Explaining Variability in Electronic Health Record Effort in Primary Care Ambulatory Encounters.

Background:  Electronic health record (EHR) user interface event logs are fast providing another perspective on the value and efficiency EHR technology brings to health care. Analysis of these detailed usage data has demonstrated their potential to identify EHR and clinical process design factors related to user efficiency, satisfaction, and burnout.

Objective:  This study aimed to analyze the event log data across 26 different health systems to determine the variability of use of a single vendor's EHR based on four event log metrics, at the individual, practice group, and health system levels.

External validation of GO-FAR 2 calculator for outcomes after in-hospital cardiac arrest with comparison to GO-FAR and trial of expanded applications.

Aim: Externally validate the GO-FAR 2 tool for predicting survival with good neurologic function after in-hospital cardiac arrest with comparison to the original GO-FAR tool. Additionally, we collected qualitative descriptors and performed exploratory analyses with various levels of neurologic function and discharge destination.

Methods: Retrospective chart review of all patients who underwent in-hospital resuscitation after cardiac arrest during the calendar years 2016-2019 in our institution ( = 397).

Perforated appendicitis: The solution to pollution is not dilution.

Background: Surgical dogma states that the "solution to pollution is dilution." We hypothesized that withholding irrigation during pediatric Single Incision Laparoscopic Surgery (SILS) appendectomies for perforated appendicitis would decrease postoperative abscess rate.

Methods: From May 2011 to 5/2015, during SILS appendectomies, saline irrigation and suctioning was performed.

Reoperation following urgent and emergent colectomy in the State of Michigan.

Background: Reoperation is associated with unfavorable outcomes and increased healthcare utilization. This study seeks to investigate the incidence and factors related to reoperation in patients undergoing urgent/emergent colectomies.

Methods: The Michigan Surgical Quality Collaborative (MSQC) database was used to identify patients undergoing urgent/emergent colectomies.

Retrospective Comparison of Prehospital Sustained Return of Spontaneous Circulation (ROSC) Rates Within a Single Basic Life Support Jurisdiction Using Manual vs Lund University Cardiac Assist System (LUCAS-2) Mechanical Cardiopulmonary Resuscitation.

Objective Several studies have examined the impact of mechanical cardiopulmonary resuscitation (CPR) devices among multi-jurisdictional emergency medical services (EMS) systems; however, the variability across such systems can inject bias and confounding variables. We focused our investigation on the effect of introducing the Lund University Cardiac Assist System 2 (LUCAS-2) into a single basic life support (BLS) fire department first response jurisdiction served by a single private advanced life support (ALS) agency, hypothesizing that the implementation of the device would increase prehospital return of spontaneous circulation (ROSC) rates as compared with manual CPR.  Methods A retrospective observational analysis of adult non-traumatic prehospital cardiac arrest ALS agency records was conducted.

Skewing of the antibody repertoire in cerebrospinal fluid B cells from healthy controls and patients with schizophrenia.

Autoantibodies play a role in the etiology of some neuropsychiatric disorders. To address the possibility that B cells and their antibodies may be involved in the pathophysiology of schizophrenia, we examined B cells in cerebrospinal fluid (CSF) and peripheral blood (PB) of 4 schizophrenic patients (SP) and 4 healthy control (HC) volunteers by analyzing immunoglobulin VH gene usage. All CSF samples contained measurable levels of B cells.

Modulation of microbiome diversity and cytokine expression is influenced in a sex-dependent manner during aging.

The microbiome and immune system have a unique interplay, which influences homeostasis within the organism. Both the microbiome and immune system play important roles in health and diseases of the aged including development of cancer, autoimmune disorders, and susceptibility to infection. Various groups have demonstrated divergent changes in the gut microbiota during aging, yet the compounding factor of biological sex within the context of aging remains incompletely understood, and little is known about the effect of housing location in the composition of gut microbiota in the context of both sex and age.

Hospitalization for Chagas Heart Disease in the United States From 2002 to 2017.

This cross-sectional study examines characteristics and outcomes of estimated discharges for Chagas heart disease in the United States from 2002 to 2017.

The Impact of Pop-Up Clinical Electronic Health Record Decision Tools on Ordering Pulmonary Embolism Studies in the Emergency Department.

Background: Emergency physicians make time-sensitive care decisions for life threatening diagnoses and utilize evidence-based decision rules and testing with high sensitivity to ensure that critical diagnoses are not missed. Current literature suggests that there is over testing for pulmonary embolism in the emergency department.

Objectives: This study aimed to determine whether the addition of a pop-up notification of the Modified Wells Criteria into the workflow would impact the number of total orders for computed tomography pulmonary angiography (CTPA) or the diagnostic yield of those studies.

Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies.

Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics.

National trends and outcomes of genetically inherited non-alcoholic chronic liver disease in the USA: estimates from the National Inpatient Sample (NIS) database.

Background: Medical literature on the prevalence of genetic liver disease is lacking. In this study, we investigated the in-hospital healthcare and economic burden from genetic causes of non-alcoholic chronic liver disease (NACLD) and non-alcoholic liver cirrhosis (NALC) in the USA.

Methods: Data were abstracted from the National Inpatient Sample database between 2002 and 2014 using ICD9 codes for patients discharged with NACLD and NALC secondary to genetic diseases including alpha-1 antitrypsin deficiency (A1ATd), cystic fibrosis (CF), Wilson disease (WD), hereditary hemochromatosis (HHC), glycogen storage disease, and disorders of aromatic amino-acid metabolism (DAAAM).

Assessment of Agreement Between Human Ratings and Lexicon-Based Sentiment Ratings of Open-Ended Responses on a Behavioral Rating Scale.

To date, there is a paucity of research conducting natural language processing (NLP) on the open-ended responses of behavior rating scales. Using three NLP lexicons for sentiment analysis of the open-ended responses of the Behavior Assessment System for Children-Third Edition, the researchers discovered a moderately positive correlation between the human composite rating and the sentiment score using each of the lexicons for strengths comments and a slightly positive correlation for the concerns comments made by guardians and teachers. In addition, the researchers found that as the word count increased for open-ended responses regarding the child's strengths, there was a greater positive sentiment rating.

Going vertical: triage flags improve extraction times for priority patients.

Objective: The number of mass casualty incidents (MCIs) has been steadily increasing. High-priority MCI patient outcomes are highly dependent on rapid identification, treatment, and transport. Although there are several methods used to mark patients for rapid extraction, most current methods utilize low-profile tags, with no gold standard.

Gender perception bias of operative autonomy evaluations among residents and faculty in general surgery training.

Background: Resident operative autonomy (ROA) is critical and a shared responsibility of both faculty and residents during training. We hypothesize that there is a perception of gender bias in residents' performance as evaluated by faculty and residents.

Method: Over a period of five academic years, between July 2014 and June 2019, ROA was evaluated using the Zwisch score.

Using Simulation in Training Pediatric Residents on Neonatal Abstinence Syndrome Scoring: An Experimental Study.

Background: Neonatal abstinence syndrome (NAS) is characterized by significant physiological and behavioral signs involving multiple-organ systems in neonates following a prenatal exposure to opioids and other nonopioid drugs. Neonatal abstinence syndrome can result in serious morbidity, and even death, if unrecognized and untreated. The purpose of this study was to develop a simulation model of a standard video training of the Finnegan Neonatal Abstinence Scoring System (FNAS) and investigate the perceptions of comfort and competency of pediatric residents undergoing video or simulation training.

Awareness of genetic testing for children with autism spectrum disorder among caregivers in an autism support group.

Recent discoveries have improved our understanding of the complex genetic mechanisms underlying autism spectrum disorder (ASD). Despite current guidelines, genetic testing for children with ASD is largely underutilized. This has been attributed to a lack of public awareness regarding genetic testing.

Hospitalizations for tuberculous peritonitis in the United States: Results from the national inpatient sample database from 2002 to 2014.

Background: Tuberculosis (TB) is an uncommon disease in the Western hemisphere that can present with peritoneal involvement, as tuberculous peritonitis(TBP) causing abdominal pain and fever. The healthcare and economic burden of TBP in the United States remains unknown.

Methods: The National Inpatient Sample database was utilized to investigate TBP hospitalizations from 2002 to 2014.

Pyomyositis in the United States 2002-2014.

Objectives: Primary pyomyositis is a bacterial infection of skeletal muscle first recognized in tropical regions of the world but needing characterization in temperate climates.

Methods: This population-based study used the Healthcare Utilization Project/Nationwide Inpatient Sample database to characterize the trends of pyomyositis admissions in the United States from 2002-2014 using ICD-9 diagnostic codes.

Results: We found a concerning more than three-fold increase in the incident pyomyositis admissions over our study period.

Synchronization of the Normal Human Peripheral Immune System: A Comprehensive Circadian Systems Immunology Analysis.

In this study, we sought to fill an important gap in fundamental immunology research by conducting a comprehensive systems immunology analysis of daily variation in the normal human peripheral immune system. Although variation due to circadian rhythmicity was not a significant source of variation in daily B-cell levels or any CD4+ functional subset, it accounted for more than 25% of CD4+ regulatory T-cell variation and over 50% of CD8+ central memory variation. Circadian rhythmicity demonstrated phase alignment within functional phenotypes.

Virtual Reality Use for Symptom Management in Palliative Care: A Pilot Study to Assess User Perceptions.

In the past two decades, virtual reality (VR) technology has found use in a variety of clinical settings including pain management, physical medicine and rehabilitation, psychiatry, and neurology. However, little is known about the utility of VR in the palliative care setting. Moreover, previous investigations have not explored user perceptions of the VR experience in this population.

Hospital admissions for tuberculous pericarditis in the United States 2002-2014.

Background: Extra pulmonary manifestations of tuberculosis (TB) are rare in developed countries. TB is the main etiology of chronic pericarditis in developing countries, but it's epidemiology is not unknown in the United States.

Methods: This retrospective study used the Healthcare Utilization Projects/Nationwide Inpatient Sample (HCUPS/NIS) database from 2002-2014 to evaluate the characteristics, risk factors, trends over time and region of tuberculous pericarditis in the United States.