bluuebunny/crossref_metadata_2025_split huggingface dataset:
HeartWatch: Implementing a Pediatric Heart Center Program to Prevent Cardiac Arrests Outside the ICU
Authors: Birely Alexandra , Avula Sravani , Butts Ryan J. , Wolovits Joshua S. , Lemler Matthew S. , Hoffman Olivia L. 
Published: February 2023

Introduction:
Pediatric patients with cardiovascular disease are at increased risk of cardiopulmonary arrest. Despite utilization of Cardiac Pediatric Early Warning Scores to identify patients at risk of decompensation, our institution had a twofold increase in cardiac arrests (CAs) in the acute care cardiology unit (ACCU) over 2 years. Through a quality improvement initiative, we developed a watcher program, HeartWatch, to reduce the CA arrest rate in the ACCU by 50% over the first year of implementation.

Methods:
HeartWatch aims to identify patients not adequately captured by Cardiac Pediatric Early Warning Scores who are at high risk for sudden decompensation. Inclusion criteria were developed and evaluated during pilot and implemented phases (April 2020–April 2021) and then monitored in a sustained phase through June 2022. Our primary outcome was the reduction in the out-of-ICU CA rate.

Results:
During the 13 months, we enrolled 169 patients, and the CA rate decreased from 0.7 to 0.33 per 1,000 patient days, a 53% reduction. The CA rate further decreased to 0.28 events per 1,000 patient days, a 60% reduction, by June 2022. The most common indications for HeartWatch inclusion were high-risk single-ventricle patients (31%) and patients with diminished ventricular function (20%).

Conclusions:
Implementation of HeartWatch was associated with a meaningful reduction in CA in the ACCU. Creating shared mental models for high-risk patients is essential for patient safety. Future work will optimize local processes that focus on the sustainability of our gains. We will also evaluate opportunities to adapt and implement a similar framework in other institutions to assess reproducibility.
Reducing Opioid Prescriptions after Common Outpatient Pediatric Urologic Surgeries: A Quality Improvement Assessment
Authors: Stout Megan , Alpert Seth , Kersey Kelly , Ching Christina , Dajusta Daniel , Fuchs Molly , McLeod Daryl , Jayanthi Rama 
Published: February 2023

Introduction:
Pediatric patients undergoing outpatient surgeries often receive prescriptions for postoperative pain, including opioid medications. As a result, the American Academy of Pediatrics formally challenged all pediatric surgeons to decrease opioid prescribing for common specialty-specific outpatient procedures at discharge. To meet this challenge, we designed a quality improvement project to decrease the average number of opioid doses administered to pediatric patients undergoing 3 common outpatient urologic surgeries: circumcision, orchiopexy, and inguinal hernia repair (IHR).

Methods:
We formally challenged providers at our institution to reduce opioid doses per prescription and administration to patients overall. We performed a retrospective chart review at our single pediatric institution to establish baseline opioid prescribing values from July 2017 to March 2018. We aimed to reduce this value by 50% in 6 months and sustain this decrease throughout the project duration.

Results:
We performed 1,518 orchiopexies, 1,505 circumcisions, and 531 IHRs. The percent change in the average number of opioid doses prescribed per patient from baseline values assessed to 2021 was statistically significant for orchiopexies (P < 0.0001), IHRs (P < 0.0001), and circumcisions (P < 0.0001). In addition, the change in the percentage of patients prescribed opioids from baseline was statistically significant for all 3 procedures (P < 0.001).

Conclusions:
This project demonstrated that through an organized quality improvement initiative, the average number of opioid medications prescribed and the total percentage of patients prescribed opioids following common outpatient pediatric urologic procedures can be decreased by at least 50% and sustained through project duration.
Interprofessional Immersive Virtual Reality Training on Sepsis Recognition
Authors: Zackoff Matthew W. , Cruse Bradley , Sahay Rashmi D. , Zhang Bin , Sosa Tina , Schwartz Jerome , Depinet Holly 
Published: February 2023

Introduction:
The implementation of evidence-based care relies on timely recognition of sepsis. Virtual reality (VR) represents a new simulation modality that can evaluate pediatric sepsis situation awareness.

Methods:
We evaluated situation awareness through a multiuser immersive VR experience (Fig. 1). A physician/APRN and nurse donned VR headsets to assess and provide initial management for a pediatric patient with sepsis during a team-based clinical simulation scenario. Participants were paused at 3 time points and asked to independently complete open-ended questions, including “what is the most likely cause for the patient’s clinical condition?” We compared experienced providers (nurses with ≥5 years’ experience and critical care or emergency medicine APRNs, fellows, or attendings) and novice providers (nurses with <5 years’ experience and pediatric residents) recognition of sepsis. Odds ratios were calculated for sepsis recognition with group differences assessed via the T test.

Results:
From January to July of 2021, 144 participants (72 physicians/APRNs and 72 nurses) participated in the experience (Table 1). When assessing for recognition of sepsis at the 2-minute time point, 81% of experienced nurses (N = 48) and 50% of novices (N = 24) recognized sepsis for, on odds ratio (OR) of 4.37 (1.28–14.96), P = 0.019. For physicians/APRNs, 92% of experienced (N = 37) compared to 71% of novices (N = 35) recognized sepsis [OR, 4.61 (0.87–14.97), P = 0.078]. When combined, 85.9% of experienced clinicians (N = 85) and 62.7% of novices (N = 59) recognized sepsis [OR, 3.70 (1.15–9.07), P = 0.004].

Conclusions:
These data provide validity evidence for use of this immersive VR experience for assessment and training; potentially addressing a remaining barrier to improving pediatric sepsis outcomes.
SARS-CoV-2 Spike-specific IFN-γ T-cell Response After COVID-19 Vaccination in Patients With Chronic Kidney Disease, on Dialysis, or Living With a Kidney Transplant
Authors: Imhof Céline , Messchendorp A. Lianne , van der Heiden Marieke , Baan Carla C. , van der Molen Renate G. , Remmerswaal Ester B. M. , de Vries Rory D. , Diavatopoulos Dimitri A. , Boerma Annemarie , Bakker Femke J. , Oosterhout Emily , Bemelman Frederike J. , Hilbrands Luuk B. , Reinders Marlies E. J. , Gansevoort Ron T. , Sanders Jan-Stephan , van Baarle Debbie ,   on behalf of RECOVAC Consortium
Published: February 2023

Background.
Studies have shown that coronavirus disease 2019 (COVID-19) vaccination is associated with a lower humoral response in vulnerable kidney patients. Here, we investigated the T-cell response following COVID-19 vaccination in kidney patients compared with controls.

Methods.
Patients with chronic kidney disease (CKD) stage G4/5 [estimated glomerular filtration rate <30 mL/min/1.73 m2], on dialysis, or living with a kidney transplant and controls received 2 doses of the mRNA-1273 COVID-19 vaccine. Peripheral blood mononuclear cells were isolated at baseline and 28 d after the second vaccination. In 398 participants (50% of entire cohort; controls n = 95, CKD G4/5 n = 81, dialysis n = 78, kidney transplant recipients [KTRs] n = 144)‚ SARS-CoV-2-specific T cells were measured using an IFN-γ enzyme-linked immune absorbent spot assay.

Results.
A significantly lower SARS-CoV-2-specific T-cell response was observed after vaccination of patients on dialysis (54.5%) and KTRs (42.6%) in contrast to CDK G4/5 (70%) compared with controls (76%). The use of calcineurin inhibitors was associated with a low T-cell response in KTRs. In a subset of 20 KTRs, we observed waning of the cellular response 6 mo after the second vaccination, which was boosted to some extent after a third vaccination, although T-cell levels remained low.

Conclusion.
Our data suggest that vaccination is less effective in these patient groups, with humoral nonresponders also failing to mount an adequate cellular response, even after the third vaccination. Given the important role of T cells in protection against disease and cross-reactivity to SARS-CoV-2 variants, alternative vaccination strategies are urgently needed in these high-risk patient groups.
The association between a genetic variant in the SULF2 gene, metabolic parameters and vascular disease in patients at high cardiovascular risk
Authors: Heidemann Britt E , Visseren Frank LJ , van Setten Jessica , Marais A David , Koopal Charlotte ,   on behalf of the UCC-SMART Study Group
Published: February 2023

Background
Clearance of triglyceride-rich lipoproteins (TRLs) is mediated by several receptors, including heparan sulfate proteoglycans (HSPGs). Sulfate glucosamine-6-O-endosulfatase-2 is a gene related to the regulation of HSPG. A variant in this gene, rs2281279, has been shown to be associated with triglycerides and insulin resistance.

Objective
To determine the relationship between rs2281279, metabolic parameters and vascular events, and type 2 diabetes mellitus (T2DM) in patients at high cardiovascular risk and whether APOE genotype modifies this relationship.

Methods
Patients (n = 4386) at high cardiovascular risk from the Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease study were stratified according to their imputed rs2281279 genotype: AA (n = 2438), AG (n = 1642) and GG (n = 306). Effects of rs2281279 on metabolic parameters, vascular events and T2DM were analyzed with linear regression and Cox models.

Results
There was no relationship between imputed rs2281279 genotype and triglycerides, non-high-density lipoprotein (HDL)-cholesterol, insulin and quantitative insulin sensitivity check index. During a median follow-up of 11.8 (IQR, 9.3–15.5) years, 1026 cardiovascular events and 320 limb events occurred. The presence of the G allele in rs2281279 did not affect the risk of vascular events [hazard ratio (HR), 1.03; 95% confidence interval (CI), 0.94–1.14] or limb events (HR, 0.92; 95% CI, 0.77–1.10). The presence of the G allele in rs2281279 did not affect the risk of T2DM (HR, 1.09; 95% CI, 0.94–1.27). The presence of the minor G allele of rs2281279 was associated with a beneficial risk profile in ε2ε2 patients, but not in ε3ε3 patients.

Conclusions
Imputed rs2281279 genotype is not associated with metabolic parameters and does not increase the risk of vascular events or T2DM in patients at high risk for cardiovascular disease.
Determinants of COVID-19 vaccine uptake in the Netherlands: an ecological analysis
Authors: Labuschagne Lisanne J.E. , Smorenburg Naomi , van de Kassteele Jan , Bom Ben , de Weerdt Anne , de Melker Hester E. , Hahné Susan J.M. 
Published: February 2023

AbstractBackgroundWhile overall COVID-19 vaccine uptake is high in the Netherlands, it lags behind in certain subpopulations.AimWe aimed to identify determinants associated with COVID-19 vaccine uptake at neighbourhood level to inform the strategy to improve uptake and guide research into barriers for vaccination. We focused on those aged 50 years and older, since they are at highest risk of severe disease.MethodsWe performed an ecological study using national vaccination register and socio-demographic data at neighbourhood level. Using univariate and multivariable generalized additive models we examined the (potentially non-linear) effect of each determinant on uptake.ResultsIn those over 50 years of age, a higher proportion of individuals with a non-Western migration background and higher voting proportions for right-wing Christian and conservative political parties were at neighbourhood level univariately associated with lower COVID-19 vaccine uptake. In contrast, higher socioeconomic status and higher voting proportions for right-wing liberal, progressive liberal and Christian middle political parties were associated with higher uptake. Multivariable results differed from univariate results in that a higher voting proportion for progressive left-wing political parties was also associated with higher uptake. In addition, with regard to migration background only a Turkish background remained significant.ConclusionWe identified determinants associated with COVID-19 vaccine uptake at neighbourhood level and observed heterogeneity between different subpopulations. Since the goal of the vaccination campaign is not only to reduce suffering and death by improving the average uptake, but also to reduce health inequity, it is important to focus on these hard-to-reach populations.
Covid-19 Vaccination in India: An Exploratory Analysis
Authors: Agarwal Sandip K. , Naha Maharnab 
Published: February 2023

AbstractOur study is designed to explore the patterns in covid vaccination coverage in India at the district level. We use data from the first six months of covid vaccination drive in India that we combine with several other administrative data to create a unique data set that facilitates heterogeneity analysis across different vaccination phases and districts. We find evidence of past reported infection rates positively correlated with higher first dose covid vaccination outcomes. Higher Deaths as a proportion of district population is associated with lower vaccination uptake but as a percentage of reported infection was positively correlated with first dose covid vaccination. Districts that on average had higher population burden per health centre also had lower covid vaccination rates. Vaccination rates were lower in rural areas relative to urban areas whereas the association with literacy rate was positive. A higher vaccination rate among the population with higher blood pressure and hypertension (one of the comorbidities with covid infection) was observed while vaccination rates were lower among pregnant women and breastfeeding mothers. Districts with higher percentage of children with complete immunisation were associated with higher covid vaccination rates whereas low vaccination rates were observed in districts that reported relatively higher percentage of wasted children.
Development and validation of a novel mobility test for IRDs, from reality to virtual reality
Authors: Authié Colas , Poujade Mylène , Talebi Alireza , Defer Alexis , Zenouda Ariel , Coen Cécilia , Mohand-Said Saddek , Chaumet-Riffaud Philippe , Audo Isabelle , Sahel José-Alain 
Published: February 2023

PurposeTo validate a novel mobility test (MOST, MObility Standardized Test) and performance outcomes in real (RL) and virtual (VR) environments to be used for interventional clinical studies in order to characterize vision impairment in rod-cone dystrophies, also known as retinitis pigmentosa (RP).DesignProspective, interventional, non-invasive, longitudinal study (test-retest).Participants89 participants in three experimental phases: 15 non visually impaired (controls) in Phase 1 (average age, 27.4 years; 66% women), 14 participants with RP in Phase 2 (average age, 45.2 years, 36% women), and 60 participants (30 RP; average age, 47.4; 44.6% women; and 30 controls, average age, 47.6 years; 45.4% women) in Phase 3.MethodsWe designed a mobility test (MOST) to be used in both VR and RL and ran three experimental studies to (1) validate the difficulty of the mobility courses, (2) determine the optimal number of light levels and training trials, and (3) validate the reproducibility (test-retest), reliability (VR/RL), sensitivity, and construct, and content validity of the test. A comprehensive ophthalmologic examination was performed in all subjects.Main outcomes measuresThe primary outcome is the performance score in the mobility test. The secondary outcomes include visual acuity, contrast sensitivity, dark adaptation thresholds, static and kinetic visual field parameters, and ellipsoid zone from optical coherence tomography. Correlation between the performance score in the mobility tests and visual function were assessed.ResultsResults revealed that the mobility courses developed exhibited statistically similar difficulty, and that five trials are sufficient to control for the learning effect in a session. MOST is highly reproducible (test-retest intra-class correlations > .98) and reliable (correlation VR/RL = .98). MOST achieved a discrimination between RP participants and controls (accuracy larger than 95% in all conditions) and between early and late stages of the disease (mean accuracy of 82.3%). The performance score is correlated with visual function parameter (.57 to .94).ConclusionMOST is a tool offering validated mobility test, a controlled learning effect, which demonstrates excellent reproducibility and high agreement between real and virtual conditions, as well as sensitivity and specificity to measure disease progression and therapeutic benefit in IRD.
Sharp/Needlestick Injuries Among Clinical Students at A Tertiary Hospital in Eastern Uganda
Authors: Elisa Ndyamuhakyi , Ssenyonga Lydia , Iramiot Jacob Stanley , Nuwasiima Doreck , Nekaka Rebecca 
Published: February 2023

AbstractBackgroundClinical students, like health workers, are at risk of sharp/needle stick injuries and potential percutaneous exposure to blood and body fluids. They acquire infections like Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) through injuries. This study determined the prevalence and factors associated with sharp injuries among clinical students at Mbale Regional Referral Hospital.MethodsAcross sectional study was carried out at Mbale Regional Referral Hospital, a teaching hospital located along Pallisa road, Mbale City, Eastern Uganda. Ethical approval was obtained, Printed and soft copy questionnaires eliciting demographics, injury occurrence and associated factors were randomly and conveniently distributed respectively to 322 clinical students. Data was entered in Microsoft excel, cleaned and exported to STATA version 14 for analysis.ResultsOne hundred sixty (55.2%) clinical students had sustained a sharp injury in their clinical practice with a self-reported prevalence of 46.6% in the last year. The majority of the students 93(68.9%), sustained multiple sharp injuries. The common cause and site of injury were solid needles 72(45%) and finger (83.1%). Most students, 197(67.9%) reported ward procedures not being supervised and 124(42%) students worked on 15 and above patients daily. Final year clinical students were more likely to sustain sharp injuries than semi-finalists (P=0.000, OR 3.195% CI 1.7-5.5). Students who worked on ≥15 patients were more likely to sustain a sharp injury than those who attended to < 15 patients daily (P=0.000, OR 6.3 95% CI 3.7-10.8%). Students’ knowledge about sharp/infection control was limited.ConclusionThis study showed a high prevalence of needle stick injuries among clinical students. The associated factors were; the year of study, having not learned about infection control, the number of patients attended to daily. Students should attend to a manageable number of patients, carry out procedures not rushing while supervised. It is important to create awareness and train students on infection control before and during their deployment in clinical areas as their health and the future of the health sector depend on them.
Piloting a pragmatic clinical audit tool for quality improvement in rural paediatric care in northern Sierra Leone
Authors: Afolabi Muhammed O. , Ayieko Philip , Njie Yusupha , Kowuor Dickens , Adetola Hammed H. , Kamara Bomposseh , Jalloh Abdulai Berber , Swaray Ernest , Odeny Lazarus , Pearce Richmonda M. , Samai Mohamed H. , Deen Gibrilla Fadlu , Koedoyoma Songor , Sesay Isaac G. , Ishola David , Leigh Bailah , Watson-Jones Deborah , Greenwood Brian 
Published: February 2023

AbstractHospital admissions and their clinical outcomes can reflect the disease burden in a population and can be utilised as effective surveillance and impact monitoring tools. Inadequate documentation of admissions and their outcomes have contributed to the poor quality of paediatric care in many health care settings in sub-Saharan Africa. We have developed and piloted a simple tool for documentation of basic, standardised patient-level information on causes of admissions, diagnoses, treatments and outcomes in patients admitted to the paediatric ward of a district hospital in a rural community in Sierra Leone.From 1 August 2019 to 31 July 2021, we used this tool to document the admissions, treatments and clinical outcomes of 1,663 children admitted to this hospital. The majority of the children (1015, 62%) were aged between 12-59 months, were boys (942, 57%), were wasted (516, 31%), stunted (238 14%) or underweight (537, 32%). More than half of the children lived more than 1 km distance from the hospital (876/1410, 62%). Most were admitted before 4pm (1171/1626, 72%) and during weekdays (1231/1662, 74%). The highest number of paediatric admissions occurred in November 2019 and the lowest in April 2020. Severe malaria was the leading cause of admission. More than 80% of the children were successfully treated and discharged home (1356/1663, 81.5%) while 122/1663 (7.3%) died. Children aged under-five years who were underweight, and those who presented with danger signs (e.g. signs of breathing difficulty, dehydration, head injury or severe infections) had a higher risk of death than children without these features (p<0.01; p=0.03; p=0.011 and p= 0.009, respectively).Lack of systematic documentation of medical histories and poor record keeping of hospital admissions and outcomes can be overcome by using a simple tool. Continuous use of the tool with regular audits could improve delivery of paediatric care in resource-limited settings.