Utilization and Outcomes of Extracorporeal Membrane Oxygenation Following Traumatic Brain Injury in the United States.

Describe contemporary ECMO utilization patterns among patients with traumatic brain injury (TBI) and examine clinical outcomes among TBI patients requiring ECMO. Retrospective cohort study. Premier Healthcare Database (PHD) between January 2016 to June 2020.

The association of lupus nephritis with adverse pregnancy outcomes among women with lupus in North America.

Objectives: We evaluated the association of lupus nephritis (LN) and adverse pregnancy outcomes in prospective cohorts of pregnant women with SLE (systemic lupus erythematosus).

Methods: We conducted a patient-level pooled analysis of data from three cohorts of pregnant women with SLE. Pooled logistic regression models were used to evaluate the association of LN and adverse pregnancy outcomes.

Ethical, Legal, and Financial Considerations of Artificial Intelligence in Surgery.

Machine learning systems have become integrated into some of the most vital decision-making aspects of humanity, including hiring decisions, loan applications, and automobile safety, to name just a few. As applications increase in both gravity and complexity, the data quality and algorithmic interpretability of the systems must rise to meet those challenges. This is especially vital for navigating the nuances of health care, particularly among the high stakes of surgical operations.

New Frontiers of Natural Language Processing in Surgery.

The vast and ever-growing volume of electronic health records (EHR) have generated a wealth of information-rich data. Traditional, non-machine learning data extraction techniques are error-prone and laborious, hindering the analytical potential of these massive data sources. Equipped with natural language processing (NLP) tools, surgeons are better able to automate, and customize their review to investigate and implement surgical solutions.

Receipt and Sharing of Information to Improve Knowledge About Living Donor Kidney Transplant among Transplant Candidates with Advanced Chronic Kidney Disease.

Knowledge about living donor kidney transplant (LDKT) is associated with greater access. Yet, little is known about factors associated with high living donor transplant knowledge. Is receipt of LDKT information from health professionals or sharing information with family and friends associated with higher knowledge? We conducted a cross-sectional analysis of data from preemptive LDKT candidates, which assessed knowledge, receipt of information about living donation from health professionals, and history of having shared living donor information with family members or friends.

Racial and Ethnic Differences in the Prevalence of Do-Not-Resuscitate Orders among Older Adults with Severe Traumatic Brain Injury.

Background: Older adults suffering from traumatic brain injury (TBI) are subject to higher injury burden and mortality. Do Not Resuscitate (DNR) orders are used to provide care aligned with patient wishes, but they may not be equitably distributed across racial/ethnic groups. We examined racial/ethnic differences in the prevalence of DNR orders at hospital admission in older patients with severe TBI.

Deep Learning Applications in Surgery: Current Uses and Future Directions.

Deep learning (DL) is a subset of machine learning that is rapidly gaining traction in surgical fields. Its tremendous capacity for powerful data-driven problem-solving has generated computational breakthroughs in many realms, with the fields of medicine and surgery becoming increasingly prominent avenues. Through its multi-layer architecture of interconnected neural networks, DL enables feature extraction and pattern recognition of highly complex and large-volume data.

Changes in Electroencephalography Alpha Associated With Childhood Neglect and Adolescent Alcohol Use.

The present pilot study is interested in the relationship between childhood neglect, brain function, and alcohol use in adolescence. The goal is to guide future prevention and intervention efforts related to alcohol use following childhood neglect. This pilot study comprised 53 adolescents (12-14 years at baseline) recruited from the Department of Social Services (DSS).

Antivenom Does Not Cause Snakebite Complications, Withholding It Does.

We read with interest the retrospective chart review "Crotalidae Polyvalent Immune Fab and Cost-Effective Management of Hospital Admission for Snakebites" by Bowden, et al. The efficacy of US snake antivenoms has been well established for decades. A randomized double-blind placebo-controlled clinical trial (RCT) has demonstrated Fab antivenom efficacy using patient-centered outcomes such as return of functionality and other patient-reported outcomes.

Age of Immigration and Depressive Symptoms Among Young Adult Latinx Immigrants: A Test of Explanatory Models.

Latinx immigrants who migrate to the United States (US) as young children are more likely to experience depression than those who migrate later in life. Our purpose is to test three models that may explain the relationship between age of immigration and depressive symptoms among Latinx immigrants. A secondary analysis of baseline data from a community-based, longitudinal study of Latinx young adults in the US Southeast was conducted.

Decision Making for Infants With Neurologic Conditions.

Parents and clinicians caring for infants with neurologic disease often make high-stakes decisions about infant care. To characterize how these decisions occur, we enrolled infants with neurologic conditions, their parents, and their clinicians in a longitudinal mixed methods study of decision making. We audio recorded family conferences as they occurred and analyzed conferences using a directed content analysis approach.

Educational Resources and Self-Management Support to Engage Patients in Advance Care Planning: An Interpretation of Current Practice in the US.

Background: Educational resources and decision aids help patients, their care partners and health care providers prepare for and confidently engage in Advance Care Planning (ACP). Incorporating ACP resources as part of a self-management approach may lead to fuller engagement with ACP beyond identifying a surrogate decision-maker, towards supporting a person to identify their values and goals and to communicate them with their care partners and health care providers.

Objective: To examine the use of educational resources and decision aids to support self-management of ACP in 11 health systems across the US.

Assessing Quality in Advance Care Planning Documentation: A Survey of Current Methods.

Background: High-quality advance care planning (ACP) documentation facilitates the communication of patients' wishes as they progress in their disease course and travel between health care settings. No consensus exists regarding evaluation of documentation quality, and diverse strategies for assessing quality have been adopted in clinical ACP studies.

Methodology: We conducted a literature review in PubMed and via manual search to identify clinical studies that assessed ACP quality or completeness as an outcome measure over a 5-year period.

SARS-CoV-2 Immunohistochemistry In Placenta.

Compared to the parental SARS-CoV-2 virus, infections by the now dominant Delta variant of SARS-CoV-2 appear to be more common and more severe in pregnant women. The need for a robust, cheap, and quick method for diagnosing placental infection by SARS-CoV-2 has thus become more acute. Here, we describe a highly sensitive and specific immunohistochemical assay for SARS-CoV-2 nucleocapsid protein for routine use in placental pathology practice.

Endoscopic Sinus Surgery for Cystic Fibrosis: Variables Influencing Sinonasal and Pulmonary Outcomes.

Background: Endoscopic sinus surgery is a well-established treatment for chronic rhinosinusitis in patients with cystic fibrosis, though its benefits seem to be limited to improving sinonasal symptoms rather than affecting lung function.

Objective: This study aims to identify clinical and demographic factors that may influence sinonasal and pulmonary outcomes after surgery.

Methods: This is a six-year retrospective analysis of adult cystic fibrosis patients who underwent endoscopic sinus surgery at a tertiary care center.

Differences in Sociodemographic Correlates of Human Papillomavirus-Associated Cancer Survival in the United States.

Objectives: Human papillomavirus (HPV)-associated cancers account for about 9% of the cancer mortality burden in the United States; however, survival differs among sociodemographic factors. We determine sociodemographic and clinical variables associated with HPV-associated cancer survival.

Methods: Data derived from the Surveillance, Epidemiology, and End Results 18 cancer registry were analyzed for a cohort of adult patients diagnosed with a first primary HPV-associated cancer (anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers), between 2007 and 2015.

Neuropalliative Care for Neonates.

Many childhood neurologic conditions are first diagnosed in the perinatal period and shorten or seriously alter the lives of affected infants. Neonatal neuropalliative care incorporates core practices and teachings of both neurology and palliative care and is directed toward patients and families affected by serious neurologic conditions in the antenatal and immediate newborn period. This review outlines key considerations for neurologists hoping to provide a neuropalliative care approach antenatally, in the neonatal intensive care unit, and around hospital discharge.

Effect of a novel healthcare leadership program on leadership and emotional intelligence.

The purpose of this study was to assess the effectiveness of the Feagin Leadership Program (FLP) in teaching leadership domains and emotional intelligence. An anonymous survey of 178 graduates of FLP (2011-2019) including the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) was used to assess emotional intelligence and program views. ANOVA was used to compare the difference in emotional intelligence domains between groups.

Age at Migration and Cognitive Health Among Chinese Older Immigrants in the United States.

This study addressed two questions: (1) Is age at migration associated with cognitive function among Chinese older immigrants? and (2) what personal and environmental factors confound the above relationship? Data were derived from the Population Study of Chinese Elderly ( = 2957). Quantile and linear regressions were used to examine the associations between age at migration and Mini-Mental State Examination (MMSE) and global cognitive function, respectively. Migration in late middle age (50-64) or late adulthood (65 or older) was associated with lower MMSE scores.

Updating an Empirically Based Tool for Analyzing Congenital Heart Surgery Mortality.

Objectives: STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes.

Methods: Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 - June 30, 2017) were analyzed.

Acceptance of Love and Remarriage Among Older Adults in the Philippines.

Later-life re-partnership has been linked to healthy aging, but little is known about Philippine older adults' perception of love and remarriage in older age. Using two nationally representative surveys on aging in the Philippines, we estimated the proportion of older adults reporting acceptance. Using weighted logistic regression, we assessed sociodemographic and health factors associated with acceptance as well as the relationship of this acceptance with social activity and health behaviors.

Grief: The Epidemic Within an Epidemic.

COVID-19 has not only dramatically changed the way we live, it has also impacted how we die and how we grieve. With more and more Americans dying in ICU settings, away from family, and more funerals being held virtually, the pandemic has seriously curtailed normal expressions of grief and cultural mourning. Given the CDC guidelines for funerals and social distancing, simple human touch is no longer a mitigating force against prolonged grief.

A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective.

Background: The medical student experience of a clinical elective in palliative care (PC) remains understudied. Reflective narrative interventions can help students hone narrative competency skills, make sense of their clinical experiences and shed light on their perception of the rotation.

Objectives: To evaluate medical student written reflections after a PC clinical elective.

Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina.

Objective: To characterize operative care for cleft lip and/or palate (CL/P) based on location (ie, from American Cleft Palate Craniofacial Association [ACPA]-approved multidisciplinary teams or from community providers).

Design: Cross-sectional analysis of Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery & Services Database databases for North Carolina from 2012 to 2015.

Setting/patients And Main Outcome Measures: Clinical encounters for children with CL/P undergoing operative procedures were identified, classified by location as "Team" versus "Community," and characterized by demographic, geographic, clinical, and procedural factors.