bluuebunny/crossref_metadata_2025 huggingface dataset:
624 A Simple Survey for Tracking Burn Wound Assessment Skill
Authors: Wengerter Brian C , Lee Christina , Rabbitts Angela , Gallagher James
Published: April 2021

Introduction

The assessment of burn wound surgical need is a critical skill of a burn provider. In an attempt to determine whether burn wound reading by physical exam is a skill that can be measured, this article describes a simple, survey-based method developed and employed at a single, high-volume urban burn center for gauging and tracking success at predicting surgical need.

Methods

This study was conducted from August 8, 2019 to October 31, 2019. Study participants were care team providers, including attending physicians, fellows, residents and physician assistants. They were divided into expert and novice groups according to prior burn wound care experience. After in person examination of the burn wounds, participants were sent an electronic link to a de-identified survey. Survey answer choices included: 1 (surgical excision not required), 2 (unsure need for excision), and 3 (clear need for excision). Correctness was judged by whether or not the patient ultimately required surgery. Evaluation surveys that were unanimous among all expert and novice providers were excluded, as these were deemed inadequate for assessing wound reading skill. Weighted group mean success rates were calculated, and statistical analysis of the means was performed using a weighted, two-tailed t-test.

Results

During the study period a total of 112 survey events were recorded, 23 of which met exclusion criteria. The percentage of correct responses was 63±3% in the expert group (n=440 votes) and 48±15% in the novice group (n=304 votes). Weighted, two-tailed t-test analysis revealed a statistically significant difference between the expert and novice groups (p < 0.01).

Conclusions

This pilot study demonstrates that the current survey method of assessing burn wound surgical need was able to discriminate the wound reading skill of a group of expert providers from that of a group of novices, suggesting that burn wound reading is a skill that can be quantitatively measured. Further development of a formative assessment could aid in the formulation of an educational module to improve wound reading skills.
626 Female External Urinary Collection Device Utilization in a Female Burn ICU Patients: A Quality Improvement Project
Authors: Peters Jasmine N , Grote Andrea C , Spera Leigh J , Gillenwater Justin , Yenikomshian Haig A
Published: April 2021

Introduction

A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications.

Methods

A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected.

Results

Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter.

Conclusions

In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.
631 Burn Unit Design – The Missing Link for Quality and Safety
Authors: Gus Eduardo , Barnes David , Eng Biomed , Sjöberg Folke , Steinvall Ingrid , Elmasry Moustafa , van Zuijlen Paul , Brekke Ragnvald L , Almeland Stian K , Singer Yvonne , Cleland Heather j
Published: April 2021

Introduction

The relationship between infrastructure, technology, model of care and human resources influences patient outcomes and safety, staff productivity and satisfaction, retention of personnel, and treatment and social costs. This concept underpins the need for evidence-based design and has been widely adopted to inform hospital infrastructure planning. The aim of this review is to establish evidence-based, universally applicable key features of a burn unit that support function in a comprehensive patient-centred model of care.

Methods

A literature search in medical, architectural, and engineering databases was conducted. Burn associations’ guidelines and relevant articles published in English, between 1990 and 2020, were included, and the available evidence is summarized in the review.

Results

Few studies have been published on burn unit design in the last thirty years. Most of them focus on the role of design in infection control and prevention, and consist primarily of descriptive or observational reports, opportunistic historical cohort studies, and reviews.

Conclusions

The evidence available in the literature is not sufficient to create a definitive infrastructure guideline to inform burn unit design, and there are considerable difficulties in creating evidence that will be widely applicable. In the absence of a strong evidence base, consensus guidelines on burn unit infrastructure should be developed, to help healthcare providers, architects and engineers make informed decisions, when designing new or renovated facilities.
637 Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series
Authors: Laun Jake , Pribaz Julian
Published: April 2021

Introduction

Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and may become a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction.

Methods

Four patients presented for reconstruction: two patients had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect resulting from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one patient had a large central face defect post-cancer resection. All four patients underwent an abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction.

Results

All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency.

Conclusions

Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a novel method of reconstruction of large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.
643 The Latest Rendition of the Ring Neck Collar Formally Known as “Watusi”
Authors: Sabel Jody , Kristine Parker , Terken Tonya , Costa Beth A , Alinson Daffodil Y
Published: April 2021

Introduction

The “Watusi” neck collar originally described by Koenig has gone through a few renditions since it was introduced in 1976. Our facility adopted its use as described by Nosanov et. al, but have since made modifications to the construction that have improved positioning of the neck, patient comfort, and tolerance.

Methods

We used the construction design of the “Watusi” collar as described by Nosanov et. al. in 2017

• Measure patients neck length and circumference

• Cut 3/8” plastic tubing

• Cut a strip of 2”loop Velcro and sew a piece of hook Velcro to the underside of the loop Velcro for adhesive closure

• Cut horizontal strips along the remaining loop Velcro and thread plastic tubing through

Here we divert from the previously published design:

• Cut ~ 8” piece of betapile and thread Velcro through (this is to pad the back of the neck).

• Using 1 1/8” and 7/8” cylindrical foam tubes, cut a slit along the length of cylindrical foam to allow for insertion of the plastic tubes. This allows for ease of application and removal for hygiene/cleaning.

• Lay the betapile pad on the posterior neck and apply the rings w/ cylindrical foam inserts (using clinical judgement regarding number and location of foam inserts until optimal neck position is achieved).

Results

We have used this method on 15 patients since 2017 and have found improved neck extension with use of foam inserts as well as pressure along cervicomental region (see attached photos). It continues to allow for some neck movement while applying targeted pressure over anterior/lateral neck bands. The removable foam inserts make cleaning easier compared to earlier versions. The application process of our modified ring neck collar is not as straight forward as alternative neck positioning devices and staff require additional training on proper application and management, however we find that when applied with adequate tension, the ring neck collar provides excellent targeted pressure to the cervicomental region as well as lateral neck bands to reduce banding and soft tissue contractures. Many patients report improved comfort with use of ring neck collar when compared to hard orthoplast anterior neck conformers and the associated risk of pressure injury is less than that of a hard neck conformer.

Conclusions

The modified ring neck collar can provide targeted pressure to soft tissue bands of the neck and should be considered as a tool to use to reduce risk of soft tissue neck contractures. Our facility will continue to utilize this device as well as seek ways to improve the design and patient tolerance.
645 Adjustable Dynamic Ankle Foot Orthosis for Recovery of Functional Mobility
Authors: Quick Charles D , Meyer Adam M , Cancio Jill M , Dewey William S , Ridge Cindy M , Brown James K , Pittman Tiffany T , Cancio Leopoldo C
Published: April 2021

Introduction

We present a case of a 23-year-old woman with primary-onset peroneal nerve impairment following diagnosis of purpura fulminans involving 30% total body surface area, who was treated in our burn center. Medical complexity required a unique rehabilitation intervention. The purpose of this case study is to demonstrate the effectiveness of a dynamic ankle-foot orthosis (AFO) to recover functional ambulation.

Methods

Upon initial evaluation and during weekly re-evaluations, a physical therapist (PT) and an occupational therapist (OT) measured active range of motion (AROM), passive range of motion (PROM), and strength. Absent to trace common peroneal nerve function was identified bilaterally 8 days after admission. The patient underwent 41 surgeries and spent 231 days in the burn intensive care unit. Medical complications included 3 episodes of acute respiratory distress syndrome and septic shock, acute renal failure requiring 150 days of continuous renal replacement therapy, and 51 ventilator days. Due to post-operative restrictions and/or medical complications, lower-extremity ROM was restricted for 63 days and supine position was restricted for 49 days. Rehabilitation interventions included PROM, AROM and continuous passive motion. Weight-bearing activities included a tilt table, Moveo™, standing frame, transfer and gait training with a rolling walker (RW). Positional interventions were sitting in a Total Lift Chair, serial casting, and custom AFO fabrication.

Results

On hospital day 215 the patient ambulated 15 feet using a platform walker and required assistance of 4 staff to support the ankle and foot. On hospital day 229, static custom AFOs were implemented and the patient ambulated 325 feet with contact guard assist (CGA). The static AFOs required frequent re-fabrication due to daily ROM progress. Adjustable dynamic AFOs were fabricated to decrease resource burden. With the dynamic AFOs, the patient progressed to 745 feet CGA on hospital day 258. The patient discharged to an acute rehabilitation center on hospital day 260.

Conclusions

Extensive medical, surgical and positional restrictions required innovative interventions by a multidisciplinary team. This resulted in the fabrication of dynamic custom AFOs for gait training. Utilization of these AFOs significantly increased activity tolerance and ambulation distance, and enabled eventual discharge to a rehabilitation center.
651 Inconspicuous Donor Sites- A Patient-Centered Approach to Donor Site Management with Autologous Skin Cell Suspension
Authors: Kopari Nicole M
Published: April 2021

Introduction

Donor site morbidity (DSM) is a major patient dissatisfier due to pain and scarring leading to aesthetic and functional limitations acutely and over time. Many of the recent advancements in burn care such as autologous skin cell suspension (ASCS), cultured tissues, and engineered tissues are driven to reduce DSM. One of the most important advancements in reducing DSM has been the approval of ASCS. Our study assesses donor site (DS) location using real-world data after ASCS procedures with an inconspicuous surgical approach for DS.

Methods

An IRB approved, retrospective chart review of all burn patients undergoing ASCS at an American Burn Center verified burn center between January 2019 and August 2020 was completed. Patients were excluded who received ASCS in combination with widely meshed skin graft or who died during their hospitalization. Demographics were reported including age, gender, % total body surface area (TBSA), length of stay (LOS), ASCS size in cm2 and % TBSA, and location of burn. All DS were harvested at 0.004–0.008 inch after clysis of the prep site with injectable saline and 0.25% Marcaine with a dermatome or Weck knife. Photographs of the DS and burn wounds were uploaded to the EMR by the surgeon of record and assessed by two experienced burn nurses that were blinded to DS location and intraoperative procedures.

Results

83 patients underwent ASCS with 25 patients meeting inclusion criteria. The average age was 33 years (range 15 months to 88 years). 68% of patients were male with an average TBSA of 11% (range 2.5–40). The mean LOS was 5.8 days (range 1–16). Burn locations included face/neck (n=9), torso (n=16), extremity (n=20), hand (n=10), and two patients had single site involvement. The adult patient average size of ASCS applied was 1700cm2 (range 250–6200) while pediatric patients had an average size of 13% TBSA (range 6–32). 21 of the 25 patients had DS adjacent to the burn. No significant difference was noted in healing time, infection rate, or hypertrophic scarring. None of the patients complained of DS pain that was distinguishable from the burn wound. Blinded observers were unable to discern the DS in 56% of the patients from the initial burn wound.

Conclusions

DSM is an iatrogenic insult to non-burn skin and a significant cause of morbidity. ASCS DS may be taken adjacent to the burn wound without risk of delayed re-epithelization, infection, or hypertrophic scarring. Placing ASCS DS adjacent to the burn wound is a more patient-centered approach with indistinguishable pain from the burn wound, a more pleasing cosmetic outcome, and potential greater patient satisfaction.
654 Successful Wound Closure in Patients with Large Total Body Surface Area Calciphylaxis with Aggressive Multi-modal Therapy Including Excision and Skin Grafting
Authors: Curfman Eric , Khandelwal Anjay
Published: April 2021

Introduction

Calcific Uremic Arteriolopathy (CUA), commonly known as Calciphylaxis, is a rare disorder characterized by ischemic necrosis of the skin and histologically by arteriolar calcification. CUA is most commonly seen in patients with end-stage renal disease (ESRD) but can be seen in other patients as well. CUA carries an extremely high mortality rate, with up to 80% in some studies, even in patients with limited disease. In light of this, many surgeons have adopted a “do-not-touch” practice with these patients. Over the past several years, our institution has seen an increase in referrals for the management of large total-body-surface-area (TBSA) CUA.

Methods

Retrospective review of all patients with biopsy-proven (by dermatopathology) large TBSA (>=5% TBSA) CUA admitted to a Verified Adult and Pediatric Burn Center from 2015 to present. Demographics, laboratory data, treatment modalities and outcomes including mortality and wound closure were recorded.

Results

A total of 8 patients with large TBSA CUA were admitted after being transferred from outside hospitals. Average TBSA affected was 13.76% (SD 7.27). 6 of these patients (75%) were noted to have non-uremic calciphylaxis. All patients had positive wound cultures on admission, and 1 patient (12.5%) developed a bacteremia in hospital. There were no central line associated bloodstream infections, catheter associated urinary tract infections or ventilator associated infections. All patients underwent surgical debridement (average 4.125, range 2–5), and 5 patients (62.5%) underwent grafting, (average 1.6, range 2–5) and subsequently proceeded to wound closure. In-hospital mortality was 25% and another patient was referred to a hospice facility after being readmitted with medical complications of her calciphylaxis. Secondary findings included 50% of the patients recently experienced significant weight loss (>100 lbs). On admission, 2 patients (25%) had abnormal serum calcium, 3 patients (37.5%) had abnormal serum PO4, and 4 (50%) patients had abnormal PTH levels. 2 patients (25%) had a recent exposure to warfarin (within 6 months).

Conclusions

Utilizing a multi-modal management strategy that includes surgical debridement and skin grafting, patients with calciphylaxis can progress to wound closure.
662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.
Authors: Navarro Eduardo , Thigpin Tera , Carson Joshua S
Published: April 2021

Introduction

In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application.

Methods

Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up.

Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay.

Results

Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing.

Conclusions

The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.
666 Autologous Skin Cell Therapy After Dermal Matrix with STSG in a 5-year-old African-American Female - How Adjunct Therapies are Refining the Dogmatic Treatment Approach to Burns
Authors: Coward Alexandra
Published: April 2021

Introduction

Split-thickness skin grafting (STSG) is the standard of care for the treatment of full thickness skin injuries. Skin grafts are associated with long-term morbidity including graft loss, adjacent structural injury, anesthetic complications, scarring, and scar contractures. Large surface area burns are additionally challenging due to limited donor site availability. Autologous skin cell suspension (ASCS) is a new adjunct for STSG using device that provides a suspension of non-cultured, autologous skin cells applied overtop of STSG. Dermal matrix templates are placed on wounds after burn excision and induces dermal regeneration in preparation for STSG, allowing for a thinner graft to be harvested and applied. This technique has been shown to require both smaller areas of donor skin as well as thinner skin harvest which improves both healing time and aesthetic outcomes of donor sites, enhancing the time-tested and well accepted technique of STSG.

Methods

We present the case of a 5-year-old African American female who suffered 18% TBSA deep partial thickness burns and full thickness burns to her abdomen, trunk and left back after her shirt was accidentally lit on fire at home. She was transferred from a local hospital to our burn center for further evaluation. She was evaluated by both the burn surgery and pediatric teams and admitted for wound cares and surgical planning.

Results

On hospital day five she underwent burn excision and placement of acellular dermal regeneration template. She returned to the operating room on hospital day 22 after daily wound cares for autografting with autologous skin cell suspension application to anterior and posterior torso and left arm, as well as to back and thigh donor sites. Her takedown on hospital day 29 showed excellent graft take. She was ultimately discharged on hospital day 47. She continued to undergo wound care in the outpatient burn clinic and daily physical and occupational therapy.

Conclusions

This case illustrates the use of dermal matrix and ASCS on a large burn with excellent aesthetic outcomes and improved healing time. This case is unique in highlighting the versatility of this therapy in a darker skinned patient. There are significant challenges with long term morbidity from STSG and the use of both dermal regenerative matrix and ASCS may provide surgeons with new approaches to decreasing depth and size of donor sites, as well as improving the length of hospital stay and overall aesthetic outcomes of donor and graft sites, specifically in darker skinned patients.
Femoral neck rotational osteotomy: a modified method for treating necrotic femoral heads with large and laterally located lesions
Authors: Zhu Junfeng , Chen Kangming , Peng Jianping , Li Yang , Shen Chao , Chen Xiaodong
Published: April 2021

In this study, we retrospectively investigated the short-term outcome of femoral neck rotational osteotomy (FNRO) for treating necrotic femoral heads with large and laterally located lesions. Twelve necrotic femoral heads (ARCO stage II or III) with an average Kerboul angle of 210° underwent FNRO through surgical hip dislocation. By circumferential release of capsule and retinaculum, femoral neck osteotomy was performed at the base of femoral neck just 1.5 cm above lesser trochanter. The severed femoral neck was rotated with a mean angle of 120.4° and fixed with a mean varus angulation of 10.2°. Both Harris hip score and International hip outcome tool improved at a mean follow-up of 29 months. The average post-operative intact rate was 55.3%. Subsequent collapse or progression to osteoarthritis was found in four hips but only one hip failed with a Harris hip score of 44 and converted to hip replacement. Post-operative leg length discrepancy was 1.1 cm. Limp presented in seven hips. Six hips had osteophyte formation. FNRO through surgical hip dislocation had the advantages of safe exposure, direct visualization of necrotic lesion and high reorientation of healthy bone and articular cartilage on femoral head. We observed satisfactory short-term survivorship and improved patient-reported outcomes in necrotic femoral heads treated with FNRO.
Law and economics challenges of natural gas—the hard case of Mexico
Authors: Cervantes Miguel Marmolejo , Rivera Rafael Garduño
Published: April 2021

This article addresses the risks and uncertainties for Mexico derived from the excessive dependency on US natural gas. It will take as a reference Btu price fluctuation and the covenants contained on the based contract for sale and purchase of natural gas, particularly in the context of the behaviour displayed by market participants (including governments) during the recent winter storm energy crisis in Texas which consequently forced shortages in Mexico due to a lack of ‘available’ natural gas to produce power (electricity). The research question includes: Should Mexico exploit its vast natural gas resources although it might not be a sustainable or a cost-effective (economically–socially and environmentally) decision? (The curse of the TEX-MEX-NG). Or instead, would it be better to prepare (within the limits of its financial situation) to address the US natural gas price fluctuations, like price hedging? Or a combination of both?
Driving forces behind open acreage resource allocation systems for petroleum upstream activities: a comparative assessment between Brazil, Colombia, India and Uruguay
Authors: Mariano Jacqueline , Szklo Alexandre , Draeger Rebecca
Published: April 2021

Facing flattening international oil prices in the next years (due to a combination of changing industry fundamentals, pandemics effects and the challenges of the global low-carbon energy transition), oil frontier countries are reviewing their petroleum exploration and production fiscal systems to increase their attractiveness to private investment. This article analyses certain open resource allocation systems by comparing the recently launched Brazilian offering to similar systems already existing in Colombia, India and Uruguay. The comparison focuses on four driving forces behind the adoption of open resource allocation systems: energy security, local economic development, government take and the so-called green paradox (reflecting the race to monetize petroleum reserves ahead of stricter climate change international regulations). Findings show that each of the analysed countries has its own target for designing a permanent offering, although the same driving forces can be found in more than one of the countries.
EVALUATION OF TWO CHEST TOMOSYNTHESIS CYSTIC FIBROSIS SCORING SYSTEMS USING HIGH-RESOLUTION COMPUTED TOMOGRAPHY BRODY SCORING AS REFERENCE
Authors: Rossi Norrlund Rauni , Meltzer Carin , Söderman Christina , Johnsson Åse Allansdotter , Vikgren Jenny , Molnar David , Gilljam Marita , Båth Magnus
Published: April 2021

Purpose

To evaluate two chest tomosynthesis (CTS) scoring systems for cystic fibrosis (CF), one system developed by Vult von Steyern et al. (VvS) and one system based on the Brody scoring system for high-resolution computed tomography (HRCT) (modified Brody (mB)). Brody scoring of HRCT was used as reference.

Methods

In conjunction with routine control HRCT at clinical follow-up, 10 consecutive adult CF patients underwent CTS for research purposes. Four radiologists scored the CTS examinations using the mB and VvS scoring systems. All scores were compared to the Brody HRCT scores. The agreement between the evaluated CTS scoring systems and the reference HRCT scoring system was determined using Spearman’s rank correlation coefficient and the intraclass correlation coefficient (ICC).

Major findings

Spearman’s rank correlation coefficient showed strong correlations between HRCT score and both the mB and the VvS CTS total scores (median rs = 0.81 and 0.85, respectively). The ICC showed strong correlation between the CTS scoring systems and the reference: 0.88 for mB and 0.85 for VvS scoring. The median time for scoring was 20 and 10 minutes for the mB and VvS scoring systems, respectively.

Conclusions

Both evaluated CTS scoring systems correlate well with the reference standard Brody HRCT scoring. The VvS CTS scoring system has a shorter reading time, suggesting its advantage in clinical practice.
Literature Review and Knowledge Distribution During an Outbreak: A Methodology for Managing Infodemics
Authors: Gruber Amit , Ghiringhelli Matteo , Edri Oded , Abboud Yousef , Shiti Assad , Shaheen Naim , Ballan Nimer , Neuberger Ami , Caspi Oren
Published: April 2021

Problem

The COVID-19 pandemic has challenged health care systems in an unprecedented way by imposing new demands on health care resources and scientific knowledge. There has also been an exceedingly fast accumulation of new information on this novel virus. As the traditional peer-review process takes time, there is currently a significant gap between the ability to generate new data and the ability to critically evaluate them. This problem of an excess of mixed-quality data, or infodemic, is echoing throughout the scientific community.

Approach

The authors aimed to help their colleagues at the Rambam Medical Center, Haifa, Israel, manage the COVID-19 infodemic with a methodologic solution: establishing an in-house mechanism for continuous literature review and knowledge distribution (March–April 2020). Their methodology included the following building blocks: a dedicated literature review team, artificial intelligence–based research algorithms, brief written updates in a graphical format, large-scale webinars and online meetings, and a feedback loop.

Outcomes

During the first month (April 2020), the project produced 21 graphical updates. After consideration of feedback from colleagues and final editing, 13 graphical updates were uploaded to the center’s website; of these, 31% addressed the clinical presentation of the disease and 38% referred to specific treatments. This methodology as well as the graphical updates it generated were adopted by the Israeli Ministry of Health and distributed in a hospital preparation kit.

Next Steps

The authors believe they have established a novel methodology that can assist in the battle against COVID-19 by making high-quality scientific data more accessible to clinicians. In the future, they expect this methodology to create a favorable uniform standard for evidence-guided health care during infodemics. Further evolution of the methodology may include evaluation of its long-term sustainability and impact on the day-to-day clinical practice and self-confidence of clinicians who treat COVID-19 patients.
How Can Anesthesiologists Influence Policymaking? Reflections from a Year at the Council of Economic Advisers
Authors: Sun Eric C.
Published: April 2021

From September 2019 to August 2020, the author served as a senior economist on the Council of Economic Advisers, a government agency charged with providing economic analysis and advice to the President of the United States and senior government officials. Working with the Council yielded many useful lessons on how anesthesiologists can influence healthcare policy. First, because the President has wide latitude over many areas of health policy that directly impact patient care and anesthesiologists’ working environment, anesthesiologists should focus their efforts on influencing policymakers within the executive branch of government in addition to influencing lawmakers. Second, policymakers are busy and typically do not have a technical background, so anesthesiologists must learn how to communicate with them succinctly and at an appropriate level. Finally, because policymakers often need analysis quickly, anesthesiologists must meet these needs even if the underlying analysis is rougher and less precise that what would normally be needed for peer review.
Effect of Brief Training to Identify Autism Spectrum Disorder During Toddler Well-Child Care Visits
Authors: Wieckowski Andrea Trubanova , Thomas Rebecca P. , Chen Chi-Ming A. , Zitter Ashley , Fein Deborah A. , Barton Marianne L. , Adamson Lauren B. , Robins Diana L.
Published: April 2021

Objective:

To examine the effect of a brief Enhanced training using the information-motivation-behavior (IMB) change model on improving providers' surveillance rates and accuracy of autism spectrum disorder (ASD) detection.

Method:

Toddlers (n = 5,672) were screened for ASD during their pediatric well-child visits. Pediatric providers (n = 120) were randomized to receive Enhanced (incorporating components of the IMB model) or Control training. Providers indicated whether they had an ASD concern at each well-child visit. Toddlers who were positive on any screener and/or whose provider indicated ASD concern were invited for a diagnostic evaluation. Differences in provider-indicated ASD concerns before and after training were evaluated using log-linear analyses.

Results:

The Enhanced training did not have a significant effect on provider-endorsed ASD concerns (p = 0.615) or accuracy of endorsing concerns (p = 0.619). Providers in the Control training showed a significant reduction in indicating whether or not they had concerns after the training (from 71.9% to 64.3%), which did not occur in the Enhanced group. The Enhanced training led to more frequent endorsements of language (χ2 = 8.772, p = 0.003) and restricted and repetitive behavior (χ2 = 7.918, p = 0.005) concerns for children seen after training.

Conclusion:

Provider training had limited impact on ASD surveillance, indicating the importance of using formal screening instruments that rely on parent report during well-child visits to complement developmental surveillance. Future research should examine whether providers who indicate specific concerns are more likely to accurately refer children for ASD evaluations.
Peritraumatic 17β-estradiol levels influence chronic posttraumatic pain outcomes
Authors: Linnstaedt Sarah D. , Mauck Matthew C. , Son Esther Y. , Tungate Andrew S. , Pan Yue , Rueckeis Cathleen , Yu Shan , Lechner Megan , Datner Elizabeth , Cairns Bruce A. , Danza Teresa , Velilla Marc-Anthony , Pearson Claire , Shupp Jeffrey W. , Smith David J. , McLean Samuel A.
Published: April 2021

Biologic factors that predict risk for and mediate the development of common outcomes of trauma exposure such as chronic posttraumatic pain (CPTP) are poorly understood. In the current study, we examined whether peritraumatic circulating 17β-estradiol (E2) levels influence CPTP trajectories. 17β-estradiol levels were measured in plasma samples (n = 254) collected in the immediate aftermath of trauma exposure from 3 multiethnic longitudinal cohorts of men and women trauma survivors. Chronic posttraumatic pain severity was evaluated 6 weeks, 6 months, and 1 year after traumatic stress exposure. Repeated measures mixed models were used to test the relationship between peritraumatic E2 levels and prospective CPTP. Secondary analyses in a nested cohort assessed the influence of participant body mass index on the E2–CPTP relationship. In women, a statistically significant inverse relationship between peritraumatic E2 and CPTP was observed (β = −0.280, P = 0.043) such that higher E2 levels predicted lower CPTP severity over time. Secondary analyses identified an E2 * body mass index interaction in men from the motor vehicle collision cohort such that obese men with higher E2 levels were at greater risk of developing CPTP. In nonobese men from the motor vehicle collision cohort and in men from the major thermal burn injury cohort, no statistically significant relationship was identified. In conclusion, peritraumatic circulating E2 levels predict CPTP vulnerability in women trauma survivors. In addition, these data suggest that peritraumatic administration of E2 might improve CPTP outcomes for women; further research is needed to test this possibility.
Cognitive Defusion Is a Core Cognitive Mechanism for the Sensory-Affective Uncoupling of Pain During Mindfulness Meditation
Authors: Zorn Jelle , Abdoun Oussama , Sonié Sandrine , Lutz Antoine
Published: April 2021

Objective

Mindfulness meditation can downregulate the experience of pain. However, its specific underlying regulatory mechanisms are still largely unknown. Here, we aimed to investigate the role of cognitive defusion—a form of psychological distancing from internal experiences—in mindfulness-based pain regulation.

Methods

We implemented a thermal heat paradigm that was designed to amplify the cognitive-affective aspects of pain in 43 novice meditators (2-day formal training; 51.2% women; 53.2 ± 7.0 years old) and 27 expert meditators (>10,000-hour practice; 44.4% women; 51.9 ± 8.4 years old). We collected pain intensity and unpleasantness reports and trait measures of pain catastrophizing assessed by the Pain Catastrophizing Scale (PCS), cognitive defusion assessed by the Drexel Defusion Scale (DDS), and cognitive fusion assessed by the Cognitive Fusion Questionnaire, as well as of several other constructs commonly reported in the literature.

Results

Experts reported lower PCS (6.9 ± 5.2 versus 17.2 ± 8.5, p < .001) but higher DDS (39.4 ± 6.4 versus 28.9 ± 6.6, p < .001) than novices. Across participants, the PCS and DDS were negatively correlated and shared unique variance that survived adjusting for other mindfulness-related and cognitive-emotional constructs (β = −0.64, p < .001). Conversely, the relationships between PCS and other commonly reported constructs did not seem specific, as none of the relationships survived adjusting for DDS (adjusted β < 0.25, p > .05). Further supporting the relevance of DDS to pain, both the DDS and PCS specifically predicted pain unpleasantness as opposed to pain intensity. However, DDS seemed to be a more specific predictor of unpleasantness than PCS, as the relationship between DDS and unpleasantness survived adjusting for PCS (adjusted β = −0.33, p = .016), but not vice versa (adjusted β = 0.20, p = .162). We also found that the Cognitive Fusion Questionnaire showed a similar pattern of associations with PCS and pain self-reports to what was found for the DDS, although these associations were less consistent.

Conclusions

Collectively, these findings highlight the central role of cognitive defusion in mindfulness-based pain regulation.
Reducing publication delay to improve the efficiency and impact of conservation science
Authors: Christie Alec P. , White Thomas B. , Martin Philip , Petrovan Silviu O. , Bladon Andrew J. , Bowkett Andrew E. , Littlewood Nick A. , Mupepele Anne-Christine , Rocha Ricardo , Sainsbury Katherine A. , Smith Rebecca K. , Taylor Nigel G. , Sutherland William J.
Published: April 2021

Evidence-based decision making is most effective with comprehensive access to scientific studies. If studies face delays or barriers to being published, the useful information they contain may not reach decision-makers in a timely manner. This represents a potential problem for mission-oriented disciplines where access to the latest data is paramount to ensure effective actions are deployed. We sought to analyse the severity of publication delay in conservation science — a field that requires urgent action to prevent the loss of biodiversity. We used the Conservation Evidence database to assess the length of publication delay (time from finishing data collection to publication) in the literature that tests the effectiveness of conservation interventions. From 7,415 peer-reviewed and non-peer-reviewed studies of conservation interventions published over eleven decades, we find that the mean publication delay (time from completing data collection to publication) was 3.6 years and varied by conservation subject — a smaller delay was observed for studies focussed on the management of captive animals. Publication delay was significantly smaller for studies in the non-journal literature (typically non-peer-reviewed) compared to studies published in scientific journals. Although we found publication delay has marginally increased over time (1912-2020), this change was weak post-1980s. Publication delay also varied inconsistently between studies on species with different IUCN Red List statuses and there was little evidence that studies on more threatened species were subject to a smaller delay. We discuss the possible drivers of publication delay and present suggestions for scientists, funders, publishers, and practitioners to reduce the time taken to publish studies. Although our recommendations are aimed at conservation science, they are highly relevant to other mission-driven disciplines where the rapid dissemination of scientific findings is important.
Accessibility, inclusivity, and implementation of COVID-19 clinical management guidelines early in the pandemic: a global survey
Authors: Pilbeam Caitlin , Malden Deborah , Newell Katherine , Dagens Andrew , Kennon Kalynn , Michelen Melina , Gobat Nina , Sigfrid Louise
Published: April 2021

Background

With a rapidly changing evidence base, high-quality clinical management guidelines (CMGs) are key tools for aiding clinical decision making and increasing access to best available evidence-based care. A rapid review of COVID-19 CMGs found that most lacked methodological rigour, overlooked many at-risk populations, and had variations in treatment recommendations. Furthermore, social science literature highlights the complexity of implementing guidelines in local contexts where they were not developed and the resulting potential to compound health inequities. The aim of this study was to evaluate access to, inclusivity of, and implementation of Covid-19 CMGs in different settings.

Methods

A cross-sectional survey of clinicians worldwide from 15 June to 20 July 2020, to explore access to and implementation of Covid-19 CMGs and treatment and supportive care recommendations provided. Data on accessibility, inclusivity, and implementation of CMGs. were analyzed by geographic location.

Results

Seventy-six clinicians, from 27 countries responded, 82% from high-income countries, 17% from low-middle income countries. Most respondents reported access to Covid-19 CMG and confidence in implementation of these. However, many respondents, particularly from LMICs reported barriers to implementation, including limited access to treatments and equipment. Only 20% of respondents reported having access to CMGs covering care for children, 25% for pregnant women and 50% for older adults (>65 years). Themes emerging were for CMGs to include recommendations for different at-risk populations, and settings, include supportive care guidance, be readily updated as evidence emerges, and CMG implementation supported by training, and access to treatments recommended.

Conclusion

Our findings highlight important gaps in Covid-19 CMG development and implementation challenges during a pandemic, particularly affecting different at-risk populations and lower resourced settings., to improve access in evidence-based care recommendations during an emergency. The findings identifies an urgent need for an improved framework for CMG development, that is inclusive and adaptable to emerging evidence and considers contextual implementation support, to improve access to evidence-based care globally.
Viola: a structural variant signature extractor with user-defined classifications
Authors: Sugita Itsuki , Matsuyama Shohei , Dobashi Hiroki , Komura Daisuke , Ishikawa Shumpei
Published: April 2021

Here, we present Viola, a Python package that provides structural variant (SV; large scale genome DNA variations that can result in disease, e.g., cancer) signature analytical functions and utilities for custom SV classification, merging multi-SV-caller output files, and SV annotation. We demonstrate that Viola can extract biologically meaningful SV signatures from publicly available SV data for cancer and we evaluate the computational time necessary for annotation of the data.

Availability

Viola is available on pip (https://pypi.org/project/Viola-SV/) and on GitHub (https://github.com/dermasugita/Viola-SV).

Contact

kdais-prm@m.u-tokyo.ac.jp
Mutant p53 in cell-cell interactions
Authors: Pilley Steven , Rodriguez Tristan A. , Vousden Karen H.
Published: April 2021

p53 is an important tumor suppressor, and the complexities of p53 function in regulating cancer cell behaviour are well established. Many cancers lose or express mutant forms of p53, with evidence that the type of alteration affecting p53 may differentially impact cancer development and progression. It is also clear that in addition to cell-autonomous functions, p53 status also affects the way cancer cells interact with each other. In this review, we briefly examine the impact of different p53 mutations and focus on how heterogeneity of p53 status can affect relationships between cells within a tumor.