Clinical characteristics and outcomes of human rhinovirus positivity in hospitalized children.

BACKGROUND: The clinical relevance of positive human rhinovirus (HRV) in hospitalized patients is unclear. Our objective was to describe the clinical characteristics and outcomes of HRV positivity in a heterogeneous population of hospitalized children, compared to those positive for another respiratory virus and those where no respiratory virus was detected. METHODS: A retrospective case-control study of children hospitalized between January 2014 to April 2015 who had a respiratory viral specimen collected. Clinical and laboratory data were collected, and baseline characteristics and clinical variables were compared. RESULTS: During the study period, there were 671 specimens obtained from 577 patients that were processed for the respiratory viral polymerase chain reaction assay, of which 198 were positive for HRV, 167 positive for another respiratory virus, and 306 where no respiratory virus was detected. A history of asthma was significantly associated with HRV-positive patients (odds ratio [OR] 3.71; P < 0.001). On multivariate analysis, HRV-positive patients had a higher requirement for mechanical ventilation (OR 1.44), lower rates of readmission (OR 0.53), and lower mortality (OR 0.35) compared to patients with no respiratory virus isolated; however, none were statistically significant. HRV-positive patients did have a significantly shorter length of stay (LOS) compared with patients with no respiratory virus isolated (difference-0.35; P = 0.001). Similar outcomes were seen in patients positive for other respiratory viruses. CONCLUSIONS: HRV-positive hospitalized pediatric patients with a heterogeneous set of clinical diagnoses had higher association with asthma compared to patients who had another, or no, respiratory virus isolated. HRV-positive patients had shorter LOS compared to patients who had no respiratory viruses isolated. These findings suggest that HRV positivity in hospitalized pediatric patients may not lead to adverse clinical outcomes, although asthma is a risk factor regardless of clinical comorbidities and diagnoses. Further research is warranted to understand the predisposition of asthma to HRV positivity.

Impact of a Transition from Respiratory Virus Shell Vial to Multiplex PCR on Clinical Outcomes and Cost in Hospitalized Children.

While respiratory virus PCR panel (RVPP) is more expensive than shell vial (SV) cell culture, it has been shown to reduce unnecessary diagnostic procedures, decrease the inappropriate use of antimicrobials, and shorten the hospital length of stay (LOS). We therefore hypothesized that, for hospitalized children, RVPP would be associated with improved clinical outcomes but higher hospital charges than SV cell culture. We performed a retrospective cohort study of hospitalized children. Multivariate analysis was performed, and p-values were calculated. Respiratory virus testing was collected in a total of 1625 inpatient encounters, of which 156 were tested positive by RVPP (57.7%) and 112 were tested positive by SV (11.1%, p < 0.05). Excluding human rhinovirus (HRV) and human metapneumovirus (hMPV) from the analysis, patients with a positive test from SV had more comorbidities (p = 0.04) and higher mortality (p = 0.008). Patients with a positive test from RVPP had shorter LOS (p = 0.0503). Hospital charges for patients with a positive test from RVPP were lower, but not significantly so. When a multivariate analysis was performed, there were no statistically significant differences in comorbidities, mortality, LOS, or median hospital charges between those patients with a positive SV and those with a positive RVPP. Although testing with RVPP significantly increased the detection of respiratory viruses, clinical outcomes remained comparable to those tested with SV, however RVPP was found to not be associated with higher long-term hospital costs.

Workshop on personal motion technologies for healthy independent living: executive summary.

The objective of the June 2010 "Workshop on Personal Motions Technologies for Healthy Independent Living" was to discuss personal motion technologies that might enable older adults and individuals with disability to live independently for longer periods. The 60 participants included clinicians, academic researchers, engineers, patient advocates, caregivers, members of the public, and federal representatives. The workshop was divided into 6 sessions that addressed the following: (1) use of technologies in identifying early indicators of disease or adverse events; (2) monitoring daily activities; (3) coping with impairment; (4) managing mild cognitive impairment; (5) rehabilitation and exercise in the home; and (6) caregiver support. Presentations and discussion focused on clinical needs, the health impact of addressing those needs, state-of-the-art technologies, and challenges to adoption of those technologies. Conclusions included the following: (1) Involvement of end-users in research and development will increase the likelihood that technologies will be adopted. (2) Integration of differing types of technology into a system that includes clinical measures is required for independent living. (3) Seniors are willing to sacrifice some privacy for an effective technology that keeps them in their homes as long as they control who receives their data. (4) Multilevel and multiscale models are needed to understand motion in the context of the environment and to design effective systems.

Implementation and evaluation of telehealth tools and technologies.

In June 2009, the National Center for Research Resources (NCRR), National Institutes of Health (NIH), convened a conference of experts to discuss future directions for research in addressing healthcare disparities through the use of telehealth technologies. As part of this conference, a panel was convened to review the status of current efforts to assess, implement, and evaluate telehealth technologies, and to recommend future directions for research. The panel members provided a series of practical recommendations to those who are contemplating establishing a telehealth service, as well as recommendations to the NIH on future funding for telehealth research. The recommendations to the NIH focused on three broad areas of concern: (1) technology assessment, (2) evaluation, and (3) technical assistance, education, and dissemination. The panel members emphasized the need for NIH to support research in areas that have been seriously underfunded in the past, including but not limited to primary care research, multisite collaborative telehealth studies, nonphysician telehealth services, and methodological development to develop a "gold standard" for telehealth studies.

Codominance of the individual posterior cruciate ligament bundles. An analysis of bundle lengths and orientation.

BACKGROUND: It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability. HYPOTHESIS: Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. STUDY DESIGN: Controlled laboratory study. METHODS: Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0 degrees to 120 degrees. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized. RESULTS: Length of the anterolateral bundle increased with increasing knee flexion angle from 10 degrees to 120 degrees. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0 degrees to 45 degrees and increased slightly from 60 degrees to 120 degrees. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0 degrees, 10 degrees, and 20 degrees of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 45 degrees (P < 0.05). The posteromedial bundle was more horizontal at 120 degrees. CONCLUSIONS: Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. CLINICAL RELEVANCE: Double-bundle reconstructions achieve more physiologic knee function.

Computer simulations of patellofemoral joint surgery. Patient-specific models for tuberosity transfer.

BACKGROUND: Variable clinical outcomes of tibial tuberosity transfer surgery have been reported. HYPOTHESES: The biomechanical outcome of surgery is patient-specific; no single procedure produces superior results for all patients. Use of patient-specific computer models can optimize choice of procedure. STUDY DESIGN: Computer simulation study using clinical data. METHODS: We used patient-specific multibody models of the patellofemoral joints of 20 patients with a diagnosis of patellar subluxation and osteoarthritis. Four tibial tuberosity transfer procedures (two anterior and two anteromedial) were simulated for each patient and compared with their preoperative model. RESULTS: When results for all patients were averaged, all simulated operations produced a statistically significant decrease in surface-wide mean contact stress, although no significant difference was found among them. CONCLUSIONS: The simulated surgical outcomes were patient-specific: no single procedure was consistently superior at decreasing peak or mean stress and each procedure produced a potentially detrimental outcome, an increase in either mean stress or peak stress, in at least one patient. CLINICAL RELEVANCE: Computer simulation may serve as a valuable tool for tailoring procedures to specific patients.