bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Pressure Mapping to Compare Efficacy of Patient Bed Positioning Devices in Participants Who Are Able-Bodied and Those with Tetraplegia
Authors: Earnest Katherine , Zoellick Samantha 
Published: January 2023

ABSTRACT

OBJECTIVE
To compare the effectiveness of four positioning aids in able-bodied participants and those with tetraplegia, to determine (1) if devices differed with regard to pressure reduction and (2) if results differed for able-bodied participants versus those with tetraplegia.

METHODS
Forty volunteers (20 able-bodied and 20 with tetraplegia) participated. The variable of interest was reduction in mean pressure in the sacral region, measured in mm Hg. Testing was conducted in a hospital bed using a tissue-interface pressure-mapping system. Four bed positioning devices were examined in use at both 0° and 30° head-of-bed elevations: standard hospital pillows, fluidized positioners, foam wedge positioners, and polystyrene bead wedge positioners.

RESULTS
No between-group differences were found for participant type (able-bodied vs tetraplegic). However, the positioning devices tested did differ significantly in pressure reduction. Foam wedge positioners, polystyrene bead wedge positioners, and fluidized positioners all resulted in greater reduction in pressure over an area inclusive of the sacrum, ischia, and buttocks when compared with standard hospital pillows, with foam wedges performing best.

CONCLUSIONS
Better pressure reduction over the sacrum, buttocks, and ischia can be achieved when using devices specifically designed for patient positioning in bed as opposed to using standard hospital pillows. Data were not significantly different between able-bodied participants and participants with tetraplegia. Thus, pressure-mapping data examining the efficacy of bed-positioning devices using convenience sampling of able-bodied individuals can likely be generalized to apply to a population with tetraplegia as well.
New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars
Authors: Soriano Kylen K.J. , Sabatini Coleen S. , Brar Ravinder K. , Jagodzinski Jason E. , Livingston Kristin S. 
Published: January 2023

Background:The coronavirus disease 2019 (COVID-19) pandemic drastically altered children’s activity patterns. Our goal was to investigate how COVID-19 affected demographics, injury characteristics, treatment patterns, follow-up, and outcomes in pediatric supracondylar humerus (SCH) fractures.Methods:This was an Institutional Review Board–approved retrospective analysis of patients undergoing surgery for a SCH fracture from May to November 2019 (pre-COVID-19) and from May to November 2020 (during COVID-19) at 2 tertiary children’s hospitals. Demographic information, injury characteristics, hospital course, and follow-up data were collected and compared.Results:SCH fractures decreased by >50% from 2019 (149) to 2020 (72). Children in the 2020 cohort were younger (mean 5.2 y old) compared with 2019 (6.0 y old) (P=0.019). Mechanism of injury was significantly different in 2020 (P<0.001), as the proportion of trampoline and furniture fractures increased from 8% and 17% to 15% and 33%, respectively. The proportion of playground and monkey bar fractures decreased from 20% and 17% to 3% and 4%, respectively. Distribution of Gartland type and neurovascular injury rates were similar in 2019 and 2020 (P=0.411 and 0.538). Time from emergency department admission to the operating room and duration of hospital admission were both unchanged from 2019 to 2020 (P=0.864 and 0.363). The duration of postoperative follow-up in 2019 was 94.5 days compared with 72.8 days in 2020 (P=0.122), as more pandemic patients were lost to follow up (22.5% vs. 35.2%,P=0.049).Conclusions:The demographics, mechanism of injury, and follow-up practices of pediatric SCH fractures changed significantly during the pandemic, likely because of school closures and lock-downs changing activity patterns. Different mechanisms of injury affected younger patients and reflected the new ways children played. Trampoline-related and furniture-related injuries overtook the classic playground falls as primary mechanism of injury. Despite the need for COVID-19 testing, there was no delay in time to the operating room. Hospitalization duration did not change, yet postoperative follow-up was shorter, and more patients were lost to follow up. Despite these stressors, outcomes remained excellent in most children.Level of Evidence:Level III—Retrospective comparative study.
Overt and Occult Hypoxemia in Patients Hospitalized With COVID-19
Authors: Gadrey Shrirang M. , Mohanty Piyus , Haughey Sean P. , Jacobsen Beck A. , Dubester Kira J. , Webb Katherine M. , Kowalski Rebecca L. , Dreicer Jessica J. , Andris Robert T. , Clark Matthew T. , Moore Christopher C. , Holder Andre , Kamaleswaran Rishi , Ratcliffe Sarah J. , Moorman J. Randall 
Published: January 2023

IMPORTANCE:
Progressive hypoxemia is the predominant mode of deterioration in COVID-19. Among hypoxemia measures, the ratio of the Pao
2 to the Fio
2 (P/F ratio) has optimal construct validity but poor availability because it requires arterial blood sampling. Pulse oximetry reports oxygenation continuously (ratio of the Spo
2 to the Fio
2 [S/F ratio]), but it is affected by skin color and occult hypoxemia can occur in Black patients. Oxygen dissociation curves allow noninvasive estimation of P/F ratios (ePFRs) but remain unproven.

OBJECTIVES:
Measure overt and occult hypoxemia using ePFR.

DESIGN, SETTING, AND PARTICIPANTS:
We retrospectively studied COVID-19 hospital encounters (n = 5,319) at two academic centers (University of Virginia [UVA] and Emory University).

MAIN OUTCOMES AND MEASURES:
We measured primary outcomes (death or ICU transfer within 24 hr), ePFR, conventional hypoxemia measures, baseline predictors (age, sex, race, comorbidity), and acute predictors (National Early Warning Score [NEWS] and Sequential Organ Failure Assessment [SOFA]). We updated predictors every 15 minutes. We assessed predictive validity using adjusted odds ratios (AORs) and area under the receiver operating characteristic curves (AUROCs). We quantified disparities (Black vs non-Black) in empirical cumulative distributions using the Kolmogorov-Smirnov (K-S) two-sample test.

RESULTS:
Overt hypoxemia (low ePFR) predicted bad outcomes (AOR for a 100-point ePFR drop: 2.7 [UVA]; 1.7 [Emory]; p < 0.01) with better discrimination (AUROC: 0.76 [UVA]; 0.71 [Emory]) than NEWS (0.70 [both sites]) or SOFA (0.68 [UVA]; 0.65 [Emory]) and similar to S/F ratio (0.76 [UVA]; 0.70 [Emory]). We found racial differences consistent with occult hypoxemia. Black patients had better apparent oxygenation (K-S distance: 0.17 [both sites]; p < 0.01) but, for comparable ePFRs, worse outcomes than other patients (AOR: 2.2 [UVA]; 1.2 [Emory]; p < 0.01).

CONCLUSIONS AND RELEVANCE:
The ePFR was a valid measure of overt hypoxemia. In COVID-19, it may outperform multi-organ dysfunction models. By accounting for biased oximetry as well as clinicians’ real-time responses to it (supplemental oxygen adjustment), ePFRs may reveal racial disparities attributable to occult hypoxemia.
Association Between Unmet Nonmedication Needs After Hospital Discharge and Readmission or Death Among Acute Respiratory Failure Survivors: A Multicenter Prospective Cohort Study*
Authors: Bose Somnath , Groat Danielle , Dinglas Victor D. , Akhlaghi Narjes , Banner-Goodspeed Valerie , Beesley Sarah J. , Greene Tom , Hopkins Ramona O. , Mir-Kasimov Mustafa , Sevin Carla M. , Turnbull Alison E. , Jackson James C. , Needham Dale M. , Brown Samuel M. ,   for the Addressing Post-Intensive Care Syndrome (APICS-01) Study Team
Published: January 2023

OBJECTIVES:
To characterize early unmet nonmedication discharge needs (UDNs), classified as durable medical equipment (DME), home health services (HHS), and follow-up medical appointments (FUAs) and explore their association with 90-day readmission and mortality among survivors of acute respiratory failure (ARF) who were discharged home.

DESIGN:
Prospective multicenter cohort study.

SETTING:
Six academic medical centers across United States.

PARTICIPANTS:
Adult survivors of ARF who required an ICU stay and were discharged home from hospital.

INTERVENTIONS:
None. Exposure of interest was the proportion of UDN for the following categories: DME, HHS, and FUA ascertained within 7–28 days after hospital discharge.

MEASUREMENTS AND MAIN RESULTS:
Two hundred eligible patients were recruited between January 2019 and August 2020. One-hundred ninety-five patients were included in the analytic cohort: 118 were prescribed DME, 134 were prescribed HHS, and 189 needed at least one FUA according to discharge plans. 98.4% (192/195) had at least one identified nonmedication need at hospital discharge. Median (interquartile range) proportion of unmet needs across three categories were 0 (0–15%) for DME, 0 (0–50%) for HHS, and 0 (0–25%) for FUA, and overall was 0 (0–20%). Fifty-six patients (29%) had 90-day death or readmission. After adjusting for prespecified covariates, having greater than the median level of unmet needs was not associated with an increased risk of readmission or death within 90 days of discharge (risk ratio, 0.89; 0.51–1.57; p = 0.690). Age, hospital length of stay, Acute Physiology and Chronic Health Evaluation II severity of illness score, and Multidimensional Scale Perceived Social Support score were associated with UDN.

CONCLUSIONS:
UDN were common among survivors of ARF but not significantly associated a composite outcome of 90-day readmission or death. Our results highlight the substantial magnitude of UDN and identifies areas especially vulnerable to lapses in healthcare coordination.
Orbital Involvement in Multiple Myeloma
Authors: Shoji Marissa K. , Chen Ying , Topilow Nicole J. , Abou Khzam Rayan , Dubovy Sander R. , Johnson Thomas E. 
Published: January 2023

Purpose:
To characterize clinical and radiographic features, management, and outcomes of patients with orbital involvement of multiple myeloma (MM).

Methods:
A retrospective chart review identified patients with MM and orbital involvement confirmed by histopathology at a single institution between 1995 and 2021. A comprehensive literature review was performed via PubMed to identify all previously reported cases of orbital MM.

Results:
Retrospective review identified 7 patients (43% male, mean age 68.7 years). Presenting symptoms included proptosis and diplopia. Orbital lesions were primarily located laterally (42.8%) with associated extraocular muscle (57.1%) or lacrimal gland (42.9%) involvement. Five patients (71.4%) had a previous diagnosis of systemic MM. Six patients received chemoradiation (85.7%). All patients had improvement of orbital disease with 2 patients deceased due to disease at follow-up (mean 8.9 months). Literature review identified 111 cases (46.8% male, mean age 58.6 years). 48.6% presented with orbital disease as the first manifestation of systemic MM. Lesions were most commonly located superolaterally (20.2%) with extraocular muscle infiltration (25.2%), lacrimal gland involvement (7.2%), and orbital bony destruction (39.6%). Treatments included chemoradiation, chemotherapy, or radiation alone. Approximately half (51.4%) of patients experienced improvement in orbital disease following treatment, and 48.6% were deceased at follow-up (mean 20.1 months).

Conclusions:
This study provides a new retrospective study and updated comprehensive literature review regarding orbital MM. Given its poor prognosis, characterization of orbital MM is essential for early diagnosis. Orbital MM is often unilateral, located superolaterally, and may represent the first manifestation of systemic disease. Treatment includes chemotherapy and radiation, which may improve orbital disease; however, the overall prognosis remains poor.
An audit of hysterectomy in a teaching hospital in India: Story of a decade
Authors: Pandey Deeksha , Hebbar Shripad , Reddy Inukollu Pranadeep , Lobo Viwal Venisa , Bansal Suvrati , Solipuram Divya , Suhas Nagashree , Habibullah Sarah Arsalan , Popat Rishi Jitesh , Agrawal Akshita , MG Sayyad 
Published: January 2023

Background:
The appropriateness of hysterectomy has gained an interest in scrutiny and debate. Periodic audits of the prevailing clinical practices are imperative for insight, and to formulate recommendations and guidelines. We report the temporal trends of hysterectomies, over the last 10 years in a teaching hospital.

Methods:
Present study involved all patients who underwent hysterectomy at a teaching hospital, from January 1, 2012 to December 31, 2021. Patients were identified by medical record tracking using International Classification of Diseases-9 codes. Case records were reviewed for demography, indication for surgery, approach, complications, hospital stay, and histopathological correlation.

Results:
Over the years the absolute number of hysterectomies in our hospital has ranged from 414 to 597 (mean 476), barring the coronavirus 19 pandemic year. The proportion of hysterectomy among all gynaecological admissions has ranged from 6% to 9%, except in 2020 where this proportion dropped down to 4%. The indications, age distribution, surgical approach, and complications have remained almost same.

Conclusion:
We report a static trend in hysterectomy over the past 10 years. This audit provides an insight for the need of shifting the abdominal to vaginal route, in carefully chosen patients. This will be beneficial for the patients, and for the trainees, where they can learn under supervision. Availability and patient education about the nonsurgical management options for benign gynecological conditions, as well as awareness about sequelae of hysterectomy, will bring down the rate in countries such as India.
Update on classification of oncocytic neoplasms of the kidney
Authors: Oszwald André , Wasinger Gabriel , Zisser Lucia , Compérat Eva 
Published: January 2023

Purpose of review
This review provides a summary of recent developments in classification of renal oncocytic neoplasms that were incorporated in the fifth edition WHO classification of renal tumors, released in 2022.

Recent findings
Besides the distinct entities of renal oncocytoma and chromophobe renal cell carcinoma, the WHO now acknowledges a heterogeneous group of oncocytic tumors of the kidney that can be reported as ‘oncocytic renal neoplasms of low malignant potential’. Case series by multiple institutions have revealed recurrent patterns of morphological features, protein marker expression, and genetic alterations within these neoplasms that may permit further subclassification in the future.

Summary
The new classification system provides pathologists with the opportunity to simplify the diagnostic workup and reporting of morphologically equivocal oncocytic neoplasms.
Defining Pediatric Chronic Critical Illness: A Scoping Review*
Authors: Zorko David J. , McNally James Dayre , Rochwerg Bram , Pinto Neethi , O’Hearn Katie , Almazyad Mohammed A. , Ames Stefanie G. , Brooke Peter , Cayouette Florence , Chow Cristelle , Junior José Colleti , Francoeur Conall , Heneghan Julia A. , Kazzaz Yasser M. , Killien Elizabeth Y. , Jayawarden Supun Kotteduwa , Lasso Ruben , Lee Laurie A. , O’Mahony Aoife , Perry Mallory A. , Rodríguez-Rubio Miguel , Sandarage Ryan , Smith Hazel A. , Welten Alexandra , Yee Belinda , Choong Karen ,   on behalf of the International Pediatric Chronic Critical Illness Collaborative
Published: January 2023

OBJECTIVES:
Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions.

DATA SOURCES:
Four electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021.

STUDY SELECTION:
We included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening.

DATA EXTRACTION:
We extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed.

DATA SYNTHESIS:
Sixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18).

CONCLUSIONS:
Pediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.
The Impact of Restrictive Transfusion Practices on Hemodynamically Stable Critically Ill Children Without Heart Disease: A Secondary Analysis of the Age of Blood in Children in the PICU Trial*
Authors: Steffen Katherine M. , Tucci Marisa , Doctor Allan , Reeder Ron , Caro J. Jaime , Muszynski Jennifer A. , Spinella Philip C. ,   Pediatric Critical Care Blood Research Network (BloodNet) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: January 2023

OBJECTIVES:
Guidelines recommend against RBC transfusion in hemodynamically stable (HDS) children without cardiac disease, if hemoglobin is greater than or equal to 7 g/dL. We sought to assess the clinical and economic impact of compliance with RBC transfusion guidelines.

DESIGN:
A nonprespecified secondary analysis of noncardiac, HDS patients in the randomized trial Age of Blood in Children (NCT01977547) in PICUs. Costs analyzed included ICU stay and physician fees. Stabilized inverse propensity for treatment weighting was used to create a cohort balanced with respect to potential confounding variables. Weighted regression models were fit to evaluate outcomes based on guideline compliance.

SETTING:
Fifty international tertiary care centers.

PATIENTS:
Critically ill children 3 days to 16 years old transfused RBCs at less than or equal to 7 days of ICU admission. Six-hundred eighty-seven subjects who met eligibility criteria were included in the analysis.

INTERVENTIONS:
Initial RBC transfusions administered when hemoglobin was less than 7 g/dL were considered “compliant” or “non-compliant” if hemoglobin was greater than or equal to 7 g/dL.

MEASUREMENTS AND MAIN RESULTS:
Frequency of new or progressive multiple organ system dysfunction (NPMODS), ICU survival, and associated costs. The hypothesis was formulated after data collection but exposure groups were masked until completion of planned analyses. Forty-nine percent of patients (338/687) received a noncompliant initial transfusion. Weighted cohorts were balanced with respect to confounding variables (absolute standardized differences < 0.1). No differences were noted in NPMODS frequency (relative risk, 0.86; 95% CI, 0.61–1.22; p = 0.4). Patients receiving compliant transfusions had more ICU-free days (mean difference, 1.73; 95% CI, 0.57–2.88; p = 0.003). Compliance reduced mean costs in ICU by $38,845 U.S. dollars per patient (95% CI, $65,048–$12,641).

CONCLUSIONS:
Deferring transfusion until hemoglobin is less than 7 g/dL is not associated with increased organ dysfunction in this population but is independently associated with increased likelihood of live ICU discharge and lower ICU costs.
Leveraging Clinical Informatics and Data Science to Improve Care and Facilitate Research in Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference
Authors: Sanchez-Pinto L. Nelson , Sauthier Michaël , Rajapreyar Prakadeshwari , Brunow de Carvalho Werther , Jouvet Philippe , Newth Christopher ,   on behalf of the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: January 2023

OBJECTIVES:The use of electronic algorithms, clinical decision support systems, and other clinical informatics interventions is increasing in critical care. Pediatric acute respiratory distress syndrome (PARDS) is a complex, dynamic condition associated with large amounts of clinical data and frequent decisions at the bedside. Novel data-driven technologies that can help screen, prompt, and support clinician decision-making could have a significant impact on patient outcomes. We sought to identify and summarize relevant evidence related to clinical informatics interventions in both PARDS and adult respiratory distress syndrome (ARDS), for the second Pediatric Acute Lung Injury Consensus Conference.DATA SOURCES:MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost).STUDY SELECTION:We included studies of pediatric or adult critically ill patients with or at risk of ARDS that examined automated screening tools, electronic algorithms, or clinical decision support systems.DATA EXTRACTION:Title/abstract review, full text review, and data extraction using a standardized data extraction form.DATA SYNTHESIS:The Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-six studies were identified for full text extraction to address the Patient/Intervention/Comparator/Outcome questions, and 14 were used for the recommendations/statements. Two clinical recommendations were generated, related to the use of electronic screening tools and automated monitoring of compliance with best practice guidelines. Two research statements were generated, related to the development of multicenter data collaborations and the design of generalizable algorithms and electronic tools. One policy statement was generated, related to the provision of material and human resources by healthcare organizations to empower clinicians to develop clinical informatics interventions to improve the care of patients with PARDS.CONCLUSIONS:We present two clinical recommendations and three statements (two research one policy) for the use of electronic algorithms and clinical informatics tools for patients with PARDS based on a systematic review of the literature and expert consensus.