bluuebunny/crossref_metadata_2025 huggingface dataset:
Injury rates and patterns in professional American rugby: a prospective observational study
Authors: Kirven James Caid , Mundy Andrew , Conroy Mark , Vasileff W. Kelton
Published: September 2021

Background:

As American rugby becomes increasingly popular, an understanding of injury rates and patterns is essential for injury prevention, management, and player safety initiatives. We evaluated the injury characteristics and associated time loss sustained at the professional rugby level in the United States over one season.

Methods:

One professional rugby team was followed, and all injury data were prospectively collected over 13 consecutive weeks, with eight games during this period. Player involvement in games and practices was recorded by a licensed medical professional. For each described injury event, the timing, body area injured, and time lost from the sport caused by the injury were recorded. The Mid-P exact test was utilized to calculate injury rates with 95% confidence intervals as well as an injury rate ratio (IRR) to quantify differences in injury rates.

Results:

A total of 49 injuries over 2,456 athletic exposures (AEs) were included in our 13-week study period of one professional rugby season, with an overall injury rate of 19.95/1000 AEs. IRR between games versus practice was 5.21. Overall, 43% of the injuries occurred in the lower extremities and 18% in upper extremities, and there was a 12% incidence of concussion. Average time lost from sport was increased for game-related injuries (8.2 days) and concussion (7.8 days); however, severe injuries occurred more often in the lower extremity (n=4).

Conclusions:

The overall injury rates in this study correspond with previous amateur and international rugby literature showing a trend toward increased injury risk during gameplay at a professional level.

Level of Evidence:

Level IV.
Assessing Soft Tissue Perfusion Using Laser-Assisted Angiography in Tibial Plateau and Pilon Fractures: A Pilot Study
Authors: Sepehri Aresh , Slobogean Gerard P. , O'Hara Nathan N. , McKegg Phillip , Rudnicki Joshua , Atchison Jared , O'Toole Robert V. , Sciadini Marcus F. , LeBrun Christopher T. , Nascone Jason W. , Johnson Aaron J. , Gitajn Ida Leah , Elliott Jonathan T. , Scolaro John A. , Pensy Raymond A.
Published: September 2021

Objectives:

To determine whether skin perfusion surrounding tibial plateau and pilon fractures is associated with the Tscherne classification for severity of soft tissue injury. The secondary aim was to determine if soft tissue perfusion improves from the time of injury to the time of definitive fracture fixation in fractures treated using a staged protocol.

Design:

Prospective cohort study.

Setting:

Academic trauma center.

Patients:

Eight pilon fracture patients and 19 tibial plateau fracture patients who underwent open reduction internal fixation.

Main Outcome Measures:

Skin perfusion (fluorescence units) as measured by LA-ICGA.

Results:

Six patients were classified as Tscherne grade 0, 9 as grade 1, 10 as grade 2, and 2 as grade 3. Perfusion decreased by 14 fluorescence units (95% confidence interval, −21 to −6; P < 0.01) with each increase in Tscherne grade. Sixteen patients underwent staged fixation with an external fixator (mean time to definitive fixation 14.1 days). The mean perfusion increased significantly at the time of definitive fixation by a mean of 13.9 fluorescence units (95% confidence interval 4.8–22.9; P = 0.01).

Conclusions:

LA-ICGA perfusion measures are associated with severity of soft tissue injury surrounding orthopaedic trauma fractures and appear to improve over time when fractures are stabilized in an external fixator. Further research is warranted to investigate whether objective perfusion measures are predictive of postoperative wound healing complications and whether this tool can be used to effectively guide timing of safe surgical fixation.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Selective synergistic anticancer effects of cisplatin and oridonin against human p53-mutant esophageal squamous carcinoma cells
Authors: Yang Huiyu , Wang Jie , Khan Suliman , Zhang Yuanying , Zhu Kuicheng , Zhou Enhui , Gong Meiyuan , Liu Bingrong , Kan Quancheng , Zhang Qi
Published: September 2021

Oridonin (ORI) is known to pose anticancer activity against cancer, which could induce the therapeutic impact of chemotherapy drugs. However, such simple combinations have numerous side effects such as higher toxicity to normal cells and tissues. To enhance the therapeutic effects with minimal side effects, here we used ORI in combination with cisplitin (CIS) against different esophageal squamous cell carcinoma (ESCC) cell lines in vitro, to investigate the synergistic anticancer effects of the two drugs against ESCC. Calcusyn Graphing Software was used to assess the synergistic effect. Apoptosis, wound healing and cell invasion assay were conducted to further confirm the synergistic effects of ORI and CIS. Intracellular glutathione (GSH) and reactive oxygen species assay, immunofluorescence staining and western blot were used to verify the mechanism of synergistic cytotoxicity. ORI and CIS pose selective synergistic effects on ESCC cells with p53 mutations. Moreover, we found that the synergistic effects of these drugs are mediated by GSH/ROS systems, such that intracellular GSH production was inhibited, whereas the ROS generation was induced following ORI and CIS application. In addition, we noted that DNA damage was induced as in response to ORI and CIS treatment. Overall, these results suggest that ORI can synergistically enhance the effect of CIS, and GSH deficiency and p53 mutation, might be biomarkers for the combinational usage of ORI and CIS.
Identification and Classification of Usability Problems in a Nursing Information System
Authors: Farzandipour Mehrdad , Nabovati Ehsan , Tadayon Hamidreza , Sadeqi Jabali Monireh
Published: September 2021

Nursing information system is a system that nurses are required to use in order to perform their daily activities. Poor user interface design of nursing information system can cause problems in nurses' interaction with the system. This research aimed to evaluate the usability of nursing information system. During this study, five evaluators examined the nursing information system with the heuristic evaluation method and by using the checklist of Nielsen usability principles. Then, the identified problems were categorized into 10 Nielsen usability principles, and the severity of the problems was determined. They also attributed each problem to one of usability attributes. A total of 104 unique problems were identified. Most of the problems were related to the principle of “consistency and standards.” More than a third of the identified problems were classed as major and catastrophe, with the highest severity in the average problems of “help and documentation” and “error prevention.” Most of the identified problems were attributed to effectiveness and satisfaction. Because a significant number of identified usability problems in nursing information system were major and catastrophe and were attributed to effectiveness and satisfaction, being able to remedy the problems could improve nurses' interaction with the system user interface and increase satisfaction and effectiveness of nurses.
Physician-Nurse Communication Surrounding Computerized Physician Order Entry Systems From Social and Technical Perspective
Authors: Xiao Shu-Qin , Liu Jun-E , Chang Hong
Published: September 2021

Although computerized physician order entry systems improve order transmission and patient safety, overdependence on these systems can impede users' communication. This ethnographic study explored physician-nurse communication surrounding computerized physician order entry systems using a sociotechnical framework. Fieldwork conducted in a tertiary teaching hospital comprised 89 hours of participant observation, and individual semistructured interviews were held with seven nurses and five physicians. In addition, documents and artifacts were collected. Three core themes emerged. First, computerized physician order entry quality-related issues undermined the work efficiency of physicians and nurses. Specifically, usability was error prone because of cognitive overload, and the system was unable to perform relevant traces and raise alerts, demonstrating poor interoperability. Second, social factors, including insufficient training, unclear responsibilities, and a lack of awareness concerning interdisciplinary communication, compounded communication problems. Last, environmental factors, including noncoterminous spaces and times and insufficient technical support, impeded the resolution of communication problems. Technical and social contextual factors relating to computerized physician order entry systems jointly affected physician-nurse communication. Cognitive issues and insufficient alerts impacted work efficiency the most and were compounded by contextual individual- and team-related factors and environmental factors. Therefore, improved functions of computerized physician order entry systems and interprofessional communication training are required to optimize technical and social aspects of physician-nurse communication.
Exploring the Outcomes and Satisfaction of Automated Physiological Monitoring Systems Among Nurses
Authors: Cheng Yu-Chen , Lee Ting-Ting , Hwang Yi-Ting , Chan Pi-Tuan , Mills Mary Etta
Published: September 2021

Vital signs are central to the assessment of physiologic functions of patients and must be included in the electronic health record. The purpose of this retrospective and cross-sectional design study was to evaluate use of—and satisfaction with—automated physiological monitoring systems. Usage data from a hospital database were analyzed 3, 6, and 12 months after implementation of the automated system (June 2018 to May 2019). In addition, questionnaires were completed by 168 nurses, and 20 nurses were interviewed between August/September 2020 and October/November 2020, respectively. Results revealed that usage frequency of automated physiological monitoring devices increased steadily with user familiarity. Although respondents indicated general satisfaction with the devices, system downtime, sufficiency of the battery charge, and data transmission speed were identified as needing correction to smooth workflow and boost work efficiency. Although most interviewees considered devices easy to use, some mentioned transmission speed of the gateway, scanner sensitivity, and accuracy of the ear thermometer as needing improvement. For nurses to use automated physiological monitoring devices fully, a user-friendly design in functions and features is vital, and in-service training and a streamlined workflow are recommended to facilitate technology adoption.
The Effect of Computer-Based Training on Self-care and Daily Living Activities in Patients With Lumbar Discectomy Surgery
Authors: Saha Busra Selma , Goktas Sonay
Published: September 2021

This research was conducted to determine the effect of computer-based discharge training on patients with lumbar disc surgery on self-care agency and independence in daily living activities. A randomized controlled study was conducted on 60 patients, 30 in the intervention group and 30 in the control group. Computer-based lumbar disc surgery discharge training and a CD containing the training content were given to the intervention group after the surgery, whereas the control group received routine discharge training in the ward. The data of the study were collected using a Patient Information Form, the modified Barthel Index, and the Exercise of Self-Care Agency Scale. The increase in the modified Barthel Index and Exercise of Self-Care Agency Scale scores after training in the intervention and control groups were statistically significant (P < .001). The increase in Exercise of Self-Care Agency Scale scores after the training was found to be higher in the intervention group than in the control group. There was no difference between the modified Barthel Index mean scores before and after the training between the groups (P > .05). Computer-based discharge training improved the participants' independence in their daily living activities and increased the self-care power of the patients compared with the control group.
Validation of “Personal Protective Equipment Conservation Strategies Tool” to Predict Consumption of N95s, Facemasks, and Gowns During Pandemic-Related Shortages
Authors: Rickard Kelly N.Z. , Cohen Joanna S. , Chamberlain James M. , Ong Hilary , Dwyer Matthew , Perritt Ashley , McKinley Kenneth W.
Published: September 2021

We sought to prospectively validate a model to predict the consumption of personal protective equipment in a pediatric emergency department during the COVID-19 pandemic. We developed the Personal Protective Equipment Conservation Strategies Tool, a Monte Carlo simulation model with input parameters defined by members of our emergency department personal protective equipment task force. Inputs include different conservation strategies that reflect dynamic reuse policies. Over the course of 4 consecutive weeks in April and May 2020, we used the model to predict the consumption of N95 respirators, facemasks, and gowns in our emergency department based on values for each input parameter. At the end of each week, we calculated the percent difference between actual consumption and predicted consumption based on model outputs. Actual consumption of personal protective equipment was within 20% of model predictions for each of the 4 consecutive weeks for N95s (range, −16.3% to 16.1%) and facemasks (range, −7.6% to 13.1%), using “maximum conservation” and “high conservation” strategies, respectively. Actual consumption of gowns was 11.8% less than predicted consumption for Week 1, gown resupply data were unavailable on Weeks 2-4. The Personal Protective Equipment Conservation Strategies Tool was prospectively validated for “maximum conservation” and “high conservation” models, with actual consumption within 20% of model predictions.
A Vax4HPV Mobile Application for Parents of Human Papillomavirus Vaccine–Eligible Children
Authors: Kim Kyounghae , Parekh De Campos Amisha , Choi Seulgi
Published: September 2021

Although the human papillomavirus vaccine is efficacious, 40% of 13-year-old adolescents have been vaccinated for human papillomavirus. Implementing theory-based, user-centered applications can address this suboptimal coverage. This formative usability test aimed to develop a theory-based, user-centered interface to stimulate and inform parents' decision making on human papillomavirus vaccination and to help them act upon that decision. Iterative formative assessments were conducted through four focus groups of parents of children aged 9 to 14 years (N = 15). Participants discussed the desired content and features of a vaccine for human papillomavirus smartphone application while reviewing application prototypes. The discussions were recorded, transcribed verbatim, and then underwent qualitative content analysis. Four of the discovered themes were related to the content desired by parents: sources of information, facilitators of human papillomavirus vaccination, addressing the reasons for vaccine hesitancy, and gender-neutral content. The remaining three themes concerned the application's desirable designs and features: clear and descriptive interfaces, accessibility to broad groups of end users, and closing the intention-behavior gap. The need for adolescent human papillomavirus vaccination was generally well received by participants. This study found that theory-based, user-centered applications offering directions to appropriate clinics and human papillomavirus vaccine recommendations offered by nurses, can mitigate hesitancy by providing information via preferred routes and closing intention-behavior gaps.
An Observational Analysis of a Novel Digital Rectoscope
Authors: Lewis James A. , Khan Shabuddin , Tilney Henry S. , Wilson Jonathan M. , Vitone Louis J. , Souvatzi Maria , Singh Baljit , Kinross James M.
Published: September 2021

BACKGROUND:

This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view.

PRELIMINARY RESULTS:

Fifty patients underwent outpatient (n = 25) and surgical rectal assessment (n = 25), with a mean age of 60 years. This included 31 men and 19 women with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48 (96%) of 50 uses, images were captured in 48 (96%) of 50 uses, and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a κ of 0.225 (95% CI, 0.144–0.305) when assessing whether the target pathology was adequately visualized.

IMPACT OF INNOVATION:

The improved views afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video that can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, “watch and wait,” and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training, and it now requires prospective trials to validate its diagnostic accuracy against more costly flexible sigmoidoscopy systems.
Effects of menopausal hormone therapy on cardiovascular diseases and type 2 diabetes in middle-aged postmenopausal women: analysis of the Korea National Health Insurance Service Database
Authors: Kim Ji-Eun , Choi Jaesung , Park JooYong , Shin Aesun , Choi Nam-Kyong , Choi Ji-Yeob
Published: September 2021

Objective:

Although menopausal hormone therapy (MHT) is the most effective treatment for menopausal symptoms, menopausal women hesitate to start MHT due to concerns about adverse events. Recently, however, it has been recommended to use it for appropriate patients who have been evaluated for baseline diseases, age, and timing of initiation. We aimed to investigate the association of MHT with cardiovascular diseases (CVDs) and type 2 diabetes among middle-aged postmenopausal women in Korea.

Methods:

Data were collected from the National Health Insurance Service database in Korea from 2002 to 2016. A total of 58,060 postmenopausal women (including 8,013 [13.8%] MHT users and 50,047 [86.2%] nonusers) were included. The time-dependent Cox regression model with a 1-year latency period was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) of the associations of MHT with CVDs and type 2 diabetes outcomes. Subgroup analyses by regimen type and cumulative duration were conducted.

Results:

In the multivariate-adjusted model, MHT was not significantly associated with CVDs (HR = 1.085, 95% CI: 0.899-1.310) or type 2 diabetes (HR = 1.104, 95% CI: 0.998-1.221). Differential effects were not observed by regimen type, cumulative duration, and years since menopause subgroups. Sensitivity analyses also did not show adverse events by MHT on CVDs and type 2 diabetes.

Conclusions:

Although protective effects of MHT against CVDs or type 2 diabetes were not observed among postmenopausal women who had screened underlying diseases, our results may contribute to reducing the current concerns about the use of MHT for middle-aged postmenopausal women in Korea.

Video Summary:

http://links.lww.com/MENO/A807.
Posterior left atrial epicardial adipose tissue: scope of the problem and impact of new technology
Authors: Sperling Jason S. , Delurgio David L. , Svinarich John Thomas
Published: September 2021

Purpose of review

Patients with persistent forms of atrial fibrillation are seeking treatments based on the promise of better restoration of sinus rhythm with newer therapies. Successful catheter ablation and maintenance of atrial fibrillation in this subgroup is negatively impacted by the presence of epicardial adipose tissue (EAT) associated with the posterior left atrium.

Recent findings

EAT is now understood to be hormonally active and promotes adverse atrial remodelling, including fibrosis and myopathy. Despite being dominantly adipose tissue, it is known to be electrically active, comprising ganglia, neural tissue and ectopic atrial myocardium that may contribute to endo-epicardial dissociation and persistent electrical activity and atrial fibrillation despite good endocardial electrical silencing. Hybrid procedures that include direct epicardial ablation of the posterior wall, including the EAT, are associated with superior outcomes in nonparoxysmal atrial fibrillation.

Therapies for persistent atrial fibrillation that also ablate the EAT as part of a well tolerated transmural posterior wall ablation may improve outcomes in this challenging subset of patients.
Cardiac Rehabilitation and Resting Blood Pressure
Authors: Quindry John C. , McNamara Michael , Oser Carrie , Fogle Crystelle
Published: September 2021

Purpose:

Exercise-based cardiac rehabilitation (CR) is essential for treating cardiovascular disease, and modifying risk factor modification, including hypertension. Because the causes of hypertension and benefits of CR are faceted, we examined the influence of phase II CR on resting blood pressure (BP).

Methods:

Outcomes straddle the release of the updated BP guidelines, and study emphases included CR session number, sex, race/ethnicity, insurance provider, and referring diagnosis.

Results:

Patient files of 31 885 individuals uploaded to the Montana Outcomes Project registry indicated that lowered systolic and diastolic BP were further improved after the release of the revised BP guidelines. The CR session number was proportional to improvements in diastolic BP. Blood pressure improved independent of sex, although female patients exhibited lower diastolic BP before and after CR. Race/ethnicity analyses indicated that Asian and White patients experienced drops in systolic and diastolic BP, while diastolic BP was improved in Hispanic patients. Neither American Indian nor Black patients exhibited statistically altered BP. Medicare, Veterans Administration, and privately insured patients had lowered systolic and diastolic BP, while Medicaid patients had lower diastolic BP, and the uninsured had lower systolic BP. Blood pressure outcomes were generally improved independent of the primary referring diagnosis, while those with peripheral artery disease showed no improvements.

Conclusions:

Findings demonstrate that phase II CR is highly effective in the control of BP, although improvements are not equally distributed to all individuals according to differences in sex, race/ethnicity, and access to insurance-funded health care.
Urine N-acetyl-Ser-Asp-Lys-Pro measurement as a versatile biomarker to assess adherence to angiotensin-converting enzyme inhibitors
Authors: Kably Benjamin , Billaud Eliane M. , Derobertmasure Audrey , Blanchard Anne , Boutouyrie Pierre , Azizi Michel
Published: September 2021

Background:

Poor adherence to treatment is a major health issue in hypertension. The large number of drugs to be detected limits the implementation of chemical adherence testing by liquid chromatography/mass spectrometry (LC-MS/MS). AcSDKP, a peptide accumulating in the presence of angiotensin-converting-enzyme inhibitor (ACEI) treatment, has been validated as a proven marker of adherence by enzyme-linked immunosorbent assay. Our aim was to validate urine measurements of AcSDKP compared with active metabolites of various ACEI, measured simultaneously by LC-MS/MS.

Method:

We first studied the time-dependent relationships between urinary perindoprilat and AcSDKP in a pharmacokinetic/pharmacodynamic study in healthy volunteers. We then compared the sensitivity and specificity of urinary AcSDKP vs. three ACEI active metabolites (enalaprilat, perindoprilat, ramiprilat) taken as reference to detect nonadherence in spot urine samples from a prospective cohort of hypertensive outpatients.

Results:

The urinary excretion profiles of AcSDKP and perindoprilat were similar, exhibited a significant correlation, and showed excellent agreement in healthy volunteers. In patients, we found a similar agreement between AcSDKP and the three ACEI metabolites urinary concentrations. The sensitivity and specificity for adherence assessment of urine AcSDKP was 92.2 and 100%, respectively. We observed a difference in the evaluation of good adherence between ACEI metabolites (85.7%) and AcSDKP (79.0%) because of discrepancies in samples where AcSDKP reached undetectability quicker than ACEI metabolites. This characteristic of AcSDKP is of particular interest and could better reflect the true adherence status of patients.

Conclusion:

Overall, spot urine AcSDKP measurement by LC-MS/MS is a reliable marker of the intake of ACEI treatment and could substitute ACEI metabolites detection.
Effect of residual astigmatism and defocus in eyes with trifocal intraocular lenses
Authors: Rementería-Capelo Laureano A. , Contreras Inés , García-Pérez Jorge L. , Blázquez Vanesa , Ruiz-Alcocer Javier
Published: September 2021

Purpose:

To assess the effect on visual function of different residual astigmatic situations combined with 0.50 diopters (D) negative defocus at different distances in patients with trifocal intraocular lenses (IOLs).

Setting:

Clínica Rementería, Madrid, Spain.

Design:

Prospective case series.

Methods:

The study included patients implanted with AcrySof IQ PanOptix IOL. Visual acuity (VA) was measured at far distance (0.00 D of vergence) and at −1.5 D, −2.5 D, and −3.0 D of vergence. Residual astigmatism was induced by adding 0.50 D and 1.00 D cylindrical lenses placed at 90 degrees (against the rule [ATR]), 45 degrees (oblique), and 180 degrees (with the rule). All measurements were made with distance correction (emmetropia as the reference situation) and with a simulated residual myopia of 0.50 D.

Results:

The study included 61 eyes of 61 patients. Residual astigmatism of 0.50 D and 1.0 D was induced in 28 and 33 eyes, respectively. For both groups, distance and intermediate VAs were better for the reference situation (P < .001 for all cases). With 1.0 D of cylinder (without and with induced defocus), the proportion of patients who lost ≥2 lines was higher for the ATR astigmatism. For near vision, differences were smaller for all simulated situations.

Conclusions:

Residual astigmatism of up to 0.50 D, regardless of its orientation, seems to be tolerated at all distances. For astigmatisms of 1.0 D, distance and intermediate VAs decreased significantly, and ATR orientations showed worse results in a higher proportion of patients. The combination of astigmatism with residual myopia significantly decreased distance VA, whereas this negative shift affected near VA less.
Efficacy and safety of Sodium-Glucose-Transporter-2 inhibitors in kidney transplant patients
Authors: Jenssen Trond G.
Published: September 2021

Purpose of review

This review discusses current evidence and future perspectives for use of SLT2 inhibitors in kidney transplant recipients (KTRs).

Recent findings

Sodium-Glucose-Transporter-2 inhibitors (SGLT2is) lower plasma glucose in patients with type 2 diabetes, and protect against heart failure and progression of chronic kidney disease by a glucose-independent mechanism. Most of the current studies with SGLT2is in kidney transplant patients are however short-term retrospective case studies. These, together with one small randomized clinical trial, show that SGLT2is lower glucose also in KTRs with type 2 diabetes or posttransplant diabetes mellitus. Larger reductions in HbA1c (−0.5 to 1.5% points) are seen only in patients with estimated GFR > 60 ml/min/1.73m2 and HbA1c > 8%. With lower gomerular filtration rate (GFR) or glycated hemoglobin (HbA1c) the glucose-lowering effect is trivial. However, a reduction in body weight, blood pressure and uric acid is also seen, whereas the frequency of side effects (mycotic or urinary tract infections) does not seem to exceed what is seen in nontransplanted patients. Long-term effects on GFR have not been studied in kidney transplanted patients, but SGLT2is induce an early dip in GFR also in these patients. This could signal a beneficial long-term effect on renal hemodynamics.

SGLT2is lower glucose safely also in patients with single kidney grafts, but long-term kidney function and patient survival are yet to be explored.
Role of chimeric antigen receptor T-cell therapy: bridge to transplantation or stand-alone therapy in pediatric acute lymphoblastic leukemia
Authors: Qayed Muna , Bleakley Marie , Shah Nirali N.
Published: September 2021

Purpose of review

To discuss the curative potential for chimeric antigen receptor T-cell (CAR-T) therapy, with or without consolidative hematopoietic stem cell transplantation (HCT) in the treatment of children and young adults with B lineage acute lymphoblastic leukemia (B-ALL).

Recent findings

CAR-T targeting CD19 can induce durable remissions and prolong life in patients with relapsed/refractory B-ALL. Whether HCT is needed to consolidate remission and cure relapse/refractory B-ALL following a CD19 CAR-T induced remission remains controversial. Preliminary evidence suggests that consolidative HCT following CAR-T in HCT-naïve children improves leukemia-free survival. However, avoiding HCT-related late effects is a desirable goal, so identification of patients at high risk of relapse is needed to appropriately direct those patients to HCT when necessary, while avoiding HCT in others. High disease burden prior to CAR-T infusion, loss of B-cell aplasia and detection of measurable residual disease by flow cytometry or next-generation sequencing following CAR-T therapy associate with a higher relapse risk and may identify patients requiring consolidative HCT for relapse prevention.

There is a pressing need to determine when CD19 CAR-T alone is likely to be curative and when a consolidative HCT will be required. We discuss the current state of knowledge and future directions.
Longitudinal Health Status and Quality of Life After Esophageal Atresia Repair
Authors: ten Kate Chantal A. , Rietman André B. , van de Wijngaert Yannick , van Gils‐Frijters Annabel , Gischler Saskia J. , Keyzer‐Dekker Claudia M.G. , Wijnen René M.H. , IJsselstijn Hanneke
Published: September 2021

Objectives:

To longitudinally evaluate self‐reported and proxy‐reported health status (HS) and quality of life (QoL) of school‐aged children born with esophageal atresia (EA).

Methods:

We obtained Pediatric Quality of Life Inventory (HS) and DUX‐25 (QoL) questionnaires from children born with EA between 1999 and 2011 at 8 and/or 12 years old. Children completed self‐reports during neuropsychological assessments in a prospective longitudinal follow‐up program. Parents filled out proxy‐reports at home. Total and subscale scores were evaluated longitudinally and compared with sex‐specific reference norms.

Results:

In total, 110 participants (62% boys) were included. Self‐reported HS improved significantly between 8 and 12 years for both boys (mean difference [md] 4.35, effect size [ES] 0.54, P = 0.009) and girls (md 3.26, ES 0.63, P = 0.004). Proxy‐reported HS tended to improve over time, while self‐reported and proxy‐reported QoL tended to decline. Self‐reported HS at 8 years was below normal for both boys (md −5.44, ES −0.35, P < 0.001) and girls (md −7.61, ES −0.32, P < 0.001). Girls’ self‐reported QoL was below normal at 8 (md −5.00, ES −0.18, P = 0.019) and 12 years (md −10.50, ES −0.26, P = 0.001). Parents reported normal HS at both ages, whereas they rated the QoL of their daughters below normal at 12 years (md −10.00, ES −0.16, P = 0.022). All above results are total scores.

Conclusions:

Self‐reported and proxy‐reported HS of children with EA improved between 8 and 12 years, while their QoL tended to decline. We recommend to consider HS and QoL as two separate concepts and to measure both simultaneously and longitudinally when evaluating the burden of disease.
20‐Year Follow‐up Study of Celiac Patients Identified in a Mass School Screening
Authors: Cozzi Giorgio , Gabbana Eleonora , Zanchi Chiara , Giudici Fabiola , De Leo Luigina , Ziberna Fabiana , Bramuzzo Matteo , Di Leo Grazia , Not Tarcisio
Published: September 2021

Objectives:

To investigate the compliance to the gluten‐free diet in a cohort of adult celiac patients 20 years after the diagnosis, received in childhood through a mass screening.

Methods:

This is an observational historic cohort follow‐up study. It was carried out at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. Two matched cohorts of adult celiac patients, diagnosed in childhood through a mass screening or for symptoms were enrolled. Adherence to the gluten free‐diet and development of autoimmune diseases were investigated through a questionnaire administrated in the course of a phone interview.

The primary study outcome was the adherence to the gluten‐free diet, measured through the Biagi questionnaire, in the two cohorts of celiac patients.

Results:

We contacted 25 patients (mean age 28 years, 19 females) diagnosed with screening and 34 patients (mean age 25 years, 26 females) diagnosed in the same period for symptoms. After 20 years, in the cohort diagnosed with screening and in the cohort diagnosed for symptoms the adherence to the gluten‐free diet was optimal in 14 (56%) and 26 (81%), improvable in 5 (20%) and 3 (9%), inadequate in 6 (24%) and 3 (9%), respectively. In the two cohorts, four patients (16%) and six patients (18%) developed other autoimmune diseases.

Conclusions:

Twenty years after the diagnosis, near half of the patients diagnosed in a mass screening, does not have an optimal adherence to the gluten‐free diet and a remarkable proportion of them have developed another autoimmune disease.
Validation of the Soul Injury Self-awareness Inventory
Authors: Grassman Deborah , Katz Abi , Conforti-Brown Luann , Wilson Josephine F.
Published: September 2021

Traumatic lifetime experiences can complicate peaceful dying, causing latent wounds such as posttraumatic stress disorder, moral injury, and soul injury to reemerge at the end of life. Soul injury is defined as an overlooked, unassessed wound that separates a person from his/her own sense of self. The Soul Injury Self-awareness Inventory (Soul Injury Inventory) was developed to identify unresolved losses and hurts that threaten a sense of self. The Soul Injury Inventory is a brief, 10-item instrument that opens the door to meaningful conversations with patients, caregivers, and professionals. This article describes 2 validation studies conducted to measure the reliability, internal consistency, and construct validity of the Soul Injury Inventory. In study 1, the Soul Injury Inventory was demonstrated to be a psychometrically sound tool in which all questions contributed significantly to a single factor characterized as soul injury. In receiver operating characteristic analyses, scores less than 23.5 were shown to be indicative of soul injury with optimal sensitivity and specificity. Study 2 demonstrated that the Soul Injury Inventory has excellent test-retest reliability. The Soul Injury Inventory also has strong internal consistency, as demonstrated in studies 1 and 2. These 2 validation studies, taken together, demonstrate that the Soul Injury Inventory is an excellent, invariant measure of soul injury.
Palliative Care in Rural Aboriginal Communities
Authors: Spelten Evelien R. , MacDermott Sean , Morgan Susan , Mitchell Lynne , van Vuuren Julia
Published: September 2021

The aim of this study was to investigate the experiences and needs of Aboriginal community members with regard to rural community-based palliative care. Conversations with Aboriginal Elders were conducted. (In this Aboriginal community, Elders was not confined to older age. It referred to community leaders and includes [younger] emerging leaders.) The results were analyzed using descriptive analysis. Our study showed that there was a general lack of understanding of palliative care as distinct from curative care and limited awareness of services available. There was a strong need for clear information and on-call and practical support. Some concerns were expressed regarding limited awareness among health care providers of specific cultural needs. However, the home-based nature of palliative care was not, in itself, perceived as a barrier, provided that appropriate respect was displayed. We concluded that the current lack of understanding and awareness of services still impedes access to, and utilization of, care. More attention is needed for specific cultural needs. Adoption of a cultural humility approach for the promotion and delivery of palliative care seems to best fit the expressed needs and experiences of the participants.
Meckel's Masquerade
Authors: Callanan Deborah L. , O'Brien Megan M.
Published: September 2021

Children with abdominal pain are frequently seen in emergency departments. Physicians and parents worry about appendicitis; physicians are also concerned about intussusception and bowel obstruction in patients with previous surgical procedures. Sometimes the patient is ill, and the diagnosis is elusive. In a 6-month period at our pediatric emergency department with an annual census of 57,400 patients, we cared for 4 patients who presented with abdominal pain due to complications of Meckel’s diverticulum. None presented with painless rectal bleeding, the complication of which physicians are most aware. We are reporting these patients to raise awareness of Meckel’s diverticulum as a cause of acute abdomen in children. Meckel’s diverticulum may masquerade as appendicitis, an abdominal mass, intussusception, or a complication of severe constipation.
A Systematic Review of Approaches for Continuous Quality Improvement Capacity-Building
Authors: Loper Audrey C. , Jensen Todd M. , Farley Amanda B. , Morgan Jenille D. , Metz Allison J.
Published: September 2021

Context:

Continuous quality improvement (CQI) has become prominent in public health settings; yet, little consolidated guidance exists for building CQI capacity of community-based organizations.

Objective:

To synthesize relevant literature to identify guiding principles and core components critical to building the capacity of organizations to adopt and use CQI.

Design:

We employed a systematic review approach to assess guiding principles and core components for CQI capacity-building as outlined in the literature.

Eligibility Criteria:

Studies meeting the following criteria were eligible for review: (1) empirical, peer-reviewed journal article, evaluation study, review, or systematic review; (2) published in 2010 or later; and (3) capacity-building activities were described in enough detail to be replicable. Studies not including human subjects, published in a language other than English, or for which full text was not available were excluded.

Study Selection:

The initial return of records included 6557 articles, of which 1455 were duplicates. The research team single-screened titles and abstracts of 5102 studies, resulting in the exclusion of 4842 studies. Two hundred sixty-two studies were double-screened during full-text review, yielding a final sample of 61 studies from which data were extracted.

Main Outcome Measures:

Outcome measures of interest were operationalized descriptions of guiding principles and core components of the CQI capacity-building approach.

Results:

Results yielded articles from medical education, health care, and public health settings. Findings included guiding principles and core components of CQI capacity-building identified in current practice, as well as infrastructural and contextual elements needed to build CQI capacity.

Conclusions:

This consolidation of guiding principles and core components for CQI capacity-building is valuable for public health and related workforces. Despite the uneven distribution of articles from health care, medical education, and public health settings, our findings can be used to guide public health organizations in building CQI capacity in a well-informed, systematic manner.
Experimental Effects of Tweets Encouraging Social Distancing: Effects of Source, Emotional Appeal, and Political Ideology on Emotion, Threat, and Efficacy
Authors: Vaala Sarah E. , Ritter Matthew B. , Palakshappa Deepak
Published: September 2021

Context:

Public health officials and celebrities use social media to provide guidance to reduce the spread of COVID-19. Messages apply different promotional strategies to motivate behavior change, likely yielding divergent reactions from partisan audiences. The Extended Parallel Process Model (EPPM) suggests that perceived threat for a negative outcome should impact perceived need for the advocated health behavior, which should be more appealing to an audience if perceived it to be efficacious and feasible.

Objective:

This study examines the interactive effects of Tweet source, message emotional appeal, and audience political affiliation on US adults' perceptions of COVID-19 threat and social distancing efficacy during early months of the pandemic.

Design and Setting:

This online survey experiment applies the EPPM to assess US adults' reactions to tweets encouraging social distancing. The experiment tests 3 emotional appeals (fear, humor, and neutral) and 2 sources (Centers for Disease Control and Prevention [CDC] and celebrity) on adults' emotional reactions and perceptions of COVID-19 threat and social distancing efficacy.

Participants:

The final sample included 415 US adults (242 Democrat and 173 Republican) recruited through Amazon's Mechanical Turk.

Main Outcome Measures:

Outcome measures were adapted from the EPPM and include perceived susceptibility to and severity of COVID-19, and response efficacy and self-efficacy regarding social distancing. Each was measured through the survey on a 7-point response scale.

Results:

Humor and fear appeal messages evoked less fear and guilt responses than a neutral tweet from the CDC. Fear and guilt emotions predicted greater perceived threat, while hope and pride predicted efficacy constructs in relationships moderated by political ideology.

Conclusions:

Public health messages targeting a bipartisan audience through social media may increase perceived threat by inducing fear of COVID-19 infection. EPPM theory suggests boosting efficacy is also critical to message acceptance and behavior change; thus, inducing feelings of hope and pride in addition to fear may be particularly effective.
Double Eyelid Tape as a Treatment Option for Severe Ptosis in Patients With Myotonic Dystrophy Type 1
Authors: Jeong Sangah , Choi Eunseok , Lee Sook Joung
Published: September 2021

Myotonic dystrophy is a systemic disorder associated with progressive muscle weakness of the limbs and multiorgan dysfunction. This condition commonly affects the levator palpebrae superioris muscle, which leads to ptosis and eventually affects patients’ activities of daily living. The effects of ptosis on activities of daily living are usually overlooked; therefore, the importance of treatment is underestimated, and surgical procedures are considered infeasible in patients with preexistent levator palpebrae superioris muscle weakness. This case report describes the case of a middle-aged man with myotonic dystrophy type 1, who presented with ptosis, which significantly restricted his participation in rehabilitation and activities of daily living secondary to a limited visual field. He was evaluated by an ophthalmologist; however, surgery was contraindicated in view of the high risk of complications, such as exposure keratitis and corneal ulcer. Double eyelid tapes were used as a nonsurgical intervention, which significantly increased the palpebral fissure height and improved the visual field, with a higher modified functional index score. Double eyelid tapes may serve as an effective, safe, and reliable therapeutic option for severe ptosis in patients with myotonic dystrophy.
Quantitative Sensory Changes Related to Physical Activity in Adult Populations
Authors: Baehr Laura A. , Frey-Law Laura A. , Finley Margaret
Published: September 2021

Exercise-induced hypoalgesia related to physical activity produces sensory adaptations, but its mechanism remains unclear. Quantitative sensory testing is an effective measurement tool to identify sensory changes, but the extent of evidence linking quantitative sensory testing and physical activity has not been explored. The purpose of this scoping review is to synthesize the evidence on using quantitative sensory testing to evaluate psychophysical changes related to physical activity in adult populations. The researchers developed a comprehensive search strategy with a Health Sciences Librarian using the Arksey and O’Malley Methodological framework. Four databases (Medline [PubMed], CINAHL, Web of Science, and Embase) were searched for peer-reviewed primary research. After 2790 articles were evaluated, 196 studies were included for final review. More than half of studies used randomized controlled trial design (50.5%), followed by quasi-experimental (24.0%) and observational (25.5%) strategies. Healthy adults (42.9%) and individuals with chronic health conditions (20.9%) were examined most frequently. Aerobic (27.6%) and strength (21.4%) physical activity types were most commonly studied. Static quantitative sensory testing measures of pressure pain threshold (84%) were used most frequently. The findings of this scoping review demonstrate available evidence for quantitative sensory testing as a measurement tool of neuromodulation related to physical activity in adult populations. A systematic review is warranted to examine outcomes and recommendations.
Development of a Cadaver Laboratory Curriculum for Interventional Spine Procedures for Physical Medicine and Rehabilitation Residents
Authors: Berlin Evan , Khan Samir , Roehmer Christian , Sherwood David , Yang Aaron
Published: September 2021

There is no standardized curriculum for teaching interventional spine procedures during residency. The objective of this protocol was to share a curriculum using a cadaver laboratory for teaching Physical Medicine and Rehabilitation residents interventional spine procedures, which can be an effective and safe medium to train residents. This protocol provides a checklist that can guide the residents while they are in the cadaver laboratory with a focus on some of the most common lumbar procedures. Twelve physical medicine and rehabilitation resident’s confidence in their ability to maneuver the x-ray image intensifier (C-arm), identify spine anatomy under fluoroscopy, and drive the needle improved after the training curriculum (P < 0.005). Although the cadaver laboratory curriculum is not a replacement for the required Accreditation Council for Graduate Medical Education training, it may serve as a tool to improve resident preparedness for spine procedures.