bluuebunny/crossref_metadata_2025 huggingface dataset:
Antenatal Corticosteroids and Neonatal Outcomes in Twins
Authors: Socha Peter , McGee Alice , Bhattacharya Sohinee , Young Catriona , Wang Rui
Published: June 2022

OBJECTIVE:

To assess whether antenatal corticosteroid treatment is associated with improved neonatal outcomes in twins.

DATA SOURCES:

We searched MEDLINE, PubMed, EMBASE, and the Cochrane Library, from inception through August 12, 2021. We did not search ClinicalTrials.gov because our inclusion criteria were restricted to nonrandomized studies.

METHODS of STUDY SELECTION:

Records (n=7,802) were screened in Rayyan by two independent reviewers. We included all nonrandomized studies that compared antenatal corticosteroid treatment with no treatment in twins. Our outcomes of interest were neonatal mortality, respiratory distress syndrome (RDS), intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity.

TABULATION, INTEGRATION, AND RESULTS:

We used the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) to assess risk of bias. We performed random-effects meta-analyses of estimates from studies without critical risk of bias due to confounding, and reported summary adjusted odds ratios (aORs) and 95% CIs. Eighteen cohort studies (that reported on 33,152 neonates) met inclusion criteria. Sixteen studies restricted to preterm gestational ages, and 11 defined exposed neonates based on an optimal corticosteroid administration-to-birth interval. Limitations due to confounding and selection bias were common concerns for the risk-of-bias assessments (n=14 at critical or higher), and 11 studies did not account for clustering within twin pairs in their analyses. All included studies had at least moderate risk of bias. Meta-analysis showed that antenatal corticosteroid administration was associated with lower odds of neonatal mortality (aOR 0.59, 95% CI 0.43–0.80, I2 69%, five studies, 20,312 neonates) and RDS (aOR 0.70, 95% CI 0.57–0.86, I2 67%, seven studies, 20,628 neonates) in twins. Results were inconclusive for the other outcomes.

CONCLUSION:

Evidence from nonrandomized studies suggests antenatal corticosteroids are associated with lower incidence of neonatal mortality and RDS in twins.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42020205302.
Addressing a Crisis in Abortion Access
Authors: Lynch Beatrice , Mallow Michaela , Bodde Katharine E. S. , Castaldi-Micca Danielle , Yanow Susan , Nádas Marisa
Published: June 2022

As restrictions on abortion increase nationwide, it is critical to ensure ongoing access to abortion care throughout pregnancy. People may seek abortions later in pregnancy as a result of financial or legal barriers that delay care or because of changing circumstances, such as the status of their partner, the health of other children, employment, or a new fetal diagnosis. New York State has been a beacon for abortion access since 1970. Yet, after Roe v Wade was decided, New York State abortion law was not in compliance with federal law, and risk-averse medical institutions hesitated to provide later abortions, forcing patients out of state for care. After years of advocacy, the Reproductive Health Act was passed in 2019. Clinicians and advocates collaborated to translate policy into expanded practice at NYC Health + Hospitals, the largest public health care system in the United States. NYC Health + Hospitals conducted an internal review, identified barriers to abortion care, and addressed these through improvements in public and internal communication, strengthening of procedural skills, and a better referral system. As a result, abortion services have become visible and the system’s capacity and gestational age limit have expanded. The example of NYC Health + Hospitals is an instructive model to ensure that abortion care is provided to the most vulnerable patients, including those who need care later in pregnancy. Given the ongoing threat to reproductive rights, this example of expanded access is particularly timely.
Age-related High-frequency Hearing Loss Is Not Associated With Horizontal Semicircular Canal Function
Authors: Schubert Nick M. A. , Roelofs Catelijne G. , Free Rolien H. , Wiersinga-Post J. Esther C. , Pyott Sonja J.
Published: June 2022

Objective:

Investigate the association between age-related hearing loss and reduced peripheral vestibular function using paired assessments of high-frequency hearing and horizontal semicircular canal (HSC) function. We hypothesized that age-related high-frequency hearing loss would be correlated with reduced HSC function and, therefore, useful to predict age-related vestibular hypofunction.

Design:

We conducted a single center, retrospective cross-sectional study in a tertiary/academic referral hospital. This study included 185 patients who were diagnosed with a cerebellopontine angle (CPA) tumor and referred to the academic hospital to evaluate treatment options. Data collected included pure-tone audiometry, caloric reflex test, video head-impulse test (vHIT), and medical history. High-frequency hearing loss was quantified by the high Fletcher index (hFI), and horizontal semicircular canal (HSC) function were quantified by the caloric reflex test and vHIT.

Results:

We observed a significant association between age and high-frequency hearing loss that was significantly worse in men compared with women. In contrast, we observed no significant association between age and HSC function assessed by either the caloric reflex test or vHIT. We observed associations between HSC function and sex, with male sex predicting reduced HSC function by caloric reflex testing but enhanced HSC function by vHIT. High-frequency hearing loss did not predict HSC hypofunction.

Conclusions:

We found no evidence indicating age-related decline in HSC function or an association between age-related high-frequency hearing loss and age-related decline in HSC function. We did observe sex-specific differences in HSC function. Our study highlights the need for sex-specific normative values for identifying age-related reduced peripheral vestibular function and for future work linking comprehensive assessments of inner ear function with tests of balance and stability to understand the complex interactions underlying hearing loss and imbalance, especially in the elderly.
Prescribing braces after forearm fractures does not decrease refracture rate
Authors: Bauer Matthew R. , Albanese Stephen A.
Published: June 2022

Refracture is one of the most common complications of pediatric forearm fractures. One way to decrease this risk is to extend immobilization with a brace after the cast has been removed to allow for a range of motion exercises. The purpose of this study was to examine whether prescribing a brace after casting was discontinued decreased the risk of refracture. A retrospective, cohort study was performed at one level I trauma center. Girls under 10 years and boys under 12 years who sustained a forearm fracture from January 2013 to December 2018 were included. Patients with open fractures, fractures that required operative intervention, fractures involving the physis, fracture-dislocations, floating elbows, fractures in children with endocrine abnormalities, and fractures in patients lost to follow-up were excluded. The primary endpoint was a refracture within 6 months of the original injury that extended through the original fracture site. In total 2093 patients met the inclusion criteria. There were 19 refractures (0.9%). There was no statistically significant difference in the refracture rate between the braced (11/1091) and unbraced (8/1002) cohorts (Fisher exact value 0.65 at P < 0.05). The most common fracture type that went on to refracture was greenstick fractures. This large, retrospective study aimed to examine whether prescribing a brace had any significant effect on the refracture rate. Bracing after the cast is removed may help ease family anxiety and extend the period of immobilization while allowing for hygiene and range of motion, but it does not significantly decrease the rate of refracture.
Cancer genomic medicine in Japan and the roles of pharmacists
Authors: Aomori Tohru , Sakurai Hiroomi , Nishihara Hiroshi
Published: June 2022

Cancer genomic medicine (CGM) is a medical service that provides optimized treatment for each patient based on genes, biomarkers, environment, and lifestyle. In Japan, the approval of designed core hospitals for CGM started in 2017. In June 2019, two types of cancer gene panel tests became available in the national health insurance system, and CGM was socially implemented. While CGM is still in its infancy and there are some issues that need to be resolved, there are cases where the treatment has shown dramatic results. The present review highlights the CGM system in Japan, the issues it faces, and the role of pharmacists in this system.
Outcomes of Prolene Gonioscopy Assisted Transluminal Trabeculotomy in Primary Open Angle Glaucoma and Pseudoexfoliation Glaucoma: A Comparative Study
Authors: Aktas Zeynep , Ozdemir Zeydanli Ece , Uysal Betul Seher , Yigiter Ahmet
Published: June 2022

Précis:

Gonioscopy-assisted transluminal trabeculotomy (GATT) provides greater intraocular pressure (IOP) reduction in pseudoexfoliative glaucoma (PXG) than in primary open angle glaucoma (POAG) in the first year of surgery; however, the difference between groups equalizes in the long term.

Purpose:

To compare outcomes of GATT in eyes with POAG and PXG.

Methods:

Single-center, retrospective, comparative case-series. A total of 202 eyes (91 eyes of POAG; 111 eyes of PXG) were included. GATT was performed as a standalone procedure or in combination with cataract extraction. Outcome measures were change in IOP and number of medications at all time points (1, 3, 6, 9, 12, 18, 24, and 36 mo after surgery), success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mmHg, without further glaucoma surgery), and complication rate. Cumulative success probabilities were compared using Kaplan-Meier survival analyses.

Results:

The mean IOP decreased by 8.8 mmHg (34.4%) in the POAG group with a mean decrease of 2 glaucoma medications at final visit. In the PXG group, the mean IOP decreased by 12.8 mm Hg (44.6%) on 2.3 fewer medications. Mean IOP reduction was significantly higher in PXG than POAG at all time points up to 2-year visit (P<0.05 for all), after which the difference was not significant. Cumulative success probability during the first year was significantly higher in PXG (97.6%) than in POAG (86.8%) (P=0.01); no significant difference was found at 2-year (P=0.07) and 3-year visits (P=0.24).

Conclusion:

GATT was safe and effectively reduced the IOP and medication burden in patients with POAG and PXG. In the first year after GATT, a significantly higher success rate was noted in PXG compared with POAG; however, in subsequent years, the success rate was similar at ~75%.
“So There. I Won.”
Authors: Jenkins Danisha , Burton Candace , Holmes Dave
Published: June 2022

Objective

The objectives of this study were to give voice to the lived experiences of nurses and law enforcement officers (LEOs) who interact with one another in acute hospital settings and to interpret and understand their unique perspectives and experiences.

Methods

This qualitative study employed interpretative phenomenological analysis in the interviews of registered nurses and LEOs. The analysis and discussion was underpinned by biopolitical theories of power and control, including Georgio Agamben, Michel Foucault, and Erving Goffman.

Results

There is a paucity of literature on nurse and law enforcement interactions in the hospital setting. Nurses and law enforcement exerted power and authority through several means. Overwhelmingly, participants described a contentious dynamic between nurses and LEOs in the hospital, wrought with argument, stress, and a feeling of coming from “different worlds.”

Conclusion

The results provide alarming examples of deformed caring practices and assert the necessity for continued unearthing and discussion of how nurses can, and should, navigate law enforcement interaction. The tangible interference of care is of particular importance and consideration for nurses. Inequity in care and unfavorable outcomes for already marginalized and vulnerable populations are of grave concern. Additional research is needed on the specific ways this struggle for power between institutions and their political actors impairs caring practices and the emotional and psychological sequelae of these interactions.
Hyponatremia Is a Powerful Predictor of Poor Prognosis in Left Ventricular Assist Device Patients
Authors: Tibrewala Anjan , Wehbe Ramsey M. , Wu Tingqing , Harap Rebecca , Ghafourian Kambiz , Wilcox Jane E. , Okwuosa Ike S. , Vorovich Esther E. , Ahmad Faraz S. , Yancy Clyde , Pawale Amit , Anderson Allen S. , Pham Duc T. , Rich Jonathan D.
Published: June 2022

Serum sodium is an established prognostic marker in heart failure (HF) patients and is associated with an increased risk of morbidity and mortality. We sought to study the prognostic value of serum sodium in left ventricular assist device (LVAD) patients and whether hyponatremia reflects worsening HF or an alternative mechanism. We identified HF patients that underwent LVAD implantation between 2008 and 2019. Hyponatremia was defined as Na ≤134 mEq/L at 3 months after implantation. We assessed for differences in hyponatremia before and after LVAD implantation. We also evaluated the association of hyponatremia with all-cause mortality and recurrent HF hospitalizations. There were 342 eligible LVAD patients with a sodium value at 3 months. Among them, there was a significant improvement in serum sodium after LVAD implantation compared to preoperatively (137.2 vs. 134.7 mEq/L, P < 0.0001). Patients with and without hyponatremia had no significant differences in echocardiographic and hemodynamic measurements. In a multivariate analysis, hyponatremia was associated with a markedly increased risk of all-cause mortality (HR 3.69, 95% CI, 1.93–7.05, P < 0.001) when accounting for age, gender, co-morbidities, use of loop diuretics, and B-type natriuretic peptide levels. Hyponatremia was also significantly associated with recurrent HF hospitalizations (HR 2.11, 95% CI, 1.02–4.37, P = 0.04). Hyponatremia in LVAD patients is associated with significantly higher risk of all-cause mortality and recurrent HF hospitalizations. Hyponatremia may be a marker of ongoing neurohormonal activation that is more sensitive than other lab values, echocardiography parameters, and hemodynamic measurements.
A Novel Percutaneous Technique for Left Ventricular Assist Device Deactivation Using a Left Atrial Appendage Occluder in the Outflow Cannula
Authors: Pereira Amanda B. , Belfort Deborah S. P. , Biselli Bruno , Melo Pedro H. M. C. , Ávila Mônica S. , Rizk Stephanie I. , Hames Renata L. , Abizaid Alexandre A. C. , Fernandes Paulo M. P. , Brito Fábio S. , Ferreira Silvia M. A.
Published: June 2022

Reverse cardiac remodeling may occur in some left ventricular assist device (LVAD) recipients. Although considered the standard therapy, surgical device explantation with repeat sternotomy might be undesirable or very high risk. On the other hand, there are few data reporting minimally invasive percutaneous LVAD deactivation. We describe a case of a man with LVAD malfunction due to driveline fracture and left ventricular (LV) function recovery who had a Heart Mate II deactivated with a percutaneous technique using a left atrial appendage occluder (LAAO) positioned inside the outflow cannula. To the best of our knowledge, this the first report of LVAD deactivation with the fully recapturable LAAO device. We propose that the use of a LAA occluder to obstruct HM II outflow cannula is feasible and safe.
Starting and Sustaining an Extracorporeal Membrane Oxygenation Program
Authors: Dhar Archana V. , Morrison Tracy , Barbaro Ryan P. , Buscher Hergen , Conrad Steven A. , Diaz Rodrigo , Deng Joseph , Ellis W. Cory , Fortenberry James , Heard Micheal , Hyslop Robert , Miranda Dinis Reis , Ogino Mark , Sin Wai Ching Simon , Zakhary Bishoy , MacLaren Graeme
Published: June 2022

The use of extracorporeal membrane oxygenation (ECMO) is growing rapidly in all patient populations, especially adults for both acute lung or heart failure. ECMO is a complex, high risk, resource-intense, expensive modality that requires appropriate planning, training, and management for successful outcomes. This article provides an optimal approach and the basic framework for initiating a new ECMO program, which can be tailored to meet local needs. Setting up a new ECMO program and sustaining it requires institutional commitment, physician champions, multidisciplinary team involvement, ongoing training, and education of the ECMO team personnel and a robust quality assurance program to minimize complications and improve outcomes.
Surgical resection versus radiofrequency ablation for early recurrent hepatocellular carcinoma
Authors: Shi Tongtong , Xu Chenghui , Feng Yuemin , Wei Yingnan , Lv Huanran , Zhu Qiang
Published: June 2022

Background

Surgical resection (SR) and radiofrequency ablation (RFA) are reasonable treatment options for early recurrent hepatocellular carcinoma (rHCC), but it is still uncertain which treatment is better. The purpose of this study was to compare the therapeutic effects of SR and RFA on patients with early rHCC.

Methods

This study enrolled 168 patients with early rHCC who underwent SR or RFA. The progression-free survival (PFS), overall survival (OS), and complications between the treatment groups for the total and propensity score-matched (PSM) cohorts were compared.

Results

Before PSM, the 1-, 3-, 5-year OS (94.8%, 63.0%, 36.1% vs. 93.8%, 58.5%, 35.4%, P = 0.580) and PFS (50.7%, 22.7%, 12.0% vs. 68.8%, 30.3%, 15.9%, P = 0.224) were similar in RFA group and the SR group. After PSM, the 1-, 3-, 5-year OS (95.5%, 71.1%, 53.3% vs. 95.5%, 58.0%, 42.1%, P = 0.285) and PFS (50%, 36.4%, 27.3% vs. 68.2%, 25.6%, 12.8%, P = 0.999) were similar in the RFA group and the SR group. For patients with early recurrent tumors ≤3 cm, RFA and SR could achieve similar curative effects. However, SR was superior to RFA in terms PFS for patients with early recurrent tumors >3 cm, but the OS was similar. For all patients, RFA had significantly fewer complications and shorter hospitalization time compared with SR.

Conclusion

SR achieves better tumor control compared with RFA for patients with early rHCC (>3 cm) after SR. RFA had significantly fewer complications and shorter hospitalization time compared with SR for all patients.
Pancreatic-Like Cells Derived From Mouse Embryonic Stem Cells Are Regulated by Pdx1 Involving the Notch Pathway
Authors: Zhong Wa , Lai Yu , Xia Zhong-Sheng , Lin Ying , Ni Chu-Yan , Yu Zhong , Li Jie-Yao , Yu Tao , Chen Qi-Kui
Published: June 2022

Objectives

Embryonic stem cells (ESCs)–derived pancreatic precursor cells have great potential for pancreas repair. Expression of pancreatic duodenal homeobox 1 (Pdx1) in definitive endoderm (DE) cells is the premise that DE cells differentiate into pancreatic cells. To achieve the required number of Pdx1-expressing DE cells for cell transplantation therapy, a valid model must be established. Using this model, researchers investigated how Pdx1 regulates ESC differentiation into pancreatic cells.

Methods

Tet-On inducible lentiviral vector encoding Pdx1 or mock vector was transduced into mouse ESC (ES-E14TG2a). The mouse ESCs were divided into 3 groups: control (ESC), mock vector (Pdx1−-ESC), and vector encoding Pdx1 (Pdx1+-ESC). All groups were separately cocultured with the DE cells sorted by immune beads containing CXCR-4+ (C-X-C chemokine receptor type-4) antibody. Doxycycline induced the expression of Pdx1 on the Pdx1+-ESC cells. The markers of cell differentiation and Notch pathway were examined.

Results

Significantly increased expression levels of Ptf1a, CK19, and amylase on day (d) 3 and d7, Neuro-D1 on d10 and d14, Pax6 and insulin on d14, as well as Notch1, Notch2, Hes1, and Hes5 on d3 and thereafter declined on d14 were observed in Pdx1+-ESC group.

Conclusions

Pdx1+-ESC could differentiate into pancreatic-like cells with involvement of the Notch pathway.
Rising Prevalence of Anxiety and Depression in Chronic Pancreatitis
Authors: Makar Michael , Vodusek Ziga , Xia Weiyi , Greenberg Patricia , Abdelsayed George G.
Published: June 2022

Objectives

We aim to characterize the prevalence and impact of anxiety and depression (AD) in hospitalized patients with chronic pancreatitis (CP). Anxiety and depression have been shown to have a significant impact on mortality and length of stay in gastrointestinal diseases, but there are limited studies evaluating its impact on CP.

Methods

We performed a retrospective analysis using the National Inpatient Sample from 2007 to 2014. The outcomes were the prevalence and trend of AD, impact on mortality, length of stay, and cost and independent predictors of AD.

Results

A total of 75,744 patients with CP were included in our analysis, of which 23,323 (31%) had anxiety or depression. The prevalence of anxiety increased from 7.33% in 2007 to 20.02% in 2014. Depression increased from 18.49% in 2007 to 23.89% in 2014. Independent predictors of AD were decreasing age, female sex, and multiple comorbidities. Decreased risk was seen in African Americans, Hispanics, and those from the South and West. Anxiety and depression did not impact overall mortality or length of stay.

Conclusions

Anxiety and depression are increasingly recognized diagnosis in patients with CP. Careful management and treatment of psychiatric illnesses and improving quality of life need to be addressed for these patients.
Estimating Fatty Pancreas—A Preoperative Bedside Assessment by Bioelectric Impedance Analysis
Authors: Angrisani Marco , Ceresoli Marco , Ippolito Davide , Pagni Fabio , Gandola Davide , Seminati Davide , Casati Gabriele , Sironi Sandro , Braga Marco , Roccamatisi Linda , Uggeri Fabio , Sandini Marta , Gianotti Luca
Published: June 2022

Objective

The aim of the study was to evaluate whether fatty pancreas could be estimated by fat mass measurement by preoperative bioelectric impedance analysis. Preoperative computed tomography scan and pathologic evaluation were used as validation methods. Moreover, the 3 methodologies were tested for their ability in predicting postoperative pancreatic fistula.

Methods

Seventy-five patients who underwent pancreatic resection were analyzed. Preoperative computed tomography attenuation in Hounsfield unit (CT-HU) was used to assess fatty pancreas. Bioelectric impedance analysis was performed the day before surgery and fat mass index (FMI) was calculated. Pancreatic steatosis was assessed by pathologists at the line of surgical transection. The ability of the methods in predicting postoperative pancreatic fistula was evaluated by the area under the receiver operating characteristics curves.

Results

There was a strong correlation between CT-HU values and grade of pancreatic steatosis evaluated at histology (r = −0.852, P < 0.001) and a moderate correlation between FMI and histologic pancreatic steatosis (r = 0.612, P < 0.001) and between CT-HU value and FMI (r = −0.659, P < 0.001) values. The area under the curve (95% confidence interval) was 0.942 (0.879–1) for histology, 0.924 (0.844–1) for CT-HU, and 0.884 (0.778–0.990) for FMI.

Conclusions

Bioelectric impedance analysis represents a valid alternative to assess pancreatic steatosis.
Aggressive Intervention of Pancrelipase After Pancreatectomy Prevents Deterioration of Postoperative Nutritional Status
Authors: Maehira Hiromitsu , Iida Hiroya , Mori Haruki , Nitta Nobuhito , Maekawa Takeru , Tokuda Aya , Takebayashi Katsushi , Kaida Sachiko , Miyake Toru , Tani Masaji
Published: June 2022

Objectives

This study aimed to investigate the effect of early administration of delayed-release high-titer pancrelipase.

Methods

The medical records of 120 patients who had undergone pancreatectomy with computed tomography (CT) before and 6 months after surgery were retrospectively reviewed. Delayed-release high-titer pancrelipase were administered daily starting on postoperative day 3, which was defined as the EP group. The postoperative nutritional status and CT attenuation values of the liver were compared between the EP and control groups.

Results

Thirty-three patients (28%) were categorized into the EP group. With regard to the postoperative nutritional status 6 months after surgery, the body mass index, total lymphocyte count, and Onodera’s prognostic nutritional index were higher, and controlling nutritional status score was lower in the EP group than that in the control group. The CT attenuation values of the liver were not significantly different. After propensity score matching analysis, body mass index (20.7 vs 19.2, P = 0.049) and Onodera’s prognostic nutritional index (47.9 vs 44.2, P = 0.045) were significantly higher, and controlling nutritional status score was significantly lower in the EP group than that in the control group (1 vs 3, P = 0.046).

Conclusions

The early administration of pancrelipase after pancreatectomy improved nutritional status after pancreatectomy.
The Association of Early Corticosteroid Therapy With Clinical and Health-Related Quality of Life Outcomes in Children With Septic Shock*
Authors: Kamps Nicole N. , Banks Russell , Reeder Ron W. , Berg Robert A. , Newth Christopher J. , Pollack Murray M. , Meert Kathleen L. , Carcillo Joseph A. , Mourani Peter M. , Sorenson Samuel , Varni James W. , Cengiz Pelin , Zimmerman Jerry J. ,   for the Life After Pediatric Sepsis Evaluation (LAPSE) Investigators
Published: June 2022

OBJECTIVES:

Corticosteroids are commonly used in the treatment of pediatric septic shock without clear evidence of the potential benefits or risks. This study examined the association of early corticosteroid therapy with patient-centered clinically meaningful outcomes.

DESIGN:

Subsequent cohort analysis of data derived from the prospective Life After Pediatric Sepsis Evaluation (LAPSE) investigation. Outcomes among patients receiving hydrocortisone or methylprednisolone on study day 0 or 1 were compared with those who did not use a propensity score–weighted analysis that controlled for age, sex, study site, and measures of first-day illness severity.

SETTING:

Twelve academic PICUs in the United States.

PATIENTS:

Children with community-acquired septic shock 1 month to 18 years old enrolled in LAPSE, 2013–2017. Exclusion criteria included a history of chronic corticosteroid administration.

INTERVENTIONS:

None.

MEASUREMENTS and MAIN RESULTS:

Among children enrolled in LAPSE, 352 of 392 met analysis inclusion criteria, and 155 of 352 (44%) received early corticosteroid therapy. After weighting corticosteroid therapy administration propensity across potentially confounding baseline characteristics, differences in outcomes associated with treatment were not statistically significant (adjusted effect or odds ratio [95% CI]): vasoactive-inotropic support duration (–0.37 d [–1.47 to 0.72]; p = 0.503), short-term survival without new morbidity (1.37 [0.83–2.28]; p = 0.218), new morbidity among month-1 survivors (0.70 [0.39–1.23]; p = 0.218), and persistent severe deterioration of health-related quality of life or mortality at month 1 (0.70 [0.40–1.23]; p = 0.212).

CONCLUSIONS:

This study examined the association of early corticosteroid therapy with mortality and morbidity among children encountering septic shock. After adjusting for variables with the potential to confound the relationship between early corticosteroid administration and clinically meaningful end points, there was no improvement in outcomes associated with this therapy. Results from this propensity analysis provide additional justification for equipoise regarding corticosteroid therapy for pediatric septic shock and ascertain the need for a well-designed clinical trial to examine benefit/risk for this intervention.
Effect of long-term exercise therapy on motor symptoms in Parkinson’s disease patients: A systematic review and meta-analysis of randomized controlled trials
Authors: Li Xuening , Gao Zixuan , Yu Huasen , Gu Yan , Yang Guang
Published: June 2022

Objective

To assess the effectiveness of long-term exercise therapy (≥12 weeks) for people with Parkinson’s Disease (PD), and to derive specific suggestions on how the motor symptom improvements can be optimized by exercise type and exercise dose.

Design

The PubMed, Web of Science, Cochrane Central Register, Embase, Scopus and CNKI databases were searched up to January 2021 for randomized controlled trial focusing on the effects of long-term exercise for PD. Two researchers independently evaluated the quality of papers using the PEDro scale. 26 studies with a total of 1,243 participants were included.

Results

Tai Chi, resistance training and dance provide significant improvements in physical function and functional mobility. Furthermore, Tai Chi and dance result in balance benefits. However, walking capacity outcomes did not improve after Tai Chi and resistance training, but did improve after dance training. With an increase in the intervention duration or length of each session, the effect sizes of exercise on these outcomes increased; higher benefits of exercise on these outcomes were observed at a frequency of 2 times/week.

Conclusions

Long-term exercise therapy is an effective treatment for improving motor symptoms, with dance being an ideal exercise choice.
Rethinking Blood Testing in Pediatric Cancer Patients: A Quality Improvement Approach
Authors: Grant Andrew M. , Wright Felicity A. , Chapman Laura R. M. , Cook Eleanor , Byrne Renee , O’Brien Tracey A.
Published: June 2022

Introduction:

The overuse of blood tests burdens the healthcare system and can detrimentally impact patient care. Risks of frequent blood sampling include infection and clinician-induced anemia, which can negatively impact patients and their families. Pediatric cancer patients are particularly vulnerable as they are immunocompromised with a small blood volume. Four blood tests had become a daily practice. Therefore, we aimed to reduce the number of blood tests taken per bed day within the inpatient pediatric cancer unit by 15% within 8 months.

Methods:

This quality improvement project combined several strategies to reduce test frequency and empower clinicians on the rationale for blood test ordering. Recommendations were developed collaboratively presented in a summary table. Targeted behavior-change methodology built engagement and momentum for the change. All clinicians were challenged to STOP and THINK about why a test is necessary for each patient. The primary outcome measure was the frequency of the tests taken per bed day. Frequency was compared between pre- and postimplementation plus follow-up periods across 2019–2021.

Results:

26,941 blood tests were captured in 1,558 admissions. The intervention led to an overall blood test reduction of 37% over 8 months. Liver Function Tests were the standout, with a 52% decrease in test frequency.

Conclusions:

A strategy incorporating education and culture change, combined with clear guidance on testing frequency, significantly reduced the ordering frequency of blood tests without increased patient harm.
High-stage Device-related Pressure Injury Reduction in a Neonatal Intensive Care Unit: A Quality Improvement Project
Authors: Moyer Laurel B. , Lauderbaugh Denise L. , Worten Katherine , Carter Chelsea , Holub Peggy , Santos Manrique Rose A. , Bergman Judy H. , Dilloway Mary Anne , Hamid Marisha , Glenn Linda
Published: June 2022

Introduction:

Pressure injuries are a common complication in neonatal intensive care settings, and neonates are at high risk for this hospital-acquired condition. Pressure injury rates in the neonatal intensive care unit (NICU) at Rady Children’s Hospital were higher than reported national comparisons in 2018. Device-related high-stage hospital-acquired pressure injuries (HAPI) were the most common injury source. We aimed to reduce the rate of device-related high-stage HAPIs per 1,000 patient days by 30% within 12 months.

Methods:

We formed an interdisciplinary quality improvement (QI) task force to address device-related injury. The team identified opportunities and interventions and created care bundles using QI methodology. To engage staff, device-related HAPI data were shared at nursing and respiratory therapy meetings. The team and stakeholders chose metrics. Outcome, process, and balancing measures were analyzed and displayed on statistical process control charts.

Results:

Device-related HAPIs were reduced by 60% from 0.94 to 0.37 per 1,000 patient days. electroencephalography and CPAP-related events were decreased to 0 and sustained for 10 months.

Conclusions:

Interprofessional collaboration, and a strong reliance on data were keys to reducing high-stage pressure injuries. This approach can be replicated and implemented by other units experiencing similar challenges.
Reducing Antibiotic Use in a Level III and Two Level II Neonatal Intensive Care Units Targeting Prescribing Practices for Both Early and Late-onset Sepsis: A Quality Improvement Project
Authors: Kahn Doron J. , Perkins Beckett S. , Barrette Claire E. , Godin Robert
Published: June 2022

Introduction:

Variation in antibiotic (ATB) use exists between neonatal intensive care units (NICUs) without demonstrated benefit to outcomes tested. Studies show that early-onset sepsis occurs in up to 2% of NICU patients, yet antibiotics (ABX) were started in over 50% of neonates admitted to our NICUs. An internal audit identified variations in prescribing practices and excessive use of ABX. As a result, we introduced ATB stewardship to our NICUs in 2015 to reduce unnecessary usage of these medications.

Methods:

We used standard quality improvement methodology utilizing multiple iterative plan-do-study-act cycles during a 6-year project to test various interventions aimed at using ABX wisely. Specifically, our goals were to reduce ABX on admission (AA), percent of patients who continued on ABX beyond 72 hours of life (AC), and ATB utilization rate in our 3 NICUs by 28% for each metric. Interventions implemented included the development of an ATB stewardship program consisting of a multidisciplinary team that met regularly, creation of tools and guidelines for evaluations of sepsis and ATB use, universal use of the neonatal early-onset sepsis calculator for all newborns 34 weeks and older gestational age, education regarding noninitiation of ABX for maternal indications in clinically well newborns, and discontinuation within 48 hours for asymptomatic newborns with negative blood cultures.

Results:

AA, AC, and ATB utilization rate decreased by 34.1%, 45.3%, and 34.9%, respectively, in our 3 NICUs.

Conclusions:

By introducing ATB stewardship in our NICUs, we exceeded our predetermined goal of significantly reducing ATB usage.
Improving Blood Pressure Screening in Neonatal Follow-up Clinic: A Quality Improvement Initiative
Authors: Flynn Rachel S. , Zedalis Jacqueline , Denburg Michelle R. , Bernbaum Judy C. , DeMauro Sara B.
Published: June 2022

Introduction:

The American Academy of Pediatrics recommends blood pressure screening at every health care encounter in children younger than 3 years if they have a history of prematurity or other neonatal complications requiring intensive care because these children have an increased risk for hypertension.

Methods:

A multidisciplinary team conducted a quality improvement initiative to improve blood pressure screening at a single-center outpatient neonatal follow-up clinic. We developed a focused intervention program including a standardized blood pressure measurement protocol, staff training and education, and streamlined documentation. We conducted two Plan-Do-Study-Act cycles from November 2019 to January 2021. The outcome measure was the percentage of patients with a blood pressure measurement. Process measures included the percentage of medical assistants educated on the new protocol, percentage of patients 3 years, and younger old with the first blood pressure measurement taken from the right arm, and the percentage of patients 1 year and younger with 3 documented blood pressures. The balancing measure was staff satisfaction with time to obtain vital signs. We used statistical process control charts and Wilcoxon rank-sum test.

Results:

At baseline, only 15.3% of patients had documented blood pressure. During the 10-month intervention period, there were 954 patient visits. Overall, blood pressure measurement increased to 54.7% with study interventions. The balancing measure was not negatively impacted.

Conclusions:

After implementing a program of focused interventions, we substantially improved the frequency of blood pressure measurements and increased adherence to American Academy of Pediatrics screening guidelines. Improved blood pressure screening allows us to identify and evaluate at-risk infants after hospital discharge.
Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia
Authors: Gordon Oren , Peart Akindele Nadine , Schumacher Christina , Hanlon Ann , Simner Patricia J. , Carroll Karen C. , Sick-Samuels Anna C.
Published: June 2022

Introduction:

Staphylococcus aureus bacteremia (SAB) in children is associated with significant mortality and morbidity, including recurrent bacteremia. Infectious disease consultation (IDC) improves SAB outcomes in adult patients. However, increasing IDC and impact for pediatric patients with SAB is not well described.

Methods:

This quality improvement project aimed to increase IDC for SAB events at a quaternary pediatric medical center. First, we evaluated the local practices regarding pediatric SAB and engaged stakeholders (July 2018–August 2020). We added an advisory comment supporting IDC for SAB to all blood culture results in September 2020. Using statistical process control charts, we monitored the number of SAB events with IDC before a SAB event without IDC. Finally, we evaluated SAB recurrences before and after initiating the advisory comment.

Results:

In the baseline period, 30 of 49 (61%) SAB events received an IDC with a mean of 1.4 SAB events with IDC before a SAB event without IDC. Postintervention, 22 of 23 (96%) SAB events received IDC with a mean of 14 events with IDC before 1 event without IDC. The SAB recurrence rate was 8%, with 6 events in 4 children; none of the index cases resulting in recurrence received an IDC (P = 0.0002), and all occurred before any intervention.

Conclusions:

An electronic advisory comment supporting IDC for SAB significantly increased the rate of pediatric IDC with no further SAB recurrence episodes following intervention. This low-resource intervention may be considered in other pediatric centers to optimize SAB management.
A Quality Improvement Approach to Ensuring Access to Specialty Care for Pediatric Patients
Authors: Vora Sheetal S. , Buitrago-Mogollon Talia L. , Mabus Sarah C.
Published: June 2022

Introduction:

With pediatric rheumatologists in short supply, maximizing appointment availability and streamlining primary/specialty collaboration are essential. Lack of an efficient referral process impacts outcomes, quality of life, satisfaction, affordability, and resource allocation. Before this quality improvement project, our clinic had a 3- to 5-month backlog for new referrals.

Methods:

Using the model for improvement with numerous rapid-cycle plan-do-study-act cycles, this team restructured processes, developed a triage tool for communication across the care continuum, maximized staff roles in multiple areas, and instituted cross-disciplinary communication strategies to reduce appointment delays while significantly increasing efficiency.

Results:

The team succeeded in decreasing time from referral to specialty consult by 60%, decreasing no-show rates from 15% to 6%, and increasing throughput by an average of 45 more patients per month. Most new patients can now see our specialists within 23 days, meaning the children in our community have 65% shorter wait times for rheumatology services.

Conclusion:

The use of a triage algorithm with structured communication allows multidisciplinary care teams at both the referring and receiving providers to efficiently and accurately place patients into specialty care. This highly scalable and transferable project was accomplished with no direct financial outlay yet yielded significant returns by standardizing processes, empowering the entire care team to build skills, and improving communication.
Identification and Prognosis of Patients With Interstitial Pneumonia With Autoimmune Features
Authors: Jiwrajka Nikhil , Loizidis Giorgos , Patterson Karen C. , Kreider Maryl E. , Johnson Cheilonda R. , Miller Wallace T. , Barbosa Eduardo Jose Mortani , Patel Namrata , Beers Michael F. , Litzky Leslie A. , George Michael D. , Porteous Mary K.
Published: June 2022

Background/Objective

Patients classified as interstitial pneumonia with autoimmune features (IPAF) have interstitial lung disease (ILD) and features of autoimmunity but do not fulfill criteria for connective tissue diseases (CTDs). Our goal was to identify patients classifiable as IPAF, CTD-ILD, and idiopathic pulmonary fibrosis (IPF) from a preexisting pulmonary cohort and evaluate the prognosis of patients with IPAF.

Methods

We reviewed the medical records of 456 patients from a single-center pulmonary ILD cohort whose diagnoses were previously established by a multidisciplinary panel that did not include rheumatologists. We reclassified patients as IPAF, CTD-ILD, or IPF. We compared transplant-free survival using Kaplan-Meier methods and identified prognostic factors using Cox models.

Results

We identified 60 patients with IPAF, 113 with CTD-ILD, and 126 with IPF. Transplant-free survival of IPAF was not statistically significantly different from that of CTD-ILD or IPF. Among IPAF patients, male sex (hazard ratio, 4.58 [1.77–11.87]) was independently associated with worse transplant-free survival. During follow-up, only 10% of IPAF patients were diagnosed with CTD-ILD, most commonly antisynthetase syndrome.

Conclusion

Despite similar clinical characteristics, most patients with IPAF did not progress to CTD-ILD; those who did often developed antisynthetase syndrome, highlighting the critical importance of comprehensive myositis autoantibody testing in this population. As in other types of ILD, male sex may portend a worse prognosis in IPAF. The routine engagement of rheumatologists in the multidisciplinary evaluation of ILD will help ensure the accurate classification of these patients and help clarify prognostic factors.
Analysis of Serbian Primary Antiphospholipid Syndrome Patients Confirmed a Strong Association Between Livedo Reticularis and Arterial Thrombosis
Authors: Djokovic Aleksandra , Stojanovich Ljudmila , Stanisavljevic Natasa , Matic Predrag , Colic Danijela , Skrijelj Daniel , Djokic Sandra , Filipovic Branka
Published: June 2022

Background

Antiphospholipid syndrome (APS) is characterized by antiphospholipid antibodies (aPLs) associated with thrombosis (arterial and/or venous) and/or obstetrical manifestations. However, various manifestations, which are considered to be noncriteria manifestations, are frequently found in APS.

Aim

The purpose of this study was to evaluate whether noncriteria manifestations may be found more frequently in subjects with thrombotic and/or obstetrical APS (“criteria” manifestations) in a population of patients with primary APS (PAPS). This study presents the results from our national cohort.

Patients and Methods

This is a cross-sectional study of 360 PAPS patients. Data regarding the presence of thrombocytopenia, livedo reticularis, chorea, and valvulopathy were analyzed. The aPL analysis included the detection of anticardiolipin antibodies (aCLs: immunoglobulin G [IgG]/IgM), anti-β2 glycoprotein I (IgG/IgM), and lupus anticoagulant positivity.

Results

In our cohort, livedo reticularis was significantly related to arterial thromboses in the same way as valvular manifestations (valvular vegetations and valvular thickening and dysfunction not related to age) (p = 0.0001, p = 0.013, respectively). Age was strongly related to all the noncriteria manifestations analyzed. Thrombocytopenia was significantly related to β2 glycoprotein I IgG and lupus anticoagulant positivity (p = 0.043, p = 0.030, respectively), as well as to double and triple aPL positivity (p = 0.041, p = 0.013 respectively). Moreover, in a multivariate model, livedo reticularis was strongly and independently related to arterial thrombosis in our cohort (odds ratio, 2.010; confidence interval, 1.229–3.288; p = 0.005).

Conclusion

This cross-sectional analysis of a large cohort of Serbian PAPS patients confirmed a strong relationship between livedo reticularis and arterial thrombosis, suggesting a more cautious approach regarding the presence of noncriteria manifestations, especially livedo reticularis, in APS.
Solitary Abdominal Wall Metastasis From Rectal Carcinoma Revealed on FDG PET/CT
Authors: Xiao Liu , Li Guannan , Li Yuhao , Li Lin
Published: June 2022

Abdominal wall metastasis from rectal carcinoma is very rare. We report FDG PET/CT findings of a solitary abdominal wall metastasis from rectal carcinoma in a 40-year-old man. On FDG PET/CT, it presents as a solitary soft tissue mass in the anterior abdominal wall with an SUVmax of 9.54. The final pathology supported a diagnosis of metastasis from rectal carcinoma.
Management of a Patient With Metastatic Gastrointestinal Neuroendocrine Tumor and Meningioma Submitted to Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE
Authors: Pirisino Riccardo , Filippi Luca , D’Agostini Antonio , Bagni Oreste
Published: June 2022

A 76-year-old woman affected by pancreatic neuroendocrine tumor previously subjected to surgery with progressive liver disease and a concomitant mild symptomatic meningioma of the left pontocerebellar angle underwent 4 cycles of peptide receptor radionuclide therapy with 177Lu-DOTATATE. A prophylactic therapy with corticosteroids was carried out before each treatment cycle, and the neurosurgery unit was alerted in case of cerebral edema and related neurologic symptoms. A 68Ga-DOTATOC PET/CT scan performed after the completion of the 4 cycles’ treatment documented a hepatic partial response and a substantial stability of the brain mass. No neurological complications occurred during treatment and follow-up.
Suprasellar Hemangioblastoma on 68Ga-DOTATATE PET/CT
Authors: Filizoglu Nuh , Ozguven Salih
Published: June 2022

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary cancer syndrome that is characterized by the presence of various malignant and benign tumors, including retinal and central nervous system hemangioblastomas. Hemangioblastomas are highly vascular tumors that can occur sporadically or within VHL disease. Herein, we present 68Ga-DOTATATE PET/CT findings of a unique case of suprasellar hemangioblastoma in a 52-year-old man with VHL disease.