Decreased Tongue Volume Post Radiation

Objectives: To evaluate volume changes within the tongue post chemoradiation therapy (CRT) Study Design: Retrospective review Setting: Academic Medical Center Subjects and Methods: Subjects included 19 patients that received CRT as the primary treatment for tonsillar or hypopharynx squamous cell carcinoma. Tongue volumes were calculated by three raters from thin slice computed tomography images collected before treatment and up to 29 months post-CRT. Body mass index (BMI) was also collected at each time point. Results: Inter-rater reliability was high with an ICC of 0.849 (95% CI = 0.773, 0.905). Linear mixed effects modeling showed a mean decrease of 0.45 cm3 (standard error of the mean [SEM] = 0.11) in tongue volume per month post-CRT ( P < .001). However, the addition of BMI to the model was significant (χ2 (4) = 25.0, P < .001), indicating that BMI was a strong predictor of tongue volume, with a mean decrease of 1.75 cm3 (SEM = 0.49) in tongue volume per unit decrease in BMI ( P < .001) and reducing the post-CRT effect on tongue volume decrease per month to 0.23 cm3 ( P = .02). BMI significantly ( P < .001) decreased by 0.11 units (SEM = 0.02) per month post radiation. Conclusion: Tongue dysfunction and decreased tongue strength are significant contributors to the dysphagia that patients experience after receiving CRT. In this study, both tongue volume and BMI decreased post-CRT; therefore, BMI could potentially be used as a predictor of tongue volume post-CRT.

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Body composition, fitness, and eating behaviors deteriorate during the COVID-19 pandemic in at-risk pediatric patients

Medical Research Archives ◽

10.18103/mra.v9i8.2540 ◽

2021 ◽

Vol 9 (8) ◽

Author(s):

Cassandra Vanderwall ◽

Jens Eickhoff ◽

R Clark ◽

Aaron Carrel

Keyword(s):

Body Composition ◽

Body Fat ◽

Eating Behaviors ◽

Pediatric Patients ◽

Disease Risk ◽

Medical Center ◽

Academic Medical Center ◽

Z Score ◽

Mixed Effects Modeling ◽

Total Fat

The COVID-19 pandemic has significantly altered children's daily routines. The health impacts of our obesogenic environment are exacerbated by COVID-19. Many clinicians have concerns that the lack of structured activity, increased stress and altered eating behaviors would lead to increases in adiposity in children. The present study examined changes in body composition as a result of the COVID-19 pandemic in pediatric patients in larger bodies and demonstrates significant increases in total body fat, percent body fat (%fat), and BMI z-score, as well as markers of insulin resistance. In this retrospective, longitudinal study, body composition was measured by dual energy x-ray absorptiometry (DXA) within a multidisciplinary pediatric fitness clinic at an academic medical center. Visit dates were categorized into Pre-COVID-19 (before 4/1/2020) and Peri-COVID-19 (on or after 4/1/2020). Linear mixed effects modeling was conducted to evaluate changes in clinical and laboratory outcomes from Pre- to Peri-COVID-19. Baseline assessment was obtained from 650 patients with higher BMI scores (52% male) with a mean (SD) age of 12.3 (3.2) years. The adjusted mean BMI z-score (BMIz) was significantly higher in the Peri-COVID-19 sample when compared to the Pre-COVID-19 samples (2.31 vs. 2.25, P < 0.0001) which can be attributed to greater total fat mass (TFM) of 93.0 (90.0-96.4) lbs. (P = 0.007) and %FAT of 40.2% (39.2-41.2) as compared to the Pre-COVID-19 patients. The COVID-19 pandemic influenced social determinants and lifestyle factors. Most notable changes observed were negative changes in physical activity and screen time. The need for social isolation in a pandemic has resulted in worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. The COVID-19 pandemic exerts disproportionate burden on children and families, magnifying their vulnerability to changes in body composition and chronic disease risk.

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Make writing a daily habit: An evaluation of an educational intervention to improve writing self-efficacy among DNP students

Journal of Nursing Education and Practice ◽

10.5430/jnep.v12n1p49 ◽

2021 ◽

Vol 12 (1) ◽

pp. 49

Author(s):

Pearman D. Parker ◽

Elizabeth Riley ◽

Leonie C. DeClerk ◽

Sharon B. Stevenson ◽

Pamela V. DeGravelles ◽

...

Keyword(s):

Self Efficacy ◽

Medical Center ◽

Clinical Care ◽

Academic Medical Center ◽

Real Life ◽

Student Body ◽

Writing Curriculum ◽

Mixed Effects Modeling ◽

Significant Difference ◽

Post Test

Background and objective: Doctorate of Nursing Practice (DNP) students are trained to integrate both clinical care and evidence-based research in order to bring together science with application. However, the educational pathways in DNP programs can be problematic, especially with regards to scholarly writing. While several interventions have been utilized for DNP students, the results show that the intervention(s) used should be tailored to the specific student body being served. However, limited evidence exists regarding the effectiveness of tailored interventions on improving central concepts such as writing self-efficacy. Given these differences in the design and delivery of the DNP curricula, we created a tailored educational-writing curriculum for new DNP students at a medium-sized academic medical center in a Southern state.Methods: We assessed changes in writing self-efficacy over the three measurement intervals using linear mixed effects modeling to account for within-student clustering of writing self-efficacy scores over time.Results: Baseline scores of writing self-efficacy improved immediately after the workshop (Timepoint 2 – immediate post-test) and a full semester later (Timepoint 3 – semester post-test). However, we observed no statistically significant difference between Timepoint 2 (immediate post-test) and Timepoint 3 (semester post-test).Conclusions: We saw a significant benefit in writing self-efficacy among incoming DNP students from baseline scores. The tailored format and integration of real-life anecdotal feedback from faculty may have been fundamental to creating an increase in writing self-efficacy among students—a concept foundational to student, and possibly professional, nursing success.

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Pre-test symptom duration and cycle threshold values for SARS-CoV-2 reverse transcription-PCR (RT-PCR) predict COVID-19 mortality

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab003 ◽

2021 ◽

Author(s):

Emily Happy Miller ◽

Jason Zucker ◽

Delivette Castor ◽

Medini K Annavajhala ◽

Jorge L Sepulveda ◽

...

Keyword(s):

Viral Load ◽

Symptom Onset ◽

Medical Center ◽

Strong Predictor ◽

Academic Medical Center ◽

Patient Characteristics ◽

Symptom Duration ◽

Rt Pcr ◽

Duration Of Symptoms ◽

The Impact

Abstract Background The relationship between SARS-CoV-2 viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with COVID-19. Methods We conducted an observational study between March 10–May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N=16,384), there were 5,467 patients with positive tests, of which 4,254 had available Ct values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms prior to testing, patient characteristics and mortality. The primary outcome is defined as death or discharge to hospice. Results Lower Ct values at diagnosis (i.e. higher viral load) were associated with significantly higher mortality among both in- and out-patients. Interestingly, patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than three days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality. Conclusions SARS-CoV-2 RT-PCR Ct value and duration of symptoms are strongly associated with mortality. These two factors add useful information for clinicians to risk stratify patients presenting with COVID-19.

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Reduction in goiter size by 131I therapy in patients with non-toxic multinodular goiter

Acta Endocrinologica ◽

10.1530/eje.0.1320086 ◽

1995 ◽

Vol 132 (1) ◽

pp. 86-87 ◽

Cited By ~ 38

Author(s):

Maria F Wesche ◽

Monique M Tiel-v-Buul ◽

Nico J Smits ◽

Wilmar M Wiersinga

Keyword(s):

Subclinical Hypothyroidism ◽

Multinodular Goiter ◽

Medical Center ◽

Academic Medical Center ◽

Thyroid Volume ◽

Academic Medical ◽

Toxic Multinodular Goiter ◽

Post Radiation ◽

Toxic Goiter

Wesche MF, Tiel-v-Buul MM, Smits NJ, Wiersinga WM. Reduction in goiter size by 131I therapy in patients with non-toxic multinodular goiter. Eur J Endocrinol 1995;132:86–7. ISSN 0804–4643 A retrospective follow-up study of 131I treatment was performed in 10 females (median age 48 years, range 40–74 years) with non-toxic multinodular goiter. The median dose of 131I given was 20 mCi (range 14–65 mCi). Thyroid volume was measured by ultrasonography. The median follow-up period was 26 months (range 12–68 months). Nine patients had a reduction of goiter size: thyroid volume decreased from 88 ± 14.9 ml (mean±sem) to 49 ± 10.9 ml 1 year after 131I treatment. The relative decrease of goiter size was 48% after 1 year (N = 9) and 59% after 2 years (N = 5). One patient did not respond and was referred for operation. Side effects were mild spontaneously resolving radiation thyroiditis in one patient and subclinical hypothyroidism in four patients. In conclusion, 131I treatment of non-toxic goiter is an effective treatment at the expense of post-radiation (subclinical) hypothyroidism. Maria F Wesche, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

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Facility Placement as a Barrier to Hospice for Older Adult Patients Discharged From a Palliative Care Unit

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118791149 ◽

2018 ◽

Vol 36 (2) ◽

pp. 93-96

Author(s):

Myrick C. Shinall ◽

Jo Ellen Wilson ◽

Mohana Karlekar ◽

E. Wesley Ely

Keyword(s):

Palliative Care ◽

Life Expectancy ◽

Older Patients ◽

Hospice Care ◽

Medical Center ◽

Strong Predictor ◽

Academic Medical Center ◽

Multivariate Logistic Regression Analysis ◽

Palliative Care Unit ◽

Facility Placement

Context: Many older adults discharged from an inpatient stay require postacute facility placement, which can be a barrier to hospice enrollment since the Medicare hospice benefit does not cover facility costs for patients under routine hospice care. Objectives: To evaluate the extent to which need for postdischarge facility care was a barrier to hospice enrollment for older patients with short life expectancy discharged from a palliative care unit. Methods: Retrospective cohort using a prospectively collected database of patients 65 and older with a life expectancy of <6 months admitted to a palliative care unit in an urban, academic medical center and discharged alive from 2012 to 2017. Primary outcome was hospice enrollment at hospital discharge. Exposure of interest was need for facility placement at discharge. Results: Of 817 included patients, 649 (79%) were discharged with hospice. Patients discharged home had a significantly higher rate of hospice enrollment than patients discharged to a facility—92% versus 71% ( P < .0001). On multivariate logistic regression analysis, discharge to home versus facility remained a strong predictor of hospice enrollment, with an odds ratio for hospice enrollment of 6.04 (95% confidence interval: 3.73-9.79). Conclusion: Need for postdischarge facility placement represents a barrier for hospice enrollment among older patients who are otherwise hospice appropriate. The structure of the hospice benefit may require modification so that these hospice appropriate patients can utilize the benefit.

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