Jacobs Institute of Women's Health
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Validation of a Demography-Based Adaptive QT Correction Formula Using Pediatric and Adult Datasets Acquired From Humans and Guinea Pigs
No full textBACKGROUND: QT correction (QTc) formulae are widely used in clinical and research settings but often underperform, possibly due to demographic influences on the QT-heart rate (HR) relationship. To address this limitation, we developed an adaptive QTc (QTcAd) formula, which adjusts for demographic factors like age, and compared its efficacy to other standard formulae. METHODS: The QTcAd formula was tested across diverse age groups with different HR in both humans and guinea pigs. Using retrospective ECG data from 1819 pediatric patients at Children\u27s National Hospital and 2400 subjects from the Pediatric Heart Network database, alongside in vivo (N=55) and ex vivo (N=66) guinea pig ECG recordings, we evaluated the formula\u27s effectiveness. Linear regression fit parameters of QTc-HR (slope and R²) were utilized for performance assessment. To evaluate the accuracy of the predicted QTc, we acquired epicardial electrical and optical voltage data from Langendorff-perfused guinea pig hearts. RESULTS: In both human subjects and guinea pigs, the QTcAd formula (QTcAd=QT+(|m|×(HR-HR)) consistently outperformed other formulae across all age groups. For instance, in a 20-year-old human group, the QTcAd formula successfully nullified the inverse QT-HR relationship (R²=5.1×10, slope=-3.5×10), whereas the Bazett formula failed to achieve comparable effectiveness (R²=0.21, slope=0.91). Moreover, the QTcAd formula exhibited better accuracy than the age-specific Benatar QTc formula, which overcorrected QTc (1-week human QT: 263.8±14.8 ms, QTcAd: 263.8±7.3 ms, P=0.62; Benatar QTc: 422.5±7.3 ms, P\u3c0.0001). The optically measured pseudo-QT interval (143±22.5 ms, n=44) was better approximated by QTcAd (180.6±17.0 ms) compared with all other formulae. Furthermore, we demonstrated that the QTcAd formula was not inferior to individual-specific QTc formulae. CONCLUSIONS: The demography-based QTcAd formula showed superior performance across human and guinea pig age groups, which may enhance the efficacy of rate-corrected K.M.M. for cardiovascular disease diagnosis, risk stratification, and drug safety testing in children and adults
A Collaborative Stakeholder Approach for Reducing the Use of Custodial Restraints in Hospitalized Patients
No full textIn hospitals across the country, most patients admitted from jails or prisons receive their care in custodial restraints regardless of clinical concerns or public safety risk. Blanket restraint protocols are deemed necessary for public safety; however, the indiscriminate use of custodial restraints causes harm to patients physically, mentally, and through propagation of prejudice. Hospitals and correctional officials must create policies that allow for a case-by-case analysis of patients to develop an individualized custodial restraint plan that will balance public safety and patient care needs. In this Viewpoint, we recommend a collaborative stakeholder approach to address this needed public policy evolution. Now is the time for health care professionals, correctional and hospital administrators, those with lived incarceration experience, and community members to work together to create policies on custodial restraints that support patient healing and reduce physical harm, emotional distress, and prejudice while optimizing staff and public safety
Academic Achievement of Children With Neurofibromatosis Type 1
No full textBACKGROUND AND OBJECTIVES: Learning difficulties are frequently reported in children with neurofibromatosis type 1 (NF1), yet little is known about the extent and predictors of their academic functions across ages. We aimed to examine the developmental patterns of academic achievement in these children from childhood to adolescence and how these patterns differ across demographic and NF1-related disease factors. METHODS: This cross-sectional study integrated data of 1512 children with NF1 (mean age, 11.2 years, SD, 3.62, range, 3-18, 46.5% female patients) from 8 institutions. Academic functioning was assessed with Woodcock-Johnson Tests of Achievement or the Wechsler Individual Achievement Test. Data were analyzed primarily using time-varying effect modeling. RESULTS: Participants\u27 academic achievement was significantly lower than the normative means across ages, and the gap widened from middle childhood to midadolescence. Academic age trends varied across academic domains and demographic and disease factors. Male patients demonstrated larger deviations in math at midchildhood and in reading and writing between midchildhood and midadolescence. Children with lower parental education demonstrated larger deviations in math, reading, and writing between midchildhood and midadolescence. Children with familial NF1 demonstrated larger deviations in math at midchildhood and mid-to-late-adolescence, and in reading and writing between midchildhood and midadolescence. CONCLUSIONS: Academic difficulties in children with NF1 emerge early and worsen with age. The findings also highlight the variability within this population across demographic and disease factors. The age-specific estimates of academic functions can serve as the first NF1-specific academic norms, providing useful insights for future research and practice
Chest Wall Injury Society recommendations for long-term follow-up after nonoperatively and operatively managed traumatic rib and sternal fractures
No full textSystematic Review/Meta-analysis; Level IV
Concordance Between DASH Diet and Coronary Artery Calcification: Results From the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Prospective Cohort Study
No full textINTRODUCTION: South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease. METHODS: Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up. RESULTS: The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score \u3e100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score \u3e100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models. CONCLUSIONS: The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men
Agnostic proteomic profiling of maternal plasma for identifying postpartum hemorrhage risk
No full text
Evaluating equitable care in the ICU:Creating a causal inference template to assess the impact of life-sustaining interventions across racial and ethnic groups
No full textBACKGROUND: Variability in the provision of intensive care unit (ICU)-interventions may lead to disparities between socially defined racial-ethnic groups. OBJECTIVES: We aimed to study the use of invasive mechanical ventilation (IMV), renal replacement therapy (RRT), and vasopressor agents (VP) to identify disparities in outcomes across race-ethnicity in patients with sepsis. METHODS: Retrospective analysis of treatment effect with a target trial design with treatment assignment within the first 24 h in MIMIC-IV (2008-2019) using targeted maximum likelihood estimation. Of 76,943 ICU stays in MIMIC-IV, 32,971 adult stays fulfilled sepsis-3 criteria. Primary outcome was in-hospital mortality. Secondary outcomes were hospital-free days, and occurrence of nosocomial infection stratified by predicted mortality probability and self-reported race-ethnicity. Average treatment effects by treatment type and race-ethnicity, Racial-ethnic group (REG) or White group (WG), were estimated. RESULTS: Of 19,419 admissions that met inclusion criteria, median age was 68 years, 57.4 % were women, 82 % were White, and mortality was 18.2 %. There was no difference in mortality benefit associated with the administration of IMV, RRT, or VP between the REG and the WG. There was also no difference in hospital-free days or nosocomial infections. These findings are unchanged with different eligibility periods. CONCLUSION: There were no differences in the treatment outcomes from three life-sustaining interventions in the ICU according to race-ethnicity. While there was no discernable harm from the treatments across mortality risk, on average there was also no measurable benefit. These findings highlight the need for research to better understand the risk-benefit ratio of interventions in the ICU
Prevalence, severity and predictors of hand eczema in patients treated for atopic dermatitis: a cross-sectional observational study
No full textBACKGROUND: Hand eczema (HE) is common among individuals with atopic dermatitis (AD), yet data on its prevalence and predictors in this population remain limited. METHODS: A prospective, dermatology practice-based study was performed in adult patients with AD to determine the prevalence of HE and associations with HE severity. AD severity was assessed using Investigator\u27s Global Assessment (IGA), body surface area (BSA), Eczema Area and Severity Index (EASI), Scoring AD (SCORAD), objective component of SCORAD (O-SCORAD), Patient-reported Global AD severity (PtGA) and Patient-Oriented Eczema Measure (POEM). RESULTS: Active HE was observed in 135 (45.9%) patients, including 83 (61.5%) with mild, 43 (31.9%) with moderate and 9 (6.7%) with severe HE. Lesions affected the dorsal hands or digits in 231 (78.6%), wrists in 69 (51.1%), palmar hands or digits in 113 (38.4%), with nail dystrophy present in only 7 (5.2%). There were no significant associations of HE severity with demographics or self-reported history of atopic disease. However, in bivariable and multivariable logistic regression models, HE severity was associated with moderate and severe IGA, BSA, EASI, SCORAD, O-SCORAD, PtGA and POEM. CONCLUSIONS: HE was highly prevalent in adult patients with AD treated in the dermatology setting, particularly among patients with moderate-severe AD
Predictors of Emergency Physician Productivity in a National Emergency Medicine Group
No full textSTUDY OBJECTIVES: We sought to identify physician and environmental factors (eg, crowding) associated with emergency physician productivity, measured as patients per hour. We also assessed whether physician productivity is associated with higher emergency department (ED) return rates. METHODS: We used data from 184 EDs in 24 states staffed by a national ED group from January 2021 to December 2022. Clinical outcomes were 72-hour returns and returns with admission. We performed multivariable linear regression models that included physician, shift, and facility characteristics. RESULTS: We examined 234,146 shifts among 2,099 physicians. The mean number of patients per hour was 1.94 (SD = 0.57). Physician factors associated with a higher number of patients per hour included younger age and longer tenure at a site, with the number of patients per hour increasing even after 60+ months at a site. Longer tenure at a site was associated with a higher number of patients per hour (0.06 [95% confidence interval {CI} 0.02 to 0.09] at 6 months and 0.11 [95% CI 0.07 to 0.15] at 12 months). The number of patients per hour was weakly associated with shifts worked in the prior 3 to 30 days (0.003 number of patients per hour [95% CI 0.002 to 0.004] for each additional shift). Overnight shifts, non-Monday shifts, more physicians working on shift, and longer shift lengths were associated with a lower number of patients per hour. The number of patients with ED length of stay more than 6 hours (boarding patients) was negatively associated with the number of patients per hour. The higher number of patients per hour, both within site and within physician, was associated with slightly decreased 72-hour returns but no meaningful difference in returns with admission. CONCLUSION: Both physician- and shift-level factors are associated with emergency physician number of patients per hour. Higher number of patients per hour is not associated with increased 72-hour returns with admission