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Recent Research Articles from JPS Health Network

Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system.

Tue, 12/29/2020 - 05:56
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Knowledge needs for implementing HIV pre-exposure prophylaxis among primary care providers in a safety-net health system.

Prev Med Rep. 2020 Dec;20:101266

Authors: Agovi AM, Anikpo I, Cvitanovich MJ, Craten KJ, Asuelime EO, Ojha RP

Abstract
Safety-net health systems are a primary source of care for socioeconomically disadvantaged individuals who may be eligible for HIV pre-exposure prophylaxis (PrEP) and are priority groups under the Ending the HIV Epidemic (EHE) initiative. Nevertheless, little evidence is available about barriers to PrEP implementation in safety-net settings. We aimed to assess the association between PrEP knowledge and prescribing practices, and to ascertain unmet knowledge needs to implement PrEP. In 2019, we surveyed primary care providers (PCPs) in a safety-net health system that serves an EHE priority jurisdiction located in North Texas. Our questionnaire ascertained self-reported prescribing practices, knowledge, and training needs related to PrEP. We used penalized logistic regression to estimate odds ratio (OR) and 95% posterior limits (PL) for the association between provider self-rated knowledge of PrEP and PrEP prescribing. Our study population comprised 62 primary care providers, of whom 61% were female, 60% were non-Hispanic White, 76% were physicians (76%), 57% had ≥ 10 years of practice experience, 45% reported low self-rated PrEP knowledge, and 35% prescribed PrEP in the past year. Providers with low PrEP knowledge had 69% lower odds of prescribing PrEP within the past year (OR = 0.31, 95% PL: 0.12, 0.82). Eligibility for PrEP, side effects and adherence concerns were key unmet knowledge needs. Our findings suggest that low provider PrEP knowledge may be a barrier to PrEP prescribing among safety-net PCPs. Our results provide insight about specific educational needs of PCPs in a safety-net health system, which are amenable to educational intervention.

PMID: 33364148 [PubMed]

Is there a Neurobiological Rationale for the Utility of the Iowa Gambling Task in Parkinson's Disease?

Tue, 12/29/2020 - 05:56
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Is there a Neurobiological Rationale for the Utility of the Iowa Gambling Task in Parkinson's Disease?

J Parkinsons Dis. 2020 Dec 23;:

Authors: Salvatore MF, Soto I, Alphonso H, Cunningham R, James R, Nejtek VA

Abstract
Up to 23% of newly diagnosed, non-demented, Parkinson's disease (PD) patients experience deficits in executive functioning (EF). In fact, EF deficits may occur up to 39-months prior to the onset of motor decline. Optimal EF requires working memory, attention, cognitive flexibility, and response inhibition underlying appropriate decision-making. The capacity for making strategic decisions requires inhibiting imprudent decisions and are associated with noradrenergic and dopaminergic signaling in prefrontal and orbitofrontal cortex. Catecholaminergic dysfunction and the loss of noradrenergic and dopaminergic cell bodies early in PD progression in the aforementioned cortical areas likely contribute to EF deficits resulting in non-strategic decision-making. Thus, detecting these deficits early in the disease process could help identify a significant portion of individuals with PD pathology (14-60%) before frank motor impairment. A task to evaluate EF in the domain of non-strategic decision-making might be useful to indicate the moderate loss of catecholamines that occurs early in PD pathology prior to motor decline and cognitive impairment. In this review, we focus on the potential utility of the Iowa Gambling Task (IGT) for this purpose, given significant overlap between in loss of dopaminergic and noradrenergic cells bodies in early PD and the deficits in catecholamine function associated with decreased EF. As such, given the loss of catecholamines already well-underway after PD diagnosis, we evaluate the potential utility of the IGT to identify the risk of therapeutic non-compliance and a potential companion approach to detect PD in premotor stages.

PMID: 33361612 [PubMed - as supplied by publisher]

Simple Nephrectomy in a Tertiary Care Safety Net Hospital - Patient Characteristics, Causes, Cost, and Renal Function Implications.

Tue, 12/29/2020 - 05:56
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Simple Nephrectomy in a Tertiary Care Safety Net Hospital - Patient Characteristics, Causes, Cost, and Renal Function Implications.

Urology. 2020 Dec 23;:

Authors: Ames KS, Baky F, Blair S, Sanchez J, Franklin W, Barefoot A, Mears J, Magness P, Johnson B, Bakare T, Hudak S, Antonelli J, Hutchinson R, Lotan Y, Woldu SL

Abstract
OBJECTIVE: To evaluate factors associated with simple nephrectomy at a safety net hospital with a diverse patient population and large catchment area. Simple nephrectomy is an underreported surgery. Performance of simple nephrectomy may represent a failure of management of underlying causes.
METHODS: We performed a retrospective review of simple nephrectomies performed at a major urban safety net hospital from 2014-2019. Detailed demographic, surgical, and renal functional outcomes were abstracted. We assessed the medical and social factors leading to performance of simple nephrectomy and report contemporaneous perception of preventability of the simple nephrectomy by the surgeon.
RESULTS: 85 patients underwent simple nephrectomy during the study period; 55% were non-white, 77% were women, and the median age at time of surgery was 46 years. The most common medical factors contributing to simple nephrectomy were stone disease in 55.3%, followed by retained ureteral stent (30.6%) and stricture (30.6%). The most common social factors were lack of insurance (58.5%), substance abuse issues (32.3%), mental health issues (24.6%), and immigration status (18.5%). In 38.8% of cases, the provider felt the surgery was preventable if medical factors leading to simple nephrectomy were properly addressed.
CONCLUSIONS: Simple nephrectomy is a common surgery in the safety net hospital setting. Both medical and sociologic factors can lead to simple nephrectomy, and awareness of these factors can lead efforts to mitigate them. This review has led to the implementation of strategies to minimize occurrences of retained stents in our patients.

PMID: 33359487 [PubMed - as supplied by publisher]

A Systematic Review of Mindfulness Practices for Improving Outcomes in Chronic Low Back Pain.

Tue, 12/22/2020 - 05:51
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A Systematic Review of Mindfulness Practices for Improving Outcomes in Chronic Low Back Pain.

Int J Yoga. 2020 Sep-Dec;13(3):177-182

Authors: Smith SL, Langen WH

Abstract
Background: Chronic pain is a serious public health problem that affects people of all ages and backgrounds. Mindfulness-based stress reduction (MBSR) techniques offer an accessible treatment modality for chronic pain patients that may complement or replace pharmacological treatment. This article reviews the literature on the efficacy of MBSR training in patients with back chronic pain syndromes for the outcomes of pain measures, quality of life (QOL), mental health, and mindfulness.
Methods: A systemized search was conducted in September of 2018 for studies published between 2008 and 2018 on mindfulness and chronic low back pain. Out of 50 articles on mindfulness and chronic pain, 12 empirical studies were selected for the inclusion in this review.
Results: Subjective pain scores and QOL improved for chronic pain patients after mindfulness interventions, compared to control groups, in most of the studies reviewed. Limitations of the studies reviewed included the varied pain measurement instruments, the small sample sizes, and the inability to blind participants to MBSR intervention.
Conclusions: MBSR interventions show significant improvements in chronic pain patients for pain measures, QOL, and mental health.

PMID: 33343146 [PubMed]

Beta Blockers for Suspected or Diagnosed Acute Myocardial Infarction.

Tue, 12/01/2020 - 07:36
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Beta Blockers for Suspected or Diagnosed Acute Myocardial Infarction.

Am Fam Physician. 2020 Dec 01;102(11):666-667

Authors: LeFevre NM, Mischel N

PMID: 33252901 [PubMed - as supplied by publisher]

Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

Fri, 11/27/2020 - 05:13
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Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study.

Emerg Med J. 2020 Nov 25;:

Authors: Byrd J, Knowles H, Moore S, Acker V, Bell S, Alanis N, Zhou Y, d'Etienne JP, Kline JA, Wang H

Abstract
BACKGROUND: Physician empathy and burnout have been shown to be independently associated with patient satisfaction. However, their correlations were uncertain in previous studies. We aimed to determine correlations among empathy, burnout, and patient satisfaction, and further analyse interactions among these factors.
METHOD: A single centre prospective observational study was conducted from December 2018 to August 2019 at JPS Health Network, USA. Emergency physician (EP) self-assessed empathy and burnout were measured by the Jefferson Scale of Empathy (JSE) and the Copenhagen Burnout Inventory (CBI) separately. We assessed patient perception of physician empathy and patient satisfaction with their treating physician by the Jefferson Scale of Patient Perception of Physician Empathy and a patient assessed satisfaction survey. Spearman's correlation was used to determine associations among JSE, patient assessed physician empathy, CBI and patient satisfaction. Additionally, JSE, patient assessed physician empathy and CBI predictive of patient satisfaction were measured by multivariate logistic regression analysis.
RESULTS: A total of 28 EPs and 423 patients were enrolled. Patient satisfaction had a weak correlation with JSE (ρ=0.11) but showed a strong correlation with patient assessed physician empathy (ρ=0.60). CBI showed no correlation with patient satisfaction (ρ<0.1). However, when JSE, patient assessed physician empathy and CBI were analysed together in relation to patient satisfaction, adjusted odds ratios (AOR) was 3.85 (95% CI 1.36 to 10.88) with high patient assessed physician empathy alone; AOR was 7.17 (2.62-19.67) when high patient assessed physician empathy was combined with low CBI; and AOR was 8.37 (3.07-22.83) when high patient assessed physician empathy, low CBI and high JSE were combined.
CONCLUSION: Patient assessed physician empathy had a strong positive correlation with patient satisfaction. Moreover, higher patient satisfaction was achieved from EPs of high patient assessed physician empathy, low CBI and high JSE, indicating a positive synergistic effect. These findings suggest different interventions might be applied to EPs of different wellness features to maximise patient satisfaction.

PMID: 33239313 [PubMed - as supplied by publisher]

Providing Ancillary Care in Clinical Research: A Case of Diffuse Large B-Cell Lymphoma during a Malaria Vaccine Trial in Equatorial Guinea.

Thu, 11/26/2020 - 06:45
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Providing Ancillary Care in Clinical Research: A Case of Diffuse Large B-Cell Lymphoma during a Malaria Vaccine Trial in Equatorial Guinea.

Am J Trop Med Hyg. 2020 Nov 23;:

Authors: Manock SR, Mtoro A, Urbano Nsue Ndong V, Olotu A, Chemba M, Sama Roca AE, Eburi E, García GA, Cortes Falla C, Niemczura de Carvalho J, Contreras J, Saturno B, Riocalo JD, Nze Mba JL, Koka R, Lee ST, Menon H, Church LWP, Ayekaba MO, Billingsley PF, Abdulla S, Richie TL, Hoffman SL

Abstract
Providing medical care for participants in clinical trials in resource-limited settings can be challenging and costly. Evaluation and treatment of a young man who developed cervical lymphadenopathy during a malaria vaccine trial in Equatorial Guinea required concerted efforts of a multinational, multidisciplinary team. Once a diagnosis of diffuse large B-cell lymphoma was made, the patient was taken to India to receive immunochemotherapy. This case demonstrates how high-quality medical care was provided for a serious illness that occurred during a trial that was conducted in a setting in which positron emission tomography for diagnostic staging, an oncologist for supervision of treatment, and an optimal therapeutic intervention were not available. Clinical researchers should anticipate the occurrence of medical conditions among study subjects, clearly delineate the extent to which health care will be provided, and set aside funds commensurate with those commitments.

PMID: 33236704 [PubMed - as supplied by publisher]

Spinal Cord Pilocytic Astrocytoma With FGFR1-TACC1 Fusion and Anaplastic Transformation.

Fri, 11/20/2020 - 06:38
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Spinal Cord Pilocytic Astrocytoma With FGFR1-TACC1 Fusion and Anaplastic Transformation.

J Neuropathol Exp Neurol. 2020 Nov 19;:

Authors: Daoud EV, Patel A, Gagan J, Raisanen JM, Snipes GJ, Mantilla E, Krothapally R, Hatanpaa KJ, Pan E

PMID: 33212490 [PubMed - as supplied by publisher]

The incidence of venous thromboembolic events in trauma patients after tranexamic acid administration: an EAST multicenter study.

Wed, 11/18/2020 - 01:46
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The incidence of venous thromboembolic events in trauma patients after tranexamic acid administration: an EAST multicenter study.

Blood Coagul Fibrinolysis. 2020 Nov 12;:

Authors: Rivas L, Estroff J, Sparks A, Nahmias J, Allen R, Smith SR, Kutcher M, Carter K, Grigorian A, Albertson S, Turay D, Quispe JC, Luo-Owen X, Vella M, Pascual J, Tororello G, Quattrone M, Bernard A, Ratnasekera A, Lee A, Tamburrini D, Rodriguez C, Harrell K, Jeyamurugan K, Bugaev N, Warner A, Weinberger J, Hazelton JP, Selevany M, Wright F, Kovar A, Urban S, Hamrick A, Mount M, Carrick M, Cullinane DC, Chang G, Jain G, Spalding C, Sarani B

Abstract
: To determine if there is a significant association between administration of tranexamic acid (TXA) in severely bleeding, injured patients, and venous thromboembolism (VTE), myocardial infarction (MI), or cerebrovascular accident (CVA). A multicenter, retrospective study was performed. Inclusion criteria were: age 18-80 years old and need for 5 units or more of blood in the first 24 h after injury. Exclusion criteria included: death within 24 h, pregnancy, administration of TXA more than 3 h following injury, and routine ultrasound surveillance for deep venous thrombosis. Incidence of VTE was the primary outcome. Secondary outcomes included MI, CVA, and death. A power analysis found that a total of 830 patients were needed to detect a true difference in VTE risk. 1333 patients (TXA = 887, No-TXA = 446 patients) from 17 centers were enrolled. There were no differences in age, shock index, Glasgow coma score, pelvis/extremity abbreviated injury score, or paralysis. Injury severity score was higher in the No-TXA group. Incidence of VTE, MI, or CVA was similar between the groups. The TXA group required significantly less transfusion (P < 0.001 for all products) and had a lower mortality [adjusted odds ratio 0.67 (95% confidence interval 0.45-0.98)]. Despite having a higher extremity/pelvis abbreviated injury score, results did not change when evaluating only patients with blunt injury. Use of TXA in bleeding, injured patients is not associated with VTE, MI, or CVA but is associated with a lower transfusion need and mortality.

PMID: 33196508 [PubMed - as supplied by publisher]

Worsening Renal Function After Diuresis Among Heart Failure Patients with Preserved Ejection Fraction --- A Dilemma to Heart Failure Management.

Tue, 11/10/2020 - 12:37
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Worsening Renal Function After Diuresis Among Heart Failure Patients with Preserved Ejection Fraction --- A Dilemma to Heart Failure Management.

Eur J Heart Fail. 2020 Nov 08;:

Authors: Starwalt JL, Ho AF, Wang H

PMID: 33161637 [PubMed - as supplied by publisher]

The value of using the HEART score among cocaine associated chest pain patients in the emergency department - A closer look.

Fri, 11/06/2020 - 06:03
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The value of using the HEART score among cocaine associated chest pain patients in the emergency department - A closer look.

Am J Emerg Med. 2020 Oct 29;:

Authors: Holmes KA, Posey RA, Wang H

PMID: 33148470 [PubMed - as supplied by publisher]

Dedicated homeless clinics reduce inappropriate emergency department utilization.

Thu, 11/05/2020 - 05:49
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Dedicated homeless clinics reduce inappropriate emergency department utilization.

J Am Coll Emerg Physicians Open. 2020 Oct;1(5):829-836

Authors: Holmes CT, Holmes KA, MacDonald A, Lonergan FR, Hunt JJ, Shaikh S, Cheeti R, D'Etienne JP, Zenarosa NR, Wang H

Abstract
Background: The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients.
Methods: We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization.
Results: A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty-nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50-0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression.
Conclusion: Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.

PMID: 33145527 [PubMed]

Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury.

Tue, 10/27/2020 - 06:48

Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury.

J Trauma Acute Care Surg. 2020 Nov;89(5):900-907

Authors: Dixon AL, McCully BH, Rick EA, Dewey E, Farrell DH, Morrison LJ, McMullan J, Robinson BRH, Callum J, Tibbs B, Dries DJ, Jui J, Gandhi RR, Garrett JS, Weisfeldt ML, Wade CE, Aufderheide TP, Frascone RJ, Tallon JM, Kannas D, Williams C, Rowell SE, Schreiber MA

Abstract
BACKGROUND: No Food and Drug Administration-approved medication improves outcomes following traumatic brain injury (TBI). A forthcoming clinical trial that evaluated the effects of two prehospital tranexamic acid (TXA) dosing strategies compared with placebo demonstrated no differences in thromboelastography (TEG) values. We proposed to explore the impact of TXA on markers of coagulation and fibrinolysis in patients with moderate to severe TBI.
METHODS: Data were extracted from a placebo-controlled clinical trial in which patients 15 years or older with TBI (Glasgow Coma Scale, 3-12) and systolic blood pressure of ≥90 mm Hg were randomized prehospital to receive placebo bolus/placebo infusion (placebo), 1 g of TXA bolus/1 g of TXA infusion (bolus maintenance), or 2 g of TXA bolus/placebo infusion (bolus only). Thromboelastography was performed, and coagulation measures including prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, D-dimer, plasmin-antiplasmin (PAP), thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were quantified at admission and 6 hours later.
RESULTS: Of 966 patients receiving study drug, 700 had laboratory tests drawn at admission and 6 hours later. There were no statistically significant differences in TEG values, including LY30, between groups (p > 0.05). No differences between prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were demonstrated across treatment groups. Concentrations of D-dimer in TXA treatment groups were less than placebo at 6 hours (p < 0.001). Concentrations of PAP in TXA treatment groups were less than placebo on admission (p < 0.001) and 6 hours (p = 0.02). No differences in D-dimer and PAP were observed between bolus maintenance and bolus only.
CONCLUSION: While D-dimer and PAP levels reflect a lower degree of fibrinolysis following prehospital administration of TXA when compared with placebo in a large prehospital trial of patients with TBI, TEG obtained on admission and 6 hours later did not demonstrate any differences in fibrinolysis between the two TXA dosing regimens and placebo.
LEVEL OF EVIDENCE: Diagnostic test, level III.

PMID: 33105308 [PubMed - as supplied by publisher]

Association between depression and hypertension using classic and revised blood pressure thresholds.

Wed, 10/21/2020 - 03:02

Association between depression and hypertension using classic and revised blood pressure thresholds.

Fam Pract. 2020 Oct 19;37(5):616-622

Authors: DeMoss DS, Teigen KJ, Claassen CA, Fisk MJ, Blair SE, Bakre SA, Hurd CL, Rush AJ

Abstract
BACKGROUND: In a primary care population, the relationship between treatment of depression and hypertension (HTN) under the recently revised American College of Cardiology and American Heart Association HTN thresholds for diagnosing HTN is unknown.
OBJECTIVE: To compare the association between changes in severity of co-occurring depression and HTN over time using the newly revised versus previous HTN guidelines.
METHODS: In this retrospective cohort study, outpatients ≥18 years (n = 3018) with clinically significant depressive symptoms and elevated blood pressure at baseline were divided into a 'revised' guideline group (baseline blood pressure ≥130/80 mmHg), a 'classic' guideline group (≥140/90 mmHg) and a 'revised-minus-classic' group (≥130/80 and <140/90 mmHg). Depressive symptom change was assessed using the Patient Health Questionnaire-9 (PHQ-9). Correlations between changes in PHQ-9 scores and HTN levels by group over a 6- to 18-month observation period were assessed using robust regression analysis.
RESULTS: There were demographic and clinical differences between groups. A total of 41% of study subjects (1252/3018) had a visit during the follow-up period where additional PHQ-9 and HTN results were available. Depressive symptom change was unrelated to change in blood pressure in the revised and revised-minus-classic groups. The classic HTN group demonstrated a clinically insignificant change in systolic blood pressure for each unit change in PHQ-9 score (β = 0.23, P-value =0.02).
CONCLUSIONS: Although a statistically significant association between reduced HTN levels and improvement in depressive symptoms was demonstrated under classic HTN guidelines, there was no clinically meaningful association between treatment of depression and improved HTN levels under either guideline.

PMID: 33075127 [PubMed - in process]

Chemiluminescent Measurement of Hydrogen Peroxide in the Exhaled Breath Condensate of Healthy and Asthmatic Adults.

Mon, 10/19/2020 - 21:16

Chemiluminescent Measurement of Hydrogen Peroxide in the Exhaled Breath Condensate of Healthy and Asthmatic Adults.

Anal Chem. 2020 Oct 16;:

Authors: Quimbar ME, Davis SQ, Al-Farra ST, Hayes A, Jovic V, Masuda M, Lippert AR

Abstract
Reactive oxygen species are centrally involved in the pathophysiology of airway diseases such as asthma and chronic obstructive pulmonary disease. This study reports the development of a chemiluminescence assay and a device for measuring hydrogen peroxide in the exhaled breath condensate of asthma patients and healthy participants. A stand-alone photon detection device was constructed for use with an optimized chemiluminescence assay. Calibrations using a catalase control to scavenge residual hydrogen peroxide in calibrant solutions provided analytically sensitive and specific measurements. We evaluated exhaled breath condensate hydrogen peroxide in 60 patients (ages 20-83; 30 healthy patients and 30 asthma patients) recruited from the John Peter Smith Hospital Network. The exhaled breath condensate hydrogen peroxide concentrations trended toward higher values in asthma patients compared to healthy participants (mean 142.5 vs 115.5 nM; p = 0.32). Asthma patients who had not used an albuterol rescue inhaler in the past week were compared to those who had and showed a trend toward higher hydrogen peroxide levels (mean 172.8 vs 115.9 nM; p = 0.25), and these patients also trended toward higher hydrogen peroxide than healthy participants (mean 172.8 vs 115.5 nM; p = 0.14). This pilot study demonstrates the ability of the newly developed assay and device to measure exhaled breath condensate hydrogen peroxide in asthma patients and healthy participants. The trends observed in this study are in agreement with previous literature and warrant further investigation of using this system to measure exhaled breath condensate hydrogen peroxide for monitoring oxidative stress in asthma.

PMID: 33064450 [PubMed - as supplied by publisher]

Age of First Use of Prescription Opioids and Prescription Opioid Non-Medical Use among Older Adolescents.

Mon, 10/19/2020 - 21:16

Age of First Use of Prescription Opioids and Prescription Opioid Non-Medical Use among Older Adolescents.

Subst Use Misuse. 2020 Oct 15;:1-8

Authors: Osborne V, Serdarevic M, Striley CW, Nixon SJ, Winterstein AG, Cottler LB

Abstract
BACKGROUND: Non-medical use (NMU) of prescription opioids is of concern due to the opioid epidemic in the United States. Objective: We examined sex differences in the effect of age of first use of prescription opioids on prescription opioid NMU among 17- and 18-year olds. Methods: The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) recruited youth 10-18 years from 10 United States cities between 2008 and 2011 (n = 11,048). The cross-sectional survey included questions on past 30 day prescription opioid use (10,965 provided responses; 278 age 17 to 18 years who used opioids in past 30 days), with NMU defined as non-oral use and/or use of someone else's opioids. Nonparametric survival analysis with lifetable estimates was used to examine age at first use. Binomial logistic regression was conducted predicting any NMU, adjusted for covariates. Results: Among 278 youth 17 to 18 years, a significant difference in age of first use between those with MU only and any NMU (p < .0001) was observed. Each one year increase in age resulted in a 33% decrease in the odds of any prescription opioid NMU compared to MU only, after controlling for covariates (Odds Ratio = 0.67, 95% Confidence Interval: 0.47,0.96). Sex differences in age at first use were not observed. Conclusions: Risk of past 30 day prescription opioid NMU decreased by a third for each one year increase in age of first use, after adjustment for other covariates. Use of prescription opioids in young adolescents may need to be limited where possible and researched further.

PMID: 33059498 [PubMed - as supplied by publisher]

Lung Ultrasound for COVID-19 Evaluation in the Emergency Department: Is It Feasible?

Tue, 10/06/2020 - 06:17

Lung Ultrasound for COVID-19 Evaluation in the Emergency Department: Is It Feasible?

Ann Emerg Med. 2020 Oct;76(4):552-553

Authors: Wolfshohl J, Shedd A, Chou EH, d'Etienne JP

PMID: 33012385 [PubMed - in process]

Study protocol for a multicentre implementation trial of monotherapy anticoagulation to expedite home treatment of patients diagnosed with venous thromboembolism in the emergency department.

Sat, 10/03/2020 - 07:48

Study protocol for a multicentre implementation trial of monotherapy anticoagulation to expedite home treatment of patients diagnosed with venous thromboembolism in the emergency department.

BMJ Open. 2020 Oct 01;10(10):e038078

Authors: Kline J, Adler D, Alanis N, Bledsoe J, Courtney D, D'Etienne J, B Diercks D, Garrett J, Jones AE, MacKenzie D, Madsen T, Matuskowitz A, Mumma B, Nordenholz K, Pagenhardt J, Runyon M, Stubblefield W, Willoughby C

Abstract
INTRODUCTION: In the USA, many emergency departments (EDs) have established protocols to treat patients with newly diagnosed deep vein thrombosis (DVT) as outpatients. Similar treatment of patients with pulmonary embolism (PE) has been proposed, but no large-scale study has been published to evaluate a comprehensive, integrated protocol that employs monotherapy anticoagulation to treat patients diagnosed with DVT and PE in the ED.
METHODS AND ANALYSIS: This protocol describes the implementation of the Monotherapy Anticoagulation To expedite Home treatment of Venous ThromboEmbolism (MATH-VTE) study at 33 hospitals in the USA. The study was designed and executed to meet the requirements for the Standards for Reporting Implementation Studies guideline. The study was funded by investigator-initiated awards from industry, with Indiana University as the sponsor. The study principal investigator and study associates travelled to each site to provide on-site training. The protocol identically screens patients with both DVT or PE to determine low risk of death using either the modified Hestia criteria or physician judgement plus a negative result from the simplified PE severity index. Patients must be discharged from the ED within 24 hours of triage and treated with either apixaban or rivaroxaban. Overall effectiveness is based upon the primary efficacy and safety outcomes of recurrent VTE and bleeding requiring hospitalisation respectively. Target enrolment of 1300 patients was estimated with efficacy success defined as the upper limit of the 95% CI for the 30-day frequency of VTE recurrence below 2.0%. Thirty-three hospitals in 17 states were initiated in 2016-2017.
ETHICS AND DISSEMINATION: All sites had Institutional Review Board approval. We anticipate completion of enrolment in June 2020; study data will be available after peer-reviewed publication. MATH-VTE will provide information from a large multicentre sample of US patients about the efficacy and safety of home treatment of VTE with monotherapy anticoagulation.

PMID: 33004396 [PubMed - in process]

Building RAFT: Trafficking Screening Tool Derivation and Validation Methods.

Thu, 10/01/2020 - 10:58
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Building RAFT: Trafficking Screening Tool Derivation and Validation Methods.

Acad Emerg Med. 2020 04;27(4):297-304

Authors: Chisolm-Straker M, Singer E, Rothman EF, Clesca C, Strong D, Loo GT, Sze JJ, d'Etienne JP, Alanis N, Richardson LD

Abstract
BACKGROUND: Labor and sex trafficking have long impacted the patients who seek care in emergency departments (ED) across the United States. Increasing social and legislative pressures have led to multiple calls for screening for trafficking in the clinical care setting, but adoption of unvalidated screening tools for trafficking recognition is unwise for individual patient care and population-level data. Development of a valid screening tool for a social malady that is largely "invisible" to most clinicians requires significant investments. Valid screening tool development is largely a poorly understood process in the antitrafficking field and among clinicians who would use the tools.
METHODS: The authors describe the study design and procedures for reliable data collection and analysis in the development of RAFT (Rapid Appraisal for Trafficking). In a five-ED, randomized, prospective study, RAFT will be derived and validated as a labor and sex trafficking screening tool for use among adult ED patients. Using a novel method of ED patient-participant randomization, intensively trained data collectors use qualitative data to assess subjects for a lifetime experience of human trafficking.
CONCLUSION: Study methodology transparency encourages investigative rigor and integrity and will allow other sites to reproduce and externally validate this study's findings.

PMID: 31725176 [PubMed - indexed for MEDLINE]

Biomechanical Study of Patellar Component Fixation with Varying Degrees of Bone Loss.

Mon, 09/28/2020 - 06:56
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Biomechanical Study of Patellar Component Fixation with Varying Degrees of Bone Loss.

J Arthroplasty. 2020 Aug 25;:

Authors: Beck CM, Nwannunu BI, Teigen KJ, Wagner RA

Abstract
BACKGROUND: The decision as to whether or not to resurface the patella in revision total knee arthroplasty (TKA) is affected by the amount of patellar bone stock remaining; however, the impact of the cancellous bone status on patellar component fixation has not been studied. Therefore, we conducted a biomechanical study of patellar component fixation with varying degrees of cancellous bone loss.
METHODS: Sixty pairs of cadaveric patellae were randomly assigned between 3 groups and prepared in similar manner to a TKA with the standard 3-hole configuration. A control patella and an experimental patella were designated in each pair. To simulate bone loss in the experimental patellae, 1, 2, and 3 of the standard drill holes were uniformly enlarged to 12 mm in group 1, group 2, and group 3, respectively. Afterward, an all-polyethylene patellar component was cemented to each patella, as done intraoperatively. Patellar components were then sheared off using a materials testing system. The resulting mean offset yield force was analyzed within each group using paired t-tests.
RESULTS: The mean offset yield force for the control patellae was greater than the experimental patellae in group 1. In groups 2 and 3, the experimental patellae produced a greater mean offset yield force than the control patellae. Comparison within each group did not demonstrate a statistically significant difference.
CONCLUSION: Bone loss with enlargement of the patellar fixation holes, as is frequently seen in revision TKA, with holes up to 12 mm, does not significantly decrease patellar component fixation shear strength in this biomechanical cadaveric study.

PMID: 32978021 [PubMed - as supplied by publisher]

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