bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Ratings of Perceived Exertion and Target Heart Rate–Based Exercise Prescription in Cardiac Rehabilitation
Authors: Shea Meredith G. , Headley Samuel , Mullin Elizabeth M. , Brawner Clinton A. , Schilling Patrick , Pack Quinn R.
Published: April 2022

Purpose:

Although ratings of perceived exertion (RPE) are widely used to guide exercise intensity in cardiac rehabilitation (CR), it is unclear whether target heart rate ranges (THRRs) can be implemented in CR programs that predominantly use RPE and what impact this has on changes in exercise capacity.

Methods:

We conducted a three-group pilot randomized control trial (#NCT03925493) comparing RPE of 3-4 on the 10-point modified Borg scale, 60-80% of heart rate reserve (HRR) with heart rate (HR) monitored by telemetry, or 60-80% of HRR with a personal HR monitor (HRM) for high-fidelity adherence to THRR. Primary outcomes were protocol fidelity and feasibility. Secondary outcomes included exercise HR, RPE, and changes in functional exercise capacity.

Results:

Of 48 participants randomized, four patients dropped out, 20 stopped prematurely (COVID-19 pandemic), and 24 completed the protocol. Adherence to THRR was high regardless of HRM, and patients attended a median (IQR) of 33 (23, 36) sessions with no difference between groups. After randomization, HR increased by 1 ± 6, 6 ± 5, and 10 ± 9 bpm (P = .02); RPE (average score 3.0 ± 0.05) was unchanged, and functional exercise capacity increased by 1.0 ± 1.0, 1.9 ± 1.5, 2.0 ± 1.3 workload METs (effect size between groups, η
p
2= 0.11, P = .20) for the RPE, THRR, and THRR + HRM groups, respectively.

Conclusions:

We successfully implemented THRR in an all-RPE CR program without needing an HRM. Patients randomized to THRR had higher exercise HR but similar RPE ratings. The THRR may be preferable to RPE in CR populations for cardiorespiratory fitness gains, but this needs confirmation in an adequately powered trial.
Steroidal saponins with anti-inflammatory activity from Tribulus terrestris L.
Authors: Yang Miaojie , Oppong Mahmood Brobbey , Di Jingrui , Yuan Qing , Chang Yanxu , Jiang Miaomiao , Cao Shijie , Dong Pengzhi , Li Lin , Xie Yan , Luan Xiaoying , Hu Limin , Chai Lijuan , Zhang Peng
Published: April 2022

Objective:

Tribulus terrestris L. (T. terrestris) is a highly valuable traditional Chinese medicine used to treat stroke, inflammation, pulmonary fibrosis, liver cancer, and urolithiasis. To identify the basic substance responsible for the anti-inflammatory effect of TST (total saponins of Tribulus), its chemical composition was systematically studied, and its effect of inhibiting nitric oxide generation and the expression of related inflammatory factors were determined.

Methods:

To separate chemical constituents from T. terrestris by column chromatography. Spectroscopic methods, including 1D and 2D nuclear magnetic resonance spectroscopy (NMR) and mass spectrometry (MS) techniques, were used to elucidate the isolated compounds. The anti-inflammatory activities of TST and several compounds were evaluated in vitro.

Results:

Fifteen steroidal saponins, including 9 furostanol steroidal saponins (1, 2, 3, 4, 5, 6, 7, 8, and 15) and 6 isospirostanol steroidal saponins (9, 10, 11, 12, 13, and 14), were isolated from T. terrestris. TST significantly decreased the expression of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in RAW 264.7 cells stimulated by lipopolysaccharides. Compounds 13 and 15 evidently reduced TNF-α expression. Compounds 6, 10, 12, 13, and 15 markedly reduced IL-6 expression.

Conclusions:

Compounds 1 was a novel furostanol steroidal saponin, named 26-O-β-D-glucopyranosyl-(25R)-5α-furostan-12-carbonyl-20(22)-en-3β, 26-diol-3-O-{β-D-xylopyranosyl-(1→2)-[β-D-xylopyranosyl-(1→3)]-β-D-glucopyranosyl-(1→4)-[α-L-rhamnopyranosyl-(1→2)]-β-D-galactopyranoside}. Compounds 2 was isolated from the family Zygophyllaceae for the first time, and 5 and 6 were isolated from the Tribulus genus. TST and compounds 6, 10, 12, 13, and 15 exerts anti-inflammatory activity.
Profiling the molecular signature of satellite glial cells at the single cell level reveals high similarities between rodents and humans
Authors: Avraham Oshri , Chamessian Alexander , Feng Rui , Yang Lite , Halevi Alexandra E. , Moore Amy M. , Gereau Robert W. , Cavalli Valeria
Published: April 2022

Peripheral sensory neurons located in dorsal root ganglia relay sensory information from the peripheral tissue to the brain. Satellite glial cells (SGCs) are unique glial cells that form an envelope completely surrounding each sensory neuron soma. This organization allows for close bidirectional communication between the neuron and its surrounding glial coat. Morphological and molecular changes in SGC have been observed in multiple pathological conditions such as inflammation, chemotherapy-induced neuropathy, viral infection, and nerve injuries. There is evidence that changes in SGC contribute to chronic pain by augmenting the neuronal activity in various rodent pain models. Satellite glial cells also play a critical role in axon regeneration. Whether findings made in rodent model systems are relevant to human physiology have not been investigated. Here, we present a detailed characterization of the transcriptional profile of SGC in mice, rats, and humans at the single cell level. Our findings suggest that key features of SGC in rodent models are conserved in humans. Our study provides the potential to leverage rodent SGC properties and identify potential targets in humans for the treatment of nerve injuries and alleviation of painful conditions.
Molecular target therapeutics of EGF-TKI and downstream signaling pathways in non-small cell lung cancers
Authors: Liu Chao-Yu , Lin Heng-Fu , Lai Wei-Yi , Lin Yi-Ying , Lin Tzu-Wei , Yang Yi-Ping , Tsai Fu-Ting , Wang Chia-Lin , Luo Yung-Hung , Chen Yuh-Min , Hsu Po-Kuei , Kai Loh Jit , Kiat Alan Ong Han , Chien Yueh , Chiou Shih-Hwa , Wang Chien-Ying
Published: April 2022

Lung carcinoma (LC) is the third most common cancer diagnosis and accounted for the most cancer-related mortality worldwide in 2018. Based on the type of cells from which it originates, LC is commonly classified into non-small cell lung cancers (NSCLC) and small cell lung cancers (SCLC). NSCLC account for the majority of LC and can be further categories into adenocarcinoma, large cell carcinoma, and squamous cell carcinoma. Accurate classification of LC is critical for its adequate treatment and therapeutic outcome. Since NSCLC express more epidermal growth factor receptor (EGFR) with activation mutations, targeted therapy EGFR-tyrosine kinase inhibitors (TKIs) have been considered as primary option of NSCLC patients with activation EGFR mutation. In this review, we present the genetic alterations, reported mutations in EGFR, and TKIs treatment in NSCLC patients with an emphasis on the downstream signaling pathways in NSCLC progression. Among the signaling pathways identified, mitogen activation protein kinase (MAPK), known also as extracellular signal-regulated protein kinase (Erk) pathway, is the most investigated among the related pathways. EGFR activation leads to the autophosphorylation of its kinase domain and subsequent activation of Ras, phosphorylation of Raf and MEK1/2, and the activation of ERK1/2. Phosphatidylinositol 3-kinase (PI3K)/Akt is another signal pathway that regulates cell cycle and has been linked to NSCLC progression. Currently, three generations of EGFR TKIs have been developed as a first-line treatment of NSCLC patients with EGFR activation and mutation in which these treatment options will be further discussed in this review. The Supplementary Appendix for this article is available at http://links.lww.com/JCMA/A138.
Assess and address: Screening and management of depression in patients with chronic heart failure
Authors: Wilhelm Elizabeth A. B. , Davis Leslie L. , Sharpe Leslie , Waters Sarah
Published: April 2022

Background:

About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF.

Local Problem:

Depression screening was not being systematically implemented in an outpatient cardiology clinic.

Methods:

To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms.

Intervention:

A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan.

Results:

Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan.

Conclusions:

We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.
Outcomes of Percutaneous Tracheostomy for Patients With SARS-CoV-2 Respiratory Failure
Authors: Arnold Jason , Gao Catherine A. , Malsin Elizabeth , Todd Kristy , Argento Angela Christine , Cuttica Michael , Coleman John M. , Wunderink Richard G. , Smith Sean B. ,   for the NU COVID Investigators
Published: April 2022

Background:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause severe respiratory failure leading to prolonged mechanical ventilation. Data are just emerging about the practice and outcomes of tracheostomy in these patients. We reviewed our experience with tracheostomies for SARS-CoV-2.

Methods:

We retrospectively reviewed the demographics, comorbidities, timing of mechanical ventilation, tracheostomy, and intensive care unit and hospital lengths of stay in SARS-CoV-2 patients who received tracheostomies performed by the interventional pulmonary team. A tertiary care, teaching hospital in Chicago, Illinois. From March 2020 to April 2021, our center had 473 patients intubated for SARS-CoV-2, and 72 (15%) had percutaneous bedside tracheostomy performed by the interventional pulmonary team.

Results:

Median time from intubation to tracheostomy was 20 (interquartile range: 16 to 25) days. Demographics and comorbidities were similar between early and late tracheostomy, but early tracheostomy was associated with shorter intensive care unit lengths of stay and a shorter total duration of ventilation. To date, 39 (54%) patients have been decannulated, 17 (24%) before hospital discharge; median time to decannulation was 22 (IQR: 18 to 36) days. Patients that were decannulated were younger (56 vs. 69 y). The rate of decannulation for survivors was 82%. No providers developed symptoms or tested positive for SARS-CoV-2.

Conclusion:

Tracheostomy enhances care for patients with prolonged respiratory failure from SARS-CoV-2 since early tracheostomy is associated with shorter duration of critical care, and decannulation rates are high for survivors. It furthermore appears safe for both patients and operators.
Incidence, Mortality, and Treatment Patterns of Synchronous Lower Genital Tract Squamous Cell Carcinoma
Authors: Wang Stephanie , Sparks Andrew D. , Rao Yuan J. , Long Beverly
Published: April 2022

Objective

The aim of the study was to define the incidence, prognosis, and treatment patterns associated with synchronous lower genital tract squamous cell carcinoma (LGTSCC) among women diagnosed with any LGTSCC.

Materials and Methods

Surveillance, Epidemiology, and End Results (SEER) database patients diagnosed with synchronous cervical, vaginal, vulvar, and/or anal SCC from 2000 to 2016 were included. Incidence and mortality were evaluated using Kaplan-Meier curves. Multivariable Cox proportional hazards regression was used to identify treatment patterns, risk factors, and mortality associated with LGTSCC.

Results

Among 15,424 women with LGTSCC, 138 had synchronous LGTSCC (0.89%). Vulvar and vaginal SCC was the most common combination (49.3%), and cervical with anal SCC was the least common (1.4%). Only one patient had 3 or more primary LGTSCC. Synchronous LGTSCC was independently associated with higher mortality compared with single-site LGTSCC (adjusted hazards ratio [aHR] = 1.67; p < .001). Synchronous LGTSCC was significantly associated with older age (63 vs. 58 years, p < .001) and lower stage (adjusted odds ratio [aOR] = 0.38; p < .001) and grade of disease (aOR = 0.32; p < .001). Patients with synchronous LGTSCC were more likely to receive radiation (aOR = 1.74; p = .005) and were more likely to receive adjuvant radiation after primary surgical resection compared with single-site LGTSCC (aOR = 1.88; p = .007). Receipt of any treatment including radiation (aHR = 0.85; p < .001), chemotherapy (aHR = 0.50; p < .001), and surgery (aHR = 0.70; p < .001) was independently associated with decreased mortality hazard.

Conclusions

Synchronous LGTSCC is rare but is associated with increased mortality and higher rates of adjuvant radiation compared with single-site LGTSCC despite lower stage and grade at diagnosis. More research is needed to define optimal therapy for these patients.
Hepatic Function in Premature Lambs Supported by the Artificial Placenta and Total Parenteral Nutrition
Authors: Harvey Stephen L. , Fallon Brian P. , McLeod Jennifer S. , Matusko Niki , Rabah Raja , Arnold Meghan A. , Rojas-Pena Alvaro , Bartlett Robert H. , Mychaliska George B.
Published: April 2022

The artificial placenta (AP) promotes organ development and reduces organ injury in a lamb model of extreme prematurity. This study evaluates hepatic outcomes after AP support with total parenteral nutrition (TPN) administration. Premature lambs (116–121 days estimated gestational age; term = 145) were cannulated for 7 days of AP support. Lambs received TPN with SMOFlipid (n = 7) or Intralipid (n = 5). Liver function and injury were compared between the two groups biochemically and histologically. Groups were compared by ANOVA with Tukey’s multiple comparisons or linear-mixed effects models. From baseline to day 7, total bilirubin (Intralipid 2.6 ± 2.3 to 7.9 ± 4.4 mg/dl; SMOFlipid 0.3 ± 0.1 to 5.5 ± 2.3 mg/dl), alanine aminotransferase, and gamma-glutamyl transferase increased in both groups (p < 0.001 for all). Direct bilirubin (0.3 ± 0.2 to 1.8 ± 1.4 mg/dl; p = 0.006) and AST (27 ± 5 to 309 ± 242 mg/dl; p < 0.001) increased in SMOFlipid group (not measured in Intralipid group). On liver histology, Intralipid showed more cholestasis than SMOFlipid; both groups showed more than tissue controls. The Intralipid group alone showed hepatocyte injury and had more congestion than controls. Lambs supported by the AP with TPN administration maintain normal hepatic function and sustain minimal hepatic injury. SMOFlipid is associated with decreased cholestasis and hepatic injury versus Intralipid.
The association between orthostatic blood pressure changes and arterial stiffness
Authors: Wu Pingping , Xu Guoyan , Pan Min , Lin Li , Cai Wenqin
Published: April 2022

Objective

Although orthostatic hypotension (OH) and orthostatic hypertension (OHT) can independently predict cardiovascular events, the underlying mechanisms remain controversial. Our study aimed to examine the relationships between orthostatic blood pressure (BP) changes and arterial stiffness.

Methods

In this cross-sectional analysis, 1820 participants were divided into three groups according to BP changes within 3 min of orthostatism: the OH group had a decrease of >20 mmHg in SBP or >10 mmHg in DBP, the OHT group had an increase of ≥20 mmHg in SBP, and the orthostatic normotensive (ONT) group had normal changes. Arterial stiffness was assessed by measuring the carotid-femoral pulse wave velocity (cfPWV).

Results

OH and OHT were observed in 257 (14.1%) and 62 (3.4%) participants, respectively. Subjects in the OH group were significantly older, were more likely to have hypertension and diabetes, and had higher cfPWV than those in the ONT group (P < 0.05); however, no differences were found between the ONT and OHT groups. Stepwise multiple regression analysis of the subgroups stratified by hypertension and diabetes revealed that age was related to increased cfPWV in all stratifications, and the change in SBP was significantly positively correlated with cfPWV in hypertensive subjects; however, this association was not observed in nonhypertensive subjects.

Conclusion

We found that arterial stiffness was closely related to OH but not to OHT. In addition to expanding current knowledge of the relationship between orthostatic BP changes and arterial stiffness, our study underlines the importance of age, SBP changes, and hypertension in evaluating arterial stiffness.
Sampling rate influences measures of blood pressure variability in ambulatory blood pressure monitoring
Authors: Goel Arun , Goyal Manish , Bhattacharya Sandeep , Tiwari Sunita , Verma Narsingh
Published: April 2022

Background

Ambulatory blood pressure monitoring (ABPM) is a valuable tool in the diagnosis and management of hypertension and it is a good predictor of future cardiovascular events. Lack of normal threshold values of ABPM parameters and inconsistency in the sampling rate of recording are hurdles in its wider usage. The aim of the present investigation was to study the influence of sampling rate on ABPM.

Methods

ABPM was performed in 47 healthy subjects and the effect of different sampling rates was studied on ABPM parameters.

Results

When data were down-sampled, there was a trend towards decreased concordance and increased dispersion with less frequent recordings. Percent dispersion of MESOR, 24-h average, 24 h standard deviation (SD), awake hours average and sleep hours average of systolic BP (SBP) were around 10% for a sampling interval of 1 h. While average real variability (ARV), morning surge and percent dip in SBP exhibited more than 30% dispersion at a sampling interval of 30 min.

Conclusion

24-h average blood pressure (BP) is less sensitive to sampling rate whereas BP variability parameters such as ARV, morning surge and percent dip in SBP are highly sensitive. We suggest that for improving the accuracy of BP variability parameters, a higher sampling rate is desirable around the time of awakening (~2 h before and after the expected time of awakening). At other times, a lower sampling rate may be used for maximizing patient comfort without compromising measurement accuracy.
Idiopathic Hypereosinophilic Syndrome Associated With Pulmonary Hypertension in an Infant
Authors: Akcabelen Yunus M. , Kaya Dinçel Gökçe , Ece İbrahim , Cinel Güzin , Bayhan Turan , Özbek Namik Y.
Published: April 2022

Hypereosinophilic syndrome (HES) is a very rare disease during childhood. It involves the different organs like skin, gastrointestinal system, heart and lungs, besides pulmonary hypertension (PHT) is a very rare morbidity of HES that may cause life-threatening complications. PHT improves with the treatment of hypereosinophilia, without the need for pulmonary vasodilator therapy. Here, we present a case of PHT developed after recovery of pulmonary infiltration in an infant with idiopathic HES. We revealed that pulmonary pressure returned to normal range in parallel with the decrease in eosinophil count with steroid treatment.
Improving Lung Cancer Screening Rates Through an Evidence-Based Electronic Health Record Smoking History
Authors: Russell Cynthia K. , McNeill Margaret
Published: April 2022

Background:

Lung cancer is prevalent worldwide, with 2.1 million new cases and 1.8 million deaths in 2020. In the United States, an estimated 131 880 lung cancer deaths are expected to occur in 2021, with most detected in later stages. Smokers are 15 to 30 times more likely to develop or die from lung cancer.

Local Problem:

Our community residents were more likely to be diagnosed with lung cancer in later stages (62%) compared with 56% nationally, resulting in an increased community mortality rate.

Intervention:

Evidence-based changes in an electronic health record system supported identification and referral of high-risk patients for low-dose computer tomography to improve early lung cancer detection rates.

Results:

Early-stage lung cancer detection increased 24%.

Conclusions:

Interprofessional teams used technology to adopt evidence-based practice and improve health outcomes in their communities.
CLABSI Rounding Team
Authors: Pate Kimberly , Brelewski Kiersten , Rutledge Sarah R. , Rankin Veronica , Layell Jessica
Published: April 2022

Background:

Central line–associated bloodstream infections (CLABSIs) are an ongoing concern in health care, resulting in increased mortality, morbidity, length of stay, and additional costs to hospitals.

Local Problem:

Despite intermittent improvements in CLABSI rates within our facility, long-term sustainment has been challenging.

Methods:

This was a quality improvement project including a collaborative rounding approach supported by specialty nursing roles.

Interventions:

In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit.

Results:

High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits.

Conclusions:

Despite challenges correlated with COVID-19, a collaborative rounding team promotes and enhances awareness of prevention methods and a culture of safety.
Detection of altered pain facilitatory and inhibitory mechanisms in patients with knee osteoarthritis by using a simple bedside tool kit (QuantiPain)
Authors: Izumi Masashi , Hayashi Yoshihiro , Saito Ryota , Oda Shota , Petersen Kristian Kjær , Arendt-Nielsen Lars , Ikeuchi Masahiko
Published: April 2022

Purpose:

Altered pain facilitatory and inhibitory mechanisms have been recognized as an important manifestation in patients with chronic pain, and quantitative sensory testing (QST) can act as a proxy for this process. We have recently developed a simple bedside QST tool kit (QuantiPain) for more clinical use. The purpose of this study was to investigate its test–retest reliability and to evaluate its validity compared with the laboratory-based QST protocols in patients with knee osteoarthritis (OA).

Methods:

QuantiPain consists of 3 items: “pressure algometer” (for pressure pain thresholds [PPTs]), “pinprick” (for temporal summation of pain [TSP]), and “conditioning clamp” (for conditioned pain modulation [CPM]). In experiment-A, intrarater and interrater test–retest reliabilities were investigated in 21 young healthy subjects by using interclass correlation coefficient (ICC). In experiment-B, 40 unilateral painful patients with OA and 40 age-matched, healthy control subjects were included to compare the bedside tool kit against the computerized pressure algometry.

Results:

In experiment-A, excellent to moderate intrarater and interrater reliabilities were achieved in PPT and TSP (ICC: 0.60–0.92) while the agreements of CPM were good to poor (ICC: 0.37–0.80). In experiment-B, localized and widespread decrease of PPT, facilitated TSP, and impaired CPM was found by using the bedside tool kit in patients with OA compared with controls (P < 0.05). The data were significantly correlated with the established laboratory-based tools (R = 0.281–0.848, P < 0.05).

Conclusion:

QuantiPain demonstrated acceptable test–retest reliability and assessment validity with the sensitivity to separate patients with painful OA from controls, which has a potential to create more practical approach for quantifying altered pain mechanisms in clinical settings.
Total Plasma Protein S Is a Prothrombotic Marker in People Living With HIV
Authors: Sim Martha M. S. , Banerjee Meenakshi , Myint Thein , Garvy Beth A. , Whiteheart Sidney W. , Wood Jeremy P.
Published: April 2022

Background:

HIV-1 infection is associated with multiple procoagulant changes and increased thrombotic risk. Possible mechanisms for this risk include heigthened expression of procoagulant tissue factor (TF) on circulating monocytes, extracellular vesicles, and viral particles and/or acquired deficiency of protein S (PS), a critical cofactor for the anticoagulant protein C (PC). PS deficiency occurs in up to 76% of people living with HIV-1 (PLWH). As increased ex vivo plasma thrombin generation is a strong predictor of mortality, we investigated whether PS and plasma TF are associated with plasma thrombin generation.

Methods:

We analyzed plasma samples from 9 healthy controls, 17 PLWH on first diagnosis (naive), and 13 PLWH on antiretroviral therapy (ART). Plasma thrombin generation, total and free PS, PC, C4b-binding protein, and TF activity were measured.

Results:

We determined that the plasma thrombin generation assay is insensitive to PS, because of a lack of PC activation, and developed a modified PS-sensitive assay. Total plasma PS was reduced in 58% of the naive and 38% of the ART-treated PLWH samples and correlated with increased thrombin generation in the modified assay. Conversely, plasma TF was not increased in our patient population, suggesting that it does not significantly contribute to ex vivo plasma thrombin generation.

Conclusion:

These data suggest that reduced total plasma PS contributes to the thrombotic risk associated with HIV-1 infection and can serve as a prothrombotic biomarker. In addition, our refined thrombin generation assay offers a more sensitive tool to assess the functional consequences of acquired PS deficiency in PLWH.
The Effects of Empowerment on Health Care Worker Performance During the COVID-19 Pandemic in Saudi Arabia
Authors: Alrige Mayda , Alshahrani Fatimah , Alharbi Amani , Aljuhani Nouf , Aldini Nuha
Published: April 2022

Background and Objectives:

In this study, we assessed the potential impact of employee empowerment on health care workers' performance during the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. In particular, we aimed to determine the empowerment practices that would have the greatest positive effect on employee performance. Understanding the relationship between performance and empowerment can help health care providers better manage worker stress during any global crisis. This understanding is crucial in guiding policies and interventions aimed at maintaining health care workers' psychological well-being and their overall performance.

Methods:

This cross-sectional study evaluated the relationship between employee empowerment and performance, determining the best empowerment practices for health care leaders to utilize. Frontline health care workers (n = 100) selected using convenience and snowball sampling completed the survey between March 15 and 31, 2020. This is the period when the pandemic just started to accelerate in Saudi Arabia. We conducted Pearson's correlation analysis to assess whether there was a relationship between performance and health care workers' empowerment practice, and stepwise linear regression analysis to investigate the impact each of these empowerment practices on health care workers' performance.

Results:

Our results indicate that health care workers' performance can be expected to increase the most through 2 empowerment practices: giving employees the discretion to change work processes and offering performance-based rewards (R
2 = 0.301, P < .05).

Conclusion:

Our findings suggest that health care leaders must invest in these 2 practices to better equip frontline health care workers. During a global crisis, additional discretion granted to employees helps reduce their anxiety and burnout and hence empowers them with the flexibility to adapt to unforeseen circumstances and improve the quality of their interactions with health service recipients.
Quantitative Patient-Reported Experience Measures Derived From Natural Language Processing Have a Normal Distribution and No Ceiling Effect
Authors: Rajagopalan Dayal , Thomas Jacob , Ring David , Fatehi Amirreza
Published: April 2022

Background and Objectives:

Patient-reported experience measures have the potential to guide improvement in health care delivery. Many patient-reported experience measures are limited by the presence of strong ceiling effects that limit their analytical utility.

Methods:

We used natural language processing to develop 2 new methods of evaluating patient experience using text comments and associated ordinal and categorical ratings of willingness to recommend from 1390 patients receiving specialty or nonspecialty care at our offices. One method used multivariable analysis based on linguistic factors to derive a formula to estimate the ordinal likelihood to recommend. The other method used the meaning extraction method of thematic analysis to identify words associated with categorical ratings of likelihood to recommend with which we created an equation to compute an experience score. We measured normality of the 2 score distributions and ceiling effects.

Results:

Spearman rank-order correlation analysis identified 36 emotional and linguistic constructs associated with ordinal rating of likelihood to recommend, 9 of which were independently associated in multivariable analysis. The calculation derived from this model corresponded with the original ordinal rating with an accuracy within 0.06 units on a 0 to 10 scale. This score and the score developed from thematic analysis both had a relatively normal distribution and limited or no ceiling effect.

Conclusions:

Quantitative ratings of patient experience developed using natural language processing of text comments can have relatively normal distributions and no ceiling effect.
Medical Home Outcomes for School-Aged Children With Chronic Health Care Needs: A Mokken Analysis
Authors: Barnard-Brak Lucy , McGaha Valerie , Little Todd D. , Fearon-Drake Danielle
Published: April 2022

Background and Objectives:

We examined the structure of the medical home construct as well as the association of having a medical home with school outcomes among children with chronic health conditions.

Methods:

The current study utilized a combination of structural equation modeling, item response theory, and Mokken scaling techniques to determine how components of a medical home may be prioritized. The components of an operationally defined medical home were the main measures along with number of missed school days and the degree of interference with a child's school.

Results:

Results of the current study provide a clear structure for the components of a medical home using Mokken scaling analyses. These components of a medical home are important as they were associated with fewer missed school days and a lower likelihood of a child's condition interfering with school as reported by parents.

Conclusion:

With the results of the current study, providers working with schools can quickly discriminate (1) whether a child has a medical home and (2) understand how to guide parents toward a comprehensive medical home by understanding the hierarchy of medical home components.
FDG PET/CT in a Case With Primary Poorly Differentiated Urothelial-Type Adenocarcinoma of the Prostate
Authors: Dong Aisheng , Zhu Yan , Zuo Changjing
Published: April 2022

Primary urothelial-type adenocarcinoma of the prostate is extremely rare. We describe FDG PET/CT findings in a case with primary poorly differentiated urothelial-type adenocarcinoma of the prostate with pelvic lymph node metastases. Both the prostate tumor and its metastatic lesions showed intense FDG uptake. The patient had normal serum prostate-specific antigen and elevated carcinoembryonic antigen levels, which may be helpful for the differential diagnosis.
18F-FDG PET/CT Demonstrating Crossed Cerebellar Diaschisis Due to Germ Cell Tumor of the Basal Ganglia
Authors: Dondi Francesco , Bertoli Mattia , Volpi Giulia , Bertagna Francesco , Giubbini Raffaele
Published: April 2022

Germ cell tumors of the basal ganglia are rare neoplasms that usually present with hemiparesis or other neurological symptoms. MR and PET/CT with different tracers have demonstrated their usefulness for the correct assessment of disease. Crossed cerebellar diaschisis refers to a depression in metabolism of a cerebellar hemisphere as a result of contralateral supratentorial lesions. We present a case in which MR and PET/CT were crucial for the assessment of left basal ganglia germ cell tumors with the presence of crossed cerebellar diaschisis.
18F-FDG PET/CT Metabolic Response With Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer Treated With Cyclin-Dependent 4/6 Kinase Inhibitors
Authors: Filizoglu Nuh , Ozguven Salih , Erdil Tanju Yusuf
Published: April 2022

Dysregulation of the cyclin D–CDK4/6–INK4–RB pathway, which leads to uncontrolled cell proliferation, is frequently observed in breast cancer. Recently, 3 CDK4/6 inhibitors have been FDA approved as first-line treatment for patients with hormone receptor–positive, human epidermal growth factor receptor 2–negative advanced breast cancer. Despite promising clinical results, the metabolic response to treatment with these new drugs has not been elaborately demonstrated yet. Herein, we presented a patient with hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer who demonstrated a complete metabolic response on 18F-FDG PET/CT to treatment with a CDK4/6 inhibitor (ribociclib).
Adamantinoma-Like Ewing Sarcoma of the Mandible Evaluated on 18F-FDG PET/CT
Authors: Huls Sean J. , Broski Stephen M. , Guo Ray Ruifeng , Binkovitz Larry A.
Published: April 2022

Ewing sarcoma is the second most common primary bone tumor in children. Typical Ewing sarcoma most frequently occurs in long bones and within the pelvis. ALES (adamantinoma-like Ewing sarcoma) is a rare subtype of Ewing sarcoma that is characterized by epithelial differentiation in addition to small round blue cells. Unlike typical Ewing sarcoma, ALES has been described in several cases in the head and neck. Herein, we describe a case of a 9-year-old boy with ALES of the mandible evaluated on 18F-FDG PET/CT with correlative MRI scans.
Breakthrough Infections Following mRNA SARS-CoV-2 Vaccination in Kidney Transplant Recipients
Authors: Mazuecos Auxiliadora , Villanego Florentino , Zarraga Sofía , López Verónica , Oppenheimer Federico , Llinàs-Mallol Laura , Hernández Ana M. , Rivas Alba , Ruiz-Fuentes María C. , Toapanta Néstor G. , Jiménez Carlos , Cabello Sheila , Beneyto Isabel , Aladrén María J. , Rodríguez-Benot Alberto , Canal Cristina , Molina María , Pérez-Flores Isabel , Saura Isabel M. , Gavela Eva , Franco Antonio , Lorenzo Inmaculada , Galeano Cristina , Tabernero Guadalupe , Pérez-Tamajón Lourdes , Martín-Moreno Paloma L. , Fernández-Girón Fernando , Siverio Orlando , Labrador Pedro J. , De Arriba Gabriel , Simal Fernando , Cruzado Leónidas , Moina Inigo , Alcalde Guillermo , Sánchez-Álvarez Emilio , Pascual Julio , Crespo Marta ,   for the Spanish Society of Nephrology COVID-19 Group
Published: April 2022

Background.

The clinical effectiveness of coronavirus disease 2019 (COVID-19) vaccination in kidney transplant (KT) recipients is lower than in the general population.

Methods.

From April to October 2021, 481 KT recipients with COVID-19, included in the Spanish Society of Nephrology COVID-19 Registry, were analyzed. Data regarding vaccination status and vaccine type were collected, and outcomes of unvaccinated or partially vaccinated patients (n = 130) were compared with fully vaccinated patients (n = 351).

Results.

Clinical picture was similar and survival analysis showed no differences between groups: 21.7% of fully vaccinated patients and 20.8% of unvaccinated or partially vaccinated died (P = 0.776). In multivariable analysis, age and pneumonia were independent risk factors for death, whereas vaccination status was not related to mortality. These results remained similar when we excluded patients with partial vaccination, as well as when we analyzed exclusively hospitalized patients. Patients vaccinated with mRNA-1273 (n = 213) showed a significantly lower mortality than those who received the BNT162b2 vaccine (n = 121) (hazard ratio: 0.52; 95% confidence interval, 0.31-0.85; P = 0.010).

Conclusions.

COVID-19 severity in KT patients has remained high and has not improved despite receiving 2 doses of the mRNA vaccine. The mRNA-1273 vaccine shows higher clinical effectiveness than BNT162b2 in KT recipients with breakthrough infections. Confirmation of these data will require further research taking into account the new variants and the administration of successive vaccine doses.
Association between Race and Perioperative Outcomes after Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis in NSQIP
Authors: Mallela Deepthi P , Canner Joseph K , Zarkowsky Devin S , Haut Elliott R , Abularrage Christopher J , Hicks Caitlin W
Published: April 2022

BACKGROUND:

Previous studies have documented that Black patients have worse outcomes after lower extremity revascularization procedures compared with White patients. However, the association of race on carotid endarterectomy (CEA) outcomes is not well described. The aim of this study was to compare perioperative outcomes of CEA for Black vs White patients with asymptomatic carotid artery stenosis.

STUDY DESIGN:

All patients who underwent CEA for asymptomatic carotid stenosis in the ACS-NSQIP targeted vascular database (2011-2019) were included. Perioperative (30-day) outcomes were compared for Black vs White patients using multivariable logistic regression adjusting for age/sex, comorbidities, and disease characteristics.

RESULTS:

Of 16,764 asymptomatic CEA patients, 95.2% (N = 15,960) were White and 4.8% (N = 804) were Black. Black patients were slightly younger (mean age 71.4 ± 0.1 vs 69.9 ± 0.3 years, P < 0.001) and more frequently had high-grade carotid artery stenosis compared to White patients (79.5% vs 74.0%, p = 0.001). Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients (p ≤ 0.01). Crude perioperative stroke (2.4% vs 1.3%, p = 0.007) and stroke/death (2.6% vs 1.4%, p = 0.003) were higher for Black patients, but myocardial infarction (1.7% vs 1.5%, p = 0.67) and death (0.4% vs 0.2%, p = 0.12) were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke (odds ratio 1.66, 95% CI 1.01 to 2.73) and stroke/death (odds ratio 1.75, 95% CI 1.10 to 2.81) remained significantly higher for Black patients compared with White patients.

CONCLUSIONS:

Black patients undergoing CEA for asymptomatic carotid artery stenosis had more severe stenosis, more comorbidities, and worse perioperative outcomes compared to White patients. Overall, our data suggest substantial differences in the treatment and outcomes of asymptomatic carotid artery stenosis based on race.
Moving Beyond Diversity: A Scoping Review of Inclusion Initiatives in the Surgical Workforce
Authors: Rajaguru Praveen P , Ademuwagun Lydia , Pierre-Louis Youry , Reddy Neha G , Moreira Carla C
Published: April 2022

Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases (Medline, PubMed, Web of Science) were queried. Peer-reviewed full-text English-language articles focused on interventions or frameworks to achieve inclusion in the surgical workforce were considered. The initial search yielded 2243 papers; 15 met inclusion criteria. The published literature regarding interventions to achieve inclusion was sparse; the most common reasons for exclusion of full texts were papers not focused on interventions (42%; n = 51) or purely focused on diversity and representation (36%; n = 42). The most common field represented was broadly academic surgery (4/15; 47%), with seven other subspecialties represented. A small minority received funding (3/15; 20%). Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.
Healthcare Disparity Education for Surgical Residents: Progress Made, More Needed
Authors: Kratzke Ian M , Portelli Tremont Jaclyn N , Marulanda Kathleen , Carter Taylor M , Reid Trista D , Perez Arielle J , Kapadia Muneera R
Published: April 2022

BACKGROUND:

Healthcare disparities are an important determinant of patient outcomes yet are not standardized within surgical resident education. This study aimed to determine the prevalence and design of current healthcare disparities curricula for surgical residents and included a resident-based needs assessment at a single institution.

STUDY DESIGN:

A national survey evaluating the presence and design of healthcare disparities curricula was distributed to general surgery program directors via the Association of Program Directors in Surgery Listserv. A related survey was administered to all general surgery residents at a single academic institution.

RESULTS:

One hundred forty-six program directors completed the survey, with 68 (47%) reporting an active curriculum. The most frequently taught topic is regarding patient race as a healthcare disparity, found in 63 (93%) of existing curricula. Fifty-two (76%) of the curricula were implemented within the last 3 years. Of the 78 (53%) programs without a curriculum, 8 (10%) program directors stated that their program would not benefit from one. Thirty-four (45%) of the programs without a curriculum cited institutional support and time as the most common barriers to implementation. Of the 23 residents who completed the survey, 100% desired learning practical knowledge regarding healthcare disparities relating to how race and socioeconomic status affect the clinical outcomes of surgical patients.

CONCLUSIONS:

Less than half of general surgery training programs have implemented healthcare disparities curricula. Resident preferences for the format and content of curricula may help inform program leaders and lead to comprehensive national standards.
Analysis of Patterns of Compliance with Accreditation Standards of National Accreditation Program for Rectal Cancer
Authors: Raman Shankar , Tsoraides Steven S , Sylla Patricia , Sarin Ankit , Farkas Linda , DeKoster Erin , Hull Tracy , Wexner Steven
Published: April 2022

BACKGROUND

We identified commonly deficient standards across rectal cancer programs that underwent accreditation review by the National Accreditation Program for Rectal Cancer to evaluate for patterns of noncompliance.

STUDY DESIGN

With the use of the internal database of the American College of Surgeons, programs that underwent accreditation review from 2018 to 2020 were evaluated. The occurrence and frequency of noncompliance with the standards, using the 2017 standards manual, were evaluated. Programs were further stratified based on the year of review, annual rectal cancer volume, and Commission on Cancer classification.

RESULTS

A total of 25 programs with annual rectal cancer volume from 14 to more than 200 cases per year underwent accreditation review. Only 2 programs achieved 100% compliance with all standards. Compliance with standards ranged from 48% to 100%. The 2 standards with the lowest level of compliance included standard 2.5 and standard 2.11 that require all patients with rectal cancer to be discussed at a multidisciplinary team meeting before the initiation of definitive treatment and within 4 weeks after definitive surgical therapy, respectively. Patterns of noncompliance persisted when programs were stratified on the basis oof the year of survey, annual rectal cancer volume, and Commission on Cancer classification. The corrective action process allowed all programs to ultimately become successfully accredited.

CONCLUSION

During this initial phase of the National Accreditation Program for Rectal Cancer accreditation, the majority of programs undergoing review did not achieve 100% compliance and went through a corrective action process. Although the minimal multidisciplinary team meeting attendance requirements were simplified in the 2021 revised standards, noncompliance related to presentation of all patients at the multidisciplinary team meeting before and after definitive treatment highlights the need for programs seeking accreditation to implement optimized and standardized workflows to achieve compliance.
Qualitative Study of Mentorship for Women and Minorities in Surgery
Authors: Mahendran Geethanjeli N , Walker Elizabeth Reisinger , Bennett Mackenzie , Chen Amy Y
Published: April 2022

BACKGROUND

Despite the growth of mentorship opportunities for women in surgery, women remain largely underrepresented in the surgical field. Mentorship is an effective strategy to increase female entry and retention within surgical careers. There is limited literature evaluating mentorship for women in surgery across different career levels and racial backgrounds.

STUDY DESIGN

In-depth interviews were conducted with female fourth-year medical students applying for a surgical residency, female surgical residents, and female surgical faculty from a single academic institution.

RESULTS

A total of 35 women in surgery, including 14 faculty, 11 residents, and 10 fourth-year medical students were interviewed. Twenty (57%) self-identified as White, 7 (20%) as Asian, 6 (17.1%) as Black, and 2 (5.7%) as Other. Key themes included: (1) access to mentorship, (2) characteristics valued in a mentor, (3) role of gender identity when choosing a mentor, (4) role of racial identity when choosing a mentor, and (5) importance of early mentorship for women and underrepresented minorities in medicine (URiM). Mentorship was important for early career development. Mentors who were approachable, invested in their mentees, and were available and honest were most valued. Shared gender and racial identity were appreciated most by younger and URiM mentees, respectively. Respondents from each career level acknowledged the importance of early mentorship for women and URiM in surgery to facilitate increased diversity in the surgical field.

CONCLUSION

Mentorship plays a pivotal role in early career development for women in the surgical field. Access to mentors with shared gender and racial compositions can provide a unique level of support for female and URiM mentees. Expanded and earlier mentorship access for women and minority students can increase diversity in the surgical field.