bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Safe Infant Sleep Compliance Through Implementation of a Safe Sleep Bundle
Authors: Sacks Alicia M. , Fitzgerald Jennifer , Boerste Laura A.
Published: April 2022

Background:

Sleep-related infant deaths continue to be a significant public health issue that nondiscriminately impacts family units with increased risk notably in premature infants discharged home from the neonatal intensive care unit (NICU). The American Academy of Pediatrics endorses the use of safe sleep practices with specific recognition of the unique challenges faced in the NICU setting.

Purpose:

The purpose of this quality improvement (QI) project was to implement a safe sleep bundle and evaluate its effectiveness in improving caregiver compliance to safe sleep practices in a level III NICU at a large joint military medical facility.

Methods:

A QI initiative with a pre- and postanalysis was performed using a convenience method of sampling. Infants 32 weeks or more post-menstrual age in a level III NICU were analyzed pre- and post-interventions. The intervention included a safe sleep bundle that encompassed: (1) policy update, (2) standardized sleep sacks, (3) crib cards and certificates, and (4) creation of a provider order set in the electronic health record (EHR). A standardized crib audit tool evaluated sleep and bed position, items in the crib, order set in the EHR with consideration of special medical circumstances.

Results:

Postintervention assessment after the implementation resulted in a significant improvement of overall safe sleep compliance modeled by NICU staff, increasing to 100% from a baseline of 18% pre-intervention (P = .029).

Implications for Practice and Research:

Role-modeling behaviors of clinical staff may reduce the risk of sleep-related infant deaths upon discharge. A multifactorial approach can leverage successful strategies for improving safe sleep compliance in a NICU setting.
Tobacco, but Neither Cannabis Smoking Nor Co-Drug Use, Is Associated With Hearing Loss in the National Health and Nutrition Examination Survey, 2011 to 2012 and 2015 to 2016
Authors: Baiduc Rachael R. , Sun Joshua W. , Spankovich Christopher , Vance Eric A.
Published: April 2022

Introduction:

A relationship between tobacco smoking and hearing loss has been reported; associations with cannabis smoking are unknown. In this cross-sectional population-based study, we examined relationships between hearing loss and smoking (tobacco, cannabis, or co-drug use).

Methods:

We explored the relationship between hearing loss and smoking among 2705 participants [mean age = 39.41 (SE: 0.36) years] in the National Health and Nutrition Examination Survey (2011 to 12; 2015 to 16). Smoking status was obtained via questionnaire; four mutually exclusive groups were defined: nonsmokers, current regular cannabis smokers, current regular tobacco smokers, and co-drug users. Hearing sensitivity (0.5 to 8 kHz) was assessed, and two puretone averages (PTAs) computed: low- (PTA0.5,1,2) and high-frequency (PTA3,4,6,8). We defined hearing loss as threshold >15 dB HL. Multivariable logistic regression was used to examine sex-specific associations between smoking and hearing loss in the poorer ear (selected based on PTA0.5,1,2) adjusting for age, sex, race/ethnicity, hypertension, diabetes, education, and noise exposure with sample weights applied.

Results:

In the age-sex adjusted model, tobacco smokers had increased odds of low- and high-frequency hearing loss compared with non-smokers [odds ratio (OR) = 1.58, 95% confidence ratio (CI): 1.05 to 2.37 and OR = 1.97, 95% CI: 1.58 to 2.45, respectively]. Co-drug users also had greater odds of low- and high-frequency hearing loss [OR = 2.07, 95% CI: 1.10 to 3.91 and OR = 2.24, 95% CI: 1.27 to 3.96, respectively]. In the fully adjusted multivariable model, compared with non-smokers, tobacco smokers had greater odds of high-frequency hearing loss [multivariable adjusted odds ratio = 1.64, 95% CI: 1.28-2.09]. However, in the fully adjusted model, there were no statistically significant relationships between hearing loss (PTA0.5,1,2 or PTA3,4,6,8) and cannabis smoking or co-drug use.

Discussion:

Cannabis smoking without concomitant tobacco consumption is not associated with hearing loss. However, sole use of cannabis was relatively rare and the prevalence of hearing loss in this population was low, limiting generalizability of the results. This study suggests that tobacco smoking may be a risk factor for hearing loss but does not support an association between hearing loss and cannabis smoking. More definitive evidence could be derived using physiological measures of auditory function in smokers and from longitudinal studies.
The Impact of Job Loss on Self-injury Mortality in a Cohort of Autoworkers
Authors: Dufault Suzanne M. , Chen Kevin T. , Picciotto Sally , Neophytou Andreas M. , Eisen Ellen A.
Published: April 2022

Background:

Recent increases in national rates of suicide and fatal overdose have been linked to a deterioration of economic and social stability. The American auto industry experienced comparable pressures beginning in the 1980s with the emergence of a competitive global market.

Methods:

Using the United Autoworkers-General Motors (GM) cohort as a case study, we examine the impact of employment loss on these self-injury mortality events. For 29,538 autoworkers employed on or after 1 January 1970, we apply incremental propensity score interventions, a novel causal inference approach, to examine how proportional shifts in the odds of leaving active GM employment affect the cumulative incidence of self-injury mortality.

Results:

Cumulative incidence of self-injury mortality was 0.87% (255 cases) at the observed odds of leaving active GM employment (δ = 1) over a 45-year period. A 10% decrease in the odds of leaving active GM employment (δ = 0.9) results in an estimated 8% drop in self-injury mortality (234 cases) while a 10% increase (δ = 1.1) results in a 19% increase in self-injury mortality (303 cases).

Conclusions:

These results are consistent with the hypothesis that leaving active employment at GM increases the risk of death due to suicide or drug overdose.
Joint Models for Estimating Determinants of Cognitive Decline in the Presence of Survival Bias
Authors: Davis-Plourde Kendra L. , Mayeda Elizabeth Rose , Lodi Sara , Filshtein Teresa , Beiser Alexa , Gross Alden L. , Seshadri Sudha , Glymour M. Maria , Tripodis Yorghos
Published: April 2022

Background:

Identifying determinants of cognitive decline is crucial for developing strategies to prevent Alzheimer’s disease and related dementias. However, determinants of cognitive decline remain elusive, with inconsistent results across studies. One reason could be differential survival. Cognitive decline and many exposures of interest are associated with mortality making survival a collider. Not accounting for informative attrition can result in survival bias. Generalized estimating equations (GEE) and linear mixed-effects model (LME) are commonly used to estimate effects of exposures on cognitive decline, but both assume mortality is not informative. Joint models combine LME with Cox proportional hazards models to simultaneously estimate cognitive decline and the hazard of mortality.

Methods:

Using simulations, we compared estimates of the effect of a binary exposure on rate of cognitive decline from GEE, weighted GEE using inverse-probability-of-attrition weights, and LME to joint models under several causal structures of survival bias.

Results:

We found that joint models with correctly specified relationship between survival and cognition performed best, producing unbiased estimates and appropriate coverage. Even those with misspecified relationship between survival and cognition showed advantage under causal structures consistent with survival bias. We also compared these models in estimating the effect of education on cognitive decline after dementia diagnosis using Framingham Heart Study data. Estimates of the effect of education on cognitive decline from joint models were slightly attenuated with similar precision compared with LME.

Conclusions:

In our study, joint models were more robust than LME, GEE, and weighted GEE models when evaluating determinants of cognitive decline.
Thyroid Bioassay and Dose Assessment System for 125I at Woods Hole Oceanographic Institution
Authors: Reif Ronald H. , Lopes Dan
Published: April 2022

Woods Hole Oceanographic Institution (WHOI) conducts research involving 125I. When an individual handles or works near unsealed radioiodine, including 125I, above certain activities bioassays are required or may be required. Because of the quantities of 125I being used for a research protocol, a thyroid bioassay and dose assessment system and procedure was developed to comply with this requirement. This procedure includes detector calibration, quality control, determination of recording level, determination of minimum detectable activity, thyroid bioassay (baseline, routine, special, and termination measurements), and intake and dose assessment calculations.
An Active Dose Measurement Device for Ultra-short, Ultra-intense Laser Facilities
Authors: Wei Shuoyang , Gong Hui , Song Honghu , Hu Ankang , Xiong Jun , Zhang Hui , Li Junli , Qiu Rui
Published: April 2022

Ultra-short, ultra-intense laser facilities could produce ultra-intense pulsed radiation fields. Currently, only passive detectors are fit for dose measurement in this circumstance. Since the laser device could generate a dose up to tens of mSv outside the chamber in tens of picoseconds, resulting in a high instantaneous dose rate of ~107 Sv s−1, it is necessary to perform real-time dose measurement to ensure the safety of nearby workers. Due to fast response and excellent radiation resistance, a diamond-based dose measurement device was designed and developed, and its dose-rate response and its feasibility for such occasions were characterized. The measurement results showed that the detector had a good dose-rate linearity in the range of 3.39 mGy h−1 to 10.58 Gy h−1 for an x-ray source with energy of 39 keV to 208 keV. No saturation phenomenon was observed, and the experimental results were consistent with the results obtained from Monte Carlo simulation. The charge collection efficiency was about 80%. Experimental measurements and simulations with this dose measurement device were carried out based on the “SG-II” laser device. The experimental and simulation results preliminarily verified the feasibility of using the diamond detector to measure the dose generated by ultra-short, ultra-intense laser devices. The results provided valuable information for the follow-up real-time dose measurement work of ultra-short, ultra-intense laser devices.
A 27-GAUGE TROCAR-ASSISTED INTRASCLERAL INTRAOCULAR LENS FIXATION TECHNIQUE USING A SILICONE MICROTUBE
Authors: Miura Shinji , Akashi Azusa , Fujiwara Ritsuko
Published: April 2022

Purpose:

This study aimed to describe a novel technique to facilitate intrascleral fixation of the intraocular lens (IOL).

Methods:

Two 27-gauge trocars were placed at an angle of 180° and a distance of 2 mm from the corneal limbus. A silicone microtube with an external diameter of 0.2 mm was introduced through a sclerocorneal incision and withdrawn via a trocar using retinal forceps. The tips of the IOL haptics were connected to the microtube. After the implantation of the IOL into the chamber, the haptics were externalized through the scleral site by pulling the microtubes. Each tip of the haptics was flanged and buried into the scleral tunnel.

Results:

The IOL was successfully placed with this method without any complications.

Conclusion:

This study presented a novel technique for intrascleral IOL fixation using a silicone microtube. We believe that our technique might increase surgical safety and help decrease the operative time for both anterior and posterior segment techniques.
CRYSTALLINE RETINOPATHY IN A 6-YEAR-OLD BOY WITH HISTORY OF HIGH-DOSE TAMOXIFEN USE
Authors: Mathew Namita E. , Kozak Jennifer , Jayasundera Kanishka Thiran , Jain Nieraj , Prabhu Shreya S.
Published: April 2022

Background/Purpose:

To report a case of crystalline retinopathy following high-dose tamoxifen use in a pediatric patient.

Methods:

Observational case report.

Results:

A 6-year-old boy with history of more than 80-g cumulative tamoxifen use over 25 months for the treatment of atypical teratoid/rhabdoid tumor of the posterior fossa presented with a 4-month history of blurred vision. Fundus examination demonstrated multiple superficial foveal refractile opacities in each eye, and spectral optical coherence tomography revealed numerous punctate hyperreflective deposits located within the inner retina. These findings were suggestive of tamoxifen retinopathy.

Conclusion:

To our knowledge, this is the first report of multimodal retinal imaging of tamoxifen retinopathy in a pediatric patient. Given the risk of permanent vision loss, ophthalmic baseline screening and monitoring should be considered for children receiving tamoxifen.
Delayed-Onset Inflammatory Optic Nerve Sheath Mass and Perineuritis Following Cessation of Ipilimumab and Nivolumab Therapy
Authors: Kamboj Alisha , Hwang Christopher J. , McClelland Collin M. , Maltry Amanda C. , Harrison Andrew R. , Mokhtarzadeh Ali
Published: April 2022

A 65-year-old male presented with headaches and painless episodes of unilateral vision loss. He had a history of renal cell carcinoma, in remission following surgery and immunotherapy with ipilimumab and nivolumab, discontinued 2 years and 3 months before presentation, respectively. MRI revealed an optic nerve sheath mass and perineuritis. After 1 month of corticosteroid therapy, there was a robust clinical and radiographic response, which relapsed dramatically following cessation. An optic nerve sheath biopsy showed chronic mild inflammation, and extensive work-up for alternative etiologies of orbital inflammation was negative. Following a prolonged taper of corticosteroids, he demonstrated complete response. In the setting of ocular immune privilege, ophthalmic immune-related adverse events (irAE) are rare, although multifarious. While on-treatment irAE are well-characterized, posttreatment irAE have become increasingly recognized across multiple organ systems. We report a case of a delayed-onset inflammatory optic nerve sheath mass and perineuritis after cessation of immunotherapy.
Using technology to bridge the transition from pediatric to adult health care
Authors: Miller Cashmere
Published: April 2022

Background:

There are unique challenges presented during the transition from pediatric to adult health care for adolescents with chronic medical conditions, and many do not transition smoothly. Although there is little research on how mobile applications can influence the transition process specifically, research shows technology, in general, can be advantageous to the transition process for adolescents. Ample literature exists on how adolescents are avid users of technology.

Local Problem:

The Children's Medical Services program in a large urban county in the southern United States lacked an efficient system for transitioning the care of children with special needs to the adult health care setting.

Methods:

Qualitative semistructured interviews and pre–post tests were conducted with 23 adolescent participants with chronic medical conditions. Multiple choice questions elicited information from four categories: knowledge of medical condition, organization/health care system navigation, identified adult health care provider, and awareness of available resources.

Interventions:

A novel website and smartphone application designed to aid adolescents and young adults during transition were developed.

Results:

Gain scores from pre–post tests showed an increase in all 4 sections of the survey: knowledge of medical condition—21% increase, organization/health care system navigation—15.3% increase, identified health care provider—32% increase, and awareness of available resources—19.3% increase. All 23 adolescent participants reported that the application would be useful for managing their health information.

Conclusions:

Smartphone applications can be helpful for adolescents in their transition into adult health care. Such applications also have potential to increase confidence and independence in managing health care needs.
Active Circulating Blood Volume During Hemodialysis: A Bench Model
Authors: Hu Dean , Krivitski Nikolai M. , Salehpour Fahimeh , Rivas Logan , Chahal Yaadveer , Aragon Michael
Published: April 2022

Intradialytic hypotension due to excessive fluid removal is a common complication of hemodialysis. A bench model was constructed to evaluate quantification of active circulating blood volume (ACBV). The model included a central pump representing the heart and compartments to represent the central and peripheral circulation. A blood oxygenator was used to simulate lung volume and two containers represented fast and slow circulation compartments. A separate dialysis circuit with a blood pump and two ultrasound flow-dilution probes was incorporated. Vascular access was simulated with both a shunt (fistula or graft) and a central venous catheter. Hypertonic saline (5%) was circulated in the system. A bolus of isotonic saline was introduced in the dialysis circuit, which dispersed through the physiologic model. ACBV was measured by comparing the baseline dilution curve to the curve as it returned to the probes. To evaluate the sensitivity of this technique, we investigated changing cardiac output, central venous volume, shunt flow, vascular access type, and HD pump flow. Overall percentage error (mean ± SD) across all tests (n = 15 conditions, each in triplicate) was 2.6% ± 7.4%. This study demonstrates the ability to accurately measure ACBV on the bench.
A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021
Authors: Carson Erin , Hemenway Alice N.
Published: April 2022

Background:

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), or long-COVID, are signs and symptoms that persist after the acute phase of Coronavirus disease 2019 infection has passed. PASC is newly recognized, and research is ongoing to answer questions about pathology, symptoms, diagnosis, and optimal treatment.

Areas of Uncertainty:

Use of pharmacologic treatment for symptoms of PASC is currently evolving. This scoping review aims to assess medical literature for any evidence supporting or refuting use of any medications to specifically treat PASC.

Data Sources:

PubMed, EMBASE, Web of Science, and gray literature sources were searched for any study of medication use for PASC. Studies were included if they described medication use in patients with PASC. There were no exclusion criteria based on study type or if results were reported. Studies were divided into completed works and ongoing research.

Results:

Fifty-two records were included in final analysis from an initial 3524 records found, including 2 randomized controlled trials, 7 prospective, open-label or observational studies, 14 case reports or case series, 1 survey, 1 correspondence, 1 retrospective analysis, and 26 studies in progress. Seven of the 26 completed works investigate ivabradine or beta-blockers, whereas 7 investigate local or systemic corticosteroids. Three investigate multi-ingredient nutritional supplements. The other 9 completed works as well as the 26 studies in progress investigate a wide variety of other treatments including drugs in development, drugs used for other conditions, herbals, supplements, and vitamins.

Conclusions:

There is limited, but evolving, literature on medication treatment for PASC. Providers who opt to use pharmacologic therapy for PASC need to be vigilant in their knowledge of these evolving data.
Sleep Apnea Screening in Children With Sickle Cell Anemia
Authors: Flores Oria Carlos A. , Stark James M. , Mosquera Ricardo A. , Brown Deborah L. , Menon Neethu M. , Sharma Kamal P. , Gonzales Traci , Nguyen Trinh , Jon Cindy K. , Emanuel Hina , Yadav Aravind
Published: April 2022

Background:

Screening for obstructive sleep apnea (OSA) is recommended by current guidelines in children with sickle cell anemia (SCA), but no specific approach is described. The Pediatric Sleep Questionnaire (PSQ) is a validated detection tool for OSA in children. We assessed the utility of PSQ to screen for OSA in children with concomitant SCA and snoring.

Materials and Methods:

A prospective study, in children 4 to 18 years old with SCA. Subjects were assessed for snoring and PSQ administered at the same visit. All children with snoring were then referred for polysomnography.

Results:

A total of 106 subjects were screened. Habitual snoring prevalence was 51/106 (48.1%). In the snoring group, OSA was detected in 83.9% (apnea-hypopnea index [AHI] ≥1.0/h) and 22.6% (AHI ≥5.0/h), respectively. Sensitivity and specificity of PSQ in children with snoring was 46.2% and 20.0% (AHI ≥1.0/h), and 57.1% and 50.0% (AHI ≥5.0/h), respectively. Physician assessment for snoring had a high sensitivity of 70.3% but low specificity of 58.4% (AHI ≥1.0/h), and 87.5% and 41.5% (AHI ≥5.0/h), respectively.

Conclusion:

PSQ is a poor screening tool for detection of OSA in those children with SCA who snore. Physician assessment for snoring could however be an initial approach before polysomnography.
Persons Who Engage in Self-Harm While in the Emergency Department
Authors: Lawrence Ryan E. , Krumheuer Aaron , Loh Ryan , Stanley Barbara , Simpson Scott A.
Published: April 2022

Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95–9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19–7.02), current manic episode (OR, 3.59; CI, 1.33–9.70), and a history of seizures (OR, 4.19; CI, 1.16–15.14). Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.
A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients
Authors: Kapoor Rajat , Rader Tiffany , Dillon Jill , Jaydev FNU , Horvath Dawn , Little Aubrey , Vickery Jessica , DiPerna Christen , Brittain Lynne , Rahman Omar
Published: April 2022

Purpose/Aims

Healthcare workers internationally continue to look for innovative ways to improve patient outcomes and optimize resource utilization during the coronavirus disease 2019 (COVID-19) pandemic. Proning awake, nonintubated patients has been suggested as a potential intervention in critical care. The aim of this study is to provide a multidisciplinary approach to safely perform awake self-prone positioning in the acute care setting.

Design

This is a prospective, descriptive study.

Method

Patients with COVID-19 were screened and enrolled within 48 hours of a positive test. After approval from the primary team, patients were provided education materials by a multidisciplinary team on the self-prone intervention. Visual cues were placed in the room. Patients were requested to maintain a diary of hours of prone positioning. Patients' baseline characteristics, admission vitals, daily oxygen requirements, and level of care were collected.

Results

Of 203 patients screened, 31 were enrolled. No pressure-related injury or catheter (intravenous or urinary) displacement was identified. Eighty-one percent of patients spent less than 8 hours a day in prone positioning. Among patients enrolled, none required invasive ventilation or died.

Conclusions

Awake self-proning can be performed safely in patients given a diagnosis of COVID-19 in the acute care setting with a multidisciplinary team.
CLE3AR Study
Authors: Steere Lee
Published: April 2022

Problem/Purpose

Intraluminal thrombotic catheter occlusions are associated with a greater risk of delayed treatment, morbidity, and mortality and higher healthcare costs.

Methods

The Vascular Access Specialist Team at Hartford Hospital used Lean Six Sigma methodology to identify and address waste, variability, and defects associated with occlusion management.

Interventions

Beginning in 2015, all central venous catheter occlusions in acute inpatient care were assessed by a vascular access nurse specialist. First, the decisions to treat with tissue plasminogen activator were determined using a catheter patency algorithm. Second, negative displacement needleless connectors were replaced by antireflux needleless connectors to reduce unintentional blood reflux and other complications associated with intraluminal thrombotic catheter occlusion.

Results

A total of 159 934 central line days were reported between 2014 and 2020. The hospital achieved a 71.3% reduction in annual tissue plasminogen activator used for occlusions over the study period. There was a sustained decrease in annual average needleless connector consumption of 41% after switching to antireflux needleless connectors in 2015. The 5-year cost savings for these 2 interventions were estimated to be $356 005.

Conclusions

Lean occlusion management interventions were associated with reduced pharmacy use, medical supply waste, and spending, which have been sustained for over a 5-year period.
Pediatric Residency Preparedness for Pediatric Emergency Medicine Fellowship
Authors: Malik Rabia N. , Langhan Melissa L.
Published: April 2022

Objective

The aim of the study was to examine the perception of pediatric emergency medicine (PEM) program directors (PDs), associate PDs (APDs) and first-year fellows regarding the preparedness of new PEM fellows who have graduated from pediatric residency programs.

Methods

Unique surveys were created and electronically distributed to PEM PDs/APDs and first-year PEM fellows. Individual and institutional demographic information was collected. Using a 5-point Likert scale, survey items centered the perceived preparedness of first-year PEM fellows within 5 domains: professionalism, independence/autonomy, psychomotor skills, clinical evaluation and management, and academia/scholarship.

Results

Forty percent (48/119) of eligible PDs and APDs and 56% (82/147) of eligible first-year PEM fellows responded. Most PDs/APDs strongly agreed or agreed that incoming fellows perform adequately in areas of professionalism, independence/autonomy, and clinical evaluation and management. The PDs/APDs perceived fellows to be less prepared in the academia/scholarship domain and several psychomotor skills. Most first-year PEM fellows perceived themselves as prepared in areas of professionalism and clinical evaluation and management. Fellows had varied feelings of preparedness in the domains of independence/autonomy, psychomotor skills, and academia/scholarship. Overall, most PDs/APDs (54%) and fellows (84%) feel that pediatric residency training was strong or very strong.

Conclusions

Most respondents in both groups felt that in general, pediatric residency programs adequately train residents for PEM fellowship. Both groups felt that the strengths of general pediatric training were among the domains of professionalism and clinical evaluation and management, whereas psychomotor skills and academia and scholarship were areas of improvement. These findings may be used by general pediatric residency and PEM fellowship programs to guide curriculum development.
A Comparison of Motorized and Nonmotorized Scooter Injuries in Pediatric Patients Seen in US Emergency Departments
Authors: Magee Lacey C. , Chan Calvin , Talwar Divya , Maguire Kathleen J. , Horn B. David
Published: April 2022

Objectives

We sought to characterize and compare trends in pediatric injuries sustained on motorized and nonmotorized scooters across the United States, to assess the use of safety equipment in children presenting with scooter-related injuries, and provide strategies for injury prevention.

Methods

The National Electronic Injury Surveillance System was queried for motorized and nonmotorized scooter–related pediatric injuries from 2014 to 2018 in patients ages 6 to 12 years. Patient demographics, diagnosis, injury location, and narrative of the incident were collected. Bivariate and regression analyses were used to determine demographic and social associations of injury characteristics.

Results

An estimated 146,000 (11,452 motorized and 134,548 nonmotorized) injuries occurred in children ages 6 to 12 years over the 5 years. Three of 4 injuries occurred in children younger than 10 years, and most injuries occurred in males (56%).

From 2014 to 2018, the nationwide estimated incidence of motorized scooter injuries increased by 112.1%, while that of nonmotorized scooter injuries decreased by 40.3%.

Upper extremity injuries were most common with nonmotorized scooters (44.4% of all injuries), while lower extremity injuries were most common with motorized scooters (39.5% of all injuries). Head and neck injuries accounted for 27.4% of nonmotorized scooter injuries and 23.4% of motorized scooter injuries. The number of concussions in motorized scooters increased from 0.4% in 2014 to 2.7% in 2018, while concussions in nonmotorized scooters decreased from 3.5% to 2.7%. Helmets were mentioned in the medical record in 6.6% of the cases. Of these, 60.5% reported no use of helmet at the time of injury.

Conclusions

From 2014 to 2018, the number of motorized scooter injuries increased by 112.1% in the pediatric population ages 6 to 12 years, whereas nonmotorized scooter injuries decreased by 40.3%. In more than 60% of the cases that mentioned a helmet, the child injured was recorded as not wearing a helmet. The rise in pediatric injuries associated with motorized scooters in contrast with the reduction of injuries associated with nonmotorized scooters highlights the need for novel public health policies and interventions promoting helmet use with motorized scooters in the pediatric population.
Sepsis Electronic Decision Support Screen in High-Risk Patients Across Age Groups in a Pediatric Emergency Department
Authors: Witting Celeste S. , Simon Norma-Jean E. , Lorenz Doug , Murphy Julia S. , Nelson Jill , Lehnig Katherine , Alpern Elizabeth R.
Published: April 2022

Objective

This study aimed to compare the performance of a pediatric decision support algorithm to detect severe sepsis between high-risk pediatric and adult patients in a pediatric emergency department (PED).

Methods

This is a retrospective cohort study of patients presenting from March 2017 to February 2018 to a tertiary care PED. Patients were identified as high risk for sepsis based on a priori defined criteria and were considered adult if 18 years or older. The 2-step decision support algorithm consists of (1) an electronic health record best-practice alert (BPA) with age-adjusted vital sign ranges, and (2) physician screen. The difference in test characteristics of the intervention for the detection of severe sepsis between pediatric and adult patients was assessed at 0.05 statistical significance.

Results

The 2358 enrolled subjects included 2125 children (90.1%) and 233 adults (9.9%). The median ages for children and adults were 3.8 (interquartile range, 1.2–8.6) and 20.1 (interquartile range, 18.2–22.0) years, respectively. In adults, compared with children, the BPA alone had significantly higher sensitivity (0.83 [95% confidence interval {CI}, 0.74–0.89] vs 0.72 [95% CI, 0.69–0.75]; P = 0.02) and lower specificity (0.11 [95% CI, 0.07–0.19] vs 0.48 [95% CI, 0.45–0.51; P < 0.001). With the addition of provider screen, sensitivity and specificity were comparable across age groups, with a lower negative predictive value in adults compared with children (0.66 [95% CI, 0.58–0.74] vs 0.77 [95% CI, 0.75–0.79]; P = 0.005).

Conclusions

The BPA was less specific in adults compared with children. With the addition of provider screen, specificity improved; however, the lower negative predictive value suggests that providers may be less likely to suspect sepsis even after automated screen in adult patients. This study invites further research aimed at improving screening algorithms, particularly across the diverse age spectrum presenting to a PED.
Impaired conditioned pain modulation was restored after a single exercise session in individuals with and without fibromyalgia
Authors: Alsouhibani Ali , Hoeger Bement Marie
Published: April 2022

Introduction:

Exercise is an effective nonpharmacological intervention for individuals with fibromyalgia syndrome (FMS); however, considerable variability is observed in their pain response after a single exercise session that could be due to differences in baseline central pain inhibition (ie, conditioned pain modulation [CPM]).

Objectives:

This study examined the effect of isometric exercise on CPM in people with FMS and control participants. A subaim was to identify whether pain inhibition after exercise was due to differences in baseline CPM.

Methods:

Twenty-one individuals with FMS (50.5 ± 14.9 years) and 22 age-matched and sex-matched controls (49.2 ± 13.3 years) participated in a familiarization session and 2 randomized experimental sessions: (1) low-intensity isometric exercise and (2) quiet rest control. Conditioned pain modulation was measured before and after each experimental session. In addition, body composition and physical activity levels were collected to determine potential group differences.

Results:

Both groups had comparable body composition and physical activity levels and reported similar exercise-induced hypoalgesia (increase in pressure pain thresholds) at the exercising muscle (quadriceps muscle) and systemically (deltoid muscle). Both groups had a decrease in CPM after exercise and quiet rest; however, in both FMS and control participants with impaired baseline CPM, there was an increase in CPM at the deltoid muscle after exercise.

Conclusion:

In persons with low CPM, irrespective of health status, isometric exercise enhanced CPM at a site distal from the exercising muscle. Our results support the use of isometric exercise when initiating an exercise program especially for individuals with impaired CPM.
A Prospective, Matched Comparison of Health-Related Quality of Life in Bariatric Patients following Truncal Body Contouring
Authors: Elfanagely Omar , Rios-Diaz Arturo J. , Cunning Jessica R. , Othman Sammy , Morris Martin , Messa Charles , Broach Robyn B. , Fischer John P.
Published: April 2022

Background:

Massive weight loss after bariatric surgery can lead to excess skin associated with functional and aesthetic sequelae. Access to the benefit provided by body contouring procedures may be limited by insurance approval, which does not consider health-related quality of life. The aim of this study was to quantify the benefit in health-related quality of life for patients who undergo body contouring procedures after massive weight loss.

Methods:

Patients evaluated for postbariatric body contouring procedures were systematically identified and prospectively surveyed using the BODY-Q. Health-related quality-of-life change for each functional scale was compared between those who underwent body contouring procedures (operative group, preoperatively versus postoperatively) and those who did not (nonoperative group, preoperatively versus resurvey) using t tests. Propensity score matching allowed the authors to balance baseline demographics, comorbidities, physical symptoms, and risk factors between cohorts.

Results:

Fifty-seven matched patients were analyzed (34 operative versus 23 nonoperative). No significant difference in age, body mass index, time between surveys, or preoperative BODY-Q scores existed between cohorts. The surgical group demonstrated a significant improvement in 10 out of 11 BODY-Q functional scales. The nonoperative group realized no improvements and, in the interim, had a significant deterioration in four BODY-Q scales.

Conclusions:

Postbariatric body contouring procedures represent a critical and final step in the surgical weight loss journey for patients and are associated with significant improvements in health-related quality of life. Further deterioration in psychosocial and sexual health-related quality of life occurs in patients who do not undergo body contouring procedures following bariatric surgery. This study provides prospective comparative data that validate the field’s standard intervention and justification for insurance approval.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Midface Multilayering Filler Injection Technique: Understanding of the Dynamic Facial Anatomy Through a “Smiling Cadavers” Anatomical Study
Authors: Trévidic Patrick , Trévidic Thibault , Imanilov Alexander , Criollo-Lamilla Gisella
Published: April 2022

Background:

Understanding age-related changes in compartmentalized facial fat and their role in facial dynamics and aesthetics is essential to target filler injections for midface rejuvenation.

Methods:

A novel anatomical approach (“smiling cadavers”) was used to identify the main midface fat compartments involved during muscular contraction when smiling and their motion and behavior with and without filler injections. Based on these insights and the literature, a multilayering filler injection approach was developed to optimize midface rejuvenation by restoring fat volumes using rheologically different products injected into different fat compartments.

Results:

Twenty-four hemifacial dissections confirmed the presence of two fat compartment layers, separated by the orbicularis oculi muscle in the horizontal plane and by the septa in the vertical plane, and revealed the anatomical effects of facial movement. The midface is composed of deep static fat compartments and a superficial dynamic adipose layer that follows the facial movements, creating a natural dynamic appearance. A proof-of-concept study involved 130 White patients (36 to 56 years; 91 percent women). After the procedure, 95 percent of patients and 98 percent of practitioners rated facial appearance as “improved” or “much/very much improved.” No major complications were reported.

Conclusions:

The smiling cadavers method enhances understanding of dynamic facial anatomy by showing the superficial and deep fat compartments of the midface at rest and their motion during a procedure to represent a smile. The multilayered injection technique takes into account these anatomical findings to rejuvenate the midface, achieving a natural appearance at rest and during motion.
We Are Not There Yet: A Qualitative System Probing Study of a Hospital Rapid Response System
Authors: Olsen Siri Lerstøl , Søreide Eldar , Hansen Britt Sætre
Published: April 2022

Objectives

The capability of a hospital’s rapid response system (RRS) depends on various factors to reduce in-hospital cardiac arrests and mortality. Through system probing, this qualitative study targeted a more comprehensive understanding of how healthcare professionals manage the complexities of RRS in daily practice as well as identifying its challenges.

Methods

We observed RRS through in situ simulations in 2 wards and conducted the debriefings as focus group interviews. By arranging a separate focus group interview, we included the perspectives of intensive care unit personnel.

Results

Healthcare professionals appreciated the standardized use of the National Early Warning Score, when combined with clinical knowledge and experience, structured communication, and interprofessional collaboration. However, we identified salient challenges in RRS, for example, unwanted variation in recognition competence, and inconsistent routines in education and documentation. Furthermore, we found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning, such as in situ simulation training.

Conclusions

Through system probing, we described the inner workings of RRS and revealed the challenges that require more attention. Healthcare professionals depend on structured RRS education, training, and resources to operate such a system. In this study, they request interventions like in situ simulation training as an interprofessional educational arena to improve patient care. This is a relevant field for further research. The Consolidated Criteria for Reporting Qualitative Studies Checklist was followed to ensure rigor in the study.
The Response of Emergency Departments (EDs) to the COVID-19 Pandemic: The Experience of 5 EDs in a Paris-Based Academic Hospital Trust
Authors: Ghazali Daniel Aiham , Choquet Christophe , Bouzid Donia , Peyrony Olivier , Fontaine Jean-Paul , Sonja Curac , Javaud Nicolas , Plaisance Patrick , Revue Eric , Chauvin Anthony , Casalino Enrique
Published: April 2022

The coronavirus disease-2019 (COVID-19) pandemic has imposed unforeseen and unprecedented constraints on emergency departments (EDs). In this study, we detail the organizational and managerial tools recently implemented among 5 academic EDs in a French region particularly affected by COVID-19 and analyze how EDs responded to the COVID-19-related disease burden during different phases of the epidemic. Initially, they focused on the early detection of suspected cases by identifying 3 predominant COVID-19 syndromes. During this diagnostic process, patients were placed in respiratory isolation (facial mask before triage) and droplet isolation (ED rooms). A 3-level strategy for triage, clinical pathways in the EDs, and the organization of hospital spaces was based on the real-time polymerase chain reaction (RT-PCR) COVID-19 positivity rate, with ED strategies adapted to the exigencies of each level. This crisis demonstrated hospitals' adaptability and capacity to mobilize in the face of new risks, with hospitals and EDs coordinating their management to reallocate resources, optimize interoperability, and rethink patient pathways. This report on their processes may assist hospitals and EDs in areas currently spared by the new variants.
Ultra-High-Field 7 T Magnetic Resonance Imaging Including Dynamic and Static Contrast-Enhanced T1-Weighted Imaging Improves Detection of Secreting Pituitary Microadenomas
Authors: Eisenhut Felix , Schlaffer Sven-Martin , Hock Stefan , Heynold Elisabeth , Kremenevski Natalia , Bluemcke Ingmar , Buchfelder Michael , Doerfler Arnd , Schmidt Manuel A.
Published: April 2022

Objective

A prospective preoperative evaluation of 7 T ultra-high-field magnetic resonance imaging (MRI) in patients with suspected pituitary microadenomas for both adenoma detection and intrasellar localization compared with 3 T MRI was carried out.

Materials and Methods

Patients underwent prospective preoperative standardized 3 and 7 T MRI. A distinct qualitative (lesion detection, intrasellar lesion location) and quantitative (lesion diameters, T1/T2 signal intensity ratio of the lesion to normal pituitary gland tissue) analysis was performed, along with an evaluation of image quality (IQ) regarding overall IQ, anatomical parameters, and artifacts; the findings of the qualitative analysis were compared with intraoperative findings and endocrinological outcomes.

Results

Sixteen patients (mean age, 43 ± 16 years; 13 women) with pituitary microadenomas were included. Using 7 T MRI allowed the detection of 15 microadenomas—3 more than 3 T MRI. In addition, 7 T MRI allowed more precise lesion localization with 93.75% (15/16) agreement with intraoperative findings, compared with 75% (12/16) agreement using 3 T MRI. Lesion diameters showed no significant difference between 3 and 7 T MRI. T1 and T2 signal intensity ratio between microadenomas and normal pituitary gland tissue were higher in 7 T MRI than in 3 T MRI. The overall IQ and the IQ of each anatomical parameter of 7 T MRI were rated higher than those of 3 T MRI. No significant differences in susceptibility or head motion artifacts were observed between 3 and 7 T MRI; however, 7 T MRI was more susceptible to pulsation artifacts.

Conclusion

Ultra-high-field MRI surpasses 3 T MRI in pituitary microadenoma detection and enables more precise delineation with higher correlation with intraoperative findings. Thus, 7 T sellar imaging is a promising option—especially in previously magnetic resonance–negative patients with endocrinologically confirmed hormone oversecretion—and helps reduce the need for invasive diagnostics.
“Occipital Pole” Sign on 18F-FDG PET for Dementia With Lewy Bodies and Posterior Cortical Atrophy
Authors: Gallucci Maurizio , Fiore Vittorio , Grassivaro Francesca , Da Ronch Chiara , Bonanni Laura
Published: April 2022

The 18F-FDG PET images of dementia with Lewy bodies and posterior cortical atrophy, a visual-cognitive phenotype described in patients with Alzheimer disease, show occipital lobe hypometabolism with relative sparing of the primary visual cortex (PVC) generating the “occipital tunnel” sign proposed by Sawyer and Kuo in 2017, which is viewable on the medial sagittal projection. We believe that the saving of PVC compared with the lateral occipital cortex can be better appreciated by capturing the posterior projection of the PVC in a 3D stereotactic surface projection map, and we propose the name of “occipital pole” sign for this evidence.
Iron Polymaltose Infusion Effects on Bone Scintigraphy and Remodeling
Authors: Kang Christine , Jiang James Y. , Wong Veronica , Man Jennifer , Mansberg Robert
Published: April 2022

A 73-year-old woman with metastatic breast cancer and known widespread skeletal metastases was referred for bone scintigraphy. Delayed images acquired at 2 and 5 hours postinjection of 30 mCi (1089 MBq) 99mTc-HDP demonstrated markedly reduced bony uptake, markedly increased renal activity, and significantly increased soft tissue accumulation. By contrast, appropriate skeletal uptake of 99mTc-HDP was seen in prior bone scans. The patient had been treated for iron deficiency anemia with an infusion of 1 g of iron polymaltose approximately 22 hours before injection of 99mTc-HDP. This phenomenon may be due to transient reduced bone resorption with increased FGF23 release secondary to IV iron supplementation.
68Ga-FAPI-04 PET/CT in Solitary Choroid Plexus Metastasis From Renal Cell Carcinoma
Authors: Yang Jian , Dong Aisheng , Zuo Changjing
Published: April 2022

Intraventricular metastasis from extracranial tumor is rare. We describe MRI and 68Ga-FAPI-04 PET/CT findings in a case of histologically proved solitary choroid plexus metastasis from clear cell renal cell carcinoma. The tumor showed remarkable enhancement on MRI and increased FAPI uptake with high tumor-to-background activity ratio on PET/CT. This case indicates FAPI PET may be useful for detection of intraventricular metastasis from renal cell carcinoma.