A Multifaceted Intervention to Improve Teamwork on an Inpatient Pediatric Neurosurgery Service.

BACKGROUND: Increased safety reports related to interprofessional teamwork on an acute care unit at a quaternary children's hospital prompted a teamwork-focused improvement effort on the pediatric neurosurgery service. METHODS: An interprofessional workgroup was formed and met twice monthly throughout the project. A survey using modified validated items was disseminated to pediatric neurosurgery nurses, advanced practice providers (APPs), and physicians in March 2021 to identify opportunities for improvement. Structured debriefs on survey results promoted discourse on teamwork. The researchers implemented two interventions: (1) nursing-centered interprofessional education and (2) a rounding checklist before redistributing the survey in December 2021. RESULTS: Baseline and follow-up survey response rates were 84.1% (58/69) and 71.4% (50/70), respectively. Nurses at baseline perceived lower teamwork scores for 12 items compared to physicians and APPs (p < 0.05). Nurse perceptions improved after interventions in: "using 'we' rather than 'they'" (21.3% vs. 51.2% agree, p = 0.003), "I am confident that this team works effectively" (46.8% vs. 80.5%, p = 0.001), "shared understanding of each other's role on the team" (48.9% vs. 73.2% agree, p = 0.02), and "getting others on the team to listen" (46.8% vs. 75.6%, p = 0.004). Mean teamwork effectiveness improved from 4.12 to 5.25 (out of 7; p < 0.0001). Nurses ranked three interventions as most effective: interprofessional training (35/41, 85.4%), educational clinical pearls (14/41, 34.1%), and structured opportunities to discuss teamwork (10/41, 24.4%). CONCLUSION: Interprofessional training, a teamwork survey, and structured debriefing improved nurse perceptions of teamwork. Interventions targeting social components of change can improve teamwork even without process changes.

A CT-Based Clinical, Radiological and Radiomic Machine Learning Model for Predicting Malignancy of Solid Renal Tumors (UroCCR-75).

BACKGROUND: Differentiating benign from malignant renal tumors is important for patient management, and it may be improved by quantitative CT features analysis including radiomic. PURPOSE: This study aimed to compare performances of machine learning models using bio-clinical, conventional radiologic and 3D-radiomic features for the differentiation of benign and malignant solid renal tumors using pre-operative multiphasic contrast-enhanced CT examinations. MATERIALS AND METHODS: A unicentric retrospective analysis of prospectively acquired data from a national kidney cancer database was conducted between January 2016 and December 2020. Histologic findings were obtained by robotic-assisted partial nephrectomy. Lesion images were semi-automatically segmented, allowing for a 3D-radiomic features extraction in the nephrographic phase. Conventional radiologic parameters such as shape, content and enhancement were combined in the analysis. Biological and clinical features were obtained from the national database. Eight machine learning (ML) models were trained and validated using a ten-fold cross-validation. Predictive performances were evaluated comparing sensitivity, specificity, accuracy and AUC. RESULTS: A total of 122 patients with 132 renal lesions, including 111 renal cell carcinomas (RCCs) (111/132, 84%) and 21 benign tumors (21/132, 16%), were evaluated (58 +/- 14 years, men 74%). Unilaterality (100/111, 90% vs. 13/21, 62%; p = 0.02), necrosis (81/111, 73% vs. 8/21, 38%; p = 0.02), lower values of tumor/cortex ratio at portal time (0.61 vs. 0.74, p = 0.01) and higher variation of tumor/cortex ratio between arterial and portal times (0.22 vs. 0.05, p = 0.008) were associated with malignancy. A total of 35 radiomics features were selected, and "intensity mean value" was associated with RCCs in multivariate analysis (OR = 0.99). After ten-fold cross-validation, a C5.0Tree model was retained for its predictive performances, yielding a sensitivity of 95%, specificity of 42%, accuracy of 87% and AUC of 0.74. CONCLUSION: Our machine learning-based model combining clinical, radiologic and radiomics features from multiphasic contrast-enhanced CT scans may help differentiate benign from malignant solid renal tumors.

The prognostic value of radiomic features in liver-limited metastatic colorectal cancer patients from the TRIBE2 study.

Aims: Evaluating the prognostic role of radiomic features in liver-limited metastatic colorectal cancer treated with first-line therapy at baseline and best response among patients undergoing resection. Patients & methods: Among patients enrolled in TRIBE2 (NCT02339116), the association of clinical and radiomic data, extracted by SOPHiA-DDM™ with progression-free and overall survival (OS) in the overall population and with disease-free survival/postresection OS in those undergoing resection was investigated. Results: Among 98 patients, radiomic parameters improved the prediction accuracy of our model for OS (area under the curve: 0.83; sensitivity: 0.85; specificity: 0.73; accuracy: 0.78), but not progression-free survival. Of 46 resected patients, small-distance high gray-level emphasis was associated with shorter disease-free survival and high gray-level zone emphasis/higher kurtosis with shorter postresection OS. Conclusion: Radiomic features should be implemented as tools of outcome prediction for liver-limited metastatic colorectal cancer.

Behavioral health and treatment-seeking behaviors among deployed vs. non-deployed service members: How impactful is deployment on well-being?

Increasing attention has been dedicated to studying behavioral health of non-deployed military personnel. This investigation explored the impacts of a variety of sociodemographic and health factors on key behavioral health outcomes among active duty personnel. A secondary analysis was conducted using 2014 Defense Health Agency Health Related Behaviors Survey data (unweighted n = 45,762, weighted n = 1,251,606). Three logistic regression models investigated factors associated with reporting symptomatology consistent with depression, anxiety, and stress. We found that after adjusting for sociodemographic and other health variables (e.g., sleep), deployment was associated with stress but not anxiety or depression. Although deployed personnel were more likely to report increased levels of stress overall, few differences with respect to the sources of stressors were identified. While behavioral health screening and treatment needs may differ for non-deployed and deployed personnel, programs to support mental and physical well-being among all service members should be robustly promoted.

Quadhelix: una herramienta en el manejo del paciente con secuela de fisuralabio-alveolo-palatina. Reporte de tres casos / Quadhelix: a tool for cleft lip and palate patients management. Report of three cases

Las fisura labio-alveolo-palatina son las anomalías congénitas más frecuentes, por lo que el ortodoncista debe conocer el manejo transversal en estos pacientes, su omisión puede hacer que se agrave la fisura, porque los efectos biomecánicos en estos pacientes merecen especial cuidado debido a su estructura maxilar. La serie de casos incluye tres pacientes, uno con secuela de fisura labio-alveolo-palatina unilateral derecho, el otro bilateral y el último unilateral izquierdo. La constricción transversal maxilar y la discrepancia en relación con el ancho mandibular, llevó a la elección del uso del quadhelix para resolver este problema. En los tres casos se lograron los objetivos transversales del tratamiento. Se concluyó que, el quadhelix representa una alternativa razonable teniendo como ventajas ser un dispositivo de expansión lenta que produce menos resistencia tisular alrededor de las estructuras circunmaxilares y, mejora la formación de hueso en la sutura intermaxilar; de igual manera al tener mayores efectos dentoalveolares, no produce pérdida ósea a nivel vestibular; adicionalmente presenta una mejor adaptación muscular y bajas probabilida-des de recidiva.

As cleft lip and palate is one of the most frequent congenital anomalies, orthodontists should know about transverse management in these patients, to ignore it might aggravate the fissure, as the biomechanical effects in these patients require special care due to their maxillary structure. This case series include three patients, one with a sequel of right unilateral cleft lip and palate, one bilateral and the last one with left unilateral cleft lip and palate. The maxillary transverse constriction and the discrepancy with the mandib-ular width, led to choice quadhelix appliance to solve this problem. In all three cases the transversal treatment objectives were achieved. In conclusion the quadhelix appliance is a reliable alternative which has advantages such as a slow expansion producing less tissue resistance around the circummaxillary structures and improves bone formation in the intermaxillary suture; similarly, it has greater dentoalveolar effects that does not cause buccal cortical bone loss; additionally, it shows better muscular adaptation and low chance of relapse

Factors Associated with False Positive Results on Screening Mammography in a Population of Predominantly Hispanic Women.

Background: Potential harms of screening mammography include false positive results, such as recall breast imaging or biopsies.Methods: We recruited women undergoing screening mammography at Columbia University Medical Center in New York, New York. They completed a questionnaire on breast cancer risk factors and permitted access to their medical records. Breast cancer risk status was determined using the Gail model and a family history screener. High risk was defined as a 5-year invasive breast cancer risk of ≥1.67% or eligible for BRCA genetic testing. False positive results were defined as recall breast imaging (BIRADS score of 0, 3, 4, or 5) and/or biopsies that did not yield breast cancer.Results: From November 2014 to October 2015, 2,361 women were enrolled and 2,019 were evaluable, of whom 76% were Hispanic and 10% non-Hispanic white. Fewer Hispanic women met high-risk criteria for breast cancer than non-Hispanic whites (18.0% vs. 68.1%), but Hispanics more frequently engaged in annual screening (71.9% vs. 60.8%). Higher breast density (heterogeneously/extremely dense vs. mostly fat/scattered fibroglandular densities) and more frequent screening (annual vs. biennial) were significantly associated with false positive results [odds ratio (OR), 1.64; 95% confidence interval (CI), 1.32-2.04 and OR, 2.18; 95% CI, 1.70-2.80, respectively].Conclusions: We observed that women who screened more frequently or had higher breast density were at greater risk for false positive results. In addition, Hispanic women were screening more frequently despite having a lower risk of breast cancer compared with whites.Impact: Our results highlight the need for risk-stratified screening to potentially minimize the harms of screening mammography. Cancer Epidemiol Biomarkers Prev; 27(4); 446-53. ©2018 AACR.

Acidosis increases the susceptibility of respiratory epithelial cells to Pseudomonas aeruginosa-induced cytotoxicity.

Bacterial infection can lead to acidosis of the local microenvironment, which is believed to exacerbate disease pathogenesis; however, the mechanisms by which changes in pH alter disease progression are poorly understood. We test the hypothesis that acidosis enhances respiratory epithelial cell death in response to infection with Pseudomonas aeruginosa Our findings support the idea that acidosis in the context of P. aeruginosa infection results in increased epithelial cell cytotoxicity due to ExoU intoxication. Importantly, enforced maintenance of neutral pH during P. aeruginosa infection demonstrates that cytotoxicity is dependent on the acidosis. Investigation of the underlying mechanisms revealed that host cell cytotoxicity correlated with increased bacterial survival during an acidic infection that was due to reduced bactericidal activity of host-derived antimicrobial peptides. These findings extend previous reports that the activities of antimicrobial peptides are pH-dependent and provide novel insights into the consequences of acidosis on infection-derived pathology. Therefore, this report provides the first evidence that physiological levels of acidosis increase the susceptibility of epithelial cells to acute Pseudomonas infection and demonstrates the benefit of maintaining pH homeostasis during a bacterial infection.

Usability Testing of a Web-Based Decision Aid for Breast Cancer Risk Assessment Among Multi-Ethnic Women.

Chemoprevention with antiestrogens could decrease the incidence of invasive breast cancer but uptake has been low among high-risk women in the United States. We have designed a web-based patient-facing decision aid, called RealRisks, to inform high-risk women about the risks and benefits of chemoprevention and facilitate shared decision-making with their primary care provider. We conducted two rounds of usability testing to determine how subjects engaged with and understood the information in RealRisks. A total of 7 English-speaking and 4 Spanish-speaking subjects completed testing. Using surveys, think-aloud protocols, and subject recordings, we identified several themes relating to the usability of RealRisks, specifically in the content, ease of use, and navigability of the application. By conducting studies in two languages with a diverse multi-ethnic population, we were able to implement interface changes to make RealRisks accessible to users with varying health literacy and acculturation.

Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools.

The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.