Nevin Manimala

Pediatr Emerg Care. 2022 Apr 19. doi: 10.1097/PEC.0000000000002712. Online ahead of print.

ABSTRACT

OBJECTIVE: Children with medical complexity (CMC) compose 1% of the pediatric population but account for 20% of pediatric emergency department (ED) visits. Previous descriptions of challenges and interventions to ensure quality of care are limited. Our objective was to elicit pediatric emergency medicine (PEM) physicians’ perspectives on challenges and opportunities for improvement of emergency care of CMC, with a focus on emergency information forms (EIFs).

METHODS: We conducted a web-based survey of PEM physicians participating the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. The survey was designed using an expert panel, and subsequently piloted and revised to an 18-item survey. Data were analyzed with descriptive statistics.

RESULTS: One hundred fifty-one of 495 respondents (30%) completed the survey. Most respondents (62.9%) reported caring for >10 CMC per month. Whereas overall medical fragility and time constraints were major contributors to the challenges of caring for CMC in the ED, communication with known providers and shared care plans were identified as particularly helpful. Most respondents did not report routine use of EIFs. Anticipated emergencies/action plan was deemed the most important component of EIFs.

CONCLUSIONS: Most PEM physicians view the care for CMC in the ED as challenging despite practicing in high-resource environments. Further research is needed to develop and implement strategies to improve care of CMC in the ED. Understanding experiences of providers in general ED settings is also an important next step given that 80% of CMC present for emergency care outside of major children’s hospitals.

PMID:35436769 | DOI:10.1097/PEC.0000000000002712

Pediatr Emerg Care. 2022 Apr 19. doi: 10.1097/PEC.0000000000002728. Online ahead of print.

ABSTRACT

BACKGROUND: Sledding is not a risk-free winter sport. According to the US Consumer Product Safety Commission, there were an estimated 13,954 sledding accidents requiring medical care in 2010. However, specific information concerning pediatric injuries related to sledding is not well defined.

OBJECTIVES: This study aimed to identify the most common types of injuries associated with sledding accidents and demographic factors related to risk of injury in pediatric patients, and to compare injuries associated with 2 different age groups and sexes.

METHODS: This is a retrospective descriptive study of pediatric patients (<18 years of age) presenting to a regional level I pediatric trauma center secondary to a sledding injury between 2006 and 2016. Demographic information including sex, age, mechanism of injury, and injury severity score was captured and analyzed using descriptive statistics.

RESULTS: There were 209 patients identified for 10 years. There were no mortalities. There were 85 patients with primary head injury, of which 82 (96.5%) were hospitalized and 33 (38.8%) required an intensive care unit (ICU) stay. Seventy-five patients primarily suffered from extremity injuries, of which 56 (74.6%) had lower extremity fractures requiring operative intervention. There was no difference in ICU or length of stay between younger children (0-11 years) and adolescents (12-18 years) or between male and female patients.

CONCLUSIONS: Childhood sledding can result in a variety of significant injuries requiring surgical intervention and hospitalization. Children pulled on sleds behind motorized vehicles are at higher risk for more severe injuries resulting in a higher rate of ICU admission.

PMID:35436765 | DOI:10.1097/PEC.0000000000002728

J Biomech. 2022 Apr 12;137:111093. doi: 10.1016/j.jbiomech.2022.111093. Online ahead of print.

ABSTRACT

Chiari malformation is characterised by the herniation of the cerebellar tonsils through the foramen magnum. However, tonsillar herniation and other 2D morphometric measurements of the posterior cranial fossa (PCF) have a weak association with patients’ symptoms and clinical outcomes. This study aimed to contrast current 2D metrics with a novel 3D shape analysis of the PCF and the hindbrain, to determine if 3D measurements provides further insight into the pathophysiology of Chiari. The cranium of 12 controls and 21 Chiari malformation patients with (N = 9) and without (N = 12) a syrinx were scanned. The morphology of the PCF was quantified with typical 2D measurements. Additionally, a correspondence-based shape model that normalised the PCF volume, was used to find 3D differences in the shape of the PCF, and the distance of the hindbrain from the inner surfaces of the PCF. Shape analysis showed that, compared to controls, the caudal (p = 0.007; 2.3 mm, IQR: 1.6-3.3 mm) and anterior (p = 0.027; 1.3 mm,IQR: 1.1-1.6 mm) surfaces of the hindbrain were closer to the PCF in patients with and without a syrinx, respectively. However, there were negligible differences in the shape of the PCF between patient groups (p > 0.39). Current morphometric measures should be normalised for variation in PCF volume, so that shape measures are not biased. The reduced CSF space between the hindbrain and PCF will alter CSF dynamics, which may compress cerebellar vasculature and contribute to patient symptomatology.

PMID:35436754 | DOI:10.1016/j.jbiomech.2022.111093

Leg Med (Tokyo). 2022 Apr 6;57:102061. doi: 10.1016/j.legalmed.2022.102061. Online ahead of print.

ABSTRACT

BACKGROUND: Recently, Olze et al. came up with a staging system based on the radiological changes in the root pulp of the third molar.

AIMS & OBJECTIVES: The current study seeks to ascertain the utility of visibility of the root pulp of the third molar as a system of forensic age estimation in the Indian population, as suggested by Olze. et al. and to assess the accuracy of cut-off stages for 18, 21, and 25 years of age.

MATERIAL AND METHODS: Radio-visiogram of 220 Patients (116 males and 104 females) of age 15 to 30 years were examined and staged as per Olze. et al. stage-based system. The statistical methods included descriptive analysis, chi-square test, and Rank-order correlation [rho] test of Spearman. EasyROC web tool was used for ROC analyses and calculating ROC curves (AUCs), likelihood ratio, predictive values, and screening tests for accuracy. Youden’s index was used to decide the cut-off stage for the different age groups.

RESULTS: Specificity close to 100% was observed among both the Sex for cut-off levels 1, 2, and 3 among 18, 21, and 25 years of age correspondingly with minimal Type II error. Inter andIntraobservations with a kappa value of 0.66 and 0.65, respectively, indicate good agreement.

CONCLUSION: Olze’s third molar root pulp 1, 2, and 3 stages can be used as an optimal cut-off for the 18, 21, and 25-year-old thresholds correspondingly with high specificity for both the sexes for age estimation among the Indian population.

PMID:35436735 | DOI:10.1016/j.legalmed.2022.102061

EBioMedicine. 2022 Apr 15;79:104007. doi: 10.1016/j.ebiom.2022.104007. Online ahead of print.

ABSTRACT

BACKGROUND: Virtually few accurate and robust prediction models of lower-grade gliomas (LGG) survival exist that may aid physicians in making clinical decisions. We aimed to develop a prognostic prediction model of LGG by incorporating demographic, clinical and transcriptional biomarkers with either main effects or gene-gene interactions.

METHODS: Based on gene expression profiles of 1,420 LGG patients from six independent cohorts comprising both European and Asian populations, we proposed a 3-D analysis strategy to develop and validate an Accurate Prediction mOdel of Lower-grade gLiomas Overall survival (APOLLO). We further conducted decision curve analysis to assess the net benefit (NB) of identifying true positives and the net reduction (NR) of unnecessary interventions. Finally, we compared the performance of APOLLO and the existing prediction models by the first systematic review.

FINDINGS: APOLLO possessed an excellent discriminative ability to identify patients at high mortality risk. Compared to those with less than the 20^th percentile of APOLLO risk score, patients with more than the 90^th percentile of APOLLO risk score had significantly worse overall survival (HR=54·18, 95% CI: 34·73-84·52, P=2·66 × 10^-69). Further, APOLLO can accurately predict both 36- and 60-month survival in six independent cohorts with a pooled AUC_36-month=0·901 (95% CI: 0·879-0·923), AUC_60-month=0·843 (95% CI: 0·815-0·871) and C-index=0·818 (95% CI: 0·800-0·835). Moreover, APOLLO offered an effective screening strategy for detecting LGG patients susceptible to death (NB_36-month=0·166, NR_36-month=40·1% and NB_60-month=0·258, NR_60-month=19·2%). The systematic comparisons revealed APOLLO outperformed the existing models in accuracy and robustness.

INTERPRETATION: APOLLO has the demonstrated feasibility and utility of predicting LGG survival (http://bigdata.njmu.edu.cn/APOLLO).

FUNDING: National Key Research and Development Program of China (2016YFE0204900); Natural Science Foundation of Jiangsu Province (BK20191354); National Natural Science Foundation of China (81973142 and 82103946); China Postdoctoral Science Foundation (2020M681671); National Institutes of Health (CA209414, CA249096, CA092824 and ES000002).

PMID:35436725 | DOI:10.1016/j.ebiom.2022.104007

J Environ Radioact. 2022 Apr 15;248:106885. doi: 10.1016/j.jenvrad.2022.106885. Online ahead of print.

ABSTRACT

With several databases available, including two sets of in situ measurements of the ambient gamma dose rate and an airborne survey of K, Th, U in soil, Belgium is a favourable case for exploring the mapping methodology for terrestrial radiation. The first step is the harmonization of the different data sets, taking in situ measurements with an ion chamber as the reference. Corrections are necessary, based on the data themselves (a) to the measurements of permanent monitoring stations, (b) to the data calculated from airborne measurements of the soil activity, due in particular to the attenuation by the forest cover, and (c) to the other data calculated from the soil activity, due to the lower activity of the upper layer. After subtracting the cosmic contribution, a harmonized database of the terrestrial gamma dose rate (TGDR) based on 379 in situ measurements was built, together with a harmonized data set of 30134 TGDR values calculated from the concentrations of K, Th, U in soil deduced from the airborne survey. The two data sets are in good agreement with each other for all statistical characteristics that were examined like basic statistics, qq-plots, analysis of variance (ANOVA) or variograms, which validates the airborne-based data set by the link with in situ ion chamber measurements. ANOVA reveals the strong relation between TGDR and the soil class, which justifies the use of a soil map as the framework for developing the TGDR map. The variograms show the absence of residual spatial correlations within soil classes. The two harmonized TGDR data sets were mapped at the nodes of a kilometric grid by the moving average method within soil groups. There is a rather good agreement between the maps, confirming the equivalence between the two data sets and the validation of the airborne based one, which can obviously give more detail. After reducing the maps to a 10 km × 10 km grid, the two data sets were used to check the accuracy of the Belgian part of the European TGDR contained in the European Atlas of Natural Radiation.

PMID:35436723 | DOI:10.1016/j.jenvrad.2022.106885

Environ Int. 2022 Apr 9;163:107231. doi: 10.1016/j.envint.2022.107231. Online ahead of print.

ABSTRACT

Climate change is causing the surface temperature to rise and the extreme weather events to increase in frequency and intensity, which will pose potential threats to the survival and health of residents. Beijing is facing multiple challenges such as coping with climate change, urbanization, and population aging, which puts huge decision-making pressure on decision maker. However, few studies that systematically consider the health effects of climate change, urbanization, and population aging for China. Based on the distributed lag nonlinear model (DLNM) and 13 global climate models in the Coupled Model Intercomparison Project Phase 6 (CMIP6), this study obtained the temporal and spatial distribution of surface temperature through statistical downscaling methods, and comprehensively explored the independent and comprehensive effects of urbanization and population aging on the projection of future temperature-related cardiovascular disease (CVD) mortality in the context of climate and population change. The results showed that only improving urbanization can reduce future temperature-related CVD mortality by 1.7-18.3%, and only intensified aging can increase future temperature-related CVD mortality by 48.8-325.9%. Taking into account the improving urbanization and intensified aging, future temperature-related CVD mortality would increase by 44.1-256.6%, and the increase was slightly lower than that of only intensified aging. Therefore, the intensified aging was the biggest disadvantage in tackling climate change, which would obviously magnify the mortality risks of temperature-related CVD in the future. Although the advancement of urbanization would alleviate the adverse effects of the intensified aging population, the mitigation effects would be limited. Even so, Urbanization should be continued to reduce health risks for residents. These findings would contribute to formulate policies related to mitigate climate change and reduce baseline mortality rate (especially the elderly) in international mega-city – Beijing. In addition, relevant departments should improve the medical health care level and optimize the allocation of social resources to better cope with and adapt to climate change.

PMID:35436720 | DOI:10.1016/j.envint.2022.107231

Int J Nurs Educ Scholarsh. 2022 Apr 18;19(1). doi: 10.1515/ijnes-2021-0157.

ABSTRACT

The aim of this study is to explore baccalaureate nursing students’ self-efficacy beliefs related to theoretical coursework. Self-efficacy, i.e., the perception of one’s ability to successfully complete a task, has been shown to correlate positively with academic performance and persistence. Nursing students from a large Norwegian university participated (n=132). Data were collected through a digital questionnaire and analyzed using SPSS statistics. Descriptive analysis was performed. Student groups were compared according to gender, age, and year of study using one-way analyses of variance and independent sample t-tests. The findings suggest that the students’ self-efficacy beliefs related to theoretical coursework are quite high, with few significant differences between the groups. While the students have confidence in their ability to reach academic goals, self-efficacy when facing stress and distraction is lower. The findings may be of interest to educators striving to optimize learning in baccalaureate nursing programs.

PMID:35436394 | DOI:10.1515/ijnes-2021-0157

Pediatr Transplant. 2022 Apr 18:e14288. doi: 10.1111/petr.14288. Online ahead of print.

ABSTRACT

PURPOSE: HT recipients experience high levels of medication non-adherence during adolescence. This pilot study examined the acceptability and feasibility of an asynchronous DOT mHealth application among adolescent HT recipients. The app facilitates tracking of patients’ dose-by-dose adherence and enables transplant team members to engage patients. The DOT application allows patients to self-record videos while taking their medication and submit for review. Transplant staff review the videos and communicate with patients to engage and encourage medication adherence.

METHODS: Ten adolescent HT recipients with poor adherence were enrolled into a single-group, 12-week pilot study examining the impact of DOT on adherence. Secondary outcomes included self-report measures from patients and parents concerning HRQOL and adherence barriers. Long-term health outcomes assessed included AR and hospitalization 6 months following DOT.

FINDINGS: Among 14 adolescent HT patients approached, 10 initiated the DOT intervention. Of these, 8 completed the 12-week intervention. Patients and caregivers reported high perceptions of acceptability and accessibility. Patients submitted 90.1% of possible videos demonstrating medication doses taken. MLVI values for the 10 patients initiating DOT decreased from 6 months prior to the intervention (2.86 ± 1.83) to 6 months following their involvement (2.08 ± 0.87) representing a 21.7% decrease in non-adherence, though not statistically significant given the small sample size.

CONCLUSIONS: Result of this pilot study provides promising insights regarding the feasibility, acceptability, and potential impact of DOT for adolescent HT recipients. Further randomized studies are required to confirm these observations.

PMID:35436376 | DOI:10.1111/petr.14288

Dermatol Ther. 2022 Apr 18:e15522. doi: 10.1111/dth.15522. Online ahead of print.

ABSTRACT

Treatment of alopecia areata is often challenging, especially for patients with extended disease. Contact immunotherapy with diphenylcyclopropenone (DPCP) has been reported as an effective topical treatment but the exact immunologic mechanism of diverting the immune response is still unknown. We investigated the efficacy of topical immunotherapy with DPCD in acute, intermediate, and chronic lesions of AA and the response rate was associated with perifollicular infiltrate of T regulatory cells. Approximately two-thirds of our patients (67.5%) had a response rate > 50% after 6 months of DPCP therapy. Patients with acute and intermediate onset of the disease were more likely to respond to the therapy. Although responders demonstrated FOXP3+ positive lymphocytes in immunohistochemistry, this association could not be confirmed by statistical significance (p = 0.052). In patients with multiple lesions, that had different chronological onset, the lesions with more recent onset responded faster than lesions of longer duration. This article is protected by copyright. All rights reserved.

PMID:35436374 | DOI:10.1111/dth.15522