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Introduction: Emergency departments (ED) are rapidly replacing conventional troponin assays with high-sensitivity troponin tests. We sought to evaluate emergency physician utilization of troponin tests before and after high-sensitivity troponin introduction in our ED. Methods: We retrospectively examined 9,477 ED encounters, identifying the percentage in which physicians ordered a serum troponin both before and after our institution adopted a high-sensitivity troponin test. Results: After introduction of high-sensitivity troponin testing, the percentage of ED encountersin which physicians ordered troponin studies decreased (28.3% before vs 22% after; P

Context.--Idiopathic pulmonary fibrosis is a clinical syndrome characterized by the presence of usual interstitial pneumonia (UIP) radiologically and pathologically. Per consensus criteria adopted in 2011, diagnosis of idiopathic pulmonary fibrosis no longer requires a biopsy in an appropriate context if UIP is seen on imaging. As a result, lung biopsies are now typically reserved for patients having indeterminate clinical or imaging findings or suspicion for alternative diagnoses, but the impact of updated guidelines on pathology practice remains unclear. Objective.--To determine the frequency of histologic UIP before and after 2011. Design.--Surgical lung biopsies from adults were studied within two 4-year periods: July 1, 2006 through June 30, 2010 and January 1, 2012 through December 31, 2015. Pathology slides were reviewed in a fashion blinded to clinical information and were classified using current guidelines. Results.--Biopsies from 177 and 86 patients (mean [SD] age, 62 [12] and 59 [14] years; 50.3% [89 of 177] and 48.8% [42 of 86] men) before and after 2011, respectively, were reviewed. Probable UIP or UIP was less-frequently encountered after 2011 in all patients with fibrosis (9 of 54 [16.7%] versus 41 of 119 [34.5%] before 2011, P = .02) and also in patients 50 years old and older (8 of 46 [17.4%] versus 39 of 109 [35.8%] before 2011, P = .02), with a concomitant rise in cases indeterminate for UIP or showing alternative diagnoses. Conclusions.--Histology for UIP is less frequently encountered in our contemporary practice compared with the historic era. The pretest probability of a non-UIP diagnosis is now high, even in elderly patients, underscoring the need for pathologists to be familiar with the histologic features of alternative diagnoses. (Arch Pathol Lab Med. 2021;145:717-727; doi: 10.5858/arpa.2020-0100-OA, Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive chronic fibrosing interstitial pneumonia of unknown cause, usually occurring in adults older than 50 years, with a poor prognosis and a median [...]

In this paper we describe the development and refinement of "evidence rules" and "measurement models" within the "evidence model" of the "evidence-centered design" (ECD) framework in the context of the "Packet Tracer" digital learning environment of the "Cisco Networking Academy." Using "Packet Tracer" learners design, configure, and troubleshoot computer networks within an interactive interface. This leads to "product data," which result from the students' final submitted network configurations, and "process data," which are log file entries detailing how they got to the final configurations. We discuss how an iterative cycle of empirical analyses and discussions with subject-matter experts is essential for identifying and accumulating evidence about skill profiles of learners and their development. We present results from descriptive, exploratory, and confirmatory diagnostic modeling analyses for both data types, which required bringing to bear a diversity of tools from multivariate statistics, modern psychometrics, and educational data mining. We close the paper with a discussion of the implications of this work for evidence-based argumentation guided by ECD principles within digital learning environments more generally.

BACKGROUND. Convalescent plasma is the only antibody-based therapy currently available for patients with coronavlrus disease 2019 (COVID-19). It has robust historical precedence and sound biological plausibility. Although promising, convalescent plasma has not yet been shown to be safe as a treatment for COVID-19. METHODS. Thus, we analyzed key safety metrics after transfusion of ABO-compatible human COVID-19 convalescent plasma in 5000 hospitalized adults with severe or life-threatening COVID-19, with 66% in the intensive care unit, as part of the US FDA expanded access program for COVID-19 convalescent plasma. RESULTS. The incidence of all serious adverse events (SAEs), including mortality rate (0.3%), in the first 4 hours after transfusion was CONCLUSION. Given the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive. These early indicators suggest that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19. TRIAL REGISTRATION. ClinicalTrials.gov NCT04338360. FUNDING. Mayo Clinic, Biomedical Advanced Research and Development Authority (75A50120C00096), National Center for Advancing Translational Sciences (UL1TR002377), National Heart, Lung, and Blood Institute (5R35HL139854 and R01 HL059842), National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK07352), Natural Sciences and Engineering Research Council of Canada (PDF-532926-2019), National Institute of Allergy and Infectious Disease (R21 AI145356, R21 AI152318, and AI152078), Schwab Charitable Fund, United Health Group, National Basketball Association, Millennium Pharmaceuticals, and Octapharma USA Inc., Introduction The number of confirmed cases of coronavirus disease 2019 (COVID-19) and the number of deaths attributed to COVID-19 in the US exceed that of any other country in the [...]

Background: Patients in the intensive care unit (ICU) often experience extended periods of immobility. Following hospital discharge, many face impaired mobility and never return to their baseline function. Although the benefits of physical and occupational rehabilitation are well established in non‐ICU patients, a paucity of work describes effective practices to alleviate ICU‐related declines in mobility. Objective: To assess how rehabilitation with physical and occupational therapy (PT‐OT) during ICU stays affects patients' mobility, self‐care, and length of hospital stay. Design: Retrospective cohort study. Setting: Inpatient ICU. Participants: A total of 6628 adult patients who received physical rehabilitation across multiple sites (Arizona, Florida, Minnesota, and Wisconsin) of a single institution between January 2018 and December 2021. Interventions: Not applicable. Main Outcome Measures: Descriptive statistics, linear regression models, and gradient boosting machine methods were used to determine the relationship between the amount of PT‐OT received and outcomes of hospital length of stay (LOS), Activity Measure for Post‐Acute Care Daily Activity and Basic Mobility scores. Results: The 6628 patients who met inclusion criteria received an average (median) of 23 (range: 1‐89) minutes of PT‐OT per day. Regression analyses showed each additional 10 minutes of PT‐OT per day was associated with a 1.0% (95% confidence interval [CI]: 0.41–1.66, p <.001) higher final Basic Mobility score, a 1.8% (95% CI: 1.30%–2.34%, p <.001) higher final Daily Activity score, and a 1.2‐day (95% CI: −1.28 to −1.09, p <.001) lower hospital LOS. One‐dimensional partial dependence plots revealed an exponential decrease in predicted LOS as minutes of PT‐OT received increased. Conclusion: Higher rehabilitation minutes provided to patients in the ICU may reduce the LOS and improve patients' functional outcomes at discharge. The benefits of rehabilitation increased with increasing amounts of time of therapy received. [ABSTRACT FROM AUTHOR]

Background The United States (US) Expanded Access Program (EAP) to coronavirus disease 2019 (COVID-19) convalescent plasma was initiated in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19. While randomized clinical trials were in various stages of development and enrollment, there was an urgent need for widespread access to potential therapeutic agents. The objective of this study is to report on the demographic, geographical, and chronological characteristics of patients in the EAP, and key safety metrics following transfusion of COVID-19 convalescent plasma. Methods and findings Mayo Clinic served as the central institutional review board for all participating facilities, and any US physician could participate as a local physician-principal investigator. Eligible patients were hospitalized, were aged 18 years or older, and had-or were at risk of progression to-severe or life-threatening COVID-19; eligible patients were enrolled through the EAP central website. Blood collection facilities rapidly implemented programs to collect convalescent plasma for hospitalized patients with COVID-19. Demographic and clinical characteristics of all enrolled patients in the EAP were summarized. Temporal patterns in access to COVID-19 convalescent plasma were investigated by comparing daily and weekly changes in EAP enrollment in response to changes in infection rate at the state level. Geographical analyses on access to convalescent plasma included assessing EAP enrollment in all national hospital referral regions, as well as assessing enrollment in metropolitan areas and less populated areas that did not have access to COVID-19 clinical trials. From April 3 to August 23, 2020, 105,717 hospitalized patients with severe or life-threatening COVID-19 were enrolled in the EAP. The majority of patients were 60 years of age or older (57.8%), were male (58.4%), and had overweight or obesity (83.8%). There was substantial inclusion of minorities and underserved populations: 46.4% of patients were of a race other than white, and 37.2% of patients were of Hispanic ethnicity. Chronologically and geographically, increases in the number of both enrollments and transfusions in the EAP closely followed confirmed infections across all 50 states. Nearly all national hospital referral regions enrolled and transfused patients in the EAP, including both in metropolitan and in less populated areas. The incidence of serious adverse events was objectively low ( Conclusions These results suggest that the EAP provided widespread access to COVID-19 convalescent plasma in all 50 states, including for underserved racial and ethnic minority populations. The study design of the EAP may serve as a model for future efforts when broad access to a treatment is needed in response to an emerging infectious disease. Trial registration ClinicalTrials.gov NCT#: NCT04338360., Author(s): Jonathon W. Senefeld 1, Patrick W. Johnson 2, Katie L. Kunze 3, Evan M. Bloch 4, Noud van Helmond 1,5, Michael A. Golafshar 3, Stephen A. Klassen 1, Allan [...]

Objective: This study describes the prevalence of pathogenic germline variants (PGVs) in head and neck cancer patients, the incremental yield compared to a guideline‐based approach to genetic evaluation, and the uptake of family variant testing. Study Design: Prospective cohort study. Setting: Three tertiary academic medical centers. Methods: Germline sequencing using an 84‐gene screening platform among unselected head and neck cancer patients who received care at Mayo Clinic Cancer Centers between April 2018 and March 2020. Results: Amongst 200 patients, the median age was 62.0 years (Q1, Q3: 55, 71), 23.0% were female, 89.0% white/non‐Hispanic, 5.0% Hispanic/Latinx, 6% of another race, and 42.0% had prognostic stage IV disease. The most common subsites were the oropharyngeal (45.0%) and salivary glands (12.0%). The most common histology was squamous cell carcinoma (74.5%). Twenty‐one patients (10.5%) had a total of 22 PGVs; 20 of the 21 patients (95.2%) did not meet criteria for testing by current guidelines. Regarding penetrance of the 22 PGVs, 11 were high or moderate (most common PMS2 or HOXB13), and 11 were low or recessive (most common MUTYH, WNR, or RECQL4). One patient had a change in care based on an identified PGV. Family variant testing was completed at a rate of 4.8%. Conclusions: Universal gene panel testing identified a PGV in 10.5% of head and neck cancer patients; almost all would have been missed by current guideline‐based testing. One of 21 patients had a treatment change due to their PGV, indicating that head and neck cancer treatment decisions are not yet widely informed by germline alterations. Level of Evidence: 3 Laryngoscope, 133:3378–3388, 2023 [ABSTRACT FROM AUTHOR]