Research Spotlight

Rutland, J., Ayoub, K., Etaee, F., Ogunbayo, G., Darrat, Y., Marji, M., Masri, A. and Elayi, C.S. (2020). “CHA(2)DS(2)-VASc and readmission with new-onset atrial fibrillation, atrial flutter, or acute cerebrovascular accident.” Int J Cardiol Aug 13;S0167-5273(20)33554-3. [Epub ahead of print.].

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BACKGROUND: Although risk factors for atrial fibrillation (AF) and atrial flutter (AFL) are known, identifying patients who will develop AF/AFL within the near future remains challenging. We sought to evaluate if the CHA(2)DS(2)-VASc risk score (CVRS) can identify hospital readmissions with AF, AFL, or acute cerebrovascular accident (CVA) among hospitalized patients without prior history of AF/AFL. METHODS: Using the Nationwide Readmission Database, a study cohort included patients without prior AF/AFL or new diagnosis of AF/AFL at the index hospitalization from 2012 to 2014. Patients were stratified based on the CVRS into three groups: Low (CVRS ≤1), Intermediate (CVRS 2-5), and High (CVRS ≥6).The primary outcome of interest was 180-day readmission rate with a primary or secondary diagnosis of AF/AFL. Secondary outcomes of interest were acute CVA and 6-month mortality rate. RESULTS: A total of 17,820,640 patients were included in our study. Over a 6-month follow up duration from the index hospitalization, the overall re-admission rate for new onset atrial arrhythmias (AF/AFL) was 3.48% (n = 620,986), acute CVA 0.13% (n = 22,522), and all-cause mortality 0.31% (n = 55,632). When compared to other groups, patients with a higher CVRS were readmitted more frequently for AF/AFL [odds ratio (OR) 2.43; 95% confidence interval (CI) 2.41-2.45, P < .0001), acute CVA (OR 3.96; 95%CI 3.85-4.08, P < .0001), and all-cause mortality (OR 2.19; 95%CI 2.14-2.24, P < .0001). CONCLUSION: In this large contemporary cohort, a CHADS2VA2SC score ≥ 6 identified patients without known prior atrial arrhythmias at an elevated risk of developing AF/AFL or acute CVA within 6 months of hospitalization.

Huddleston, P. (2020). “Measuring Unlicensed Assistive Personnel Perceptions of a Healthy Work Environment in Acute Care Settings, Part 4.” J Nurs Adm Sep 1. [Epub ahead of print.].

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BACKGROUND: Survey items on the Healthy Work Environment Scale (HWES) for Unlicensed Assistive Personnel (UAP) were developed using statements from a qualitative research study conducted in a large urban healthcare system. PURPOSE: The purposes of this research study were to develop items on the HWES for UAP, to assess the validity and reliability of this tool, and to describe the UAP perceptions of a healthy work environment (HWE) using a nonexperimental descriptive design. METHODS: This research study has 2 separate phases. In phase 1, the UAP assigned each item to 1 of the 8 characteristics of an HWE to assess face validity. The 2nd step in this phase was to have the 10 content experts rate each survey item based on its relevancy to measuring an HWE using a 4-point Likert scale ranging from “not relevant” to “very relevant” to determine content validity by calculating a scale content validity and item content validity indices. Based on the results, there were no items deleted from the survey. In phase 2, principal component analysis assessed the validity of the tool, a Cronbach’s α served as the test for reliability, and the UAP perceptions of an HWE were measured. RESULTS: Samples included 45 content experts for phase 1 and 406 for phase 2. Principal component analysis revealed 49 items comprising 6 components. Internal consistency was 0.976 for all items. Based on the findings, the HWES for UAP demonstrated strong psychometric properties to measure an HWE in acute care settings.

Shah, R.A., Powell, P.R. and Parekh, P.K. (2020). “What Lies Beneath: Cutaneous Involvement of Mantle Cell Lymphoma Underlying an Insect Bite-like Reaction.” J Cutan Pathol Aug 9. [Epub ahead of print.].

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Mantle cell lymphoma (MCL) is an uncommon subtype of mature B-cell non-Hodgkin lymphoma characterized by specific morphologic, immunophenotypic, and genetic characteristics, namely the t(11;14)(q13;q32) chromosomal translocation with resultant cyclin D1 overexpression. MCL has a generally aggressive course and is often widely disseminated at the time of diagnosis. Skin involvement is exceedingly rare and is seldom the first manifestation of MCL. We present a case of mantle cell lymphoma in an 84-year-old man with cutaneous involvement as the first manifestation, discovered incidentally after biopsy of a persistent nodule believed to be an insect bite. This case not only serves to raise awareness of the possibility of MCL presenting in the skin but also to point out that MCL can have lesions with both an insect-bite-like reaction and a deeper dermal MCL infiltrate.

Elsbernd, B.L., Nussenzveig, D.R. and Nguyen, A.D. (2020). “A rare cause of melena.” Clin J Gastroenterol Sep 3. [Epub ahead of print.].

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Melanoma presenting in the gastrointestinal tract is commonly due to metastasis from a primary cutaneous or ocular lesion. There have been a few case reports of primary GI melanoma which is commonly seen in the rectum and anus. We report a case of a 77-year-old man who presented with GI bleeding and was found to have a primary small bowel melanoma. This case highlights how to approach the workup of a melanoma lesion found in the GI tract.

Monticciolo, D.L. (2020). “Priscilla F. Butler, MS – Pioneer in radiation dose assessment and image quality.” Clin Imaging Aug 22;S0899-7071(20)30310-7. [Epub ahead of print.].

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Few people have had the impact that Priscilla “Penny” Butler, MS, has had on radiological technique in the United States. Being a woman leader in medical physics is equally rare. Penny forged both new avenues for women and new ideas for all during her long and productive career in the radiological sciences. She has done so with such grace and humility as to always remain accessible to those with whom she worked and served. This year, Ms. Butler was awarded the American College of Radiology Gold Medal, the College’s highest honor. She is only the 10th woman to receive this recognition, the first being Madame Marie Curie in 1931. In this editorial, we celebrate Ms. Butler for her ground breaking roles in radiological dose assessment and image quality. [No abstract; excerpt from Editorial.].