Practice variation in the management of children hospitalized with bronchiolitis: A Canadian perspective

Abstract Objectives To describe variations in the monitoring, treatment, and discharge of children hospitalized with bronchiolitis among physicians across Canadian paediatric teaching hospitals. Methods We conducted an electronic survey of paediatricians with experience in the management of inpatient bronchiolitis at 20 Canadian paediatric teaching hospitals. Only physicians who worked a minimum of 6 weeks on their hospital inpatient unit in the 2015 calendar year were eligible to participate in the study. The questionnaire explored the monitoring, treatment, and discharge of children with bronchiolitis. Central tendency (mean) and dispersion (SD) statistics were produced for continuous variables and frequency distributions for categorical variables. Results A total of 142 respondents were included in the analysis. 45.1% reported the routine use of continuous oxygen saturation monitoring. 27.5% used a higher cut-off for oxygen supplementation of 92% and 12.7% use a lower cut-off of 88%. 29.6% routinely used deep nasal suctioning. Seventy-three per cent reported using nebulized therapies. 55.6% reported having preprinted order sheets or guidelines for management of inpatient bronchiolitis at their institutions and 28.2% reported having specific discharge criteria. The length of time required to be off oxygen prior to discharge varied (31% at 12 hours, 27.5% at 24 hours, and 24.6% after the last sleep period without oxygen). Conclusion There is significant practice variation in the monitoring, treatment, and discharge of children hospitalized with bronchiolitis within and between Canadian paediatric teaching hospitals. Future research is needed to establish best practices, effective knowledge translation, and implementation strategies to standardize care and decrease length of stay.

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Characterization of self-reported communication disorders in elderly women living in Manaus, state of Amazonas, Brazil

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1809-9823.2014.13177 ◽

2014 ◽

Vol 17 (3) ◽

pp. 485-495 ◽

Cited By ~ 1

Author(s):

Karla Geovanna Moraes Crispim ◽

Aldo Pacheco Ferreira ◽

Terezinha Lima Silva ◽

Euler Esteves Ribeiro

Keyword(s):

Hearing Loss ◽

Elderly Women ◽

Descriptive Analysis ◽

Communication Disorders ◽

Cross Sectional Study ◽

Categorical Variables ◽

Continuous Variables ◽

Cross Sectional ◽

Significance Level ◽

Frequency Distributions

OBJECTIVES: Characterize self-reported communication disorders highlighting the association between variables of health conditions, socio-demographic factors, lifestyle, hearing loss and diseases in an elderly group. METHODS: Cross-sectional study conducted from August to December 2012, with 159 women aged 60 or more, recruited at UnATI/UEA (University of the Third Age, University of the State of Amazonas), Manaus, Amazonas State, Brazil. The subjects were interviewed and asked for self-reported communications disorders. Descriptive analysis was performed using central tendency and dispersion measures for continuous variables and frequency distributions for categorical variables and the prevalence of self-reported language disorders was estimated. To verify the presence of statistically significant differences it was used χ2, considering the significance level of 5% (p≤0.05). RESULTS: Communication disorders were reported by 8.18% of elderly women. The following deficits were reported: intelligibility (6.92%), oral comprehension (10.69%), lexical access (10.69%), and recent memory (38.36%). Reading and writing difficulties were informed by 5.66% and 6.92%, respectively. Among the illiterate group, 20% declared communication disorders, while the literate group, 8.44%. Statistical association was verified between communication disorders and self-reported hearing loss (p=0.03). Association was not detected between communication disorders and diseases. CONCLUSIONS: Considering the diversity of communication disorders within this population, further studies are needed to assess if changes occur at the aging process and how they work so that possibilities for prevention can be discussed.

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Evaluation of a Breastmilk Hand Expression Toolkit: The M.I.L.K Survey Study

10.21203/rs.3.rs-565356/v1 ◽

2021 ◽

Author(s):

Kameela Miriam Alibhai ◽

Malia SQ Murphy ◽

Sandra Dunn ◽

Erin Keely ◽

Paloma O’Meara ◽

...

Keyword(s):

Information Seeking ◽

Implementation Strategies ◽

Sociodemographic Factors ◽

Survey Study ◽

Future Research ◽

Educational Resource ◽

Continuous Variables ◽

Breastfeeding Practices ◽

Obstetrical Patient ◽

Informational Value

Abstract Background: Breastmilk hand expression (BMHE) is recommended to promote lactation, relieve breast engorgement, and collect milk for future infant feedings. Resources to teach this skill are limited and infrequently developed in partnership with the obstetrical population. In collaboration with maternity care experts and individuals with recent breastfeeding experience, we designed a one-page toolkit that describes the process of BMHE and includes step-by-step instructions and images to illustrate the technique. This study aimed to evaluate the readability, clarity of content, layout, and informational value of this BMHE toolkit. Methods: Individuals who intended to breastfeed, were currently breastfeeding, or had recently breastfed were electronically surveyed between November 2020 and March 2021. The two-part survey consisted of radio, multi-select, Likert scale, and open-ended questions. Part one captured sociodemographic factors, obstetrical history, and breastfeeding practices. Part two collected feedback on the BMHE toolkit. Participant characteristics and feedback were summarized using descriptive statistics. Categorical and continuous variables were summarized using frequencies and percentages, and means and standard deviations, respectively. Results: Of the 123 participants, 117 (95.1%) had heard of hand expression prior to reviewing the toolkit and 99 (80.5%) had hand expressed before. Among the 48 participants who were no longer exclusively breastfeeding at the time of the survey, 22 (45.8%) had exclusively breastfed their infant for at least six months and 7 (14.6%) had discontinued exclusive breastfeeding within the first month. When asked about the BMHE toolkit, 118 (95.9%) participants said it was informative, 115 (93.5%) said it was easy to understand, and 114 (92.7%) said it was well laid-out. When asked about information seeking behaviours, participants indicated a preference for online resources (58.5%) and video resources (22.0%).Conclusion: The BMHE toolkit was well received by participants and the feedback was favourable overall. The survey feedback will be used to create a revised version of the toolkit that has been validated by the obstetrical patient population. Future research should focus on identifying implementation strategies to optimize the use of the toolkit and increase its effectiveness as an educational resource to correctly teach BMHE.

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Surgeons’ Attitudes About Use of Preoperative Risk Assessment Tools

10.21203/rs.3.rs-1075088/v1 ◽

2021 ◽

Author(s):

Nisha Pradhan ◽

Adam R. Dyas ◽

Michael R. Bronsert ◽

Anne Lambert-Kerzner ◽

William G. Henderson ◽

...

Keyword(s):

Risk Assessment ◽

Significant Risk ◽

Improve Patient Care ◽

Assessment Tools ◽

Perioperative Outcomes ◽

Categorical Variables ◽

Continuous Variables ◽

Tertiary Referral Hospital ◽

Frequency Distributions ◽

Risk Assessment Tools

Abstract Background: Formal surgical risk assessment tools have been developed to predict risk of adverse postoperative patient outcomes. Such tools accurately predict common postoperative complications, inform patients and providers of likely perioperative outcomes, guide decision making, and improve patient care. However, these are underutilized. We studied the attitudes towards and techniques of how surgeons preoperatively assess risk.Methods: 108 surgical faculty, 95 surgical residents, and 58 affiliate surgeons at a large academic tertiary referral hospital and affiliate community hospitals were emailed a 16-question survey between 8/2019-6/2020. Surveys were analyzed using descriptive statistics (frequency distributions and percentages for categorical variables, means, and standard deviations for continuous variables), and Fisher’s exact test and unpaired t-tests comparing responses by surgical attendings vs. residents.Results: Overall response rates were 50.0% for faculty surgeons, 47.4% for residents, and 36.2% for affiliate surgeons. Only 20.8% of surgeons used risk calculators most or all of the time. Attending surgeons were more likely to use prior experience and current literature while residents used risk calculators more frequently. Risk assessment tools were more likely to be used when predicting major complications and death in older patients with significant risk factors. Greatest barriers for use of risk assessment tools included time, inaccessibility, and trust in accuracy.Conclusions: Even though risk assessment tools are available, few surgeons use them as part of their routine practices. Developers of the tools need to design the tools to better promote the positive features and to avoid the burdens commonly reported by users.

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Abstract TP318: The Hospital Level Variation in Interhospital Transfer in Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp318 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Murali K Kolikonda ◽

Anne S Tang ◽

Jesse D Schold ◽

Ken Uchino ◽

Shumei Man

Keyword(s):

Ischemic Stroke ◽

Low Flow ◽

Teaching Hospitals ◽

Categorical Variables ◽

Fee For Service ◽

Continuous Variables ◽

American Hospital ◽

American Hospital Association ◽

Hospital Size ◽

Interhospital Transfer

Background: Interhospital transfer of patients with stroke to higher level of care is a resource intensive practice. This study aimed to understand the patterns of interhospital transfer in the context of hospital characteristics. Methods: This study included Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized in 2012 for ischemic stroke and underwent interhospital transfers. The data obtained from the American Hospital Association Annual Survey were linked to the 2012 Medicare inpatient and outpatient files. This study included patients admitted to the hospitals which were categorized as “general hospitals” with emergency departments. Hospitals were classified into receiving (high transfer in rate), sending (high transfer out rate), low flow (low transfer in or out rates), and high flow (both high transfer in and out) hospitals. Pearson’s chi-square tests were used for categorical variables and Wilcoxon Rank-Sum tests for continuous variables. Results: Interhospital transfers for ischemic stroke occurred in 2876 out of 4198 hospitals (68.5%), and 5.7% of ischemic stroke admissions (19,283 of 338,306 admissions). Using national average of 5.7% as cut off, the four hospital groups : 411 receiving hospitals (14.3%), 559 sending hospitals (19.4%), 1863 low-flow hospitals (64.8%). Receiving hospitals were larger than low-flow and sending hospitals by the number of beds (Median 371, 189, and 88, respectively, p<0.001) and by annual stroke volume (median 205, 86, and 26, respectively, p<0.001). The majority of receiving (75%) and low-flow hospitals (54%) were in the Metropolitan area, while sending hospital were more evenly distributed in both urban and rural area. Higher proportion of teaching hospitals were in receiving hospitals(28%) compared to low-flow(6%) and sending hospitals (1%) with p<0.001. Higher proportion of receiving (75%) and low-flow (47%) hospitals were certified stroke centers, compared to sending hospitals (16%) with p<0.001. Conclusions: The national patterns of interhospital transfer for ischemic stroke varies depending on the hospital size, geographical location, academic status, and stroke certification. Further study of the associated outcomes will aid in health care resource utilization.

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Genetic testing patterns for homologous recombination repair (HRR) alterations in patients with metastatic prostate cancer (mPC): An assessment at the University of Rochester (UR).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.322 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 322-322

Author(s):

Kerry Schaffer ◽

Kaitlin Kyi ◽

Carol Lustig ◽

Deepak M. Sahasrabudhe ◽

Michelle Shayne ◽

...

Keyword(s):

Genetic Testing ◽

Hospice Care ◽

Categorical Variables ◽

Future Research ◽

Continuous Variables ◽

Exact Test ◽

Nccn Guidelines ◽

Clinically Significant ◽

The University ◽

Testing Patterns

322 Background: Germline and somatic HRR alterations are present in 12% and 20% of patients with mPC, respectively, and can have treatment implications. NCCN guidelines recommend offering genetic testing for patients with mPC. This study examines genetic testing patterns in patients with mPC at UR. Methods: We conducted a retrospective study of all patients (n = 240) with mPC who saw medical oncology at UR from 10/1/2017 to 4/1/2018. We abstracted the following data from medical records: patient demographics, mPC characteristics, types of genetic testing, and clinically significant (CS) HRR alterations as defined by Myriad, Ambry, and Foundation One. To compare characteristics of patients who had genetic testing to those who did not, we used non-parametric Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables. Results: The median age at mPC diagnosis was 71 years (range: 42-93 years), 86.3% were white, and 35% had mPC at initial diagnosis. 64 patients (26.7%) were offered genetic testing and 40 patients (16.7%) completed germline (n = 12), somatic (n = 21), or both germline and somatic genetic testing (n = 7). Median time from diagnosis of mPC to germline and somatic genetic testing were 9 months and 35 months, respectively. Among the 24 patients who were offered, but did not have testing, the reasons were: patients’ refusal (n = 10), death/hospice care (n = 7), insurance issue (n = 3), patient’s preference to have somatic testing at disease progression (n = 3), and missed genetic counseling visit (n = 1). Compared to patients who did not have genetic testing, those who had testing were younger at the time of mPC diagnosis (63.5 vs 73.0 years; p < 0.0001). CS HRR alterations were identified in 8 of 40 patients tested (20%): somatic HRR alterations include BRCA2 (n = 2), ATM (n = 1), CDK 12 (n = 1), and C HEK2 (n = 1); germline HRR alterations include BRCA2 (n = 2) and CHEK2 (n = 1). Conclusions: We report that approximately one-fourth of patients with mPC at UR had genetic testing offered, with a 20% prevalence of HRR alterations in those tested. Future research should develop strategies to address barriers to genetic testing.

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Identification of functional missense single-nucleotide polymorphisms in TNFAIP3 in a predominantly Hispanic population

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.3 ◽

2018 ◽

Vol 2 (6) ◽

pp. 350-355 ◽

Cited By ~ 1

Author(s):

Bing Zhang ◽

Brooke Naomi Nakamura ◽

Aryeh Perlman ◽

Omeed Alipour ◽

Sadeea Qureshi Abbasi ◽

...

Keyword(s):

Point Mutation ◽

Luciferase Reporter ◽

Categorical Variables ◽

Future Research ◽

Continuous Variables ◽

Necrosis Factor Alpha ◽

Single Nucleotide ◽

Predominantly Hispanic ◽

Potential Biomarker

AbstractBackground:Tumor necrosis factor alpha-induced protein 3 (TNFAIP3) is a multifunctional ubiquitin binding and editing enzyme that regulates inflammation. Genetic studies have implicated polymorphisms within the TNFAIP3 locus to the development of numerous immune-related diseases. This study evaluated the frequencies of single-nucleotide polymorphism (SNPs) within the exonic regions of the TNFAIP3 gene and an associated point mutation from the Illumina array among a predominantly Hispanic cohort.Methods:Genomic DNA was obtained from 721 participants and sequencing of all TNFAIP3 exons and an intergenic point mutation (rs6920220) was performed. In-vitro functional assessment was performed by transfecting mutated TNFAIP3 constructs into TNFAIP3 knockout cells containing the NF-kB luciferase reporter and stimulating with TNFα. Comparative statistics were performed with Student’s t-test for continuous variables and chi-squared test for categorical variables.Results:Sequencing revealed two missense SNPs, rs146534657:A>G and rs2230926:T>G, both within exon 3 of TNFAIP3, which encodes the protein’s deubiquitinating enzymatic domain. Frequencies of all three point mutations differed significantly across racial groups (χ2-test, P = 0.014 to P < 0.001). Compared to Caucasians, rs146534657:A>G was overrepresented among Hispanics (odds ratio (OR) [95% CI] 4.05 [1.24−13.18]), and rs2230926:T>G was more prevalent among African-Americans (OR [95% CI] 3.65 [1.58−8.43]). In-vitro assays confirm rs146534657:A>G and rs2230926:T>G decrease the ability of TNFAIP3 to abrogate NF-κB activation by 2-fold (P < 0.01) and 1.7-fold (P < 0.01), respectively.Conclusions:This study reports the frequency of rs146534657:A>G among Hispanics and is the first to evaluate its potential physiologic impact, establishing a basis for future research as a potential biomarker among this population.

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Gene Polymorphism in Five Target Genes of Immunosuppressive Therapy and Risk of Development of Preeclampsia

Healthcare ◽

10.3390/healthcare9070821 ◽

2021 ◽

Vol 9 (7) ◽

pp. 821

Author(s):

Francesca Previtera ◽

Stefano Restaino ◽

Giulio Romano ◽

Giuseppe Vizzielli ◽

Andrea Neri ◽

...

Keyword(s):

Target Genes ◽

Transplant Rejection ◽

Organ Transplant ◽

Interleukin 10 ◽

Categorical Variables ◽

Future Research ◽

Nucleotide Polymorphisms ◽

Continuous Variables ◽

Significant Difference ◽

Student’S T

Pregnancy can be considered as an allogeneic transplant and preeclampsia can be seen as a failure of the acceptance mechanisms of this transplant as occurs in acute organ transplant rejection. Some genetic polymorphisms may be involved in its pathogenesis. Since the kidney is one of the organs mainly involved in preeclampsia, our study attempted to determine the frequencies of single nucleotide polymorphisms of DNA (SNP) in 3 genes (adenosine triphosphate-binding cassette sub-family B member 1 (ABCB1)/multi drug reactivity 1 (MDR1) gene, interleukin 10 gene and tumor necrosis factor α gene) which are targets of immunosuppressive therapies and related to acute renal rejection. The study was an observational, monocentric, case-control study. We enrolled 20 women with severe preeclampsia and 10 women age-matched with regular pregnancy. Continuous variables were compared by the Student’s t- test for independent variables or using the Mann-Whitney test depending on their distribution. We used Fisher test to compare categorical variables between cases and controls, while we used logistic regression model to evaluate which risk factor was associated with preeclampsia. Although there was no statistically significant difference between the two groups, we found different percentages of two of the polymorphisms considered (rs1045642 and rs2032582 in the gene ABCB1). Despite these results, our work may be helpful for future research to better understand the pathogenesis of preeclampsia.

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Moving From Interprofessional Education Toward Interprofessional Practice: Bridging the Translation Gap

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig10-2018-0020 ◽

2019 ◽

Vol 4 (5) ◽

pp. 971-976

Author(s):

Imran Musaji ◽

Trisha Self ◽

Karissa Marble-Flint ◽

Ashwini Kanade

Keyword(s):

Interprofessional Education ◽

Interprofessional Collaboration ◽

Evaluation Model ◽

Implementation Strategies ◽

Future Research ◽

Successful Implementation ◽

Interprofessional Practice ◽

Translational Model ◽

Key Stakeholders ◽

Clear Identification

Purpose The purpose of this article was to propose the use of a translational model as a tool for identifying limitations of current interprofessional education (IPE) research. Translational models allow researchers to clearly define next-step research needed to translate IPE to interprofessional practice (IPP). Method Key principles, goals, and limitations of current IPE research are reviewed. A popular IPE evaluation model is examined through the lens of implementation research. The authors propose a new translational model that more clearly illustrates translational gaps that can be used to direct future research. Next steps for translating IPE to IPP are discussed. Conclusion Comprehensive reviews of the literature show that the implementation strategies adopted to date have fostered improved buy-in from key stakeholders, as evidenced by improved attitudes and perceptions toward interprofessional collaboration/practice. However, there is little evidence regarding successful implementation outcomes, such as changed clinician behaviors, changed organizational practices, or improved patient outcomes. The authors propose the use of an IPE to IPP translational model to facilitate clear identification of research gaps and to better identify future research targets.

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Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes

Journal of Neurosurgery ◽

10.3171/2018.12.jns182093 ◽

2020 ◽

Vol 132 (3) ◽

pp. 692-699 ◽

Cited By ~ 1

Author(s):

Sarah K. Bick ◽

Marjan S. Dolatshahi ◽

Benjamin L. Grannan ◽

Andrew J. Cole ◽

Daniel B. Hoch ◽

...

Keyword(s):

Minimally Invasive ◽

Treatment Decision ◽

Temporal Lobectomy ◽

Categorical Variables ◽

Continuous Variables ◽

Foramen Ovale ◽

Mri Findings ◽

Noninvasive Methods ◽

Diagnostic Modality ◽

Diagnostic Investigations

OBJECTIVEForamen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure.METHODSAll cases of diagnostic investigations performed with FOEs at the authors’ institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables.RESULTSNinety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018).CONCLUSIONSFOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.

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Small Choroidal Melanoma: Correlation of Growth Rate with Pathology

Ocular Oncology and Pathology ◽

10.1159/000517203 ◽

2021 ◽

pp. 1-10

Author(s):

Vishal Raval ◽

Shiming Luo ◽

Emily C. Zabor ◽

Arun D. Singh

Keyword(s):

Growth Rate ◽

Retinal Pigment ◽

Choroidal Melanoma ◽

Case Series ◽

Subretinal Fluid ◽

Categorical Variables ◽

Continuous Variables ◽

Basal Diameter ◽

Orange Pigment ◽

Rpe Atrophy

Purpose: The aim of the study was to evaluate equivalence of growth rate and pathologic confirmation in small choroidal melanoma (SCM). Design: This study is a case series. Subjects, Participants, and Controls: A total of 61 patients with a choroidal melanocytic tumor of size 5.0–16.0 mm in the largest basal diameter and 1.0–2.5 mm in thickness were classified into the pathology-confirmed group (n = 19), growth-confirmed group (n = 30), and with combined observations (n = 12). Methods: Distribution of clinical variables (age, gender, laterality, tumor dimensions, tumor location, and presence of orange pigment, subretinal fluid, drusen, and retinal pigment epithelial [RPE] atrophy) between the groups was analyzed. Patient and disease characteristics were summarized as the median and interquartile range for continuous variables and the frequency and percentage for categorical variables. Comparisons were made using the Wilcoxon rank sum test for continuous variables and either Fisher’s exact test or the χ2 test for categorical variables with a p value threshold of 0.05 for statistical significance. Growth rate (change in basal dimension/12 months) diagnostic of SCM was quantified. Main Outcome Measures: The primary aim of this study was to test the hypothesis that “growth” was diagnostic of SCM with the secondary aim of quantifying the malignant “growth rate” (growth rate of SCM). Results: The clinical characteristics among all 3 groups were similar except more patients with symptoms (68 vs. 20 vs. 42%, p = 0.004) and juxtapapillary location (p = 0.03) were in the pathology group than in the growth-confirmed group. Those in the combined and growth-confirmed groups had more patients with drusen (11 vs. 60 vs. 50%, p = 0.003) and RPE atrophy (11 vs. 23 vs. 67%, p = 0.003), respectively, than in the pathology group. The median time to detect growth was 9 months (range 3–26 months). The mean growth rate in basal dimension was 1.8 mm/12 months (range, 0.0–7.4 mm; [95% CI: 1.32–2.28]). Conclusions and Relevance: Choroidal melanocytic lesions exhibiting a defined growth rate can be clinically diagnosed as SCM without a need for biopsy.

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