bluuebunny/crossref_metadata_2025 huggingface dataset:
0838 Cheyne-Stokes Breathing in a Pediatric Patient with Dilated Cardiomyopathy and Muscular Dystrophy Prior to Heart Transplant
Authors: Dang LeQuan , Kaplan Kevin , Revana Amee
Published: May 2022

Introduction

Cheyne-Stokes breathing (CSB) has rarely been identified in the pediatric population. Neuromuscular diseases (NMD) such as Duchene Muscular Dystrophy (DMD) can predispose patients to sleep-disordered breathing including central sleep apnea (CSA) and CSB. Sleep-disordered breathing in children with NMD may not have symptoms; thus, treatment can be delayed. Currently, there is limited data to support resolution of CSB in DMD with dilated cardiomyopathy post-transplant.

Report of Cases: We present a 15-year old female with a significant history of both dilated cardiomyopathy and DMD who presented with acute on chronic heart failure. Due to her disease progression, she was listed for heart transplant. Prior to her transplant, she completed an inpatient polysomnography (PSG) to rule out sleep-disordered breathing due to concerns of snoring and dyspnea during sleep. Her Pediatric Daytime Sleepiness Scale score (PDSS) was 8. The polysomnogram recorded moderate obstructive sleep apnea (OSA) and central sleep apnea

(CSA) consistent with Cheyne-Stokes breathing along with rare premature ventricular

contractions (PVCs). Patient was started on BPAP of 13/8 cm H2O with a back-up rate of 12

breaths per minute after titration study. The patient subsequently received a heart transplant in

which the patient’s dyspnea and snoring resolved. Post-transplant PSG pending to reassess the

severity of sleep-disordered breathing.

Conclusion

Though CSA can be seen in children, CSB is rarely seen in children with either heart failure or muscular dystrophy. When CSB is observed, the cornerstone of treatment is correcting the underlying cause. This patient demonstrated CSB with symptoms that improved with BPAP and now post-heart transplant. When both heart failure and neuromuscular disease are involved, close monitoring for clinical symptoms along with screening for CSB is important and may affect overall quality of life and recovery.

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0840 Be Wary Of Adjustment Disorder with Anxiety In Patient With Insomnia And Discomfort With Positive Pressure Airway Therapy
Authors: Jamil Saad Bin , Kachechian Talar , Doghramji Karl , Fast Zhanna
Published: May 2022

Introduction

Insomnia is a common complaint. When it occurs in the context of treatment with continuous positive airway pressure (CPAP), it can complicate treatment and lead to dissatisfaction with CPAP therapy. Adjustment disorder with anxiety (ADWA) is a condition that develops following an identifiable stressor and can be associated with insomnia. We describe a case of ADWA causing disrupted sleep and dissatisfaction with CPAP therapy.

Report of Cases: The patient is an 80-year-old man with history of severe obstructive sleep apnea (OSA) and chronic obstructive lung disease, under stable management with CPAP. During a routine follow up visit, he reported the recent onset of frequent, and often prolonged, nocturnal awakenings associated with daytime sleepiness and fatigue. Insomnia was associated with discomfort with breathing, especially during exhalation, while using CPAP. His machine report indicated a significant decrement in compliance. Upon questioning, he reported that a few of his family members had died unexpectedly, following which he began to experience significant anxiety. His wife noted that he had become moody and irritable. On examination, the patient was visibly anxious; his speech was accelerated and animated, and he displayed psychomotor activation. Affect also displayed despondency. The patient was diagnosed with ADWA leading to insomnia and discomfort with CPAP use. He was prescribed buspirone 10 mg twice daily. On two week follow up patient reported no improvement in symptoms and was switched to escitalopram 10 mg daily. Following approximately three weeks, his clinical evaluation revealed significant improvement in mood; anxiety had dissipated, and sleep was more continuous with infrequent and brief awakenings. Daytime alertness had been restored. Of interest was the temporary return of anxiety and insomnia symptoms following the brief discontinuation of escitalopram because of hospitalization.

Conclusion

ADWA can occur in the setting of recent stressors and can result in sudden onset of insomnia, compromise CPAP adherence and decrease subjective benefit from PAP therapy. This case highlights the importance of questioning patients for the possibility of recent stressors and traumatic events when they develop difficulties with PAP use. These may indicate the presence of ADWA, whose management can restore CPAP compliance and improve sleep quality and daytime functioning.

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0844 Isolated, Idiopathic Periodic Breathing in a School Age Child
Authors: Isaacs Thomas , Valenzuela Andrew , Malhotra Sonal
Published: May 2022

Introduction

Periodic breathing (PB) is a well described physiologic phenomenon of infancy and usually resolves with age1. PB that persists outside of infancy has been described in association with various pathologies such as Chiari malformation, upper airway anomalies and genetic abnormalities2. Isolated PB that persists past infancy is less well described, and there is little data to guide subsequent management and clinical decision making.

Report of Cases: Here we present a case of a 12-year-old female with isolated PB on polysomnography (PSG). She initially presented to our sleep center clinic with complaints of snoring, gasping during sleep and daytime sleepiness. She had no significant past medical history and not on any sleep-modifying medications. PSG was ordered to evaluate for suspected obstructive sleep apnea. Total sleep time was 7.75 hours with a mildly reduced amount of REM (16% of total sleep time). She had a total of 4 minutes of central sleep apnea that met AASM criteria for periodic breathing. This occurred exclusively during transitions between N1 and N2 and was not associated with hypoxemia nor hypocapnia. The patient’s total apnea hypopnea index (AHI) was 2.97/hr, obstructive AHI 0.65/hr and central apnea index was 2.32/hr. Of note, this studywas not conducted at high altitude and was done in Houston (approximately 100 feet above sea level). Given the lack of significant sleep apnea, a conservative approach with nasal fluticasone and close follow-up was utilized.

Conclusion

Though rare, this case highlights the possibility of PB being an incidental finding of PSG in otherwise healthy, school aged children. The need for further research as to the significance of this incidental finding is also emphasized.

Support (If Any)

1. MacLean, Joanna E., Dominic A. Fitzgerald, and Karen A. Waters. "Developmental changes in sleep and breathing across infancy and childhood." Paediatric respiratory reviews 16.4 (2015): 276-284.2. Ghirardo, Sergio, et al. "Central apnea and periodic breathing in children with underlying conditions." Journal of Sleep Research (2021): e13388.
0845 Large arachnoid cysts and hypersomnolence: symptomatic or not?
Authors: Shigeru Chiba , GoEun Han , Takashi Kambayashi
Published: May 2022

Introduction

Arachnoid cysts are the most common type of brain cyst. They are often congenital, and most of them are stable and do not require treatment. On the other hand, some of them present a symptomatic problem such as headache, nausea and seizures. This rare condition was seen in a female patient who also had hypersomnolence.

Report of Cases: A 37-year-old female presented to hospital for evaluation of excessive daytime sleepiness (EDS) for the past 20 years, with repeated attacks several times a day without any REM sleep related symptoms. She also showed irregular wake sleep pattern of sleep extending over 24 hours, disturbing nocturnal sleep after each episode. Her sleep log showed sudden onset hypersomnolence with sleep duration of 30-40 hours every week. Epworth sleep scale was 10/24. PSG demonstrated her sleep architecture of 8 hours duration was unusual with sleep onset REM period (SOREMP) and decreased N3 sleep stage. MSLT showed reduced sleep onset latency (average: 5 minutes) and sleep onset REM on 1 of 4 naps. Brain MRI revealed a large arachnoid cyst on her left cerebral hemisphere. She was diagnosed as narcolepsy type2 and referred to the department of neurosurgery, but due to unclear association between hypersomnolence and the cyst, surgical treatment was not carried out. She was started on Modafinil 50mg which progressively increased to 200mg, but little effect was seen in sudden onset hypersomnolence and caused side effects such as headache and nausea. After Modafinil was discontinued, Melatonin agonist was administered in order to control her irregular sleep-wake rhythm, and since then her sleep-wake cycle has changed relatively stable and regular. At present, the frequency of hypersomnolence is gradually getting low and Epworth is 4/24.

Conclusion

In the present case, there is no evidence that her symptoms concerning sleep were secondary to any other disorder. Also, to our knowledge, there have been only a few cases reporting coexistence of hypersomnolence and arachnoid cysts. We are carefully following up on this patient and will reconsider to refer her to neurosurgery if any other symptoms appear.

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0846 Severe OSA in a 17yr old patient with Prader Willi Syndrome and poorly controlled Diabetes Mellitus
Authors: Kochhar Rashi , Geer Jacqueline , Guandalini Cindy , Weiss Pnina
Published: May 2022

Introduction

Prader Willi Syndrome (PWS), while rare, is the most common genetic cause of obesity. It is caused by a functional loss of paternally expressed genes from chromosomal region 15q11-13. PWS is characterized by short stature, neurodevelopmental delay, obsessive-compulsive behaviors, hypothalamic dysfunction, and hyperphagia, associated with an aberrant satiety response and elevated levels of ghrelin. Excessive daytime sleepiness (EDS) and sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea, are common.

Report of Cases: A 17-year-old male, with PWS, morbid obesity, autism, and diabetes mellitus (DM) type-2 was referred for evaluation of snoring and EDS (Epworth Sleepiness Score 16). He had recently been admitted with diabetic ketoacidosis associated with binge eating. He had no prior sleep testing. He denied sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy. He had a body mass index of 54 kg/m2 with short stature (1.6m). On exam, he had a Mallampati score of 4 and 1+ tonsils. A recent echocardiogram was normal. Polysomnography showed sleep latency of 10 mins, apnea-hypopnea index (AHI) of 148/hr, nadir oxygen saturation of 73%, with 45% of total sleep time < 90%. Hypoventilation was not present. He was prescribed auto-titrating positive airway pressure (PAP) therapy. His mother was instructed to start locking access to food again. He was treated with insulin and metformin, with a plan to start on a glucagon-like peptide-1 (GLP-1) agonist. He had been on growth hormone (GH) previously, but in the context of his other morbidities, it was not reinitiated.

Conclusion

It is critical to screen and monitor patients with PWS for OSA, as SDB occurs in almost 70%. While PAP therapy may improve OSA, there is often residual EDS (likely due to underlying hypothalamic dysfunction), and alerting agents may be needed. GH can be considered for short stature but is contraindicated in patients with morbid obesity, untreated severe OSA, and uncontrolled diabetes. Management of diabetes, obesity, and hyperphagia in patients with PWS is challenging. Supervision and strict limitation of food intake using physical barriers are important. While data are limited, GLP-1 agonists may provide potential benefits for weight, glycemic, and appetite control in patients with PWS.

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0847 Sleep Disordered Breathing in a case series of 4 children with Trisomy 18
Authors: Kochhar Rashi , Brumer Eliaz , Canapari Craig
Published: May 2022

Introduction

Trisomy 18 (Edwards syndrome) is the second-most-common viable autosomal trisomy syndrome after trisomy 21, occurring in 1 in 2500 pregnancies. Obstructive Sleep Apnea (OSA) in Trisomy 21 has been well described in the literature. Even though trisomy 18 patients have upper airway obstructive (UAO) features overlapping with trisomy 21 that could predispose them to develop SDB, there is a dearth of data published about it.

Report of Cases: We present a case series of four patients with trisomy 18 who were evaluated for SDB aged 17mo-3yrs at the time of the reported polysomnographies (PSGs). Two patients had multiple prior studies. Moderate OSA was noted in two patients, and one was noted to have severe OSA, while the fourth patient had resolution of their severe OSA post adenotonsillectomy (T&A). Reduced sleep efficiency was noted in 2 patients. All but one patient had abnormal EEGs, consistent with known underlying seizure disorders. While all patients desaturated during sleep, only two patients fulfilled the criteria for hypoxemia (SpO2 below 90% for more than 5

minutes). One of these had resolution of hypoxemia with a trial of positive airway pressure therapy (PAP) of 5 cmH2O on a titration study. While capnography showed hypoventilation in two patients, one of the patients was treated with supplemental oxygen and the recommendation for titration PSG study to evaluate the need for PAP.

Conclusion

With aggressive interventions, children with trisomy 18 have seen a higher survival over the recent years. These children often have micrognathia or retrognathia, midface hypoplasia, glossoptosis, and hypotonia, predisposing them to have UAO. Endoscopic assessments reveal laryngomalacia and/or tracheomalacia, tonsillar and adenoid hypertrophy. In a previously reported study by Kettler et al. (2020), a prevalence of SDB of 44.68% was noted compared to the 1-4% average prevalence in non-syndromic children, hence clinicians should have a low threshold to screen them. In our small case series, all 4 patients had moderate-to-severe OSA, to begin with. Our results show that both surgery and PAP therapy may be successful in the treatment of OSA. More longitudinal data is needed to understand the pathology and management of SDB in these children.

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0851 Longitudinal Management of Narcolepsy with Atypical presentation of Cataplexy (unilateral with symptoms only on the right side for the past 13 years)
Authors: Pant Alok , Ghildiyal Naomi , Khan Yousaf , Ho Minh , Monceaux Brittany , Liendo Cesar , Chernyshev Oleg
Published: May 2022

Introduction

Narcolepsy with atypical unilateral cataplexy is a rare phenotype. We would like to share single center, single patient experience over the last 13 years of managing this patient.

Report of Cases: 64-year-old female diagnosed with narcolepsy with unilateral cataplexy in 2008 with MSLT. Her cataplexy syndrome has been atypical, in that it has a strictly unilateral presentation for the past 13 years, with right face, arm, and leg weakness with strong emotions(anger/laughter). Her right-side extremities go limp for a few seconds to a minute.

Her cataplexy syndrome has never evolved to become bilateral or unilaterally on her left side.

Her physical examination has been largely unremarkable. For Narcolepsy, was on Modafinil (2008) which was up titrated to 600 mg with no side effects, eventually switched to Armodafinil 250 mg (2013). Eventually did not control EDS fully, methylphenidate (2014) was added. The patient reported cognitive impairment with gradual memory loss on stimulants (starting in 2012) and nocturnal insomnia on methylphenidate SR. Due to worsening cognition and memory, stimulants were discontinued in 2014 and patient referred to neurology and had neuropsychiatric evaluation for memory loss. Dementia lab workup and MRI with spectroscopy were unremarkable. Due to continuation of EDS was restarted on Modafinil until May 2021. In May 2021, she reported no longer fully controlled daytime sleepiness and Pitolisant was added with improvement in ESS from 17/24 to 9/24. For the management of unilateral cataplexy, patient was well controlled initially on venlafaxine (2008), eventually up titrated with an additional dose a few times. After cognitive impairment, patient stopped refilling it in 2014 and subsequently slept better without the venlafaxine. She reported that she would fall when she got very upset/mad so learnt not to get mad at people. She had many episodes of unilateral cataplexy mainly with laughing or excitement so was started on Fluoxetine 20 mg and eventually up titrated to 40 mg. Her unilateral cataplexy symptoms have been well controlled with the addition of Pitolisant.

Conclusion

Management of Narcolepsy with atypical unilateral cataplexy is challenging and requires use of multiple medications with different sites of action.

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Evidence of improved outcomes using patient-generated health data
Authors: Erickson Thomas J.
Published: May 2022

Demonstrated value depends on a collaborative approach
Targeted muscle reinnervation prevents and reverses rat pain behaviors after nerve transection
Authors: Roth Elizabeth , Linehan Allison , Weihrauch Dorothee , Stucky Cheryl , Hogan Quinn , Hoben Gwendolyn
Published: May 2022

Targeted muscle reinnervation (TMR) is a clinical intervention that is rapidly becoming common in major limb amputation to prevent or reduce amputation-related pain. However, TMR is much less effective when applied long after injury compared with acute TMR. Since the mechanisms governing pain relief in TMR of amputated nerves are unknown, we developed a preclinical model as a platform for mechanistic examination. Following spared nerve injury (SNI), rats underwent either TMR, simple neuroma excision, or a sham manipulation of the injury site. These interventions were performed immediately or delayed (3 or 12 weeks) after SNI. Pain behavior was measured as sensitivity to mechanical stimuli (pin, von Frey, and dynamic brush) and thermal stimuli (acetone and radiant heat). Spared nerve injury produced hypersensitivity to all mechanical stimuli and cold, which persisted after sham surgery. Targeted muscle reinnervation at the time of SNI prevented the development of pain behaviors and performing TMR 3 weeks after SNI reversed pain behaviors to baseline. By contrast, TMR performed at 12 weeks after SNI had no effect on pain behaviors. Neuroma excision resulted in significantly less reduction in hyperalgesia compared with TMR when performed 3 weeks after SNI but had no effect at 12 weeks after SNI. In this model, the pain phenotype induced by nerve transection is reduced by TMR when performed within 3 weeks after injury. However, TMR delayed 12 weeks after injury fails to reduce pain behaviors. This replicates clinical experience with limb amputation, supporting validity of this model for examining the mechanisms of TMR analgesia.
Resurgent neuropathic discharge: an obstacle to the therapeutic use of neuroma resection?
Authors: Tal Michael , Minert Anne , Devor Marshall
Published: May 2022

Ectopic discharge (“ectopia”) in damaged afferent axons is a major contributor to chronic neuropathic pain. Clinical opinion discourages surgical resection of nerves proximal to the original injury site for fear of resurgence of ectopia and exacerbated pain. We tested this concept in a well-established animal neuroma model. Teased-fiber recordings were made of ectopic spontaneous discharge originating in the experimental nerve-end neuroma and associated dorsal root ganglia in rats that underwent either a single transection (with ligation) of the sciatic nerve or 2 consecutive transections separated by 7, 14, 21, or 30 days. Ectopia emerged in afferent A and C fibers after a single cut with kinetics anticipated from previous studies. When resection was performed during the early period of intense A-fiber activity, a brief period of resurgence was observed. However, resection of neuromas of more than 14 days was followed by low levels of activity with no indication of resurgence. This remained the case in trials out to 60 days after the first cut. Similarly, we saw no indication of resurgent ectopia originating in axotomized dorsal root ganglion neuronal somata and no behavioral reflection of resurgence. In summary, we failed to validate the concern that proximal resection of a problematic nerve would lead to intense resurgent ectopic discharge and pain. As the well-entrenched concept of resurgence is based more on case reports and anecdotes than on solid evidence, it may be justified to relax the stricture against resecting neuromas as a therapeutic strategy, at least within the framework of controlled clinical trials.
Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative
Authors: Radmall Ashley O. , Calder Spencer , Codell Nodira , Kelley Alan Taylor , Hawkins Eric , Jones Audrey L. , Hagedorn Hildi J. , Reynolds Mary Anne , Gordon Adam J.
Published: May 2022

Background

In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings.

Methods

From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative—a national program intending to implement MOUD in general medical settings—to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes.

Results

Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care.

Conclusions

In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD.
When Moods and Behaviors Do Not Add Up
Authors: Larrieu-Jimenez Patricia , Salani Deborah
Published: May 2022

This case report presents a 40-year-old man presenting with mixed mental health symptoms including depression, anxiety, euphoria, sleep cycle disturbances, and alcohol use over several years. Multiple providers see the patient in varying specialties, initially focusing on depression, anxiety, and, later, substance use. Alcohol misuse can shadow underlying mental disorders. Therefore, early recognition and collaborative management are imperative to unveil the possibility of comorbid mental health disorders.
The Association Between Self-reported Sleep Quality and Self-care in Adults With Heart Failure
Authors: Spedale Valentina , Fabrizi Diletta , Rebora Paola , Luciani Michela , Alvaro Rosaria , Vellone Ercole , Riegel Barbara , Ausili Davide
Published: May 2022

Background

Sleep disturbance is one of the most common symptoms among patients with heart failure (HF), and it may affect the ability of patients to perform self-care. There is a lack of evidence on the association between sleep quality and its components and self-care in adults with HF.

Objective

The aim of this study was to evaluate the association between sleep quality and its components and self-care in adults with HF.

Methods

This study is a secondary analysis of baseline data from the MOTIVATE-HF study, a randomized controlled trial on patients with HF and their caregivers. Only patients' data were analyzed in this study (n = 498). Sleep quality and self-care were evaluated with the Pittsburgh Sleep Quality Index and the Self-Care of Heart Failure Index v6.2, respectively.

Results

A habitual sleep efficiency of 75% to 84% was associated with lower self-care maintenance compared with a habitual sleep efficiency of 85% or greater (P = .031), as was taking sleep medications once or twice a week compared with less than once a week (P = .001). A frequency of daytime dysfunction less than once a week was associated with lower self-care management compared with a frequency of daytime dysfunction of 3 or more times a week (P = .025). Taking sleep medications less than once a week was associated with lower self-care confidence compared with taking sleep medications 3 or more times a week (P = .018).

Conclusion

Poor sleep quality is frequently reported by patients with HF. Sleep efficiency, sleep medications, and daytime dysfunction may influence self-care more than the other sleep quality components.
Associations Between Different Self-reported Social Risks and Neighborhood-level Resources in Medicaid Patients
Authors: Miller-Rosales Chris , McCloskey Jodi , Uratsu Connie S. , Ralston James D. , Bayliss Elizabeth A. , Grant Richard W.
Published: May 2022

Background:

Adverse social conditions are a key contributor to health disparities. Improved understanding of how social risk factors interact with each other and with neighborhood characteristics may inform efforts to reduce health disparities.

Data:

A questionnaire of 29,281 patients was collected through the enrollment of Medicaid beneficiaries in a large Northern California integrated health care delivery system between May 2016 and February 2020.

Exposures:

Living in the least resourced quartile of neighborhoods as measured by a census-tract level Neighborhood Deprivation Index score.

Main Outcomes:

Five self-reported social risk factors: financial need, food insecurity, housing barriers, transportation barriers, and functional limitations.

Results:

Nearly half (42.0%) of patients reported at least 1 social risk factor; 22.4% reported 2 or more. Mean correlation coefficient between social risk factors was ρ=0.30. Multivariable logistic models controlling for age, race/ethnicity, sex, count of chronic conditions, and insurance source estimated that living in the least resourced neighborhoods was associated with greater odds of food insecurity (adjusted odds ratio=1.07, 95% confidence interval: 1.00–1.13) and transportation barriers (adjusted odds ratio=1.20, 95% confidence interval: 1.11–1.30), but not financial stress, housing barriers, or functional limitations.

Conclusions and Relevance:

We found that among 5 commonly associated social risk factors, Medicaid patients in a large Northern California health system typically reported only a single factor and that these factors did not correlate strongly with each other. We found only modestly greater social risk reported by patients in the least resourced neighborhoods. These results suggest that individual-level interventions should be targeted to specific needs whereas community-level interventions may be similarly important across diverse neighborhoods.
Predicting High-risk and High-cost Patients for Proactive Intervention
Authors: Gao Jian , Moran Eileen , Higgins Donald S. , Mecher Carter
Published: May 2022

Background:

It is well known that 20% of the patients incur 80% of health care costs and many diseases and complications can be prevented or ameliorated with prompt intervention. One of the well-recognized strategies for cost reduction and better outcomes is to predict or identify high-risk and high-cost (HRHC) patients for proactive intervention.

Objective:

The objective of this study was to develop a predictive model that can be used to identify HRHC patients more accurately for proactive intervention.

Methods:

This is an observational study using fiscal year (FY) 2018 administrative data to predict FY 2019 total cost at the patient level. All 5,676,248 patients who received care in both FYs 2018 and 2019 from the Veterans Health Administration were included in the analyses. The Veterans Health Administration Corporate Data Warehouse was our main data source. With split-sample analyses, 3 sets of patient comorbidities and 5 statistical models were assessed for the highest predictive power.

Results:

The Box-Cox regression using comorbidities designated by the expanded CCSR (Clinical Classifications Software Refined) groups as predictors yielded the highest predictive power. The R
2 reached 0.51 and 0.37 for the transformed and raw scale cost, respectively.

Conclusions:

The predictive model developed in this study exhibits substantially higher predictive power than what has been reported in the literature. The algorithm based on administrative data and a publicly available patient classification system can be readily implemented by other value-based health systems to identify HRHC patients for proactive intervention.
Teams Model of Clinical Nursing Education
Authors: Bednarek Salina , Kenny Katherine (Kathy) , Karshmer Judith F. , Brewer Melanie
Published: May 2022

The need for registered nurses has never been greater. Only through thoughtful academic-practice partnerships will it be possible to align the current and future demands of the workplace with the knowledge, attitudes, and skills that are required. Outdated nursing education models that treat practice partners as “real estate” and try to expose all students, in the same way, to the full array of patient populations, most often in acute care settings, do not serve the profession well. Attending to the heightened expectations for nurses to lead complex, interprofessional teams across an array of settings led to the development of the Teams Model of clinical nursing education. In this model, students match to practice partner facilities where they complete the majority of their clinical hours. They do not rotate through various settings, they do not spend precious practice time reorienting to new facilities, and they are not relegated to the periphery of the interprofessional team when in the student role. They become expected and valuable members of the care delivery team. They focus on developing depth as a nurse rather than breath across patient populations. The Teams Model is predicated on advancing academic-practice partnerships that provide a pipeline for workforce development and prepares the new graduate as a work-ready hire. Ongoing evaluation of the students' development and their knowledge acquisition is linked to practice partner assessments and provides support for this model as an innovative alternative to preparing the next generation of nurses. This partnership program builds confidence through immersion experiences in a consistent, welcoming, and prepared clinical environment, with opportunities to advance the priorities of the practice setting in addition to promoting positive patient outcomes. Benefits include student exposure to nontraditional fields of nursing and areas of critical shortage as well as the ability to pivot quickly as workforce needs shift.
Aortic Stenosis in Elderly Populations
Authors: Bittner Mary , Lyle-Edrosolo Giancarlo
Published: May 2022

Previous Finance Matters columns in Nursing Administrative Quarterly have emphasized the importance of utilizing financial statements to build and promote a successful evidence-based business case. The latest column addressed return on investment substantiation to solidify the business case being presented. Given the current and future state of federal value-based payment models (where health care delivery providers will accept more downside risk for reimbursement), the cost-benefit and cost-effectiveness analyses can be useful measurements. This column defines utilization of cost-benefit analysis and cost-effectiveness analysis when framing the cost, value, and benefit of an innovative health care intervention.
AACN Essentials as the Conceptual Thread of Nursing Education
Authors: Welch Teresa D. , Smith Todd B.
Published: May 2022

In March 2021, the American Association of Colleges of Nursing (AACN) endorsed and published a report that included a reenvisioned framework for nursing education. This report introduced innovative and bold ideas for transforming nursing education and pedagogy from a concept-based model to a competency-based model of nursing education. This new model of nursing education establishes a core set of expectations and standards of competency-based nursing curricula common to all nursing educational programs moving forward. Before this transformative change can occur, nurse educators must first understand what is expected of them before they can adapt current nursing curricula to meet the future needs of our communities and employers. This article will dissect the Re-envisioned Essentials and provide the reader with new terminology introduced by the Essentials document, as well as the core expectations and standards established by the AACN for future nursing education and curricula. With this new understanding, we will introduce and discuss strategies supporting the transitional process of moving from concept-based educational models to competency-based models using a think-backward approach to change that begins with an alignment of program-level learning outcomes with national standards and working backwards to build assessments.
“A Different Normal”: Living With Cancer During the COVID-19 Pandemic in Australia
Authors: Kerr Lucille , Ilangakoon Chanika , Russo Philip
Published: May 2022

Background

The COVID-19 pandemic has seen mass disruptions to healthcare globally. People with cancer are in a vulnerable position, and treatment teams may be anxious in making decisions that try to balance risks associated with malignant disease with those of potential exposure to COVID-19. In addition, palliative care is likely to have experienced significant burdens during the pandemic. As a result of COVID-19 disturbances, people with cancer and their caregivers may have increased stressors and therefore poor outcomes.

Objective

The aim of this study was to explore the experiences of people with cancer and their caregivers during the COVID-19 pandemic, with the aim to inform future oncology practice during infectious crises.

Methods

This qualitative study had 2 stages. Stage 1 involved key informant interviews (n = 16) conducted with healthcare professionals working in cancer care. These were used to inform the stage 2 interview guide for participants who had cancer or were caregivers of someone with cancer (n = 19). Data were thematically analyzed using NVivo.

Results

Five interconnected themes were identified from the interviews: uncertainty and vulnerability, constraints and restrictions, isolation and disconnection, burdens and stressors, and adaptability and resilience. Across themes, complexity and diversity in experience were demonstrated.

Conclusions

The findings suggest cancer concerns outweigh those associated with the COVID-19 pandemic. Many difficulties experienced by healthcare professionals and people with cancer during the COVID-19 pandemic were related to social isolation.

Implications for Practice

Provision of psychosocial and spiritual telehealth services should be increased. It is important during times of crisis to pay attention to those who are most vulnerable.
The Journey: Parental Expectations and Perceptions of Therapy Services for Children With Down Syndrome
Authors: Early Diana , Thompson Mary , Simpkins Susan , Luedtke-Hoffmann Kathleen , Poskey Gail
Published: May 2022

Purpose:

The researchers sought to identify and describe parents' expectations and perceptions of therapy services received by their children with Down syndrome.

Methods:

This study used a qualitative descriptive approach conducted in 2 phases: individual semi-structured parent interviews followed by focus groups. Analysis of interview transcripts served as the basis for development of codes, categories, and themes describing parents' beliefs, values, and opinions of their children's therapy.

Results:

Within the metaphor of The Journey, 3 major themes emerged: Where are we going? Who's driving the car? What I really need for this trip.

Conclusions:

Parents value the principles of family-centered care and want a partnership with therapists in caring for their children. Therapists can help parents of children with Down syndrome navigate their children's therapy services by establishing a relationship of trust and by communicating with respect, understanding, and compassion.
Pediatric Assessments for Preschool Children in Digital Physical Therapy Practice: Results From a Scoping Review
Authors: Trottier Nathalie , Hurtubise Karen , Zischke Cherie , Camden Chantal
Published: May 2022

Purpose:

To examine and map the extent and scope of pediatric physical therapy assessments previously used in the digital context.

Methods:

A 6-step evidence-based scoping methodological framework was used. Articles containing assessments conducted by a physical therapist using technology to assess a child aged 0 to 5 years were included and synthesized using descriptive statistics and thematic analysis.

Results:

Eighteen studies identifying 25 assessments were eligible. Asynchronous observational developmental instruments administered in the child's natural environment to those at risk or presenting with neurodevelopmental conditions were the most common. There is a need for detailed procedures and training for caregivers and clinicians.

Conclusion:

Limited research exists on the use of pediatric physical therapy assessments for young children with musculoskeletal and cardiorespiratory conditions in a digital context. The development of new instruments or modifications of existing ones should be considered and be accompanied by detailed administration protocols and user guides.
Glucose dysregulation and repolarization variability markers are short-term mortality predictors in decompensated heart failure
Authors: Piccirillo Gianfranco , Moscucci Federica , Carnovale Myriam , Corrao Andrea , Di Diego Ilaria , Lospinuso Ilaria , Sciomer Susanna , Rossi Pietro , Magrì Damiano
Published: May 2022

Objective

As recently reported, elevated fasting glucose plasma level constitutes a risk factor for 30-day total mortality in acutely decompensated chronic heart failure (CHF). Aim of this study was to evaluate the 30-day mortality risk in decompensated CHF patients by fasting glucose plasma level and some repolarization ECG markers.

Method

A total of 164 decompensated CHF patients (M/F: 94/71; mean age, 83 ± 10 years) were studied; Tend (Te), QT interval (QT) and 5 min of ECG recordings were obtained, studying mean, SD and normalized index of the abovementioned ECG intervals. These repolarization variables and fasting glucose were analyzed to assess the 30-day mortality risk among these patients.

Results

Thirty-day mortality rate was 21%, deceased subjects showed a significant increase in N terminal-pro-brain natriuretic peptide (P < 0.001), higher sensitivity cardiac troponin, fasting glucose, creatinine clearance, QTSD, QTVN, Te mean, TeSD and TeVN than the survivals. Multivariable regression analysis reported that fasting glucose (hazard ratio, 1.59; 95% confidence interval, 1.09–2.10; P < 0.01), Te mean (hazard ratio, 1.03; 95% confidence interval, 1.01–1.05; P < 0.01) and QTSD (hazard ratio, 1.17; 95% confidence interval, 1.01–1.36; P < 0.05) were significantly related to higher mortality risk, whereas only fasting glucose (hazard ratio, 1.84; 95% confidence interval, 1.12–3.02; P < 0.05) and Te mean (hazard ratio, 1.07; 95% confidence interval, 1.02–1.11; P < 0.01) were associated to cardiovascular mortality.

Conclusion

Data suggest that two simple, inexpensive, noninvasive markers, as fasting glucose and Te, were capable to stratify the short-term total and cardiovascular mortality risk in acutely decompensated CHF.
Sessilibacter corallicola gen. nov., sp. nov., a sessile bacterium isolated from coral Porites lutea
Authors: Liu Jianfeng , Li Jin , Luo Jixin , Li Yuanjin , Yang Zian , Huang Chengli , Sun Feilong , Wang Guanghua
Published: May 2022

A Gram-stain-negative, non-spore-forming, motile, aerobic bacterium (strain C21T) was isolated from coral and identified using polyphasic identification approach. Global alignment of 16S rRNA gene sequences indicated that strain C21T shares 95.7 % sequence identity to its closest neighbour,

Marinibactrum halimedae

NBRC 110095T, followed by other type strains with identities of lower than 95 %. The average nucleotide identity and average amino acid identity values between strain C21T and

M. halimedae

NBRC 110095T were 69.6 and 64.8 %, respectively, indicating that strain C21T may represent a new species in a new genus. Phylogenetic analysis based on 16S rRNA gene and phylogenomic results indicated that strain C21T forms a distinct branch in the family

Cellvibrionaceae

. Cellular fatty acids and polar lipids could also readily distinguish strain C21T from closely related type strains. Therefore, strain C21T is suggested to represent a new species in a new genus, for which the name Sessilibacter corallicola gen. nov., sp. nov. is proposed. The type strain is C21T (=MCCC 1K03260T=KCTC 62317T).
ICTV Virus Taxonomy Profile: Polymycoviridae 2022
Authors: Kotta-Loizou Ioly , Coutts Robert H. A. ,   ICTV Report Consortium
Published: May 2022

Members of the family Polymycoviridae are small viruses with multi-segmented and non-conventionally encapsidated double-stranded (ds) RNA genomes. Typically, polymycoviruses have four genomic segments, although some have up to eight. The genus Polymycovirus includes several species whose members infect fungi (ascomycetes and basidiomycetes), and oomycetes, altering host morphology, sporulation, growth and virulence. This is a summary of the International Committee on Taxonomy of Viruses (ICTV) Report on the family Polymycoviridae, which is available at ictv.global/report/polymycoviridae.
Incorporating Genetics Services into Adult Kidney Disease Care
Authors: Bogyo Kelsie , Vena Natalie , May Halie , Rasouly Hila Milo , Marasa Maddalena , Sanna-Cherchi Simone , Kiryluk Krzysztof , Nestor Jordan , Gharavi Ali
Published: May 2022

Studies have shown that 1 in 10 adults with chronic kidney disease has a genetic component to their disease. However, genetic services in adult nephrology are limited. An adult Kidney Genetics Clinic was established within the nephrology division at a large urban academic medical center to increase access to genetic services and testing in adults with kidney disease. Between June 2019 through December 2021, a total of 363 patients were referred to the adult Kidney Genetics Clinic. Of those who completed genetic testing, a positive, diagnostic finding was identified in 27.14% and a candidate diagnostic finding was identified in 6.67% of patients, while a non-diagnostic positive finding was identified in an additional 8.57% of patients, resulting in an overall yield of 42.38% for clinically relevant genetic findings in tested patients. A genetic diagnosis had implications for medical management, family member testing, and eligibility for clinical trials. With the utilization of telemedicine, genetic services reached a diverse geographic and patient population. Genetic education efforts were integral to the clinic’s success, as they increased visibility and helped providers identify appropriate referrals. Ongoing access to genomic services will remain a fundamental component of patient care in adults with kidney disease.
HMGB1 correlates with severity and death of COVID-19 patients
Authors: Vicentino Amanda Roberta Revoredo , Fraga-Junior Vanderlei da Silva , Palazzo Matheus , Tasmo Natalia Recardo Amorim , Rodrigues Danielle A. S. , Barroso Shana Priscila Coutinho , Ferreira Samila Natiane , Borges Anna Cristina Neves , Allonso Diego , Fantappié Marcelo Rosado , Scharfstein Julio , Oliveira Ana Carolina , Vianna-Jorge Rosane , Vale André Macedo , Coutinho-Silva Robson , Savio Luiz Eduardo Baggio , Canetti Claudio , Benjamim Claudia Farias
Published: May 2022

SARS-CoV-2, the causative agent of the ongoing COVID-19, has spread worldwide since it was first identified in November 2019 in Wuhan. Since then, it was already demonstrated an exuberant inflammation, cytokine storm, endothelium dysfunction, platelets hyperactivation and aggregation, following T cell exhaustion leading to severe multi-organ damage and death of COVID-19 patients. Here, we sought to identify molecular biomarkers of disease severity in a Brazilian cohort of COVID-19 patients by measuring the serum levels of endogenous danger signals. Our data revealed that ICU patients that are critically ill, at the early hyperinflammatory phase of COVID-19 (around 12-25 days after hospital admission) display higher serum levels of the classical alarmin HMGB1. Serum levels of HMGB1 were positively correlated with cys-leukotrienes, D-dimer, AST, and ALT. Notably, we verified that HMGB1 levels above 125.4 ng/mL is the cut off that distinguishes the patients that are at higher risk of death. Serum levels of extracellular ATP, PGE2, LTB4, cys-LTs, and tissue factor were also elevated in the serum of ICU patients. In conclusion, we propose that serum levels of HMGB1 serve as prognostic biomarker of risk of death in patients suffering from severe COVID-19.
Research Letter: Incidence of SARS-CoV-2 infection among unvaccinated US adults during the Omicron wave
Authors: Alejo Jennifer L. , Chiang Teresa PY , Mitchell Jonathan , Abedon Aura T. , Jefferis Alexa A. , Werbel William , Massie Allan B. , Makary Martin A. , Segev Dorry L.
Published: May 2022

As of 4/20/2022, approximately 23% of the eligible US population was unvaccinated. We studied COVID-19 infections during the Omicron (B.1.1.529) wave in unvaccinated US adults, stratified by pre-Omicron antibody levels. Anti-spike serologic testing was performed prior to the Omicron wave in the United States (9/23/21-11/5/21) and participants were surveilled to determine incident COVID-19. Only 12% of those who entered the wave with antibodies reported a test-confirmed COVID-19 infection, compared to 35% of those without antibodies prior to the Omicron wave. Effectiveness of these anti-RBD antibodies in this unvaccinated population was 67%. Among people with antibodies, titer did not appear to be associated with risk of test-confirmed Omicron infection.
Clinical assessment and voxel-based morphometry study of untreated Adult Attention deficit hyperkinetic disorders patients
Authors: Morsy Sara , Ghozy Sherief , Morsy Ahmed , Dmytriw Adam A. , Kallmas Kevin , Naveed Sadiq
Published: May 2022

Purpose

Adult ADHD is one of the most undiagnosed diseases mainly because of the misperception that ADHD is a childhood disease. In this study, we assess the characteristic features of adult ADHD using clinical assessment and structural Magnetic resonance imaging (sMRI)

Methods

We obtained structural MRI data from the UCLA Consortium for Neuropsychiatric Phenomics for 21 untreated adult ADHD patients and 21 age and gender propensity-matched control patients. For clinical assessment, we compared the scores of Barrat impulsivity score, Dickman impulsivity inventory II, and Eysenck’s Impulsivity Inventory. We then compared grey matter volume (GMV) between ADHD and control patients using a two-sample t-test. We also assessed the correlation between different clinical assessments and GMV.

Results

Based on our results, adult ADHD showed significantly higher impulsivity scores, however, no significant difference in functional impulsivity scores or empathy summary scores. For sMRI, there was a significant decrease of GMV of the left cuneus in female ADHD patients. For clinical assessment scales, only the motor impulsiveness subdomain showed a significant positive correlation with the GMV of the left precuneus.

Conclusions

In this study, we assessed the characteristic sMRI features and clinical assessment scores for untreated adult ADHD. Our results show that a study with a bigger sample size can identify diagnostic features for adult ADHD.