bluuebunny/crossref_metadata_2025_split huggingface dataset:
N02 The importance of the multidisciplinary team (MDT) and its impact on quality of life and medication adherence in patients with Inflammatory Bowel Disease
Authors: Herrerias G , Barros J R , Lopes M A , Saad-Hossne R , Baima J P , Sassaki L Y 
Published: January 2022

Abstract

Background
IBD is a chronic immune-mediated disease that requires continuous patient care. The frequent contact and the good relationship with the multidisciplinary team (MDT) are essential for improving quality of life (QoL) and medication adherence aiming at treatment success. The aim of the study was to assess the importance of MDT in the view of patients with IBD and its impact on QoL and in medication adherence.

Methods
A cross-sectional study was carried out, including 114 patients from an IBD reference center in Brazil. The relevance of MDT was assessed through a questionnaire that included the importance of physicians, nurses, nutritionists and psychologists in the patient care. QoL was assessed by IBDQ. Treatment adherence and knowledge about the disease were assessed using the Morisky and CCKNOW questionnaires, respectively.

Results

In total, 69 (60.53%) patients with CD and 45 (39.47%) patients with UC were included. The mean age was 39.16 (±13.50) years and 58.77% were female. The disease duration was 9.88 (±7.35) years. Presence of comorbidities was observed in 52.63% patients. About 57 (82.61%) patients with CD use biological therapy, with a statistical difference (p &lt;0.0001) when compared to patients with UC (37.78%). The gastroenterologist was considered very important by 91.23% of patients, coloproctologist by 62.07% of patients, nurse by 65.05% of patients, nutritionist by 50% of patients and psychologist by 47.25% of patients. In the analysis of QoL, 24 (21.05%) patients had excellent QoL, 52 (45.61%) had good QoL, 29 (25.44%) had regular QoL and 9 (7.89%) had poor QoL, with no difference between patients who followed with nurses or other MDT professionals (Table 1). Medication adherence was low in 58.88% of patients. Knowledge about the disease was low (6.21 ± 3.99 points), being higher among patients with CD (p = 0.01). Patients identify the doctor as the main provider of care for their health, but about 10% leave with doubts from their appointments. 10% of patients think that more care with the nurse is necessary and less than 10% of patients are clarified by the nurse about QoL, ostomies, fecal incontinence, disease activity, biological therapy and sexuality.

Conclusion
Patients considered doctors as the most important professionals in their care. Although the service has a multidisciplinary team, not all patients had the opportunity to consult with all professionals, mainly do the Covid pandemic in 2020 and 2021. The lack of contact with the entire team, especially with the nurse, may have contributed to low medication adherence and low knowledge of the disease, impacting disease control and QoL.
N20 Safety of extended blood monitoring for adult Inflammatory Bowel Disease (IBD) patients on oral azathioprine during the COVID-19 pandemic: a single-centre audit
Authors: Al-Hasani A , Younge L , Chana A 
Published: January 2022

Abstract

Background
Azathioprine (AZA) is a recognised treatment option for maintaining remission in IBD patients. Myelotoxicity and abnormal liver function tests may present at any stage of therapy, therefore ECCO advises practitioners to check full blood count, liver and kidney function tests at 3-monthly intervals for patients established on therapy. During the COVID-19 pandemic, UK guidance suggested reducing blood test monitoring to a minimum safe frequency to facilitate ‘shielding’ of vulnerable patient groups.
Patients established on treatment at St Mark’s Hospital for more than 12 months, on stable doses were deemed eligible for extended blood monitoring intervals of 6-monthly. The aim of this audit was to assess the impact of this extension on patient safety, by measuring outcomes against locally agreed standards.

Methods
All patients on AZA were identified using the pharmacy dispensing system and patient information software for blood test results, clinic letters and notes. Outcomes for patients who had extended blood monitoring were collected retrospectively including monitoring calls to the IBD advice line and any hospital admissions associated with therapy. Subsequent blood test results were also captured.

Results
A total of 92 patient records were identified and analysed. Table 1 shows the achieved compliance (%) to the audit standards compared to the target compliance (%). 54% of patients (n=50) received medication that lasted beyond the standard 12-week validity of a blood test, i.e. had extended blood monitoring. Of those 50 patients, 43 were eligible for extended blood monitoring (86%). From 50 patients with extended blood monitoring, one patient had elevated alanine aminotransferase levels which improved after a one-week treatment break. Another patient called the IBD advice line reporting nausea and abdominal cramps due to treatment and was advised to split the dose and monitor for side effects. No patients were admitted to emergency care or hospital due to deranged blood test results or adverse effects from their medication.

Conclusion
Overall the findings suggest that the temporary relaxation of blood monitoring did not adversely affect patient safety. For more comprehensive results, it would be prudent to repeat the audit using a larger sample size; however the audit has established a baseline at a time of unprecedented changes in the workplace, which will be useful in guiding future practice.
The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia
Authors: Everett Brandon P , Nakonezny Paul A , Mulligan Edward P , Chhabra Avneesh , Wells Joel 
Published: January 2022

ABSTRACT
The aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.
Rates of readmission and reoperation following pelvic osteotomy in adolescent patients: a database study evaluating the pediatric health information system
Authors: Faust Millis , Allahabadi Sachin , Swarup Ishaan 
Published: January 2022

ABSTRACTRates and reasons for readmission and reoperation following adolescent pelvic osteotomy are not well-defined. This study aimed to (1) determine 30-day and 90-day readmission rates and the 2-year reoperation rate after pelvic osteotomy in adolescents and (2) identify reasons for readmission and reoperation. The Pediatric Health Information System database was queried between 10 January 2015 and 1 January 2020 for patients meeting selected International Classification of Diseases (ICD-10) procedure and diagnosis codes relating to pelvic osteotomies. Readmission rates were calculated within 30 and 90 days from index osteotomy. The ipsilateral reoperation rate was calculated within 2 years from index osteotomy. Reasons for these outcomes were identified. Univariate and multivariate analyses were utilized to identify readmission risks. Of 1475 patients, 5.4% and 9.2% were readmitted within 30 and 90 days, respectively. Reasons for readmission were consistent across both time points and included infection, hip-related orthopedic conditions and neurologic conditions. Younger age (OR 0.83, 95% CI: 0.76, 0.89; P &lt; 0.0001) and male sex (OR 1.77, 95% CI: 1.23–2.54; P = 0.002) were predictive of readmission within 90 days. The 2-year reoperation rate was 32.1%, of which 79.8% underwent reoperation for hardware removal, 17.7% for revision and 1.3% for hip replacement. 30-day readmission, 90-day readmission and 2-year reoperation rates after adolescent pelvic osteotomy were 5.4%, 9.2% and 32.1%, respectively. Younger age and male sex were predictive of 90-day readmission. Most ipsilateral reoperations were for hardware removal. Understanding readmission and reoperation risks following pelvic osteotomy can benefit patient counseling and improve expectations of post-surgical outcomes.Level of Evidence:IV, case series.
Evaluation of Diaphragmatic Function after Interscalene Block with Liposomal Bupivacaine: A Randomized Controlled Trial
Authors: Berg Aaron A. , Flaherty James M. , Habeck Jason M. , Harrison Alicia K. , Braman Jonathan P. , Kaizer Alexander M. , Hutchins Jacob L. 
Published: January 2022

Background
Interscalene blocks provide analgesia for shoulder surgery but also cause phrenic nerve paralysis. Liposomal bupivacaine is approved for use in interscalene blocks with the potential to provide longer pain control. However, the impact of liposomal bupivacaine on the phrenic nerve has not been evaluated. It was hypothesized that patients who received an interscalene block with both bupivacaine and liposomal bupivacaine would have a decreased diaphragmatic excursion when compared to bupivacaine alone at 24 h.

Methods
This was a double-blinded study of adult patients who were randomized to receive an interscalene block with either 20 ml 0.5% bupivacaine (bupivacaine group) or 10 ml 0.5% bupivacaine plus 10 ml liposomal bupivacaine (liposomal bupivacaine group). Twenty-six patients were randomized with 22 included in the analysis. Diaphragmatic excursion (via ultrasound) and spirometry were assessed before the block, in the postanesthesia care unit, and at 24 h postblock. The primary outcome was diaphragm excursion with sigh. No adverse events were observed.

Results
At 24 h, the liposomal bupivacaine group median [25th, 75th], had a greater percent change in diaphragmatic excursion during sigh breath compared to the bupivacaine group, –24% [–30, –9] versus 9% [–8, 26], difference in location, 32 (95% CI, 12 to 52), P = 0.007. Five patients in the liposomal bupivacaine group had a greater than 25% reduction in diaphragmatic excursion at 24 h versus zero in the bupivacaine group. They also had a significantly greater percent reduction in forced expiratory volume in 1 s and forced vital capacity compared with the bupivacaine group at 24 h (median decrease of 22% vs. 2%, P = 0.006, and median decrease of 19% vs. 1%, P = 0.049, respectively).

Conclusions
The addition of liposomal bupivacaine to bupivacaine in an interscalene block results in statistically significant reductions in diaphragm excursion and pulmonary function testing 24 h after block placement when compared to bupivacaine alone. This reduction, however, falls within the range of normal diaphragmatic function.

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What This Article Tells Us That Is New
Effect of Percutaneous Posterior Pelvic Ring Reduction and Fixation on Patient-Reported Outcomes
Authors: Obey Mitchel R. , Buesser Katherine E. , Hofer Erin L. , Miller Anna N. 
Published: January 2022

Objectives:
The purpose of this study was to assess patient outcomes using Patient-Reported Outcomes Measurements Information System (PROMIS) scores after closed reduction and percutaneous fixation (CRPF) of the posterior pelvic ring and determine whether quality of reduction affects the outcomes.

Design:
This is a retrospective cohort study.

Setting:
The study involved a Level I trauma center.

Patients:
The study included 46 adult patients with operatively treated pelvic ring injuries (63% OTA/AO 61-B) who underwent CRPF between 2014 and 2018 at a single institution.

Intervention:
The intervention involved closed reduction and percutaneous posterior pelvic ring fixation.

Main Outcome Measurements:
The main outcome measurements were postoperative patient PROMIS scores, including physical function, pain interference, anxiety, and depression, and radiographic measurements of postoperative displacement and pelvic deformity.

Results:
After CRPF, PROMIS scores of physical function, pain interference, and anxiety were significantly improved at the time of final follow-up when compared with the first postoperative visit. The amount of malreduction or pelvic deformity did not significantly affect outcome scores; however, results were limited by small sample size.

Conclusions:
CRPF of posterior pelvic ring injuries results in good functional and radiographic outcomes. Degree of malreduction may not affect outcomes as much as previously believed.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Novel Role for Cytochrome P450 Epoxygenase Metabolites in Septic Shock
Authors: Jones Timothy N. , Janani Leila , Gordon Anthony C. , Al-Beidh Farah , Antcliffe David B. 
Published: January 2022

IMPORTANCE:
This is the largest study describing the role of P450 epoxygenase metabolites in septic shock in humans and suggests a novel therapeutic target.

Objectives:
Oxylipins are oxidative breakdown products of cell membrane fatty acids. Animal models have demonstrated that oxylipins generated by the P450 epoxygenase pathway may be implicated in septic shock pathology. However, these mediators are relatively unexplored in humans with septic shock. We aimed to determine if there were patterns of oxylipins that were associated with 28-day septic shock mortality and organ dysfunction.

Design:
Retrospective analysis of samples collected during the Vasopressin versus Norepinephrine as Initial Therapy in Septic Shock trial.

Setting:
ICUs in the United Kingdom.

PARTICIPANTS:
Adults recruited within 6 hours of onset of septic shock.

MAIN OUTCOMES AND MEASURES:
Oxylipin profiling was performed on 404 serum samples from 152 patients using liquid chromatography-mass spectrometry.

Results:
Nonsurvivors were found to have higher levels of 14,15-dihydroxyeicosatrienoic acid (DHET) at baseline than survivors (p = 0.02). Patients with 14,15-DHET levels above the lower limit of quantification of the assay were more likely to die than patients with levels below this limit (hazard ratio, 2.3; 95% CI, 1.2–4.5). Patients with measurable 14,15-DHET had higher levels of organ dysfunction and fewer renal failure-free days than those in whom it was unmeasurable. Considering samples collected over the first week of intensive care stay, measurable levels of DHET species were associated with higher daily Sequential Organ Failure Assessment scores that appeared to be accounted for predominantly by the liver component. Measurable 14,15-DHET showed positive correlation with bilirubin (r
s = 0.38; p < 0.001) and lactate (r
s = 0.27; p = 0.001).

CONCLUSIONS AND RELEVANCE:
The P450 epoxygenase-derived DHET species of oxylipins were associated with organ, particularly liver, dysfunction in septic shock and 14,15-DHET was associated with septic shock mortality. These results support further investigation into the role of the P450 epoxygenase-derived oxylipins in sepsis and suggest that this pathway may offer a novel therapeutic strategy in septic shock.
The anatomy of enjoyment: the flow experience and cardiac surgery
Authors: Jiang Stephanie M. , McQueen Sydney , Mobilio Melanie Hammond , Bisleri Gianluigi , Yanagawa Bobby , Moulton Carol-Anne 
Published: January 2022

Purpose of review
In a time of record levels of physician burnout coupled with a global pandemic, protecting physician wellness is critical. The experience of cognitive flow has been found to enhance both wellness and performance. Although flow has been vastly explored in other fields including elite sport, it has not been deeply investigated or applied in cardiac surgery. Here we discuss flow and flow-promoting techniques employed in other fields that may be beneficial within cardiac surgery.

Recent findings
Flow is a prevalent experience among surgeons, amplified during operations. Possible strategies to cultivate flow may be separated into individual skills training, such as mindfulness practice and stress management, institutional changes, such as ensuring adequate resources and protected spaces, and strategies targeting the intersectionality of individuals and systems, such as how workplace culture shapes an individual's experience. These techniques may be applicable within cardiac surgery, especially in training.

Summary
Flow has been identified as a key component of a happy and meaningful life, and a potential protector against burnout. Harnessing the benefits of flow may help promote flourishing, particularly in demanding fields, such as cardiac surgery.
Contact Lens Prescribing Trends for Keratoconus at an Academic Medical Center: Increased Utilization of Scleral Lenses for Severe Disease
Authors: Scanzera Angelica C. , Deeley Marc , Joslin Charlotte , McMahon Timothy T. , Shorter Ellen 
Published: January 2022

Objectives:
To describe contact lens prescription trends for patients with keratoconus.

Methods:
Demographics, corneal curvature, visual acuity, and type of contact lens prescribed were reviewed for all patients with keratoconus evaluated in the contact lens service in 2010 and 2020.

Results:
There were 292 patients in 2010 and 217 in 2020. In 2010, 69% were using corneal gas-permeable lenses (GP), 16% soft toric, 13% hybrid, and 2% soft sphere with no scleral lens (SL). In 2020, 60% were using corneal GP, 22% SL, 12% soft toric, 5% hybrid, and 1% soft sphere. Mean log of minimum angle of resolution visual acuities with manifest refraction were (represented in mean [SD, range]) 0.42 (0.33, 0–1.3) in 2010 and 0.35 (0.33, 0–1.6) in 2020 improving to 0.19 (0.18, 0–1.3; P≤0.01) and 0.13 (0.14, 0–0.60; P<0.01) with contact lenses. Mean keratometry measurement in patients using SLs was 53.0 diopters (D) (9.9, 42.1–84.5), which was steeper than 46.6 D in patient's using all other lens types in 2010 and 2020 (3.9, 40.9–57.9; P<0.01).

Conclusions:
Scleral lens prescription increased during the past decade; however, corneal GP lenses remain the most frequent lens prescribed for patients with keratoconus in this cohort. Despite being prescribed for patients with the most advanced disease, SLs provide good visual acuity.
Menin Inhibitors in Acute Myeloid Leukemia—What Does the Future Hold?
Authors: Swaminathan Mahesh , Bourgeois Wallace , Armstrong Scott A. , Wang Eunice S. 
Published: January 2022

Abstract
Menin inhibitors constitute a novel class of agents targeting the underlying biology of nucleophosmin (NPM1) mutant and KMT2A (formerly known as MLL1) rearranged (KMT2Ar) acute leukemias. KMT2Ar acute leukemias constitute 5% to 10% of acute leukemias, and NPM1 mutations are identified in 30% of newly diagnosed acute myeloid leukemias (AMLs). In preclinical AML models, small molecule inhibitors of the menin-KMT2A protein-protein interaction induce differentiation, downregulate critical gene expression programs, and confer a survival advantage in patient-derived xenograft models of NPM1 mutant and KMT2Ar AML. Multiple clinical trials evaluating oral menin inhibitors in acute leukemias are ongoing. Preliminary results in relapsed/refractory NPM1 mutant and KMT2Ar AML have shown on-target effects, tolerable toxicity, and promising clinical activity. This review details the current clinical experience of menin inhibitors in AML and discusses how these agents can be successfully integrated into future therapeutic approaches.
Incorporation of FLT3 Inhibitors Into the Treatment Regimens for FLT3 Mutated Acute Myeloid Leukemia
Authors: Perl Alexander E. , Pratz Keith W. 
Published: January 2022

Abstract
Therapeutic outcomes for acute myeloid leukemia patients with Fms-like tyrosine kinase 3 (FLT3) mutations have improved substantially since the discovery of small molecule tyrosine kinase inhibitors. Today, use of FLT3 inhibitors is standard in frontline intensive chemotherapy as well as patients with relapsed or refractory acute myeloid leukemia and FLT3 mutations and increasingly used as for prolonged remission maintenance posttransplant and/or postconsolidation. Yet, FLT3 inhibitors alone are not curative, and best outcomes are seen when the drugs are used as part of combination regimens. Optimizing therapy for patients with FLT3 mutations remains a work in progress. Overall, modern therapeutic approaches generate cure rates for this group at levels that argue against considering these mutations adverse risk. Still, such survivals require intensive therapy and often transplant. Therefore, efforts are underway to determine if lower toxicity regimens can attain comparable outcomes, at least for patients responding optimally. This review will review the various FLT3 inhibitors that are approved or in development, highlight the areas where they have been shown to add value, and identify areas where their use remains controversial.
Improving Efficiency of Multidisciplinary Bedside Rounds in the NICU: A Single Centre QI Project
Authors: Shivananda Sandesh , Osiovich Horacio , de Salaberry Julie , Hait Valoria , Gautham Kanekal S. 
Published: January 2022

Introduction:
Inconsistent workflow, communication, and role clarity generate inefficiencies during bedside rounds in a neonatal intensive care unit. These inefficiencies compromise the time needed for essential activities and result in reduced staff and family satisfaction. This study’s primary aim was to reduce the mean duration of bedside rounds by 25% within 3 months by redesigning the rounding processes and applying QI principles. The secondary aims were to improve staff and family experience.

Methods:
We conducted this work in an academic 50-bed neonatal intensive care unit involving 350 staff members. The change interventions included: (i) reinforcing essential value-added activities like standardizing rounding time, the sequencing of patients rounded, sequencing each team member rounding presentations, team preparation, bedside presentation content, and time management; (ii) reducing non-value-added activities; and (iii) moving value-added nonessential activities outside of the rounds.

Results:
The mean duration of rounds decreased from 229 minutes in the pre-implementation to 132 minutes in the postimplementation phase. The proportion of staff showing satisfaction regarding various components of the rounds increased from 5% to 60%, and perceived staff involvement during the rounds increased from 70% to 77%. Ninety-three percent of family experience survey respondents expressed satisfaction at being invited for bedside reporting and being involved in decision-making or care planning. The staff did not report any adverse events related to the new rounds process.

Conclusion:
Redesigning bedside rounds improved staff engagement and workflow, resulting in efficient rounds and better staff experience.