2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T727,Emergency triage nurses frequently experience significant fatigue owing to long shifts, high patient volumes, and rapid decision-making demands. This chronic fatigue not only affects nurses' health and job satisfaction but also compromises patient care through increased risk of errors. This quality improvement project aimed to assess and address triage nurse fatigue by implementing a reduced shift length protocol at a single academic medical center. Using the focus, analyze, develop, and execute model, this project compared fatigue levels during traditional 12-hour triage shifts with reduced 6-hour shifts. A Qualtrics-based pre- and postsurveys using the Samn-Perelli fatigue scale assessed self-reported fatigue levels among emergency triage nurses at 6- and 12-hour intervals. Surveys also captured demographic data including gender (man/woman), experience, education, and ethnicity. Preintervention data were collected over 34 days, followed by the implementation of a 6-hour rotational shift model. Data analysis from 66 responses over 68 days revealed a statistically significant reduction in fatigue after the intervention. The average fatigue level decreased from 4.58 at the 12-hour mark before the intervention to 3.21 after the intervention (P = .02), representing a 29.91% overall reduction. Experienced nurses reported lower fatigue scores than less experienced peers, whereas nurses with bachelor's degrees demonstrated lower fatigue than those with associate degrees. The implementation of shorter, 6-hour triage shifts effectively reduced fatigue among emergency triage nurses, highlighting a feasible strategy to improve nurse well-being, job retention, and patient care quality. Further projects should evaluate long-term outcomes and explore additional strategies to address nurse fatigue comprehensively.31:T72f,Abstract Objective Optimize use of rapid genomic sequencing (rGS) in a level IV NICU. Study design We designed interventions to improve patient identification, ordering processes, and provider education for rGS in our level IV NICU. We measured the percentage of infants eligible for rGS by internal criteria who had rGS sent, diagnostic yield of rGS (balancing measure), and days from genetics consult to rGS result (balancing measure). Result Our study included 560 infants undergoing genetics evaluation. The percentage of eligible infants who had rGS sent significantly increased from 37% pre-intervention (January 2019–March 2021) to 54% post-intervention (April 2021–September 2024) ( p < 0.001). Diagnostic yield of rGS remained stable (32% vs 34%). Time from genetics consult to rGS result significantly decreased from median 32 to 27 days ( p = 0.04). Conclusion Our quality improvement initiative increased rGS use with stable diagnostic yield and decreased time to rGS result for critically ill infants with suspected genetic disorders. 32:T406,Improve regional clinical care for infants with neonatal encephalopathy presumed to be due to hypoxic-ischemic encephalopathy (HIE) by developing a clinical data registry. We developed a regional multicenter registry of newborns at risk for HIE and leveraged data collected within the registry to design and monitor biannually quality improvement metrics in a collaborative effort among site investigators. Over the 3 years since beginning our improvement efforts, we have demonstrated positive trends in all three initial metrics decided on by our investigators: increasing the cord blood gas acquisition in high-risk deliveries (median 74-87%); increasing neurological exam and encephalopathy score documentation in infants with perinatal acidosis (17-36%); and decreasing the incidence of infants discharged on anti-seizure medication (60-29%). In addition to providing hypothesis-generating research data, local and regional registry data can be successfully utilized for quality improvement efforts across multiple hospitals.33:T4ea,Parental presence at bedside is a critical component of family-centered care for infants admitted to Neonatal Intensive Care Units (NICUs) and their caregivers, allowing for engagement with baby as well as education from the care team. Many families face barriers to physical presence, including transportation, childcare responsibilities, work, and illness, among others. Telehealth can be an avenue for parents to be engaged while not directly at bedside. This project details efforts to launch virtual visits in a Level III NICU, including challenges and lessons learned, across 4 PDSA cycles. We measured the percentage of families on the NICU who attended 4 or more cares sessions per week. We obtained survey responses and open-ended feedback about the implementation from staff and patients. Family engagement rates were higher during active PDSA cycles at trending significance level. Most providers and parents rated the intervention as highly feasible and satisfying. Attendance in cares sessions improved across the QI project, especially for families with public insurance. We found that telehealth visits were able to lessen the disparities in cares participation rates between families with private insurance and families with public insurance.34:T71c,Non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is characterised by the clinical triad of hypersensitivity to NSAIDs, nasal polyposis, and asthma. The cells and mediators causing acute symptoms when driving the hypersensitivity reaction to acetylsalicylic acid (ASA) ingestion, remain poorly defined. To investigate the dynamics of nasal mediators during ASA provocation in N-ERD patients before and 24 weeks after therapy with the IL-4 receptor alpha-blocking antibody dupilumab (EudraCT (2019-004889-18) and ClinicalTrials.gov (NCT04442256)). Nasal mucosal lining fluids of patients with N-ERD, chronic rhinosinusitis patients with nasal polyp (CRSwNP) and healthy disease controls were collected at selected time points up to 2 h after ASA provocation. Analysis of thirty-three different inflammatory mediators as well as transcriptomic profiling was performed. In N-ERD patients, provocation was repeated after 24 weeks of dupilumab therapy. Sixty minutes after provocation with ASA, N-ERD patients showed a significant increase in type 2 associated cytokines (i.e., TSLP, IL-5 and eotaxin-3) as compared to the other patient groups. This effect was diminished after 24 weeks of dupilumab therapy and was independent of the development of ASA tolerance. Transcriptomics revealed dampened upregulation of type 2 associated pathway genes (i.e., AREG) as well as enhanced downregulation of lipid (i.e., ALOX15) and peroxisome metabolisms (i.e., NOS2) at ASA provocation after dupilumab therapy. Treatment with dupilumab leads to reduced nasal type 2 cytokine secretion and distinct changes in transcriptomic profile during ASA provocation, but changes in type 2 mediators show no association with tolerance development. EudraCT (2019-004889-18) and ClinicalTrials.gov (NCT04442256).35:Td9d,ABSTRACT Background Non‐steroidal anti‐inflammatory drug‐exacerbated respiratory disease (N‐ERD) is characterised by the clinical triad of hypersensitivity to NSAIDs, nasal polyposis, and asthma. The cells and mediators causing acute symptoms when driving the hypersensitivity reaction to acetylsalicylic acid (ASA) ingestion, remain poorly defined. Objective To investigate the dynamics of nasal mediators during ASA provocation in N‐ERD patients before and 24 weeks after therapy with the IL‐4 receptor alpha‐blocking antibody dupilumab (EudraCT (2019‐004889‐18) and ClinicalTrials.gov (NCT04442256)). Methods Nasal mucosal lining fluids of patients with N‐ERD, chronic rhinosinusitis patients with nasal polyp (CRSwNP) and healthy disease controls were collected at selected time points up to 2 h after ASA provocation. Analysis of thirty‐three different inflammatory mediators as well as transcriptomic profiling was performed. In N‐ERD patients, provocation was repeated after 24 weeks of dupilumab therapy. Results Sixty minutes after provocation with ASA, N‐ERD patients showed a significant increase in type 2 associated cytokines (i.e., TSLP, IL‐5 and eotaxin‐3) as compared to the other patient groups. This effect was diminished after 24 weeks of dupilumab therapy and was independent of the development of ASA tolerance. Transcriptomics revealed dampened upregulation of type 2 associated pathway genes (i.e., AREG ) as well as enhanced downregulation of lipid (i.e., ALOX15 ) and peroxisome metabolisms (i.e., NOS2 ) at ASA provocation after dupilumab therapy. Conclusion and Clinical Relevance Treatment with dupilumab leads to reduced nasal type 2 cytokine secretion and distinct changes in transcriptomic profile during ASA provocation, but changes in type 2 mediators show no association with tolerance development. Trial Registration EudraCT (2019‐004889‐18) and ClinicalTrials.gov (NCT04442256) 36:T773,Failure to complete cancer treatment is associated with worse oncologic outcomes. This 2-year prospective National Quality Improvement (QI) Collaborative aimed to decrease patient- and program-level rates of missed radiotherapy appointments by 20% at American College of Surgeons (ACS)-accredited cancer programs. One hundred ninety-four accredited cancer programs scheduled 99,057 patients for radiotherapy while voluntarily participating in the ACS Breaking Barriers National QI Collaborative from March 2023 to December 2024. Programs identified patients who missed 3 or more planned radiotherapy treatments, completed community needs assessments, engaged in educational webinars and peer learning discussions, and implemented system-level strategies to improve treatment adherence using an ACS toolkit. Chi-square tests assessed differences in rates of missed radiotherapy treatments, barriers addressed, and interventions implemented. Reductions of 39.8% (from 8.3% to 5.0%) and 31.7% (from 8.2% to 5.6%) were seen in no-show rates at the patient and program levels, respectively. Reductions were demonstrated for all program types, for most census regions, and for breast, gynecologic, and gastrointestinal cancers. The most frequently addressed barriers were transportation (62.3%) and patient illness unrelated to toxicity (37.1%). The most frequently implemented interventions included the development of a workflow and/or protocol related to identified barriers (68.9%) and the creation of internal resources to address these barriers (54.3%). Breaking Barriers is the largest prospective study to decrease rates of missed radiotherapy appointments across multiple program types, census regions, and disease sites. These findings demonstrate the strength of ACS-led National QI Collaborative as an effective large-scale approach to address modifiable barriers to high-quality cancer care delivery.37:T9c7, BACKGROUND: Failure to complete cancer treatment is associated with worse oncologic outcomes. This 2-year prospective National Quality Improvement (QI) Collaborative aimed to decrease patient- and program-level rates of missed radiotherapy appointments by 20% at American College of Surgeons (ACS)–accredited cancer programs. STUDY DESIGN: One hundred ninety-four accredited cancer programs scheduled 99,057 patients for radiotherapy while voluntarily participating in the ACS Breaking Barriers National QI Collaborative from March 2023 to December 2024. Programs identified patients who missed 3 or more planned radiotherapy treatments, completed community needs assessments, engaged in educational webinars and peer learning discussions, and implemented system-level strategies to improve treatment adherence using an ACS toolkit. Chi-square tests assessed differences in rates of missed radiotherapy treatments, barriers addressed, and interventions implemented. RESULTS: Reductions of 39.8% (from 8.3% to 5.0%) and 31.7% (from 8.2% to 5.6%) were seen in no-show rates at the patient and program levels, respectively. Reductions were demonstrated for all program types, for most census regions, and for breast, gynecologic, and gastrointestinal cancers. The most frequently addressed barriers were transportation (62.3%) and patient illness unrelated to toxicity (37.1%). The most frequently implemented interventions included the development of a workflow and/or protocol related to identified barriers (68.9%) and the creation of internal resources to address these barriers (54.3%). CONCLUSIONS: Breaking Barriers is the largest prospective study to decrease rates of missed radiotherapy appointments across multiple program types, census regions, and disease sites. These findings demonstrate the strength of ACS-led National QI Collaborative as an effective large-scale approach to address modifiable barriers to high-quality cancer care delivery. 38:T67d,A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) is the most efficacious dietary therapy for irritable bowel syndrome (IBS). However, the mechanisms by which fermentable oligosaccharides, disaccharides, monosaccharides, and polyols drive IBS pathophysiology are unclear. Patients with Rome IV diarrhea-predominant IBS (IBS-D) underwent barrier function evaluation pre- and post-LFD along with assessment of mast cell number and activation profile. Finally, fecal supernatants (FS) were administered intracolonically to wild-type mice with and without pharmacologic inhibition, toll-like receptor 4 (tlr4) Of 42 patients, 34 responded to the LFD and 8 did not. Patients with IBS-D had significant improvement in colonic barrier structure and function, mast cell number, and levels of mast cell mediators post-LFD. The magnitude of physiological changes did not correlate with the magnitude of clinical response. Humanization of germ-free mice with pre-LFD feces caused barrier dysfunction and post-LFD feces did not. Similarly, pre-LFD FS caused barrier dysfunction in wild-type mice, whereas post-LFD FS did not. Lipopolysaccharide removal and TLR4 antagonism reversed pre-LFD IBS FS-induced barrier dysfunction. Barrier dysfunction was absent in tlr4 Patients with IBS-D exhibited improvement in colonic barrier dysfunction, mast cell recruitment, and activation post LFD. Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols-mediated barrier dysfunction in IBS-D is mediated by direct activation of the TLR4 receptor on colonic mast cells by fecal lipopolysaccharide. gov, Number: NCT04542018.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Before-After Study: study design Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Before-After Study (study design). Clinician-written summaries and actionable practice insights. 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Key quantitative outcomes (sample size, success rates, complication rates) could not be extracted and may differ from what is summarized here.","value_numeric":null}],"summaries":{"what_studied":"This study evaluated whether the introduction of standardized intubation kits and a procedural checklist improved first-pass success rates and reduced complications of endotracheal intubation in a Rwandan emergency or critical care setting.","key_result":"The use of intubation kits combined with a checklist was associated with improved first-pass intubation success and fewer complications during endotracheal intubation, though specific numerical results were not available in the provided source text.","limitations":"The study is set in a single low-resource country (Rwanda), which may limit generalizability; the full methodology and sample size details were not available in the provided abstract, restricting appraisal of internal validity.","practice_takeaway":"Implementing standardized intubation kits and a checklist may be a low-cost, high-impact intervention to improve airway management safety in resource-limited settings. Clinicians in similar environments should consider adopting structured procedural tools to reduce intubation-related complications."}},{"doi":"10.1186/s12884-026-09593-1","pmid":"42401857","title":"Health system strengthening to reduce maternal and perinatal deaths in Central Region of Ghana – project approach","journal_title":"BMC Pregnancy and Childbirth","journal_issn":"1471-2393","published_at":"2026-07-04T00:00:00.000Z","url":"https://doi.org/10.1186/s12884-026-09593-1","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-06T13:36:20.630Z","updated_at":"2026-07-06T13:36:20.630Z","tags":[{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"condition","value":"Maternal Mortality","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"condition","value":"Neonatal Mortality","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"condition","value":"Perinatal Mortality","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"modality","value":"Health System Strengthening","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"modality","value":"Quality Improvement","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"modality","value":"Telemedicine","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"study_design","value":"Before-After Study","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"warning","value":"Absolute MMR and perinatal mortality rate values are not provided, only relative percentage changes, limiting comparison with national or global benchmarks.","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"warning","value":"No concurrent control group — observed improvements may reflect secular trends, seasonality, or improved reporting completeness rather than the interventions alone.","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"warning","value":"Sample size (total deliveries or population denominator) is not reported, making precision of effect estimates unclear.","value_numeric":null},{"paper_doi":"10.1186/s12884-026-09593-1","tag_type":"warning","value":"Study design is labeled 'before-after impact evaluation' but lacks randomization or matching; level of evidence is conservatively set at 4.","value_numeric":null}],"summaries":{"what_studied":"A 3-year before-after quality improvement project (2021–2023, baseline 2020) in Ghana's Central Region evaluated a bundle of health system interventions — life-saving skills training, safe motherhood training, a maternal death tracker, and WhatsApp-based telemedicine clinical supervision — to reduce institutional maternal mortality ratio (MMR) and perinatal mortality rate.","key_result":"Over 3 years, institutional MMR declined by 25.3% and neonatal deaths by 45.2%; skilled birth rate rose from 61.6% to 63.9%, family planning acceptor rate from 28.5% to 45.1%, audited maternal deaths entered into DHIMS2 improved from 78.7% to 100%, and audit recommendation implementation improved from 20% to 72% (4,800 staff trained).","limitations":"Before-after design without a concurrent control group limits causal inference; absolute MMR and perinatal mortality rate figures are not reported, only relative changes; improvements in surveillance (more complete death reporting) may partly explain observed mortality reductions.","practice_takeaway":"A bundled approach — combining staff training, maternal death surveillance tools, and low-cost telemedicine supervision via WhatsApp — was associated with meaningful reductions in institutional maternal and neonatal mortality in a resource-limited setting. Policymakers in similar contexts may consider scaling this model, but controlled evaluation is needed to confirm causal impact."}},{"doi":"10.1016/j.jaip.2026.06.039","pmid":"42398761","title":"ASTHMA CONTROL BEFORE AND AFTER CHANGING GAS STOVES TO ELECTRIC STOVES","journal_title":"The Journal of Allergy and Clinical Immunology: In Practice","journal_issn":"2213-2198","published_at":"2026-07-03T00:00:00.000Z","url":"https://doi.org/10.1016/j.jaip.2026.06.039","source_score":3,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-09T13:35:55.460Z","updated_at":"2026-07-09T13:35:55.460Z","tags":[{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"category","value":"Allergy","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"condition","value":"Asthma","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"modality","value":"Environmental Intervention","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"sample_size","value":"n=85","value_numeric":85},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"study_design","value":"Before-After Study","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"warning","value":"Age and sex distributions of the 85 participants are not reported in the abstract, so age_group and sex tags are estimated as 'mixed' based on the mixed school/work day outcome language.","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"warning","value":"Follow-up period is only 2–3 months; long-term durability of benefit is unknown.","value_numeric":null},{"paper_doi":"10.1016/j.jaip.2026.06.039","tag_type":"warning","value":"No control group was used; the authors explicitly call for a randomized controlled trial to confirm findings. Observed improvements may partly reflect regression to the mean, as participants were enrolled during a period of poor asthma control.","value_numeric":null}],"summaries":{"what_studied":"This before-after study evaluated whether replacing gas stoves with electric stoves improved asthma control in 85 adults with poorly controlled asthma (ACQ score >1.5), comparing outcomes 1–4 weeks before stove change to 2–3 months after.","key_result":"ACQ score improved from 2.6 to 1.5 (difference −1.1, 95% CI −1.3 to −0.8). ER visits or hospitalizations dropped from 11.8% to 3.5% (absolute difference −8.2%, 95% CI −16.2% to −3.4%). Indoor NO₂ fell from 21.0 to 6.3 ppb (change −14.7 ppb).","limitations":"No control group — improvements could reflect regression to the mean, seasonality, or placebo effect. Short follow-up (2–3 months) limits assessment of long-term benefit. Trial is unblinded by design, introducing performance and reporting bias.","practice_takeaway":"For patients with poorly controlled asthma who cook with gas, switching to an electric stove may meaningfully reduce indoor NO₂ and improve symptom control — worth discussing, especially if resources allow. These results are preliminary; a randomized controlled trial is underway and needed before this becomes a standard recommendation."}},{"doi":"10.5546/aap.2025-10884","pmid":null,"title":"Implementación de una escala de alerta tempranapediátrica para identificar el deterioro clínico enuna sala de internación pediátrica","journal_title":"Archivos Argentinos de Pediatria","journal_issn":"0325-0075","published_at":"2026-03-02T00:00:00.000Z","url":"https://doi.org/10.5546/aap.2025-10884","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-06-13T15:34:56.174Z","updated_at":"2026-06-13T15:34:56.174Z","tags":[{"paper_doi":"10.5546/aap.2025-10884","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"condition","value":"Clinical Deterioration","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"condition","value":"Pediatric Unplanned PICU Transfer","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"modality","value":"Pediatric Early Warning System","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"sample_size","value":"n=119","value_numeric":119},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"study_design","value":"Before-After Study","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"warning","value":"EVAT is primarily validated in pediatric oncology populations in Latin America; this study extends its use to a general pediatric population, which is a notable but still single-center generalization.","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"warning","value":"Sample size reflects deterioration events (n=119 total), not total admissions (n=4,652); tags reflect the events cohort as the analytic population. Total admissions are much larger but outcomes were analyzed at the event level.","value_numeric":null},{"paper_doi":"10.5546/aap.2025-10884","tag_type":"warning","value":"The study period overlaps with the COVID-19 pandemic (post-implementation phase: April 2020–November 2021), which may have influenced patient volume, case mix, and staffing — a potential confounder not discussed by the authors.","value_numeric":null}],"summaries":{"limitations":"- Single-center design at a high-complexity tertiary center limits generalizability.\n- Small sample size reduces statistical power, especially for rare outcomes like mortality.\n- Observational before-after design cannot exclude unmeasured confounders or secular trends.","what_studied":"A before-after study evaluated the implementation of EVAT (Escala de Valoración de Alerta Temprana), a Spanish-language pediatric early warning system, in a general pediatric ward at a high-complexity private university hospital in Argentina (April 2019–November 2021), comparing clinical deterioration events, mortality, and critical interventions before (n=53 events) and after (n=66 events) rollout.","key_result":"Critical PICU-level interventions performed in the general ward dropped significantly from 15.4% to 3.0% (OR 0.17, 95% CI 0.03–0.88; p=0.01), an 83% reduction. Mortality fell from 9.4% to 3.0% (OR 0.30; p=0.14) and event rates from 7.64 to 6.42 per 1,000 patient-days (p=0.34), but neither reached statistical significance. EVAT adherence exceeded 90% with error rates consistently below 15%.","practice_takeaway":"Implementing EVAT in a general pediatric ward is feasible and achieves high staff adherence, and it significantly reduces the need for urgent PICU-level interventions outside the ICU. Clinicians in similar settings should consider EVAT as part of a broader patient safety culture, while using process measures (not just mortality) to gauge its impact."}},{"doi":"10.1016/j.jen.2025.11.004","pmid":"41543461","title":"Reduction of Triage Nurse Fatigue Through the Implementation of an Evidence-Based Rotational Protocol","journal_title":"Journal of Emergency Nursing","journal_issn":"0099-1767","published_at":"2026-01-16T00:00:00.000Z","url":"https://doi.org/10.1016/j.jen.2025.11.004","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-17","doi":"10.1016/j.jen.2025.11.004","days":"7","issn":"0099-1767","rank":"7","field":"Clinical Medicine","score":"1","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1016/j.jen.2025.11.004","title":"Reduction of Triage Nurse Fatigue Through the Implementation of an Evidence-Based Rotational Protocol.","journal":"Journal of emergency nursing","methods":"","results":"Data analysis from 66 responses over 68 days revealed a statistically significant reduction in fatigue after the intervention. 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Staff recorded day‑1 postoperative patients’ certainty before rollout (n=20 over two weeks) and again two months after rollout (n=18 over two weeks).","key_result":"Very certain/certain responses increased for: need to posture from 85% (17/20) to 94.4% (17/18); knowing the correct posture from 60% (12/20) to 83.3% (15/18); and knowing the duration from 45% (9/20) to 72.2% (13/18). Patient feedback (n=8) was 100% positive on need, clarity, amount, print size, and page content; staff (n=8) were 87.5% very satisfied and 12.5% satisfied, with 37.5% very certain and 50% certain the leaflet would help patients.","limitations":"Single‑centre, before–after design with small samples (n=20 before; n=18 after). Outcomes were limited to self‑reported certainty and satisfaction; adherence and clinical outcomes were not measured.","practice_takeaway":"An accessible, illustrated leaflet with short videos and large, high‑contrast print can raise patients’ certainty about posturing after vitreoretinal surgery. 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Transcriptomics after dupilumab showed dampened upregulation of type 2 pathway genes (e.g., AREG) and enhanced downregulation of lipid (ALOX15) and peroxisome metabolism (NOS2) pathways during provocation.","practice_takeaway":"In N‑ERD, dupilumab blunts the acute nasal type 2 mediator response to ASA challenge, but these biomarker changes do not indicate development of ASA tolerance."}},{"doi":"10.1097/xcs.0000000000001637","pmid":"41217348","title":"Results of an American College of Surgeons Prospective National Quality Improvement Collaborative to Successfully Overcome Barriers to Cancer Care Across the US","journal_title":"Journal of the American College of Surgeons","journal_issn":"1072-7515","published_at":"2025-11-11T00:00:00.000Z","url":"https://doi.org/10.1097/xcs.0000000000001637","source_score":246,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-12-23","doi":"10.1097/xcs.0000000000001637","days":"30","issn":"1072-7515","rank":"2","field":"Clinical Medicine","score":"246","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1097/XCS.0000000000001637","title":"Results of an American College of Surgeons Prospective National Quality Improvement Collaborative to Successfully Overcome Barriers to Cancer Care Across the US.","journal":"Journal of the American College of Surgeons","methods":"","results":"Reductions of 39.8% (from 8.3% to 5.0%) and 31.7% (from 8.2% to 5.6%) were seen in no-show rates at the patient and program levels, respectively. 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Targeting transportation and non-toxicity illness barriers were frequent and feasible actions."}},{"doi":"10.1053/j.gastro.2025.07.016","pmid":"40749856","title":"Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet Improves Colonic Barrier Function and Mast Cell Activation in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Mechanistic Trial","journal_title":"Gastroenterology","journal_issn":"0016-5085","published_at":"2025-08-02T00:00:00.000Z","url":"https://doi.org/10.1053/j.gastro.2025.07.016","source_score":44,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-12-20","doi":"10.1053/j.gastro.2025.07.016","days":"30","issn":"0016-5085","rank":"9","field":"Clinical Medicine","score":"44","category":"Gastroenterology & Hepatology","categories":["Gastroenterology & Hepatology"],"_categories":["Gastroenterology & Hepatology"]},"pubmed":{"doi":"10.1053/j.gastro.2025.07.016","title":"Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet Improves Colonic Barrier Function and Mast Cell Activation in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Mechanistic Trial.","journal":"Gastroenterology","methods":"","results":"Of 42 patients, 34 responded to the LFD and 8 did not. Patients with IBS-D had significant improvement in colonic barrier structure and function, mast cell number, and levels of mast cell mediators post-LFD. The magnitude of physiological changes did not correlate with the magnitude of clinical response. Humanization of germ-free mice with pre-LFD feces caused barrier dysfunction and post-LFD feces did not. Similarly, pre-LFD FS caused barrier dysfunction in wild-type mice, whereas post-LFD FS did not. Lipopolysaccharide removal and TLR4 antagonism reversed pre-LFD IBS FS-induced barrier dysfunction. 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Post-diet, patients had significant improvements in colonic barrier structure/function, mast cell numbers, and mediator levels; pre-diet feces/fecal supernatants induced barrier dysfunction in mice, which was reversed by lipopolysaccharide removal or TLR4 antagonism, and barrier dysfunction was absent in tlr4.","limitations":"Single-arm pre/post human study without a comparator (n=42). Physiological changes did not correlate with the magnitude of clinical response, and key mechanistic results rely on mouse models and fecal supernatants.","practice_takeaway":"For IBS-D, a low-FODMAP diet was associated with symptom response in most patients (34/42) and improved mucosal barrier and mast cell measures. Mechanistic data implicate fecal lipopolysaccharide–TLR4 signaling, but physiologic shifts did not track symptoms, so they are not ready as response biomarkers."}}],"initialOffset":13,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"study_design","value":"Before-After Study"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Study Designs","href":"/hub/tag/study_design"},{"name":"Before-After Study"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"study_design","hub_tag_value":"Before-After Study"}}}]]

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