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Parent Satisfaction With Neonatal Care: A Secondary Analysis
No full textBACKGROUND: Understanding parent satisfaction with care is an integral part of ensuring care delivery is family-focused and responsive to family needs, preferences, and values.
PURPOSE: The purposes of the study were to describe parental satisfaction with neonatal care, assess differences between satisfaction scores and identify areas for care improvement.
METHODS: A secondary analysis of data collected from an online survey of the neonatal intensive care unit (NICU) parent experiences during the early months of the COVID-19 Pandemic in the United States was used. Parent satisfaction with NICU care was measured using the EMpowerment of PArents in THe Intensive Care (EMPATHIC) scale. Descriptive statistics described individual items, domain scores, and total score. Independent t-tests with Bonferroni correction compared this study to previously published results.
RESULTS: 159 mothers and 5 fathers responded to the EMPATHIC scale. The overall mean and all domain scores were significantly different from a pre-pandemic sample where scores were consistently higher. Parents indicated their desire for more cultural competence, emotional support, acknowledgement, and space to discuss their experience, guidance for discharge, better medication information and quicker response to an infant\u27s condition.
IMPLICATIONS FOR PRACTICE AND RESEARCH: Our study identified statistically significant differences between our sample and a pre-pandemic sample and found the absolute mean difference in 3 domain scores to be \u3e 1, suggesting clinical significance. We were able to offer more clarity about what factors were contributing to higher or lower satisfaction scores
Photoprotection in pregnancy: addressing safety concerns and optimizing skin health
No full textPregnancy is associated with physiological skin changes, altered response to UV exposure and increased risk of pigmentary disorders such as melasma and linea nigra, which can impact quality of life. This review explores the effects of photoprotection during pregnancy, focusing on safety, efficacy, and the role of sunscreens in preventing pregnancy-associated hyperpigmentation and UV-induced skin damage. Sunscreen use in pregnant women is generally low, despite evidence supporting the benefits of broad-spectrum sunscreens to mitigate pigmentation changes and prevent DNA damage from UV exposure. Physiological changes during pregnancy influence sunscreen selection; ideally, sunscreens should be mineral-based, cosmetically acceptable, potentially supplemented with safe organic filters to optimize cosmetic acceptability and adherence, and free from ingredients associated with potential risks during pregnancy. Tinted sunscreens, which provide protection against high-energy visible light (HEVL), may offer enhanced prevention of hyperpigmentary disorders, and are recommended due to their added camouflage benefits, though shade options should ideally match diverse skin tones. Photoprotection strategy should include the use of wide-brimmed hats, sun-safe clothing and regular use of high-SPF, broad-spectrum sunscreens that protect against UVB, UVA, and HEVL. Tinted, mineral-based formulations potentially supplemented with safe organic filters may be optimal for pregnant women providing both effective protection and cosmetic benefits
The Safety Profile of Inclisiran in Patients with Dyslipidemia: A Systematic Review and Meta-Analysis
No full textINTRODUCTION: Inclisiran is a novel drug that employs ribonucleic acid (RNA) interference to lower the levels of the proprotein convertase subtilisin/kexin type 9 (PCSK9) protein. It has demonstrated a significant reduction in LDL cholesterol levels compared to a placebo. We aim to comprehensively evaluate the safety of using Inclisiran in patients with dyslipidemia and ASCVD or an ASCVD risk equivalent.
METHODS: Four electronic databases, namely, Pubmed/MEDLINE, Web of Science, Embase, and ClinicalTrials.gov, were searched from inception to June 2024 to identify relevant randomized controlled trials (RCTs) comparing safety profiles of Inclisiran and the control group. The outcomes investigated were all-cause mortality, major adverse cardiovascular events (MACEs), injection-site adverse events, new-onset or worsening type 2 diabetes mellitus (T2DM), and nasopharyngitis. The effect estimates of outcomes were assessed using the risk ratio (RR) with a 95% confidence interval (CI). Random-effects meta-analysis was conducted using the restricted maximum likelihood method. Subgroup analysis was performed based on different dosing regimens.
RESULTS: The study included 7 RCTs, enrolling 4790 patients (age 63.8 ± 9.7 years, 33.2% females) who received Inclisiran. Compared to the control group, Inclisiran use did not yield a significant effect on all-cause mortality (RR, 0.92; 95% CI, 0.54 to 1.54; I(2) = 0%), MACEs (RR, 0.98; 95% CI, 0.82 to 1.17; I(2) = 0%), nasopharyngitis (RR, 1.10; 95% CI, 0.83 to 1.45; I(2) = 0%), and T2DM (RR, 1.02; 95% CI, 0.85 to 1.21; I(2) = 0%). However, Inclisiran use demonstrated a significant increase in injection-site adverse events (RR, 6.50; 95% CI, 3.20 to 13.20; I(2) = 29%).
CONCLUSIONS: Inclisiran use significantly increased injection-site reactions, with no increase in mortality, T2DM, or nasopharyngitis. It demonstrates a generally favorable safety profile, making it a promising option for lipid management in individuals at high cardiovascular risk, such as those with ASCVD or equivalent conditions. While it effectively improves dyslipidemia, decision-makers should be aware of an increased incidence of injection-site reactions, which, though typically mild, warrant consideration in clinical practice. Further trials are required to assess the safety of Inclisiran, particularly the association of the severity of injection-site adverse events over longer treatment durations
Exploring the causes of stiff left atrial syndrome: a case series
No full textBACKGROUND: Stiff left atrial syndrome (SLAS) is a complication that occurs due to left atrial scarring following procedures such as radiofrequency catheter ablation for atrial fibrillation.
CASE SUMMARY: We present a series of four patients with pre-existing conditions that ultimately were diagnosed as SLAS. In each case, clinical manifestations of SLAS may overlapped with other conditions and required a high index of clinical suspicion and diligent hemodynamic assessment to differentiate it from other concomitant cardiac conditions.
DISCUSSION: We aim to highlight key differentiating diagnostic features from overlapping cardiac conditions and to summarize current treatment options for patients with SLAS
Strength and strain distributions obtained from digital wrist tomosynthesis discriminate patients with and without a history of fragility fracture
No full textBone fractures due to osteoporosis are a significant problem. Limited accuracy of standard bone mineral density (BMD) for fracture risk assessment, combined with low adherence to bone health screening precludes identification of those at risk of fracture. Because of the wide availability of digital breast tomosynthesis (DBT) imaging, bone screening using a DBT scanner at the time of breast screening has been proposed. Earlier studies have shown that BMD, microstructure, and stiffness of the distal radius can be calculated using digital tomosynthesis imaging of the wrist (DWT). However, strength and stress/strain parameters, which are more relevant to structural failure, and have the potential to enhance the utility of DWT, were not examined previously. Therefore, this study aimed to examine the ability of DWT to discriminate patients with and without fragility fracture using DWT based finite element (DWT-FE) derived strength and stress/strain distribution properties, and to determine in vivo repeatability of these biomechanical properties. Twenty-two postmenopausal women with any fragility fracture (included spine, hip, distal radius, humerus and tibia fractures) and 68 without were recruited. Each participant\u27s nondominant arm (dominant arm if history of fracture in the nondominant arm) was scanned with DWT and compressive loading was simulated using FE modeling. Six additional patients were DWT-scanned thrice, with repositioning, to determine the repeatability of the study variables. Age and T-score were not different between fracture and nonfracture groups (p \u3e 0.1), but strength and stress/strain parameters were significant predictors of fracture status (AUC = 0.64-0.74). Standard deviation of tensile strain was the most discriminatory variable for fracture status (AUC = 0.74) and was independent from stiffness. Repeatability error of DWT biomechanical properties was 0.7 % to 5.8 %. This study demonstrated that DWT-FE based strength and standard deviation of tensile strain were reproducible and predict fracture status independent from BMD and stiffness. The results suggest that the accuracy of fracture risk screening can be improved in the highly accessible environment of mammographic imaging
Self-Reported Improvement After Carpal Tunnel Release in Patients With Motor Axonal Loss
No full textPURPOSE: Electrodiagnostic studies can identify evidence of sensory and motor axonal loss (AL) in carpal tunnel syndrome (CTS) patients. However, the impact of sensory and motor AL on outcomes following carpal tunnel release (CTR) remains unclear. We hypothesize that patients with no evidence of sensory and motor AL will experience greater improvement following CTR compared to those with evidence of AL.
METHODS: Patients undergoing open and endoscopic CTR by four fellowship-trained orthopedic hand surgeons were identified. Sensory and motor AL were identified using preoperative electromyography and nerve conduction studies. Patients completed the following before surgery and 3-month postoperative patient-reported outcomes: Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) and Pain Interference (PI) as well as Disabilities of the Arm, Shoulder, and Hand (QuickDASH [QD]). Preoperative and postoperative scores, changes in scores, and rates of achieving the minimally clinically important difference (MCID) were compared between patients with and without sensory and motor AL.
RESULTS: One hundred and seventy-five patients were included. Of these, 91 exhibited sensory AL and 98 exhibited motor AL. Demographic matched analysis of patients with and without sensory AL showed no differences in before surgery, after surgery, difference, or proportion meeting MCID for UE, PI, or QD. Matched analysis revealed no difference in preoperative PROMs between patients with and without motor AL. Patients with motor AL had increased postoperative UE (better function), decreased postoperative PI (less PI) and QD (less disability), increased changes in PI and QD, as well as a greater proportion meeting MCID for QD compared to those without motor AL.
CONCLUSIONS: There was no difference in post-CTR improvement between patients with and without sensory AL. However, contrary to our hypothesis, motor AL patients experienced greater postoperative improvement according to QD. These findings suggest surgery should be recommended for severe CTS patients with evidence of AL. These results can better inform physicians and patients as they discuss expectations of CTR outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis II
Practice patterns on the management of secondary hyperparathyroidism in the United States: Results from a modified Delphi panel
No full textBACKGROUND: Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD). Many recommendations in the Kidney Disease Improving Global Outcomes (KDIGO) CKD-mineral and bone disorder guidelines are supported by modest evidence and predate the approval of newer agents. Therefore, an expert panel defined consensus SHPT practice patterns in the United States with real-world context from the nephrology community.
METHODS: Ten US healthcare providers and one patient participated in a modified Delphi method comprising three phases. Consensus was determined via iterative responses to a questionnaire based on the 2009 and 2017 KDIGO guidelines and published literature on the identification, evaluation, monitoring, and interventional strategies for patients with SHPT. The threshold for consensus was 66% agreement.
RESULTS: Panelists generally agreed with KDIGO recommendations, with some differences. Consensus was reached on 42/105 (40%), 95/105 (90.5%), and 105/105 (100%) questions after phases 1, 2, and 3, respectively. Panelists unanimously agreed that SHPT treatment is often started late. There was a preference for serum phosphate level \u3c4.6 mg/dL, and consensus to maintain serum calcium levels \u3c9.5 mg/dL. There was unanimous agreement for vitamin D analogues as first-line options in patients not on dialysis with severe, progressive SHPT and unanimous preference for intravenous calcimimetic, etelcalcetide, in appropriate in-center dialysis patients. Factors such as formularies, dialysis center protocols, and insurance were recognized to influence therapeutic strategies.
CONCLUSIONS: Expert consensus was reached on SHPT management, further defining therapeutic strategies and medication use and emphasizing need for treatment early. Despite evidence-based treatment preferences supported by clinical experience, factors other than scientific evidence influence decision making, particularly with medications
Outcomes of adjunctive eravacycline for severe and fulminant Clostridioides difficile infection
No full textOBJECTIVES: To characterize eravacycline (ERV) treatment for severe or fulminant Clostridioides difficile infection (CDI) and describe patient outcomes.
METHODS: This was an institutional review board-approved, cross-sectional study of hospitalized adult patients with CDI who received adjunctive ERV with standard-of-care antibiotics for CDI from January 2019 to December 2023 at a five-hospital health system. Patients were included if they received ERV with standard-of-care antibiotics for ≥24 hours for severe or fulminant CDI. Patients with a history colectomy or with non-CDI ERV indications were excluded. The primary outcome was the proportion of patients that required colectomy due to C. difficile; secondary outcome was all-cause mortality at 30 days.
RESULTS: Seventy-five patients were included: 25 (33%) had severe and 50 (67%) fulminant CDI and 23 (31%) had refractory severe/fulminant CDI. Patients receiving ERV were frequently immunocompromised (30, 40%) and required treatment in an intensive care unit (46, 61%). Eleven (14.7%) patients required colectomy within 30 days of adjunctive ERV; 28 (37%) patients died at 30-days.
CONCLUSIONS: ERV may be useful as a potential adjunctive therapy for severe or fulminant CDI. Patients receiving ERV often were immunocompromised and had fulminant disease with critical illness. Future comparative studies are needed to evaluate the impact of adjunctive ERV for CDI
Factors associated with breast lymphedema after adjuvant radiation therapy in women undergoing breast conservation therapy
No full textPURPOSE: Breast lymphedema after post-lumpectomy radiation therapy (RT) is poorly defined and difficult to treat. The aim of this study was to define the incidence of breast lymphedema and identify factors associated with the risk of developing breast lymphedema (BL) in women undergoing breast-conserving therapy.
METHODS: A retrospective cohort study of patients with early-stage breast cancer who underwent breast-conserving surgery (lumpectomy) followed by RT between January 1, 2014 and July 31, 2019 at a single institution. Women who developed BL, defined as swelling of the breast persisting ≥1 year after RT, were compared with women who did not. Univariate and multivariate regression analyses were used to identify factors associated with risk of BL.
RESULTS: A total of 1052 patients were included in the study: 99 (9.6 %) developed BL and 953 (90.6 %) did not develop BL. The mean ± standard deviation age was 62.9 ± 11.1 years and the mean breast volume was 1352.0 ± 744.9 cm(3). Patients with breast volume ≥1500 cm(3) (adjusted odds ratio [aOR] = 2.34; 95 % CI, 1.40-3.91; p = 0.001), Black patients (aOR = 1.78; 95 % CI, 1.12-2.82; p = 0.015), those who received neoadjuvant (aOR = 3.05; 95 % CI, 1.28-7.30; p = 0.012) or adjuvant chemotherapy (aOR = 2.14; 95 % CI, 1.29-3.55; p = 0.003), those with postoperative cellulitis (aOR = 3.94; 95 % CI, 2.20-7.06; p \u3c 0.001), and women who developed arm lymphedema (aOR = 2.94; 95 % CI, 1.50-5.77; p = 0.002) had significantly higher odds of developing BL.
CONCLUSION: Patients with larger breast volumes, Black patients, those receiving chemotherapy, and those who develop arm lymphedema or cellulitis may be at higher risk of BL after lumpectomy and RT, suggesting that patients with these risk features may benefit from complementary or alternative surgical approaches and heightened monitoring to avoid BL