bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association of Early Corticosteroid Therapy With Clinical and Health-Related Quality of Life Outcomes in Children With Septic Shock*
Authors: Kamps Nicole N. , Banks Russell , Reeder Ron W. , Berg Robert A. , Newth Christopher J. , Pollack Murray M. , Meert Kathleen L. , Carcillo Joseph A. , Mourani Peter M. , Sorenson Samuel , Varni James W. , Cengiz Pelin , Zimmerman Jerry J. ,   for the Life After Pediatric Sepsis Evaluation (LAPSE) Investigators
Published: June 2022

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

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

SETTING:
Twelve academic PICUs in the United States.

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

INTERVENTIONS:
None.

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

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

Abstract

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Abstract
Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary cancer syndrome that is characterized by the presence of various malignant and benign tumors, including retinal and central nervous system hemangioblastomas. Hemangioblastomas are highly vascular tumors that can occur sporadically or within VHL disease. Herein, we present 68Ga-DOTATATE PET/CT findings of a unique case of suprasellar hemangioblastoma in a 52-year-old man with VHL disease.
Reference Values for Dopamine Transporter Imaging With 99mTc-TRODAT-1 in Healthy Subjects and Parkinson’s Disease Patients
Authors: Pitella Felipe Arriva , Trevisan Ana Carolina , Alexandre-Santos Leonardo , Kato Mery , Macruz Brito Manuelina Mariana Capellari , Tumas Vitor , Wichert-Ana Lauro 
Published: June 2022

Purpose
The aim of this study was to evaluate different quantitative indexes of striatum dopamine transporter density in healthy subjects and patients with PD.

Patients and Methods
Sixty-seven patients, 23 healthy (8 male; 59 ± 11 years old) and 44 age-matched patients (29 male; 59 ± 7 years old), with various degrees of severity of idiopathic PD (duration of symptoms, 10 ± 6 years; Hoehn and Yahr Scale, 2.16 ± 0.65; UPDRS-3, 29.74 ± 17.79). All patients performed 99mTc-TRODAT-1 SPECT. Binding potential indexes (BPIs) of striatum and subregions, asymmetry index (AI), and putamen/caudate ratio (P/C) were calculated.

Results
Binding potential index was lower in the PD than in healthy subjects. A BPI cutoff for striatum and putamen ranging from 0.73 to 0.78 showed 95% to 100% sensitivity and 84% to 88% specificity. For the caudate nucleus, a BPI threshold of 0.8 to 0.88 revealed 100% sensitivity and 77% to 84% specificity. The BPI’s respective areas under the curve ranged from 0.92 to 0.98. For AI and P/C, the area under the curve was less than 0.70. Binding potential index intraclass correlation coefficient was close to 1.0 in the intraobserver evaluation and 0.76 to 0.87 in the interobserver assessment. Intraclass correlation coefficient for AI and P/C was inferior to 0.75 in the intraobserver and interobserver evaluations.

Conclusions
Different semiquantitative indices differentiated PD and healthy subjects and may help the differential diagnosis of other entities involving the dopaminergic system. Asymmetry index and P/C performances were lower than BPI, including their intraobserver and interobserver reliability, and therefore should be used with caution.