Chris Wichman

Diagnostic value of tumor antigens in malignant pleural effusion: A meta-analysis

The diagnostic value of tumor markers, carcinoembryonic antigen (CEA), cancer antigen (CA) 15-3, CA 19-9, CA 125, cytokeratin fragment (CYFRA), and neuron-specific enolase (NSE) in pleural fluid to differentiate between benign and malignant pleural effusion (MPE) has not yet been clearly established. A review of English language studies using human subjects was performed. Sensitivity and specificity values of the chosen tumor markers were pooled using a random effects model to generate hierarchical summary receiver operator curves to determine the diagnostic performance of each tumor marker. A total of 49 studies were included in the final analysis. Pooled sensitivity and specificity values for chosen tumor markers for diagnosing MPE are as follows: CEA, 0.549 and 0.962; CA 15-3, 0.507 and 0.983; CA 19-9, 0.376 and 0.980; CA 125, 0.575 and 0.928; CYFRA, 0.625 and 0.932; NSE, 0.613 and 0.884. The use of individual tumor markers in diagnosing MPE has many benefits (cost, invasiveness, and so forth). Although these tumor markers exhibit high specificity, the low sensitivity of each marker limits the diagnostic value. We conclude that tumor markers used individually are of insufficient diagnostic accuracy for clinical use. Tumor markers used in various combinations or from serum may have some potential worth further investigation.

Lighting conditions used during visual shade matching in private dental offices.

STATEMENT OF PROBLEM To our knowledge, no data are available on the actual lighting that is used for visual shade matching in private dental offices. PURPOSE The purpose of this study was to determine the shade matching practices and interest in continuing education in dental practices and to determine the quantity and quality of the ambient lighting used during visual shade matching in a sample cohort of dentists in private practices. MATERIAL AND METHODS Thirty-two private practices were enrolled, and each completed a 1-page survey on the clinics shade matching practices. A spectrophotometer was used to measure the ambient lighting in each practice, collecting data on color temperature (Kelvin), color rendering index (CRI), and light intensity (foot candles/fc). A 2-sided nonparametric sign test was used to compare the true median color temperature with the standard (5500°K). A 1-sided t test was used to compare the CRI with the standard (CRI >90) (α=.05 for all statistical analyses). RESULTS All dental practitioners surveyed used mainly visual shade matching in their practices. Of those, 87.5% showed interest in attending continuing education on this topic, with 56.3% preferring a clinical demonstration course. The mean color temperature was 4152.9°K and was significantly different from the standard 5500°K (P<.001). The 1-sided t test indicated that the mean CRI was less than 90 (P=1). The 95% confidence interval for the intensity was 80.7 to 111.6 fc. CONCLUSIONS The ambient light in the majority of the 32 dental private practices measured was not ideal for visual shade matching.

Implementing Collaborative Learning in Prelicensure Nursing Curricula: Student Perceptions and Learning Outcomes.

This study evaluated learning outcomes and student perceptions of collaborative learning in an undergraduate nursing program. Participants in this 3-phase action research study included students enrolled in a traditional and an accelerated nursing program. The number of students who passed the unit examination was not significantly different between the 3 phases. Students had positive and negative perceptions about the use of collaborative learning.

Role of B-Type Natriuretic Peptide in Predicting In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease With Preserved Left Ventricular Function A 5-Year Retrospective Analysis

Background: The role of B-type natriuretic peptide (BNP) is less understood in the risk stratification of patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), especially in patients with normal left ventricular ejection fraction (LVEF). Methods: This retrospective study from 2008 to 2012 evaluated all adult patients with AECOPD having BNP levels and available echocardiographic data demonstrating LVEF ≥40%. The patients were divided into groups 1, 2, and 3 with BNP ≤ 100, 101 to 500, and ≥501 pg/mL, respectively. A subgroup analysis was performed for patients without renal dysfunction. Outcomes included need for and duration of noninvasive ventilation (NIV) and mechanical ventilation (MV), NIV failure, reintubation at 48 hours, intensive care unit (ICU) and total length of stay (LOS), and in-hospital mortality. Two-tailed P < .05 was considered statistically significant. Results: Of the total 1145 patients, 550 (48.0%) met our inclusion criteria (age 65.1 ± 12.2 years; 271 [49.3%] males). Groups 1, 2, and 3 had 214, 216, and 120 patients each, respectively, with higher comorbidities and worse biventricular function in higher categories. Higher BNP values were associated with higher MV use, NIV failure, MV duration, and ICU and total LOS. On multivariate analysis, BNP was an independent predictor of higher NIV and MV use, NIV failure, NIV and MV duration, and total LOS in groups 2 and 3 compared to group 1. B-type natriuretic peptide continued to demonstrate positive correlation with NIV and MV duration and ICU and total LOS independent of renal function in a subgroup analysis. Conclusion: Elevated admission BNP in patients with AECOPD and normal LVEF is associated with worse in-hospital outcomes and can be used to risk-stratify these patients.

257: TRAUMA PATIENTS HAVE BEEN EXPOSED TO INCREASING RADIATION DOSES OVER THE DECADE 2001–2010

patients transported by a specialized pediatric transport team at ACH and state EMS services. Final disposition, Emergency Department (ED) length of stay (LOS), hospital LOS, and time to the operating room (OR) were compared between group. Demographic characteristics and baseline clinical variables were assessed with two sample t-tests for continuous variables (with appropriate log transformations of the skewed variables) and Pearson test for categorical variables. Multivariate linear models using ordinary least squares was used to assess whether the differences in LOS between EMS and specialized teams remained significant after adjusting for age, gender, race and ISS. Results: There were significant differences between specialized transport team and EMS groups for demographic variables; in particular median age of the specialized team group was lower; [EMS team 10.4y (9.6 ± 5.6) vs. Specialized team 6.2y (7.4 ± 5.8) median (mean ± SD)] and ISS scores were lower in the specialized transport group. For outcome variables, un-adjusted differences in ED disposition were different, LOS was shorter, ED LOS was shorter, and the probability of survival was higher in patients transported by a specialized pediatric team. Multivariate analysis, adjusting for age and ISS revealed a significantly different ED LOS with patients transported by EMS teams spending an average of 0.67 (95% CI 0.65 to 0.68) hours longer in the ED. Conclusions: The age difference between groups was expected as specialized teams are more often called upon to transport younger patients. The difference in ED LOS [EMS Team 2.5 (3.2 ± 3.9) vs Specialized Team 2.3h (2.6 ± 2.2) P<0.001] suggests that improved care provided by specialized pediatric teams may result in enhanced resuscitation during transport, decreasing time spent in the ED. In turn, patients are transferred to ICUs or ORs more quickly, thus expediting appropriate ongoing care and rationing ED resources more efficiently. Future evaluations will determine if differences exist in subsets of trauma patients and if the number of interventions during transport differs among specialized pediatric teams versus EMS teams. Specialized pediatric transport teams may provide better care and shorten ED LOS in trauma patients transported to tertiary care children’s hospitals.