bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecological Momentary Assessment: A Field Evaluation of Subjective Ratings of Speech in Noise
Authors: Jenstad Lorienne M. , Singh Gurjit , Boretzki Michael , DeLongis Anita , Fichtl Elmar , Ho Rachel , Huen Myron , Meyer Vincent , Pang Flora , Stephenson Ellen
Published: May 2021

Purpose:

As hearing rehabilitation research evolves to include both retrospective and momentary assessment outcome measures, it is important to understand how in-the-moment contextual factors influence subjective ratings. We aimed to determine, over a 4-week period of participants responding to ecological momentary assessments (EMAs) in their own environments, whether: (1) participants will complete surveys in speech-in-noise listening situations; (2) ratings of speech in noise change in a predictable manner as the acoustic conditions change; and (3) EMAs provide patient insights beyond those provided from retrospective ratings.

Design:

Fourteen adults aged 26 to 86 years with at least 6 months of hearing aid experience were recruited for an 8-week crossover field trial (4 weeks wearing hearing aids with no EMA; 4 weeks wearing hearing aids with EMA). Participants were fitted with hearing aids and provided with a streamer and a smartphone with an app that analyzed the acoustic signal from the hearing aids and alerted the participant to respond to a survey when predetermined acoustic conditions were detected. Participants were prompted to complete brief surveys up to 9 times/day that contained establishing questions, quality ratings, and items assessing perceived benefit, residual activity limitation, and satisfaction. Participants also completed retrospective questionnaires at intake and after each 4-week field trial.

Results:

Participants completed an average of 4.4 surveys per day. The quality ratings changed as the acoustics changed: Ratings of intelligibility were lower for 10 dB signal-to-noise ratio (SNR) than 20 dB SNR (p = 0.006); ratings of noisiness were higher for 10 dB SNR than 20 dB SNR (p = 0.001) and higher for 65 dB SPL than 50 dB SPL (p < 0.001); ratings of effort were higher for 65 dB SPL than 50 dB SPL (p = 0.004); ratings of loudness were higher for 65 dB SPL than 50 dB SPL (p = 0.001). Descriptive analysis of satisfaction, benefit, and residual activity limitation responses showed that the momentary surveys provided more detail about individual variability across acoustic conditions than the retrospective questions.

Conclusions:

Participants completed more than 99% of the triggered surveys, demonstrating high compliance. Because the quality ratings generally changed in the hypothesized direction, it is concluded that the participants provided valid responses. The greater variability in responses with EMA than retrospective questionnaires demonstrates its potential utility as a clinical tool for exploring hearing aid outcomes in real-world environments.
Risk Factors for Failure of Pavlik Harness Treatment in Infants With Dislocated Hips That Are Evaluated by Dynamic Sonography
Authors: Imerci Ahmet , Rogers Kenneth J. , Bhattacharjee Abhishek , Bowen James Richard , Thacker Mihir M.
Published: May 2021

Background:

Frankly dislocated hips occur in ∼1% to 3% of infants with developmental dysplasia of the hip and are often difficult to treat. In the most severely dislocated hips, the femoral head is positioned outside the posterior/lateral rim of the acetabulum and is irreducible, that is, the femoral head will not reduce by positioning the leg. The purpose of this study was to determine risk factors, using univariate and multivariate analyses, for Pavlik harness failure in infants who initially presented with irreducible/dislocated hips (confirmed by dynamic sonography).

Methods:

Following institutional review board approval, 124 infants (170 hips) with frankly dislocated hips treated using a Pavlik harness between 2000 and 2018 were evaluated. Patients’ demographic characteristics, clinical findings, dynamic sonographic findings (dislocated-fixed vs. dislocated-mobile), age at onset of Pavlik harness treatment, duration of harness usage, and follow-up treatments were recorded. Univariate analyses were used to determine risk factors for treatment failure.

Results:

In frankly dislocated hips (confirmed by dynamic sonography to be positioned outside the posterior/lateral rim of the acetabulum), Pavlik harness treatment was successful in 104 of 170 hips (61%) while it failed in 66 hips. Mean follow-up was 4.86±4.20 years. Univariate analysis determined the risk factors to be onset of treatment after the seventh week of age (P=0.049) and initial mobility (dislocated-fixed group) (P<0.001) by dynamic sonography. In addition, multivariate analysis (P=0.007) showed infants of multigravida mothers (non-firstborn) to be another risk factor for failure. Six percent of hips with no risk factors failed Pavlik harness treatment, those with 1 risk factor had 42% failure, 2 risk factors had 69% failure, and all 3 risk factors had 100% failure.

Conclusions:

In our patients with frankly dislocated irreducible hips, 39% of hip failed Pavlik harness treatment. Independent multivariate, logistic regression analysis, and multivariate analysis determining the risk factors for failure of Pavlik harness treatment were onset of treatment after the seventh week of age, infants of multigravida mothers, and initial hip mobility (fixed-dislocated hips) by dynamic sonography.

Level of Evidence:

Level III.
Limb Lengthening in Russell-Silver Syndrome: An Update Confirming Safe and Speedy Healing
Authors: Goodbody Christine M. , Buksbaum Joshua , Harbison Madeleine D. , Fragomen Austin T. , Rozbruch S. Robert
Published: May 2021

Introduction:

Russell-Silver syndrome (RSS) is a unique cause of syndromic, and often severe, limb length discrepancy (LLD). RSS causes growth retardation both in utero and postnatally, with asymmetry in limb length more noticeable as growth progresses throughout childhood and adolescent. We aim to present the largest cohort in the literature on limb lengthening in patients with RSS and to validate previous literature supporting faster bony consolidation in these patients with more robust data. We further aim to establish differences in healing within this cohort based on age, sex, segment lengthened, or type of lengthening procedure performed, to help refine patient expectations and guide practitioners in treating this population.

Methods:

This was a retrospective study of patients with a diagnosis of RSS who underwent a limb lengthening procedure for the purpose of limb equalization. They were compared with a historic control group of patients who underwent limb lengthening for LLD of a non-RSS etiology. The primary outcome measure was bone healing index (BHI).

Results:

The RSS group consisted of 24 patients with 29 segments lengthened, and was compared with a historic control group consisting of 20 patients with 22 segments lengthened (Goldman). Patients with RSS had a significantly lower BHI, and therefore faster healing of their lengthening site, than their non-RSS peers (P=0.02). Within the RSS cohort, we did not detect a difference in BHI based on intervention type or sex, but we did find a trend toward faster healing in femurs over tibiae (P=0.08), and established that younger patients tended toward lower BHIs (P<0.01).

Conclusions:

Our results confirmed with more robust data the prior finding that patients with RSS may undergo limb lengthening procedures at least as safely as their non-RSS counterparts, and with even faster bony consolidation, especially in younger patients. We hypothesize that concurrent treatment with growth hormone supplementation may contribute to this finding, although further study is necessary. This is the largest cohort of RSS patients treated with limb lengthening for LLD reported in the literature, and these findings will help to guide surgeon decision-making when treating this unique population.

Level of Evidence:

Level III—retrospective comparative study.
Intraoperative Burden of Flexible Intramedullary Nailing and Spica Casting for Femur Fractures in Young Children
Authors: Barnett Scott A. , Song Bryant M. , Yan Justin , Leonardi Claudia , Gonzales Joseph A. , Heffernan Michael J.
Published: May 2021

Background:

Spica casting (Spica) remains the widely accepted treatment of closed femoral shaft fractures in young children aged 6 months to 5 years. In some centers, there has been a recent trend towards surgical fixation of these fractures with flexible intramedullary nails (FINs). Despite numerous studies evaluating both Spica and FIN treatment of femoral shaft fractures, there remains a paucity of data regarding patient burden during the intraoperative period. The purpose of this study was to compare the intraoperative burden, defined as anesthetic exposure, fluoroscopic duration, and radiation load, between Spica and FIN treatment of femoral shaft fractures in young children.

Methods:

A retrospective chart review was conducted for pediatric femoral shaft fractures presenting to a tertiary pediatric referral hospital from 2012 to 2017. Comparison groups included pediatric femur fractures treated with Spica and those treated with FIN. Outcomes included anesthetic exposure, fluoroscopy duration, and radiation exposure. In addition, length of stay, clinic visits, and complications were recorded.

Results:

Of 449 consecutive pediatric femur fractures treated at our center, 143 patients ages 2 to 6 years (mean age 3.8±1.4 y) met inclusion criteria. The Spica group contained 91 patients; FIN contained 52 patients. Mean anesthetic exposure was less for Spica compared with FIN [45.1 min, 95% confidence interval (CI): 38.0-52.3 vs. 90.7 min, 95% CI: 80.5-100.8 min; P<0.001]. On average, Spica procedures required less fluoroscopy time compared with FIN (15.4 s, 95% CI: 4.8-26.0 vs. 131.6 s, 95% CI: 117.6-145.6 s; P<0.001). Mean radiation load was less for Spica compared with FIN (1.6 mGy, 95% CI: 0.6-2.6 vs. 6.9 mGy, 95% CI: 5.7-8.1 mGy; P<0.001). There was no difference in length of hospital stay (P=0.831), follow-up visits (P=0.248), or complication rate (P=0.645) between Spica and FIN groups. The most common complication was skin irritation for Spica (18.7%) and symptomatic hardware for FIN (17.3%).

Conclusions:

The findings of this study suggest that pediatric patients with femoral shaft fractures experience an increased intraoperative burden when treated with FIN compared with Spica. Treatment with FIN was associated with increased exposure to anesthesia, fluoroscopic duration, and radiation load despite similar complication rates when compared with Spica.

Level of Evidence:

Level III.
Human Position Brace Versus Pavlik Harness for Infants Under 6 Months of Age With Developmental Dislocation of the Hip: A Comparison of Therapeutic Efficacy
Authors: Gou Pan , Zhang Yuan , Wu Jun , Li Jun , Li Xiang , Li Ming , Liu Xing
Published: May 2021

Background:

For 0- to 6-month-old patients with developmental dislocation of the hip, the likelihood of Pavlik harness treatment failure may be increased. The human position brace is an available option. We aimed to compare therapeutic efficacy between the Pavlik harness and human position brace.

Methods:

We included 87 patients (106 hips) in the human position brace group and 47 patients (62 hips) in the Pavlik harness group. Clinical and radiologic outcomes were recorded and compared, respectively.

Results:

The mean follow-up was 17.73±14.56 months (range, 5 to 56 mo). Human position brace produced higher success rates (65.1% vs. 43.5%; P=0.006) and had significant advantages in the 4 to 6 months group (P<0.001). According to the last follow-up x-ray, when compared with that of the Pavlik harness group, upper space was larger (P=0.032) and inner space was smaller (P<0.001) in the human position brace group.

Conclusions:

Given the increased success rates and better hip development by the last follow-up, the human position brace could be considered as an alternative, or even as the first choice for 4- to 6-month-old infants with developmental dislocation of the hip to address the specific deficits of Pavlik harness.

Level of Evidence:

Level III—retrospective comparison.
Global, regional and national burden of lung cancer and its attributable risk factors in 204 countries and territories, 1990–2019
Authors: Yuan Jingmin , Sun Yan , Bu Xiang , Ren Hui , Chen Mingwei
Published: May 2021

Objective

To explore the lung cancer burden and related risk factors in groups of different sex, ages and levels of sociodemographic index (SDI) at global, regional and national levels.

Methods

Using newly released GBD 2019 data, we explored the trends of lung cancer burden and its related risk factors in groups of different sex, ages and levels of SDI at global, regional and national levels. The Global Health Data Exchange query tool was used to obtain the data.

Results

While lung cancer has an overall stable age-standardized incidence rate (ASIR), the death rate (ASDR) and disability-adjusted life-years (DALYs) rate (with even a trend of decline), it is still the number one malignant tumor. The ASIR and ASDR grew slowly in women worldwide. In 2019, High-income North America, East Asia and Central Europe ranked top three in ASIR, ASDR and age-standardized DALY rate, with growth in East Asia the highest. These three indicators were not in a single linear relation with SDI at a national level, and a peak appeared when SDI was about 0.8. The top three attributable risk factors to DALYs were smoking, particulate matter pollution and occupational carcinogens.

Conclusions

Given the high heterogeneity in lung cancer burden among different populations, decision-makers should understand local epidemiological characteristics of lung cancer in detail to formulate effective policies. Stricter tobacco control and improvement in lung cancer screening and treatment are imperative.
Institute to Frontline ICU Quality
Authors: McGonigal Michelle , Snyder Amy
Published: May 2021

Organizational structures have been shifting in health care over the past decade. Although hierarchal structures exist in many hospitals and health care entities, matrix approaches have been implemented to complement the traditional reporting configuration. The institute model is a hybrid structure implemented within medical and surgical service lines to promote patient-centered care within a hospital network. Physician administrators lead the institutes with collaboration by key liaisons such as nursing and quality leaders. In order to be successful, the concepts must extend from the boardroom to the front line. Teams focused specifically on quality metrics were developed within the service lines using an interdisciplinary approach to promote engagement and achieve desired outcomes. A key strategy was the implementation of a nurse manager/attending physician dyad model. This partnership is the linkage from the front line to the institute chair. The focus on collegiality and collaboration has led to improved engagement and problem-solving within the service lines.
A Lean Approach to Patient Transfers
Authors: Chiaramonte Theresa , Grenesko Michelle
Published: May 2021

Recognizing delays in patient transfers from the intensive care unit (ICU) to its designated telemetry unit impeded patient flow, a group of nurses from both units came together to identify barriers for the transfer process and worked on a solution that benefited the patient, staff, and hospital. Nurses changed the process of patient handoff by means of telephone to bedside handoff, creating a culture change and eliminated approximately 60 minutes from the average time to transfer patient from the ICU to the telemetry unit. The bedside handoff included a neurological assessment, which helped facilitate continuity of care and decreased anxiety for the patient during transition to the telemetry unit.
Prognostic Factors of Second-line Immune Checkpoint Inhibitors in Patients With Advanced-stage Non–Small Cell Lung Cancer
Authors: Roh Jiyeon , Eom Jung Seop , Lee Min Ki , Kim Jehun , Jang Taewon , Yoon Seong Hoon , Son Choon-Hee , Lee Hyun-Kyung , Kim Hyun-Kuk , Lee Shin Yup , Shin Kyeong Choel , Kim Mi-Hyun
Published: May 2021

Objectives:

Immune checkpoint inhibitors (ICIs) targeting the programmed cell death receptor-1 and its ligand have achieved impressive success in treating patients with advanced-stage non–small cell lung cancer (NSCLC) after failed first-line cytotoxic chemotherapy. However, knowledge on clinical biomarkers that could help select patients who will respond well to second-line ICI therapy is limited.

Patients and Methods:

Medical records of patients with NSCLC treated with first-line platinum-based chemotherapy and subsequent second-line ICI were collected from 6 medical centers between January 2018 and June 2020. Clinical information, pathologic variables, and radiologic findings of the data collected were reviewed. The patients were followed up until the date of the last visit, the death of any cause, or the end of data recording (December 31, 2020).

Results:

A total of 181 patients with NSCLC were treated with second-line ICI following first-line platinum-based doublet chemotherapy. The median progression-free survival was 2.0 months (interquartile range, 1.0 to 5.5 mo), and the median overall survival was 12.0 months (interquartile range, 6.0 to 20.0 mo). Low body mass index (BMI) was independently associated with progression-free survival (odds ratio [OR], 0.826; 95% confidence interval [CI], 0.723-0.945; P=0.005). Similarly, a low BMI (OR, 0.839; 95% CI, 0.740-0.952; P=0.005) and a high number of metastatic organs (OR, 1.682; 95% CI, 1.156-2.448; P=0.007) were independently associated with the overall survival after second-line ICI therapy.

Conclusion:

BMI and the number of metastatic sites were significantly associated with second-line ICI therapy outcomes in patients with NSCLC receiving first-line platinum-based chemotherapy.
The Role of BCL-2 Proteins in the Development of Castration-resistant Prostate Cancer and Emerging Therapeutic Strategies
Authors: Soliman Luke , De Souza Andre , Srinivasan Praveen , Danish Matthew , Bertone Paul , El-Deiry Wafik S. , Carneiro Benedito A.
Published: May 2021

The development of androgen resistance in advanced prostate cancer remains a challenging clinical problem. Because androgen deprivation therapy constitutes the backbone of first-line treatments for metastatic prostate cancer, the phenotypic switch from an androgen-dependent to an androgen-independent growth state limits the treatment options for these patients. This critical change from an androgen-dependent to an androgen-independent growth state can be regulated by the B-cell lymphoma gene 2 (BCL-2) family of apoptotic proteins. While the roles of BCL-2 protein family members in the carcinogenesis of prostate cancer have been well-studied, emerging data also delineates their modulation of disease progression to castration-resistant prostate cancer (CRPC). Over the past 2 decades, investigators have sought to describe the mechanisms that underpin this development at the molecular level, yet no recent literature has consolidated these findings in a dedicated review. As new classes of BCL-2 family inhibitors are finding indications for other cancer types, it is time to evaluate how such agents might find stable footing for the treatment of CRPC. Several trials to date have investigated BCL-2 inhibitors as therapeutic agents for CRPC. These therapies include selective BCL-2 inhibitors, pan-BCL-2 inhibitors, and novel inhibitors of MCL-1 and BCL-XL. This review details the research regarding the role of BCL-2 family members in the pathogenesis of prostate cancer and contextualizes these findings within the contemporary landscape of prostate cancer treatment.
Diagnostic Values of 8 Different Imaging Modalities for Preoperative Detection of Axillary Lymph Node Metastasis of Breast Cancer
Authors: Kim Keunyoung , Shim Sung-Ryul , Kim Seong-Jang
Published: May 2021

Objective:

This study aimed to compare diagnostic performances of 8 different imaging modalities for preoperative detection of axillary lymph node (LN) metastasis in patients with breast cancer by performing a network meta-analysis (NMA) using direct comparison studies with 2 or more imaging techniques.

Materials and Methods:

PubMed, Cochrane, and Embase were searched for the studies evaluating the performances of 8 different imaging modalities for preoperative axillary LN staging in patients with breast cancer. The NMA was performed in patient-based analyses. The consistency was evaluated by examining the agreement between direct and indirect treatment effects, and publication bias was assessed by funnel plot asymmetry tests. The surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of each imaging modality being the most effective diagnostic method.

Results:

A total of 2197 patients from 22 direct comparison studies using 8 different imaging modalities for preoperative detection of axillary LN metastasis in patients with breast cancer were included. For preoperative detection of axillary LN metastasis of breast cancer, elastography showed the highest SUCRA values of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and diagnostic odds ratio. In addition, fluorine-18 fluorodeoxyglucose positron emission tomography (PET) or PET/computed tomography, fluorine-18 fluorodeoxyglucose PET/magnetic resonance, and contrast-enhanced computed tomography showed high SUCRA values.

Conclusion:

Elastography showed the highest SUCRA values. Seven imaging modalities showed the complementary diagnostic roles for preoperative detection of axillary LN metastasis in patients with breast cancer, except mammography.
New Releasable Nonabsorbable Polypropylene 8.0 Suturing Technique for Sclerotomy Sealing in 23-Gauge Vitrectomy
Authors: Savastano Alfonso , Crincoli Emanuele , Caporossi Tomaso , Rizzo Clara , Savastano Maria Cristina , De Vico Umberto , Rizzo Stanislao
Published: May 2021

Purpose:

We propose a new releasable 8.0 polypropylene suture for leaking sclerotomies at the end of vitrectomy. Characteristic of this suture is that it can be easily removed the day after surgery at the slit-lamp examination.

Methods:

Patients undergoing 23-gauge pars plana vitrectomy with the need for at least 2 sclerotomy sutures and having a preoperative Ocular Surface Disease Index score <12 were consecutively allocated to sealing with either polyglactin 910 absorbable suture (VY GROUP) or nonabsorbable 8.0 polypropylene releasable suture (PR GROUP). Evaluation of adverse events, Ocular Surface Disease Index score, and conjunctival hyperemia (through the Efron scale) was performed at 1, 7, and 30 days postoperatively.

Results:

Both methods effectively sealed sclerotomies. PR GROUP showed a significantly lower Ocular Surface Disease Index score and lower degree of conjunctival hyperemia at both 7 and 30 days follow-up. The Ocular Surface Disease Index score decreased significantly after 7 days in PR GROUP while in VY GROUP improved at 30 days postoperatively. PR GROUP showed a lower degree of conjunctival hyperemia both at 7 and 30 days follow-up.

Conclusion:

Polypropylene 8-0 releasable sutures proved to be effective in 23-gauge pars plana vitrectomy wound sealing while inducing less ocular surface inflammation and patient discomfort compared with the standard polyglactin 910 suture.
Updated safety precautions and guidance on eye banking procedures during the coronavirus disease 2019 pandemic
Authors: Armenti Stephen T. , Ballouz Dena , Mian Shahzad I.
Published: May 2021

Purpose of review

severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious coronavirus causing the COVID-19 pandemic. Although airborne spread through infectious respiratory droplets is the primary source of transmission, recent literature has suggested the ocular surface may be able to harbor viral particles. Here, we aim to discuss how SARS-CoV-2 affects the ocular surface and updated guidance on how SARS-CoV-2 transmission should be considered in the setting of eye banking and corneal transplantation procedures.

Recent findings

SARS-CoV-2 RNA can be found on the ocular surface, which may suggest the eye as a site of viral replication. However, there is poor correlation between PCR positivity on the ocular surface and ocular symptoms. To date, although viral particles can be found on the ocular surface, use of standard antiseptic procedures during corneal tissue procurement appears to sufficiently reduce viral load. In addition, preprocedure testing may further decrease the chances of transplanting an infected cornea without significantly impacting the overall accessibility to corneal tissue by decreasing the donor pool.

Corneal transplantation remains a well tolerated and highly successful procedure with no evidence of viral transmission with transplantation. Although the ocular surface has the required receptors to allow for viral replication, there is no clear evidence that the eye is a site for primary viral infection.
Relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious coronary artery anomalies
Authors: Kalkan Mehmet Emin , Güner Ahmet , Kalçik Macit , Turna Önder , Cansever Aysel Türkvatan , Uzun Fatih , Akgün Taylan , Aslan Serkan , Güner Ezgi Gültekin , Çörekçioğlu Büşra , Akman Cemalettin , Ulutaş Ahmet Emir , Ertürk Mehmet
Published: May 2021

Background

Congenital coronary artery anomalies (CCAAs) have the potential for life-threatening complications, including malignant ventricular arrhythmias and sudden cardiac death (SCD). In this study, we aimed to evaluate the relationship between impaired repolarization parameters and poor cardiovascular clinical outcomes in patients with potentially serious CCAAs.

Methods

This retrospective study included 85 potentially serious CCAA patients (mean age: 54.7 ± 13.6 years; male:44) who were diagnosed with conventional and coronary computed tomography angiography (CCTA). All patients underwent transthoracic echocardiography and 12-lead surface electrocardiography. Cardiac events were defined as sustained ventricular tachycardia or fibrillation, syncope, cardiac arrest and SCD.

Results

The presence of interarterial course (IAC) was confirmed by CCTA in 37 (43.5%) patients. During a median follow-up time of 24 (18–50) months, a total of 11 (12.9%) patients experienced cardiac events. The presence of IAC was significantly more frequent and Tp–e interval, Tp–e/QTc ratio and frontal QRS/T angle (fQRSTa) were significantly greater in patients with poor clinical outcomes. Moreover, the presence of IAC, high Tp-e/QTc ratio and high fQRSTa were found to be independent predictors of poor clinical outcomes and decreased long-term cardiac event-free survival in these patients. A net reclassification index was +1.0 for the Tp-e/QTc ratio and +1.3 for fQRSTa which were confirmable for additional predictability of these repolarization abnormalities

Conclusion

Impaired repolarization parameters, including wider fQRSTa, prolonged Tp–e interval, and increased Tp–e/QTc ratio, and IAC may be associated with poor cardiovascular clinical outcomes in potentially serious CCAA patients.
Epidemiology and causes of cardiogenic shock
Authors: Berg David D. , Bohula Erin A. , Morrow David A.
Published: May 2021

Purpose of review

Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. The purpose of this review is to describe the contemporary epidemiology of cardiogenic shock, including trends in clinical outcomes and recent efforts to refine risk assessment.

Recent findings

The incidence of cardiogenic shock among patients with AMI has remained remarkably stable at 3–10%; however, the proportion of cardiogenic shock cases related to AMI has decreased over time to ∼30%, while the proportion of cardiogenic shock cases due to acute decompensated heart failure has steadily increased. Estimated in-hospital mortality from cardiogenic shock in contemporary registries is approximately 30–40%, suggesting modest improvement in cardiogenic shock outcomes over the last decade. There is a wide spectrum of clinical severity among patients presenting with cardiogenic shock, which is described by the Society for Cardiovascular Angiography and Interventions clinical staging criteria.

Improved clinical characterization and risk assessment of patients with cardiogenic shock may facilitate more effective clinical investigations of this morbid clinical syndrome.
An Alternative Method of Public Reporting of Comparative Hospital Quality and Performance Data for Transparency Initiatives
Authors: O’Mahen Patrick , Mehta Paras , Knox Melissa K. , Yang Christine , Kuebeler Mark , Rajan Suja S. , Hysong Sylvia J. , Petersen Laura A.
Published: May 2021

Background:

Hospital performance comparisons for transparency initiatives may be inadequate if peer comparison groups are poorly defined.

Objective:

The objective of this study was to evaluate a new approach identifying hospital peers for comparison.

Design/Setting:

We used Mahalanobis distance as a new method of developing peer-specific groupings for hospitals to incorporate both external and internal complexity. We compared the overlap in groups with an existing method used by the Veterans’ Health Administration’s Office for Productivity, Efficiency, and Staffing (OPES).

Participants:

One hundred twenty-two acute-care Veterans’ Health Administration’s Medical Facilities as defined in the OPES fiscal year 2014 report.

Measures:

Using 15 variables in 9 categories developed from expert input, including both hospital internal measures and community-based external measures, we used principal components analysis and calculated Mahalanobis distance between each hospital pair. This method accounts for correlation between variables and allows for variables having different variances. We identified the 50 closest hospitals, then eliminated any potential peer whose score on the first component was >1 SD from the reference hospital. We compared overlap with OPES measures.

Results:

Of 15 variables, 12 have SDs exceeding 25% of their means. The first 2 components of our analysis explain 24.8% and 18.5% of variation among hospitals. Eight of 9 variables scaling positively on the first component measure internal complexity, aligning with OPES groups. Four of 5 variables scaling positively on the second component but not the first are factors from the policy environment; this component reflects a dimension not considered in OPES groups.

Conclusion:

Individualized peers that incorporate external complexity generate more nuanced comparators to evaluate quality.
Pain Reported by Chinese Children During Cancer Treatment
Authors: Cheng Lei , Yuan Changrong , Wang Jiashu , Stinson Jennifer
Published: May 2021

Background

Pain is a frequently reported and distressing symptoms during cancer treatment. However, there is limited evidence on pain reported by Chinese children with cancer.

Objectives

This study aimed to investigate the prevalence, intensity, interference, and management of pain reported by Chinese children during cancer treatment and explore the predictors of pain interference.

Methods

We conducted a cross-sectional survey to investigate the pain intensity, pain interference, co-occurring symptoms (anger, anxiety, depression, fatigue), and pain management strategies reported by children 8 years and older undergoing active cancer treatment in 4 Chinese hospitals.

Results

Data were analyzed for 187 children. The prevalence of moderate to severe pain (≥4/10) was 38.50%, with an average pain interference score of 52.97 out of 100. Approximately 24% of children were prescribed pain medicine. Pain interference and pain intensity were marginally correlated (r = 0.047, P < .01) and were both positively correlated with pain duration and co-occurring symptoms and negatively correlated with perceived pain alleviation (all P < .01). Multiple regression analyses suggested that severe pain intensity (B = 2.028, P = .003) and fatigue (B = 0.440, P < .001) significantly predicted higher levels of pain interference (R
2 = 0.547, F = 23.102, P < .001).

Conclusion

Chinese children with cancer reported a low pain intensity score but a relatively high level of pain interference. According to the children’s reports, pain has not been sufficiently addressed through Chinese pediatric oncology supportive care.

Implications for Practice

There is an urgent requirement for comprehensive pain assessment and standardized, targeted interventions in Chinese pediatric oncology pain management.
Delivering Hospice Care During the COVID-19 Pandemic
Authors: Medina Ashleigh , Tzeng Huey-Ming
Published: May 2021

This discussion article highlights the challenges of providing hospice care in nursing homes since the start of the COVID-19 (coronavirus disease 2019) pandemic and illuminates practice changes needed in nursing homes. The article provides an overview of the expectations of hospice care, explains the differences in delivering hospice care during the COVID-19 pandemic, examines social isolation and emotional loneliness and the role of familial caregivers, and describes policy changes related to the COVID-19 affecting hospice care delivery in nursing homes. This article answers the following questions: (1) How did residents receiving hospice care have their needs met during the COVID-19 pandemic? (2) What areas of nursing home care need to be improved through governmental policy and restructuring? This article also summarized the lessons learned as a result of the COVID-19 pandemic and provided practical implications for nursing, specific to changes in hospice care deliveries for nursing home residents.
Characteristics of Environmental influences on Child Health Outcomes (ECHO) Cohorts Recruited During Pregnancy
Authors: Faro Elissa Z. , Sauder Katherine A. , Anderson Amber L. , Dunlop Anne L. , Kerver Jean M. , McGrath Monica , Roary Mary , Roman Carolyn W. , Weidinger Cara , Huddleston Kathi C.
Published: May 2021

Purpose:

The objective of this study was to characterize the study designs, recruitment strategies, and other study characteristics among cohorts that initiated during pregnancy as part of the Environmental influences on Child Health Outcomes (ECHO) program.

Methods:

ECHO research programs (cohorts) were reviewed. Only those who had or were currently recruiting during pregnancy were surveyed in 2018 about research recruitment strategies (participant incentives, study burden, community collaboration, and cultural adaptations). Data are presented with cohort characteristics (location, inclusion and exclusion criteria, sociodemographics, medical information, behavioral factors, and biospecimens).

Results:

Forty-seven of the 84 ECHO pediatric cohorts recruited during pregnancy. Findings demonstrate various recruitment strategies, domains of data collection, and biospecimen collection are all characteristics of successful cohorts.

Clinical Implications:

These data that include over 50,000 children from families across the country, many in underserved areas, will be used for research with the potential to lead to profound policy changes. Prenatal conditions such as maternal age, obesity, depression, and drug use can be examined using study data, including biological markers, from pregnancy through childbirth and into childhood and will inform national policies on the role of early life exposures and underlying mechanisms of disease progression.
Letter to Friends
Authors: Reid-Ponte Patricia
Published: May 2021

This past year brought the deadliest pandemic of our time and a huge social awakening and movement for racial justice. It became clear to me in late spring that I needed to learn more about structural racism, White supremacy, racial healthcare disparities, unconscious bias, and my own prejudices that govern my attitudes, values, behaviors, and decisions as a nurse leader, faculty member, board member, and a human being. To that end, I began to read, watch, and listen to both scholarly and lay journals and media that provide historical and current empirical accounts and studies of how racism and White supremacy have dominated our society, organizations, and communities in the United States for hundreds of years.
Decline in Physical Restraint Use Following Implementation of Institutional Guidelines
Authors: Shields Lisa B. E. , Edelen Avalena , Daniels Michael W. , Flanders Kimberly
Published: May 2021

OBJECTIVE

To investigate the strategies implemented at our institution to reduce medical restraint use.

BACKGROUND

Restraints have been utilized to prevent agitation, self-extubations, and falls, although they are often associated with negative repercussions for nurses and patients.

METHODS

The restraint data at our institution were compared with the National Database of Nursing Quality Indicators (NDNQI) benchmark. We also described the measures taken to improve restraint documentation.

RESULTS

The number of patients in medical restraints, medical restraint hours, medical restraints/patient-days, and deaths in restraints at our institution all significantly decreased (P < 0.00001). There were 27 self-extubations of restrained patients compared with 11 self-extubations of nonrestrained patients. The percentage of inpatients with restraints in critical care and step-down areas declined and remained below the NDNQI benchmark.

CONCLUSIONS

This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.
The Reality for Minorities Exploring Nurse Executive Leadership
Authors: Harris Trarina Jerome
Published: May 2021

Practices to increase diversity in nursing have had little effect at the executive leadership level. Lack of diversity in leadership threatens efforts to improve patient care and reduce disparities. This article advocates for formal mentorship as an evidence-based pathway to expand diversity in nurse executive leadership.
Cumin
Authors: Singletary Keith W.
Published: May 2021

Cumin is an aromatic herb prepared from the dried seeds of the plantCuminum cyminumL. (family Apiaceae). As a culinary ingredient, it is a major constituent of curry powder, and as a spice, its popularity is considered second only to pepper. Therapeutic uses of cumin in traditional medicines date back millenia and include treatment for gastrointestinal distress, diarrhea, and jaundice, as well as for hypertension, epilepsy, fever, childhood maladies, and gynecological and respiratory disorders. This narrative review summarizes recent human trials that assess its efficacy in relieving symptoms associated with diabetes and cardiovascular disease and considers suggestions for future studies.
Is a Surrogate Pregnancy a High-Risk Pregnancy?
Authors: Amorado Patricia , Magann Everett F. , Phillips Amy M. , Moutos Dean M. , Whittington Julie R. , Hughes Dawn S. , Klausen Jack H.
Published: May 2021

Importance

As assisted reproductive technology has advanced, there has been an increase in gestational carriers/surrogate pregnancies. Information is needed to determine if these pregnancies are high-risk pregnancies and should be managed by maternal fetal medicine or if they are not high risk and should be cared for by residency-trained obstetricians and gynecologists.

Objective

In this review of the literature, we explore whether surrogate pregnancies should be classified as high-risk pregnancies and managed by subspecialists.

Evidence Acquisition, Results

Our literature search discovered 28 relevant studies that evaluated surrogate pregnancy and pregnancy complications/outcomes. We learned that the overall risk by using artificial reproductive technology and risks for hypertension, preterm delivery, cesarean delivery, low birth weight neonate, fetal anomalies, and stillbirth did not seem to increase maternal/perinatal risk to the level where a subspecialist was required for the inclusive management of a gestational surrogate. Given that the ideal gestational carrier is healthy, has previously had a term pregnancy, has a single embryo implanted, and has had no more than 3 prior cesarean deliveries, these pregnancies should be lower-risk pregnancies.

Conclusions

We recommend that close monitoring and high index of suspicion should be maintained for complications, but care for the surrogate pregnancy can be accomplished by a residency-trained obstetrician-gynecologist.

Relevance

An uncomplicated surrogate pregnancy can be managed by a residency-trained obstetrician-gynecologist and does not need to be managed by high-risk obstetric subspecialists.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to counsel patients on the risks of surrogate pregnancy; identify outcomes associated with assisted reproductive technology; and conduct risk-based stratification of surrogate pregnancy.
Clinical Significance and Prognostic Value of SOX2 Protein Expression in Patients With Oral Squamous Cell Carcinoma
Authors: Ghazaghi Faezeh , Saffar Hana , Yazdani Farzad , Etebarian Arghavan
Published: May 2021

Objectives:

Cancer stem cells are a small group of highly tumorigenic cells with the trend of self-renewal, tumor progression, metastasis, recurrence, and therapeutic resistance. SOX2 is an important cancer stem cell marker that is involved in tumorigenesis and correlated with aggressive features in various types of malignancies. The present study was aimed to investigate the expression of this biomarker in neoplastic tissues of oral squamous cell carcinoma (OSCC) to determine whether it has the potential to predict the outcomes and survival of the affected patients.

Materials and Methods:

The medical records of 73 patients diagnosed with OSCC were retrospectively studied. Clinical and pathologic features included age, sex, tumor size, histologic grade, lymph node involvement, recurrence, metastasis, and follow up. Immunohistochemical analysis for SOX2 protein expression was performed, and its correlations with clinicopathologic features were evaluated.

Results:

SOX2 was significantly associated with tumor size, lymph node metastasis, and patients’ survival. We found no apparent correlation between SOX2 and tumor recurrence, distant metastasis, or differentiation. The multivariate analysis identifies patients’ age, sex, and SOX2 expression as independent prognostic factors for overall survival.

Conclusion:

SOX2 may worsen the prognosis and be a progressive malignant factor, which can help clinicians investigate OSCC patients’ survival and plan the appropriate treatment accordingly.
Minimal Residual Disease in Multiple Myeloma
Authors: Mina Roberto , Bonello Francesca , Oliva Stefania
Published: May 2021

Minimal residual disease (MRD) techniques are essential to identify the small clonal fraction within and outside the bone marrow. In the last years, evidence regarding their prognostic role for the evaluation of the depth of response of current treatment strategies has grown rapidly. Consequently, MRD was incorporated in an increasing number of clinical trials for multiple myeloma patients, also as primary endpoint, and even to guide therapeutic choices. A robust correlation between MRD negativity and survival was established. Yet, several issues regarding MRD evaluation remain to be addressed: from the optimal and more cost-effective techniques for its assessment and its harmonization worldwide to its use in clinical practice to its impact on treatment modulation. This review focuses on the available evidence supporting the use of MRD status for the management of multiple myeloma patients and on open issues that still need an answer.
From Bench to Bedside
Authors: Morgan Gareth J. , Boyle Eileen M. , Davies Faith E.
Published: May 2021

The summation of 20 years of biological studies and the comprehensive analysis of more than 1000 multiple myeloma genomes with data linked to clinical outcome has enabled an increased understanding of the pathogenesis of multiple myeloma in the context of normal plasma cell biology. This novel data have facilitated the identification of prognostic markers and targets suitable for therapeutic manipulation. The challenge moving forward is to translate this genetic and biological information into the clinic to improve patient care. This review discusses the key data required to achieve this and provides a framework within which to explore the use of response-adapted, biologically targeted, molecularly targeted, and risk-stratified therapeutic approaches to improve the management of patients with multiple myeloma.
An Overview of Organoid and 3-Dimensional Models in Multiple Myeloma
Authors: Rodriguez Cesar
Published: May 2021

Multiple myeloma is a hematological malignancy of differentiated B cells that resides primarily in bone marrow niches. Its interaction with the microenvironment is known to provide a survival advantage and plays an important role in drug resistance. Despite the increased efficacy of new treatment drugs, clinical results oftentimes fall short of in vitro observations, and this disease remains incurable. Conventional 2-dimensional cultures used to perform chemosensitivity assays and the established multiple myeloma cells lines commonly used do not replicate the conditions seen in vivo. This review presents various 3-dimensional culture platforms for myeloma that attempt to overcome this obstacle by incorporating aspects of the tumor microenvironment. The unique features of each model and contributions they have provided in personalized medicine, tumor physiology, and chemosensitivity assays will be summarized.
Clinical Importance of Incidentally Detected Hyperenhancing Liver Observations on Portal Venous Phase Computed Tomography in Patients Without Known Malignancy or Liver Disease
Authors: Corwin Michael T. , DiGeronimo Ryan T. , Navarro Shannon M. , Fananapazir Ghaneh , Wilson Machelle , Loehfelm Thomas W.
Published: May 2021

Objective

The aim of the study was to determine the prevalence of clinically important masses among incidental hyperenhancing liver observations on portal venous phase computed tomography (CT) in patients without known malignancy or liver disease.

Methods

Retrospective search of portal venous phase CTs was performed to identify hyperenhancing liver observations in patients without cancer or liver disease. Observations were assigned a morphology of homogeneous, hemangioma, or heterogeneous. The reference standard was pathology (n = 2), liver protocol CT/magnetic resonance imaging (n = 40), follow-up portal venous phase CT for 2 years or more (n = 81), or clinical follow-up for 5 years or more (n = 107).

Results

There were no clinically important masses among 83 observations with homogeneous morphology or 110 with hemangioma morphology. There were 2 clinically important masses (1 hepatocellular carcinoma and 1 hepatic adenoma) among 37 (5.4%) heterogeneous morphology observations.

Conclusions

Incidental hyperenhancing liver observations on portal venous phase CT with homogeneous or typical hemangioma morphology in patients without known cancer or liver disease are highly likely benign.