wu Zhengyuan
Published: September 2022

Pyroptosis is a form of inflammatory programmed cell death. However, because of no specific molecular biomarker, pyroptosis has not been considered as a novel therapeutic method to treat cutaneous melanoma (CM). Here, we identified pyroptosis genes that associate with the prognosis of CM patients and constructed an effective model for the prognostic prediction of CM patients. To identify genes related to pyroptosis that are differentially expressed in CM, we obtained gene expression data of CM patients and normal skin tissues from the Cancer Genome Atlas and the Genotype-Tissue Expression databases, and used another cohort obtained from Gene Expression Omnibus database for validation. Three genes (BST2, GBP5, and AIM2) that were associated with prognosis were found and incorporated into our prognostic model. Furthermore, we divided the patients into 2 groups: a high-risk group and a low-risk group. Functional analyses indicated that our model was correlated with patient survival and cancer growth. Multivariate and univariate Cox regressions revealed that the constructed model could serve as an independent prognostic factor for CM patients. Meanwhile, compared with other clinical characteristics, our model significantly improved the diagnostic accuracy. Gene function analysis revealed that pyroptosis genes BST2, GBP5, and AIM2 were differentially expressed in CM patients and positively associated with patient prognosis. Finally, a risk score was used to generate nomograms that displayed favorable discriminatory abilities for CM. In summary, our model could significantly predict the prognosis of CM patients and be used for the development of CM therapy.
Host-directed immunotherapy to fight infectious diseases
Authors: Langelier Mélanie J. , Vinh Donald C.
Published: September 2022

Purpose of review

This review provides readers with examples of refractory infections due to inborn errors of immunity, highlighting how they may be successfully treated by deducing and targeting the underlying immunodeficiency.

Recent findings

The use of host-directed immunotherapy to treat infectious disease in inborn errors of immunity is currently limited but growing. Different strategies include depleting the cellular reservoir for pathogens with restricted cell-tropism; augmenting the diminished effector response; and restoring molecular equipoise. The immunotherapies illustrated are existing drugs that have been re-purposed and rationally used, depending on the molecular or cellular impact of the mutation. As more biologic response modifiers and molecular targeted therapies are developed for other indications, they open the avenues for their use in inborn errors of immunity. Conversely, as more molecular pathways underlying defective immune responses and refractory infections are elucidated, they lend themselves to tractability with these emerging therapies.

Infections that fail appropriate antimicrobial therapy are a harbinger of underlying inborn errors of immunity. Dissecting the mechanism by which the immune system fails provides opportunities to target the host response and make it succeed.
An update on teratogens for pediatric healthcare providers
Authors: Valladares Daniel A. , Rasmussen Sonja A.
Published: September 2022

Purpose of review

To review updates regarding teratogens and give pediatric healthcare providers insight into the prevention of teratogenic exposures.

Recent findings

Application of the principles of teratology can help to assess the potential for exposures to be teratogenic. Identification of Zika virus as a teratogen, the most recent teratogenic agent identified, allowed public health measures to be put in place to mitigate its spread. Risk management strategies for teratogenic medications have resulted in a decrease but often not elimination of prenatal exposures. The failure to include pregnant persons in clinical trials results in their being less likely to receive needed medications and vaccines in a timely manner.

Pediatricians play an important role in the prevention of teratogenic exposures. Ensuring optimal management of patients with chronic illnesses that might increase their risk of birth defects during pregnancy due to the illness itself or its treatment is essential. For patients with pregnancy potential who are on teratogenic medications, ensuring effective contraception is also important. Inclusion of pregnant persons in clinical trials and research studies will be critical to advancing our knowledge of the safety of medications and other exposures during pregnancy.
Role of cytoreductive surgery in the era of immunotherapy
Authors: Isali Ilaha , Braun Avery , Bukavina Laura , Psutka Sarah P.
Published: September 2022

Purpose of review

The benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) was first called into question in the tyrosine kinase inhibitors (TKIs) era. It remains undefined in the context of the recent development and approval of immune checkpoint inhibitors (ICIs) and level one evidence supporting the rapid adoption of dual ICI and combination ICI + TKI therapeutic approaches for mRCC. Our objective is to synthesize the available contemporary data regarding the safety, feasibility, and oncologic outcomes with CN for mRCC in the age of immunotherapy as well as to highlight trials in progress that will address this key knowledge gap.

Recent findings

Data from the SURTIME and CARMENA trials provided insight to guide patient selection for CN in patients with mRCC receiving TKI-based treatment strategies. At present, there is a body of retrospective data supporting the safety and oncologic efficacy of CN in carefully selected patients with mRCC in both the upfront and delayed setting. The results of ongoing trials evaluating the safety and feasibility for CN as well as optimal patient selection and sequencing strategies are eagerly awaited.

Although the optimal selection criteria and timing for CN remains to be established for patients with mRCC in the immunotherapy era, the available body of evidence underscores the importance of careful patient selection. Ongoing prospective studies, such as Cyto-KIK, PROBE, and NORDIC-SUN, will better define the role of CN in the rapidly evolving treatment landscape for mRCC.
Adrenal functional imaging – which marker for which indication?
Authors: Werner Rudolf A. , Hartrampf Philipp E. , Schirbel Andreas , Hahner Stefanie
Published: September 2022

Purpose of review

In recent years, a broad spectrum of molecular image biomarkers for assessment of adrenal functional imaging have penetrated the clinical arena. Those include positron emission tomography and single photon emission computed tomography radiotracers, which either target glucose transporter, CYP11B enzymes, C-X-C motif chemokine receptor 4, norepinephrine transporter or somatostatin receptors. We will provide an overview of key radiopharmaceuticals and determine their most relevant clinical applications, thereby providing a roadmap for the right image biomarker at the right time for the right patient.

Recent findings

Numerous radiotracers for assessment of adrenal incidentalomas ([18F]FDG; [123I]IMTO/IMAZA), ACC ([123I]IMTO/IMAZA; [18F]FDG; [68Ga]PentixaFor), pheochromocytomas and paragangliomas ([123I]mIBG; [18F]flubrobenguane; [18F]AF78; [68Ga]DOTATOC/-TATE), or primary aldosteronism ([11C]MTO, [68Ga]PentixaFor) are currently available and have been extensively investigated in recent years. In addition, the field is currently evolving from adrenal functional imaging to a patient-centered adrenal theranostics approach, as some of those radiotracers can also be labeled with ß-emitters for therapeutic purposes.

The herein reviewed functional image biomarkers may not only allow to increase diagnostic accuracy for adrenal gland diseases but may also enable for achieving substantial antitumor effects in patients with adrenocortical carcinoma, pheochromocytoma or paraganglioma.
Pancreatitis in the Complex Care Population: Presentation, Incidence, and Severity
Authors: Hawa Kathryn , Corker Lisa , Hornung Lindsey , Noritz Garey , Gariepy Cheryl , Shaikhkhalil Ala , Abu-El-Haija Maisam
Published: September 2022

Objectives:

To describe the incidence and presentation of pancreatitis in Children with Medical Complexity (CMC) while evaluating severity of disease and outlining risk factors.

Methods:

This was a retrospective chart review between January 2010 and December 2019 of patients seen in the complex care clinic at Nationwide Children’s Hospital (NCH) and Cincinnati Children’s Hospital Medical Center (CCHMC). Data collected included sex, underlying diagnosis, family history of pancreatitis, type of pancreatitis, signs/symptoms, abdominal imaging, severity of attack, and presence of various risk factors associated with pancreatitis. Severity and diagnosis of pancreatitis was determined based on North American Society for Pediatric Gastroenterology, Hepatology and Nutrition criteria.

Results:

One hundred and twelve patients from both institutions were included, 62% from NCH, median age 11.5 [interquartile range (IQR): 5–16 years], 50% male. Most patients were less than 18 years of age with a median age of 8 years (IQR: 4–13 years). Underlying diagnoses included seizures (67%), cerebral palsy/spastic quadriplegia (65%), diabetes (3.6%), and mitochondrial disease (3%). Majority of patients were found to have multiple underlying diagnoses (88%). Incidence of pancreatitis for both institutions was 336 of 100,000 patients/year which is significantly higher than the general pediatric population (P < 0.0001). Majority of first episodes of pancreatitis were mild (82%) with abdominal pain as the predominant symptom (50%). Adult patients were more likely to have pancreatitis related to medication use than pediatric patients (70% vs 38%, respectively P = 0.007).

Conclusions:

Individuals in the CMC population at our institutions have a high incidence of pancreatitis with unique risk factors compared to the general pediatric/young adult populations.
Evaluation of secondary complication awareness among individuals with spinal cord injury
Authors: Korkmaz Nurdan , Yardimci Gokhan , Ülgen Esra , Köroğlu Özlem , Yilmaz Bilge
Published: September 2022

Secondary complications (SCs) are common and cause high morbidity and mortality in individuals with spinal cord injury (SCI). There is no information or a satisfactory scale of measurement for evaluating the opinions of individuals with SCI on whether they have sufficient knowledge about these complications. This study aimed to evaluate the opinions of individuals with SCI about whether they have sufficient information on SCI-related SCs. Demographic and clinical characteristics of 64 SCI individuals were recorded. A questionnaire was applied to evaluate the opinions of the participants and whether they have sufficient information about SCs before and after a multidisciplinary rehabilitation for SCI. A test was performed to measure the knowledge level at admission to the hospital and discharge. The mean value of the total questionnaire score, which was 6.2 at admission, increased to 7.91 at discharge (P < 0.001). All subgroup scores of the questionnaire were higher at discharge than at admission (all P < 0.05). Total, neurogenic bladder, neurogenic bowel and spasticity test scores increased at discharge compared to admission (all P < 0.05). There is a relationship between the change in questionnaire scores and some demographic and injury characteristics. The opinions of the individuals with SCI on having sufficient information about SCs and their knowledge levels increased after a multidisciplinary rehabilitation program. Applying such a questionnaire and test at admission may have increased the awareness of the participants about SCs and contributed to a higher level of knowledge and opinion.
Derivation of a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis
Authors: Amano Tetsuya , Tamari Kotaro
Published: September 2022

The aim of this study was to derive a screening tool for predicting the risk of falls in community-dwelling older adults with knee osteoarthritis. This prospective cohort study was conducted in four orthopedic clinics. The main outcome measure was falls or nonfalls for 5 months, and the predictors were sex, age, BMI, Kellgren–Lawrence grade, laterality, number of comorbidities, pharmacotherapy, physical therapy period, use of a cane, household, previous history of falls, visual analog scale for pain, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and Frenchay activities index. Ninety outpatients (74 females and 16 males) with a mean (SD) age of 73.1 (9.3) years completed a 5-month follow-up. According to the binomial logistic regression analysis, previous history of falls [odds ratio (OR), 6.85; P = 0.019], OLST (OR, 5.97; P = 0.048), and FTSST (OR, 12.93; P = 0.034) were identified as risk factors for falls, and the clinical prediction rule was derived from these variables. The pretest probability of fallers in this study was 21.1% (19 of 90 participants). When the total screening tool score was three points (the participant scored one point for each item: previous history of falls, yes; OLST, ≤6.84 s; FTSST, ≥8.77 s), the positive likelihood ratio was 16:19, and the posttest probability increased to 81.3%. Therefore, this simple screening tool possesses potential clinical utility for identifying patients with knee osteoarthritis at high risk of falls in the future because it demonstrated sufficient diagnostic test accuracy.
Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy
Authors: Lin Yufen , Bailey Donald E. , Xiao Canhua , Hammer Marilyn , Paul Steven M. , Cooper Bruce A. , Conley Yvette P. , Levine Jon D. , Kober Kord M. , Miaskowski Christine
Published: September 2022

Background

Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life.

Objectives

Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics.

Methods

Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses.

Results

Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function.

Conclusions

Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers.

Implications for Practice

Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
Effectiveness of a Multimodal Nursing Intervention on Quality of Sleep, Fatigue, and Level of Depression Among Indonesian Patients With Gynecological Cancer
Authors: Erfina Erfina , Nurmaulid Nurmaulid , Hariati Suni , Andriani Andriani , McKenna Lisa
Published: September 2022

Background

The use of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important in providing holistic care. However, limited studies have reported on integrating nonpharmacological interventions to improve physical and psychological symptoms of women with gynecological cancer.

Objective

The aim of this study was to examine the effect of a multimodal nursing intervention (MNI) on sleep quality, fatigue, and level of depression among Indonesian women with gynecological cancer.

Methods

The quasi-experimental nonequivalent group design involved 50 patients in 2 groups and used convenience sampling. An experimental group (n = 25) received MNI including progressive muscle relaxation and a counseling session; the control group received routine hospital care (n = 25). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), depression levels by the Beck Depression Inventory-II, and fatigue by the Piper Fatigue Scale (PFS). Pretest data were collected after 3 days of hospital admission; posttest data were gathered after the intervention.

Results

The PSQI (P = .000), Beck Depression Inventory-II (P = .008), and PFS (P = .000) changed significantly in the intervention group; the PSQI (P = .000) and PFS (P = .000) in the control group changed significantly. The PSQI (P = .00) and PFS (P = .000) scores differed significantly between the 2 groups before and after the intervention. The effect size of the MNI for difference scores before and after the intervention was medium effect size.

Conclusions

The role of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important to providing holistic care.

Implication for Practice

Gynecology nurses can lead the implementation of MNI to decrease patient fatigue and depression and to increase sleep quality.
Capturing patient-reported outcomes: paper versus electronic survey administration
Authors: Nguyen Mai P. , Rivard Rachael L. , Blaschke Breanna , Vang Sandy , Schroder Lisa K. , Cole Peter A. , Cunningham Brian P.
Published: September 2022

Objective: To compare the capture rates and costs of paper patient-reported outcomes (pPRO) administered in-clinic and electronic PROs (ePRO) collected through emails and texts.

Design: Retrospective review.

Setting: Level 1 trauma center.

Patients/Participants: The pPRO program enrolled 2164 patients for postsurgical follow-up in 4 fracture types: ankle, distal radius, proximal humerus, and implant removal from 2012 to 2017. The ePRO program enrolled 3096 patients in 13 fracture types from 2018 to 2020. Among the patients enrolled in the ePRO program, 1296 patients were matched to the 4 original fracture types and time points.

Main Outcome Measures: PRO capture rates in 4 fracture types by matched time point and estimated cost of each program per enrolled patient.

Results: At first follow-up, pPRO provided a higher capture rate than ePRO for 3 of 4 fracture types except for implant removal (P < 0.05). However, at 6-month and 1-year follow-ups, ePRO demonstrated statistically significant higher capture rates when compared with pPRO for all applicable modules (P < 0.05). The average cost for the pPRO program was $171 per patient versus $56 per patient in the ePRO program. Patients were 1.19 times more likely to complete ePRO compared with pPRO (P = 0.007) after controlling for age, sex, fracture type, and time point.

Conclusion: The electronic PRO service has improved long-term capture rates compared with paper PROs, while minimizing cost. A combined program that includes both in-clinic and out of clinic effort may be the ideal model for collection of PROs.

Level of Evidence: Level 3.
Comparison of Bedside and Video-Based Capillary Refill Time Assessment in Children
Authors: Nickel Amanda J. , Hunter Ryan Brandon , Jiang Shen , Boulet John R. , Hanks Jasmine , Napolitano Natalie , Nadkarni Vinay M. , Nishisaki Akira
Published: September 2022

Objectives

Capillary refill time (CRT) to assess peripheral perfusion in children with suspected shock may be subject to poor reproducibility. Our objectives were to compare video-based and bedside CRT assessment using a standardized protocol and evaluate interrater and intrarater consistency of video-based CRT (VB-CRT) assessment. We hypothesized that measurement errors associated with raters would be low for both standardized bedside CRT and VB-CRT as well as VB-CRT across raters.

Methods

Ninety-nine children (aged 1–12 y) had 5 consecutive bedside CRT assessments by an experienced critical care clinician following a standardized protocol. Each CRT assessment was video recorded on a black background. Thirty video clips (10 with bedside CRT < 1 s, 10 with CRT 1–2 s, and 10 with CRT > 2 s) were randomly selected and presented to 10 clinicians twice in randomized order. They were instructed to push a button when they visualized release of compression and completion of a capillary refill. The correlation and absolute difference between bedside and VB-CRT were assessed. Consistency across raters and within each rater was analyzed using the intraclass correlation coefficient (ICC). A Generalizability study was performed to evaluate sources of variation.

Results

We found moderate agreement between bedside and VB-CRT observations (r = 0.65; P < 0.001). The VB-CRT values were shorter by 0.17 s (95% confidence interval, 0.09–0.25; P < 0.001) on average compared with bedside CRT. There was moderate agreement in VB-CRT across raters (ICC = 0.61). Consistency of repeated VB-CRT within each rater was moderate (ICC = 0.71). Generalizability study revealed the source of largest variance was from individual patient video clips (57%), followed by interaction of the VB-CRT reviewer and patient video clip (10.7%).

Conclusions

Bedside and VB-CRT observations showed moderate consistency. Using video-based assessment, moderate consistency was also observed across raters and within each rater. Further investigation to standardize and automate CRT measurement is warranted.
Reducing Admission for Anaphylaxis in a Pediatric Emergency Department Using a Clinical Decision Support Tool
Authors: Wolpert Katherine H. , Kestle Rebecca , Weaver Nicholas , Huynh Kelly , Yoo Minkyoung , Nelson Richard , Lane Roni D.
Published: September 2022

Introduction:

Anaphylaxis is a life-threatening condition necessitating emergent management. However, the benefits of prolonged observation and indications for hospitalization are not well established. Through the implementation of a disposition-focused clinical decision support tool (CDST), this quality improvement initiative aimed to reduce hospitalization for low-risk patients presenting to the pediatric emergency department (PED) with anaphylaxis from 49% to ≤12% within 12 months of implementation.

Methods:

The intervention included patients 18 years and younger of age presenting with anaphylaxis to the PED. A multidisciplinary team identified a 2006 evidence-based guideline as a significant contributor to hospitalization. The updated guideline incorporated a disposition-focused CDST that stratified patients as low-risk or high-risk and recommended discharge of low-risk patients after a 4-hour observation period. The primary outcome measure was the percentage of low-risk patients hospitalized. Balancing measures included low-risk patient 72-hour return rate and PED length of stay for all comers. Secondary outcomes included a focused cost analysis.

Results:

Fifty-three children preintervention and 43 children postintervention presenting with anaphylaxis met low-risk criteria. Postimplementation, hospitalization of low-risk patients decreased from 49% to 7% (P < 0.0001). No low-risk patients returned in 72 hours for an anaphylaxis-related concern (P = 0.83). The median PED length of stay increased from 189 to 193 minutes (P < 0.0001). The median cost per low-risk encounter decreased by $377 (P = 0.013).

Conclusions:

After implementing an evidence-based disposition-focused CDST, hospitalization of low-risk patients presenting to the PED with anaphylaxis significantly decreased without an increase in 72-hour returns. In addition, patient encounters demonstrated cost savings.
A prospective study of clinical outcomes of HIV-associated and HIV-negative Kaposi sarcoma in Uganda
Authors: Phipps Warren , Adams Scott V. , Mooka Peter , Kafeero James , Sekitene Semei , Mubiru Dennis , Nankoma Janet , Namirembe Constance , Okoche Lazarus , Namubiru Elizabeth B. , Kayemba Shadiah , Baker Kelsey K. , Redman Mary W. , Casper Corey , Orem Jackson , Warren Edus H.
Published: September 2022

Objective:

Improved understanding of the effect of HIV infection on Kaposi sarcoma (KS) presentation and outcomes will guide development of more effective KS staging and therapeutic approaches. We enrolled a prospective cohort of epidemic (HIV-positive; HIV+KS) and endemic (HIV-negative; HIV−KS) KS patients in Uganda to identify factors associated with survival and response.

Methods:

Adults with newly diagnosed KS presenting for care at the Uganda Cancer Institute (UCI) in Kampala, Uganda, between October 2012 and December 2019 were evaluated. Participants received chemotherapy per standard guidelines and were followed over 1 year to assess overall survival (OS) and treatment response.

Results:

Two hundred participants were enrolled; 166 (83%) had HIV+KS, and 176 (88%) were poor-risk tumor (T1) stage. One-year OS was 64% (95% confidence interval [CI] 57–71%), with the hazard of death nearly threefold higher for HIV+KS (hazard ratio [HR] = 2.93; P = 0.023). Among HIV+KS, abnormal chest X-ray (HR = 2.81; P = 0.007), lower CD4+ T-cell count (HR = 0.68 per 100 cells/μl; P = 0.027), higher HIV viral load (HR = 2.22 per log10 copies/ml; P = 0.026), and higher plasma Kaposi sarcoma-associated herpesvirus (KSHV) copy number (HR = 1.79 per log10 copies/ml; P = 0.028) were associated with increased mortality. Among HIV−KS, factors associated with mortality included Karnofsky score <70 (HR = 9.17; P = 0.045), abnormal chest X-ray (HR = 8.41; P = 0.025), and higher plasma KSHV copy number (HR = 6.21 per log10 copies/ml; P < 0.001).

Conclusions:

Although survival rates were better for HIV
−
KS than HIV+KS, the high mortality rate seen in both groups underscores the urgent need to identify new staging and therapeutic approaches. Factors associated with mortality, including high plasma KSHV, may serve as important targets of therapy.
A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi
Authors: Kidman Rachel , Breton Etienne , Behrman Jere , Kohler Hans-Peter
Published: September 2022

Objective:

Adverse childhood experiences have been robustly associated with poor sexual health in later life. In low-income countries, there is growing evidence that children experience greater adversity than those in higher income countries. Research suggests this may contribute to later sexual risk taking and HIV infection, though most studies to date have been cross-sectional.

Design:

We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes.

Methods:

We interviewed 1878 adolescents living in Malawi in 2017–2018 (age 10–16) and again in 2021 (age 13–20). Adolescents completed the Adverse Childhood Experience – International Questionnaire. HIV-risk was assessed through both behavioral (e.g. condom use) and biological (HIV and herpes simplex virus 2 [HSV2] infection) outcomes. ordinary least squares (OLS) and logistic multivariate regression models are used to explore associations between adversity and HIV risk.

Results:

In longitudinal analyses, adverse childhood experiences (ACEs) were significantly associated with intimate partner violence and girls’ behavioral risk scores only. HIV incidence was too low to model; there were no significant associations with HSV2. In cross-sectional analyses, ACEs were additionally associated with an early sexual debut, lack of condom use, a greater number of sexual partnerships, and sexually transmitted infection symptoms.

Conclusions:

Our findings emphasize the importance of collecting prospective data: results from longitudinal and cross-sectional analyses drew qualitatively different conclusions. Cross-sectional analyses may not be accurate representations of longitudinal processes. However, they suggest that recent adversity and distress drives HIV-related behavior, perhaps more than early adversity. Interventions that combat emotional abuse or peer violence during adolescence could potentially reduce HIV risk.