bluuebunny/crossref_metadata_2025 huggingface dataset:
854 Sexsomnia in a Divorce Proceeding and its Custody Implications
Authors: Uppalapati Madhuri , Strohl Kingman , Sibilia Robert
Published: May 2021

Introduction

Sexsomnia is a NREM parasomnia under the subtype of Confusional Arousals, defined as abnormal sexual behaviors emerging from partial arousals during slow-wave sleep. Case reports suggest that is more common in men. Precipitating factors include Obstructive Sleep Apnea, insufficient sleep, alcohol and fatigue/stress and history of NREM parasomnias.

Report of case(s)

A 37-year-old male with bruxism (using mouth guard) and anxiety for 7 years, who presented to the sleep clinic for a second opinion to discuss concerns around the safety of his children due to his sleep related sexual behavior. Sexsomnia was first noted with the stressors related to becoming a parent (fostering children and having biological children). Sexual behavior reported by the couple was mostly provoked with spouse’s touch during sleep. Behaviors ranging from fondling to aggressive sexual intercourse were reported to occur 1 to 3 times/week. There were no injuries during episodes which only occurred in the bedroom with the spouse and the patient was amnestic of his behavior. Due to marital discord provoked by other stressors, he began to sleep alone in the basement. A video-polysomnogram revealed no parasomnia, sleep apnea, or other sleep arousal disorders. Normal REM with atonia was observed. The patient was treated with Duloxetine 20mg for anxiety after the initial sleep visit. His condition contributed to marital separation. In the divorce proceedings, the spouse argued for denial of visitation rights related to his sleep-sexual behaviors noting that the children may be at risk. After separation, his anxiety and stress levels lowered in conjunction with therapy and medication. Follow up after 2 months found the patient asymptomatic. He placed an alarm on his bedroom door, to alert him and others during sleep. There are no published reports to provide a prediction as to whether his condition would-be supporting restrictions in overnight visitation by the foster and biological children.

Conclusion

In this case, there was a precedent condition (bruxism) and precipitating stress and anxiety, known to provoke NREM parasomnia. The absence of polysomnographic evidence is not unusual. Forensic repercussions, in particular prospective calculations of risk, are poorly described in the literature.

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855 Sexsomnia: A Case Series Looking at a Rare Parasomnia
Authors: Ku Brian , Mujuruki Cephas , Patel Abha , Carter Gregory
Published: May 2021

Introduction

Sexsomnia is a male predominant, rare subset of NREM parasomnia involving sleep-related sexual activity. Symptoms can range from individual sexual acts, such as masturbation, to acts involving bed partners, often without recollection. Sexsomnia results in profound personal, social, and legal ramifications. Though typically treated with benzodiazepines, here we present three patients that were managed nontraditionally.

Report of case(s)

Case 1 A 34-year-old man with a history of optimized obstructive sleep apnea (OSA), alcohol abuse, and bipolar disorder reported eight-years of parasomnia characterized by fondling, sexual intercourse, and aggressive sexual acts, despite treatment with benzodiazepines. His fiancé noted that his advances when sleeping were atypical for their normal intimate interactions. He was observed to have frequent arousals from N3 sleep during PSG. The patient denied current substance use, but did report bilateral foot discomfort leading to sleep disturbance. His ferritin was 38 ng/mL, and he was started on oral iron and vitamin C. Case 2 A 41-year-old woman with a history of anxiety, psoriatic arthritis, insomnia and childhood somnambulism presented with parasomnia ranging from fondling to sexual intercourse. Her husband noted that during the episodes, her mannerisms and speech pattern were vastly different from normal. She endorsed difficulty initiating sleep, with a sleep latency of one hour and frequent arousals despite using trazodone nightly. She consumed two to five glasses of whiskey in the evenings several nights a week. Parasomnia events were more prevalent on nights that she partook in alcohol and improved with alcohol cessation. Case 3 A 44-year-old man with a history of optimized mild OSA presented with parasomnias characterized by somnambulism with goal-directed behavior and sexual activity, with a family history of violent parasomnias. Given the atypical nature of his events, he was referred to the epilepsy monitoring unit, which was ultimately nondiagnostic. Benzodiazepine therapy was ineffective. He chose to defer further medical management, leading the patient to pursue cognitive behavioral therapy, with moderate benefit. He reports infrequent parasomnias off medications.

Conclusion

Sexsomnia remains a rare, and likely under reported phenomenon. In each of the highlighted cases, the patients responded to treatment without the use of standard benzodiazepine therapy.

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859 Trial of average volume-assured pressure support (AVAPS) to treat hypoventilation in a child with rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) and systolic heart failure
Authors: Reiling Krista , Sagar Malvika , Finch Robert , Typaldos Marlene , McHugh Erin , Spielberg David , Malhotra Sonal
Published: May 2021

Introduction

ROHHAD syndrome is a rare disorder of respiratory control and autonomic nervous system regulation with endocrine abnormalities. Although children may present with obstructive sleep apnea, their blunted respond to hypoxemia and hypercapnia is a life-threating feature, often leading to cardiorespiratory arrest. There is limited literature regarding non-invasive positive pressure ventilation (NIPPV) in these children. We report a trial of AVAPS in a child with ROHHAD syndrome.

Report of case(s)

Our patient is a 6-year-old male with history of rapid weight-gain (49.9 kg in 2.5 years), type-2 diabetes, and mild OSA who presented to an outside hospital (OSH) in March 2020 with acute hypercapnic hypoxemic respiratory failure. He required bilevel PAP therapy, steroids, and bromocriptine for thermoregulatory dysfunction. His clinical presentation, along with negative PHOX2B gene mutation and absence of parenchymal lung disease on chest computerized tomography suggested a diagnosis of ROHHAD syndrome. Outpatient, he was successfully transitioned to empiric AVAPS therapy. In November 2020, he presented again to an OSH in hypercapnic hypoxemic respiratory failure with new systolic heart failure with ejection fraction of 28%. After clinical stabilization, he was transferred to our hospital on CPAP 10 cmH20 with 100% FiO2 for further management. Awake blood gas was consistent with chronic hypercapnic respiratory failure; therefore, the patient was placed initially on bilevel PAP therapy empirically until an inpatient bilevel PAP titration polysomnogram was conducted. The patient remained hypercapnic and was converted to continuous AVAPS therapy starting at a tidal volume of 8.6mL/kg based on ideal body weight. AVAPS was titrated until achieving adequate ventilation, but the patient was unable to tolerate continuous NIPPV. Because of his heart failure in the setting of expected worsening respiratory failure, the decision was made to pursue tracheostomy placement for invasive positive pressure ventilation.

Conclusion

ROHHAD syndrome is a rare disorder that begins within the first decade of life, making adherence to daytime NIPPV difficult. This case illustrates a trial of AVAPS in a child with ROHHAD syndrome prior to tracheostomy placement. It highlights the need for future research in advanced ventilatory support strategies in children.

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863 When sleep takes you to unwanted places?
Authors: Araji Fayruz , Patel Abha
Published: May 2021

Introduction

Somnambulism is a parasomnia occurring in non-rapid eye movement sleep, and is characterized by ambulation as a disorder of arousal regulation. Sleep deprivation, alcohol abuse, fragmented sleep and certain medications can increase the risk of sleep walking.

Report of case(s)

Here we present a 35-year-old man with multiple triggers for sleep walking, resulting in recurrent parasomnia events over fifteen years. He had a history of bipolar disorder, post-traumatic stress disorder (PTSD), chronic insomnia, moderate untreated obstructive sleep apnea (OSA), anxiety with violent daytime behaviors, and prior alcohol abuse status post six years of sobriety. He was sent to our clinic due to increased frequency and severity of events, with nightly events for the last five years. Episodes were characterized by walking around the home, leaving the home, and driving on occasion. He reported at least one minor car accident as a result of sleep driving. He also reported an injury resulting from a fall in his home while sleep walking. Several security measures were implemented, including door gates, door alarms, and hiding car keys. His family slept in different bedrooms with locked doors for safety. The patient’s chronic insomnia improved with cognitive behavioral therapy, leading to an average sleep time of five hours per night with no reported hypersomnia or daytime fatigue. After his initial evaluation, he was referred for a mandibular advancement device for treatment of his OSA, due to prior poor compliance with positive airway pressure therapy related to his PTSD. Optimizing his OSA helped decrease arousals that might trigger sleep walking events. He also maintained close follow up with mental health for pharmacotherapy and psychological therapy. Treatment with clonazepam 0.25 mg at bedtime was initiated given the severity of his somnambulism.

Conclusion

The use of a benzodiazepine can reduce slow wave sleep duration by its effect on the inhibitory neurotransmitter gamma aminobutyric acid (GABA). Our patient had multiple risk factors for parasomnias, with severe, frequent episodes of sleepwalking leading to self-injury. His treatment involved both pharmacotherapy as well as optimization of underlying triggers.

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722 Sleep Loss in Healthcare Workers During the COVID-19 Pandemic
Authors: Stewart Nancy , Koza Anya , Dhaon Serena , Shoushtari Christiana , Martinez Maylyn , Arora Vineet
Published: May 2021

Introduction

During the pandemic, healthcare workers have shared their stresses on social media, including regarding sleep disturbances. However, an assessment of sleep using validated measures among healthcare workers on social media is lacking.

Methods

A restricted, self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days targeting healthcare workers who were clinically active during COVID-19. In addition to demographics and career information, participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index. Poor sleep quality was defined as PSQI > 5. Moderate-to-severe insomnia was defined as an ISI > 14. Multivariate logistic regression tested the association between demographics and career characteristics and sleep outcomes.

Results

Of the 983 who clicked our link, 906 completed the survey. Participants were mostly white (70%), female (75%), physicians (64%). Mean sleep duration was 6.1 (SD1.2) hours. Nearly 90% experienced poor sleep (PSQI). One third reported moderate or severe insomnia. Many (60%) reported sleep disruptions due to device usage or due to bad dreams at least once per week (45%). In multivariable regression, non-physicians (OR 3.5, CI: 2.5, 5.0), Hispanic ethnicity (OR 2.2; CI: 1.44, 3.45), being single (1.5, CI: 1.03, 2.21), and youngest age group (18–24) (OR 9.9; CI: 1.44, 68.09) had increased odds of insomnia. In open-ended comments, sleep disruptions mapped to 5 categories: (1) Work demands (“The volume of calls and messages from my patient and caregiver population is through the roof”); (2) Pandemic related (“I never had sleep issues prior to the COVID-19 pandemic. Suddenly I had issues with sleep initiation.”; (3) Children and family (“COVID plus home stress plus stress over my kids, my job, my marriage.”); (4) Personal health (“Insomnia predating COVID, but worsened with COVID.”); (5) Responses to the pandemic (“I worry about how COVID is being managed by the President...This does keep me awake at night.”).

Conclusion

During the COVID-19 pandemic, 90% of healthcare workers surveyed on social media reported poor sleep, with over one-third of participants reporting moderate-severe insomnia. Online sleep interventions for healthcare workers are urgently needed.

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Molecular and microscopic prevalence of intestinal microsporidia among HIV+/AIDS patients in the Alborz province, Iran
Authors: Hosseini Parsa Maryam , Bahadory Saeed , Heidari Aliehsan , Khatami Alireza , Bairami Amir
Published: May 2021

Background

Microsporidia are a large family of obligate intracellular protozoa; these medically important species are recognized as opportunistic agents in intestinal complications in HIV+/AIDS patients.

Methods

The current cross-sectional study was designed and conducted from October 2018 to June 2019 to determine intestinal microsporidia in HIV+/AIDS patients by trichrome/Zeihl-Neelsen staining and SYBR Green-based real-time PCR.

Results

Out of 80 HIV+/AIDS patients, 23.75% (n=19) and 12.5% (n=10) were identified by molecular and microscopic methods, respectively. The predominant species in patients was Encephalitozoon (94%), which was found by quantitative real-time PCR and its high resolution melting tool.

Conclusion

As far as we know, this is the first report from the Alborz region. The prevalence of intestinal microsporidiosis in this area in HIV+/AIDS patients was higher than both the global and national average. In addition to the need for further studies to prove protozoan pathogenicity in the aforementioned group, preventive measures should be considered.
Usability Evaluation of a Smartphone Medication Reminder Application in Patients Treated With Short-term Antibiotic
Authors: Sherwin LeeAnne B. , Deroche Chelsea B. , Yevu-Johnson Justina , Matteson-Kome Michelle , Bechtold Mathew , Jahnke Isa , Alexander Gregory L.
Published: May 2021

Medication adherence is poor in persons with chronic disease, especially in those with multiple chronic diseases, one of which is a psychological disorder. Social support, medication education, and external reminders have been identified as facilitators of adherence. Mobile health applications have the potential to enhance adherence; however, it is unknown if publicly available applications are user-friendly and useful. We aimed to examine the usability and feasibility of the “MediSafe” medication reminder application in adults with diarrhea-predominant irritable bowel syndrome undergoing short-term antibiotic therapy and a “Medfriend” from their social support network (N = 14). A mixed-methods study was conducted. All patient participants used the MediSafe application daily for 14 days. Ease of use, ease of learning, and satisfaction scales were rated highest by both patient participants and Medfriends, whereas usefulness was rated lowest by both groups, with Medfriends' usefulness rating significantly lower than that of patient participants. Telephone interviews identified patient participants found the application instrumental in facilitating medication adherence, and Medfriends viewed themselves as active participants in the patient participants' care. The MediSafe medication reminder application is easy to use and accepted by both patients and their designated Medfriend. The MediSafe is instrumental in facilitating short-term antibiotic adherence and social support engagement.
Selective transperineal prostate biopsy for fluoroquinolone-resistance patients reduces sepsis and cost
Authors: Al-Mitwalli Abdullah , Kyriazis Grigorios , El-Taji Omar , Chandra Elizabeth , Deborah Wearmouth , Burns Phillipa , Fady Youssef , Simms Matthew , Nicholas Smith
Published: May 2021

Background:

Urosepsis is a recognized complication of transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Pre-biopsy rectal swabs have been used to identify patients with microorganisms in the rectal flora resistant to the conventionally used empirical prophylaxis. The transperineal route of biopsy (TP-Bx) has a lower complication risk but comes at an increased cost.

Materials and methods:

Retrospective cohort study including patients undergoing prostate biopsies between October/2015 and April/2018. The intervention cohort, a rectal swab was performed, the result of which dictated the biopsy route; TRUS-Bx against TP-Bx. TP-Bx for patients with fluoroquinolone resistance or extended-spectrum β-lactamase. The control cohort underwent TRUS without a rectal swab receiving empirical antibiotics—oral ciprofloxacin and intravenous gentamicin.

Results:

Total 1000 patients were included in which 500 underwent a swab, 14 (2.8%) developed post-TRUS biopsy infective complications with 3 having positive bacteremia (0.6%); 500 had no swab, 47 (9.4%) developed post-TRUS biopsy infective complications with 22 (4.4%, p < 0.05) having positive bacteremia. Three patients (0.6%) of patients who underwent swab developed urinary tract infection symptoms whilst 12 (2.4%) had urinary tract infection in the control group. In those patients that underwent a swab, 14 required hospitalization with mean length of stay of 2.5 days versus 43 patients of the control with 3.6 days. Cost analysis concluded savings of this strategy was £18,711.

Conclusions:

We have demonstrated a protocol that reserves template biopsies for higher risk patients and can significantly reduce sepsis and other infectious complication rates whilst also proving to be a cost-efficient strategy. We recommend that units not utilizing rectal swabs to uncover the fluoroquinolone resistance rate by introducing them. We advocate units that already utilize rectal swabs, to introduce transperineal biopsy for their higher risk patients.
Association Between Preinjury Symptoms and Postconcussion Symptoms at 4 Weeks in Youth
Authors: Ledoux Andrée-Anne , Tang Ken , Gagnon Isabelle , Osmond Martin H. , Yeates Keith O. , Healey Katherine , Gioia Gerard A. , Zemek Roger L.
Published: May 2021

Objective:

To investigate whether preinjury physical, emotional, cognitive, and sleep symptoms on the Post-Concussion Symptoms Inventory (PCSI) are associated with persistent postconcussion symptoms (PPCS) at 4 weeks and whether any associations are moderated by sex or age.

Study Setting and Participants:

A total of 3063 participants with acute concussion, presenting to 9 Canadian pediatric emergency departments, were enrolled from August 2013 to June 2015.

Design:

A planned secondary analysis of a prospective, multicenter cohort study (Predicting Persistent Post-concussive Problems in Pediatrics or 5P). Primary outcome was PPCS at 4 weeks, defined as 3 or more new or worsening individual symptoms compared with the preinjury score at 28 days on the PCSI. The association between preinjury scores and PPCS was analyzed with a multivariable logistic regression analysis that included preinjury, sex, age, sex × preinjury, and age × preinjury interactions as predictors. Missing baseline covariates were imputed.

Results:

A total of 2123 (n = 844 [39.8%] girls; median [IQR] age = 12.9 [10.7, 15.0] participants were included in the analysis. Preinjury physical symptom score was associated with PPCS at 4 weeks (χ2 = 13.87, df = 6, P = .031). The preinjury emotional score also contributed to the variability in PPCS (χ2 = 11.79, df = 6, P = .067). While girls reported higher preinjury physical, emotional, and cognitive scores than boys, neither sex nor age interacted with preinjury to predict PPCS at 4 weeks. Independent of age and sex, preinjury physical symptoms were associated with PPCS at 4 weeks (OR = 1.40; 95% CI, 1.15-1.70).

Conclusion:

Preinjury physical symptoms are associated with the probability of having PPCS at 4 weeks postconcussion independent of age and sex. Providers should consider preinjury symptoms to inform prognosis and recovery management.
Report of Early Childhood Traumatic Injury Observations & Symptoms: Preliminary Validation of an Observational Measure of Postconcussive Symptoms
Authors: Dupont Dominique , Beaudoin Cindy , Désiré Naddley , Tran Maria , Gagnon Isabelle , Beauchamp Miriam H.
Published: May 2021

Objective:

To report preliminary empirical data on a novel, developmentally appropriate, observational postconcussive symptoms inventory for infants, toddlers, and preschoolers.

Setting:

Emergency departments of 2 tertiary, urban pediatric hospitals.

Participants:

Ninety-eight children (0-8 years of age; mean age at injury = 33.00, SD = 24.7 months) with mild traumatic brain injury (concussion) divided into younger (0-2 years) and older (3-8 years) age groups.

Design:

Observational study.

Main Measure:

The Report of Early Childhood Traumatic Injury Observations & Symptoms (REACTIONS) documents 17 postconcussive symptoms representing observable manifestations thereof and was completed by parents in the acute (24-48 hours; n = 65), subacute (7-14 days; n = 78), and/or persistent phase (25-35 days; n = 72) post–mild traumatic brain injury.

Results:

Different patterns of postconcussive symptoms were reported by age group, with behavioral manifestations particularly salient in younger children. More children younger than 2 years had sleep and comfort-seeking symptoms at each of the 3 postinjury time points.

Conclusion:

Postconcussive symptoms may manifest differently after mild traumatic brain injury sustained during early childhood. To fully understand and address their presence and evolution, developmentally sound measures such as the REACTIONS inventory are required.
Application of Trypan Blue Stain in the Microbiological Diagnosis of Infectious Keratitis—A Case Series
Authors: Sharma Supriya , Rathi Varsha M. , Murthy Somasheila I. , Garg Prashant , Sharma Savitri
Published: May 2021

Purpose:

The purpose of this study was to report 3 cases of microbial keratitis, wherein trypan blue staining was used to aid the microbiological diagnosis of fungal keratitis and Pythium keratitis in a rural setup.

Methods:

Three consecutive patients who presented with a diagnosis of infectious keratitis underwent corneal scraping, and the smears were assessed using trypan blue stain and potassium hydroxide (KOH) mount.

Results:

Of the 3 cases, the first 2 cases showed septate fungal filaments in trypan blue–stained preparation and KOH mount. Case 3 showed the presence of broad aseptate filaments with ribbon-like folds on both KOH mount and trypan blue stain, consistent with the diagnosis of Pythium keratitis. The first 2 cases improved with topical and systemic antifungals. Case 1 healed with scarring at 7 weeks with improvement in best-corrected visual acuity (BCVA) to 20/60. Case 2 healed within 2 weeks, and BCVA improved to 20/40. Case 3 received topical linezolid (0.2%), azithromycin eye ointment, and oral azithromycin. At 5 weeks the infection decreased but thinning was noted, which necessitated tissue adhesive and bandage contact lens application. Scarring was noted at 10 weeks, and BCVA improved to 20/40.

Conclusions:

In this case series, trypan blue staining showed promising results in the easy identification of aseptate and septate fungal elements. This is the first case series showing the utility of this stain in the management of microbial keratitis.
An Unusual Presentation of Neisseria gonorrhoeae
Authors: Masutani Rebecca , Yen Christina , Stead Wendy
Published: May 2021

Cases of disseminated gonococcal infections are less commonly reported. We present a case of an immunocompetent 46-year-old man who developed a right calf abscess that grew Neisseria gonorrhoeae. This was suspected to have developed from a disseminated gonococcal infection that subsequently seeded a preexisting right calf hematoma.
History of Weight Cycling Is Prospectively Associated With Shorter and Poorer-Quality Sleep and Higher Sleep Apnea Risk in Diverse US Women
Authors: Cao Vivian , Makarem Nour , Maguire Moorea , Samayoa Ivan , Xi Huaqing , Liang Citina , Aggarwal Brooke
Published: May 2021

Background

Poor sleep and history of weight cycling (HWC) are associated with worse cardiovascular health, yet limited research has evaluated the association between HWC and poor sleep patterns.

Methods

The American Heart Association Go Red for Women Strategically Focused Research Network cohort at Columbia University (n = 506; mean age, 37 ± 15.7 years; 61% racial/ethnic minority) was used to evaluate the cross-sectional associations of HWC and sleep at baseline and the prospective associations of HWC from baseline with sleep at the 1-year visit. History of weight cycling, defined as losing and gaining 10 lb or more at least once (excluding pregnancy), was self-reported. Sleep duration, sleep quality, insomnia severity, and obstructive sleep apnea risk were assessed using the validated Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Berlin questionnaires. Linear and logistic regression models, adjusted for age, race/ethnicity, education, health insurance status, pregnancy history, and menopausal status, were used to evaluate the relation of HWC with sleep.

Results

Most women reported 1 or more episodes of weight cycling (72%). In linear models of cross-sectional and prospective data, each additional weight cycling episode was related to shorter sleep duration, poorer sleep quality, longer sleep onset latency, greater insomnia severity, more sleep disturbances, lower sleep efficiency, and higher sleep medication use frequency. In the logistic models, HWC (≥1 vs 0 episodes) was associated with greater odds for short sleep, poor sleep quality, long sleep onset latency (≥26 minutes), high obstructive sleep apnea risk, and sleep efficiency lower than 85%.

Conclusion

History of weight cycling predicted poor sleep among women, suggesting that weight maintenance may represent an important strategy to promote sleep health. The potential bidirectional relationship between HWC and sleep requires further investigation.
Anastomotic Ulcers: A Tertiary Centre Experience of Endoscopic Management Techniques
Authors: Barraclough Harriet , Girach Ayesha , Rao Prithviraj , Urs Arun , Marven Sean , Murthi Govind , Thomson Mike , Narula Priya
Published: May 2021

Improvements in neonatal care and surgical advances, has led to an increased prevalence of children with small and large bowel anastomoses. Ulceration at the site of anastomosis is a rare, but well-recognised phenomenon, with no clearly understood pathogenesis. Paediatric case series have been reported but there remains no clear effective treatment strategy and there is limited experience with endoscopic techniques in their management. We report our tertiary centre experience of managing nine anastomotic ulcer patients, including endoscopic treatment with argon plasma coagulation and clips.

Two patients with inflammatory bowel disease (IBD) responded to optimisation of medical therapy. In our non-IBD patients, those requiring a blood transfusion (n = 2) ultimately required surgery and those who did not require a blood transfusion responded to aminosalicylate treatment (n = 1) or endoscopic therapeutic techniques (n = 3).

We conclude that endoscopic interventions can be an effective management strategy for anastomotic ulcers when a blood transfusion isn’t required.
A Preliminary Investigation of Psychoneurological Symptoms in Low-Income Mothers
Authors: Salomon Rebecca E. , Muscatell Keely A. , Crandell Jamie , Anderson Ruth A. , Beeber Linda S.
Published: May 2021

Background

Exposure to chronic stressors may contribute to the development of psychoneurological symptoms (i.e., fatigue, cognitive dysfunction, sleep disturbance, depressed mood, and pain) that can compromise maternal function.

Objectives

In two studies of low-income mothers, we investigated the presence of psychoneurological symptoms and explored associations between mothers’ stressors and psychoneurological symptoms as well as between symptoms and function. We also considered the possible mediating role of the symptoms between stressors and function.

Methods

We conducted secondary analyses of psychoneurological symptoms in two studies of low-income mothers of infants and toddlers in the United States. Study 1 sampled Latina women with limited English proficiency, whereas Study 2 was conducted with English-speaking women from diverse backgrounds. In both studies, symptoms were measured using items from the Center for Epidemiological Studies Depression Scale and the Medical Outcomes Study Short-Form Health Survey. Maternal function was measured through self-report and researcher observation. In Study 2, stressors were measured using the Everyday Stressors Index. Multiple linear regressions were used to investigate associations while controlling for relevant covariates.

Results

In both studies, mothers endorsed a wide range of psychoneurological symptoms. In Study 1, psychoneurological symptoms had significant negative associations with role function, social function, and developmental stimulation. In Study 2, psychoneurological symptoms had significant negative associations with role function, social function, and physical function. Using Aroian test for mediation, we found that psychoneurological symptoms mediated all significant relationships between stressors and maternal functions in Study 2.

Discussion

In two samples of low-income mothers, psychoneurological symptoms were prevalent and associated with chronic stressors and with maternal function and may mediate the association between those two factors. These findings extend prior research on depressive symptoms in mothers by investigating pain as an additional key symptom. The studies advance symptom science by highlighting psychoneurological symptoms in a heterogeneous sample without known health conditions.
Leveraging E-Learning Infrastructure in Times of Rapid Change: Use of the National Sexually Transmitted Diseases Curriculum in the Era of COVID-19
Authors: Bauer Karin M. , Corcorran Maria A. , Budak Jehan Z. , Johnston Christine , Spach David H.
Published: May 2021

The National Sexually Transmitted Diseases Curriculum is an e-learning platform. New registrations and learning group creations in March to April 2020 were compared with previous 12-month data. Substantial increases in registrations and learning groups demonstrate that the National Sexually Transmitted Diseases Curriculum was successfully leveraged to meet rapidly shifting training needs due to the COVID-19 pandemic.
Pathology, Radiology, and Genetics of Interstitial Lung Disease in Patients With Shortened Telomeres
Authors: Cecchini Matthew J. , Tarmey Tara , Ferreira Allison , Mangaonkar Abhishek A. , Ferrer Alejandro , Patnaik Mrinal M. , Wylam Mark E. , Jenkins Sarah M. , Spears Grant M. , Yi Eunhee S. , Hartman Thomas E. , Scott John P. , Roden Anja C.
Published: May 2021

Interstitial lung diseases (ILDs) in patients with shortened telomeres have not been well characterized. We describe demographic, radiologic, histopathologic, and molecular features, and p16 expression in patients with telomeres ≤10th percentile (shortened telomeres) and compare them to patients with telomere length >10th percentile. Lung explants, wedge biopsies, and autopsy specimens of patients with telomere testing were reviewed independently by 3 pathologists using defined parameters. High-resolution computed tomography scans were reviewed by 3 radiologists. p16-positive fibroblast foci were quantified. A multidisciplinary diagnosis was recorded. Patients with shortened telomeres (N=26) were morphologically diagnosed as usual interstitial pneumonia (UIP) (N=11, 42.3%), chronic hypersensitivity pneumonitis (N=6, 23.1%), pleuroparenchymal fibroelastosis, fibrotic nonspecific interstitial pneumonia, desquamative interstitial pneumonia (N=1, 3.8%, each), and fibrotic interstitial lung disease (fILD), not otherwise specified (N=6, 23.1%). Patients with telomeres >10th percentile (N=18) showed morphologic features of UIP (N=9, 50%), chronic hypersensitivity pneumonitis (N=3, 16.7%), fibrotic nonspecific interstitial pneumonia (N=2, 11.1%), or fILD, not otherwise specified (N=4, 22.2%). Patients with shortened telomeres had more p16-positive foci (P=0.04). The number of p16-positive foci correlated with outcome (P=0.0067). Thirty-nine percent of patients with shortened telomeres harbored telomere-related gene variants. Among 17 patients with shortened telomeres and high-resolution computed tomography features consistent with or probable UIP, 8 (47.1%) patients showed morphologic features compatible with UIP; multidisciplinary diagnosis most commonly was idiopathic pulmonary fibrosis (N=7, 41.2%) and familial pulmonary fibrosis (N=5, 29%) in these patients. In conclusion, patients with shortened telomeres have a spectrum of fILDs. They often demonstrate atypical and discordant features on pathology and radiology leading to diagnostic challenges.
The Effects of Safety Climate on Psychosocial Factors: An Empirical Study in Healthcare Workplaces
Authors: Wang Jiana-Fu , Wu Chieh-Liang , Tsai Yao-Te , Weng Shao-Jen , Hsu Ya-Chen
Published: May 2021

How to develop a better patient safety culture has been an important goal for healthcare organizations, but the effects of safety culture on psychosocial factors, such as emotional exhaustion and stress, have not been fully addressed. This study aimed to reconfigure important dimensions affecting safety culture and examine the associations between safety culture and psychosocial factors (emotional exhaustion and work-life balance). The partial least squaring technique was used to analyze the data, showing that job satisfaction (β = 0.320, P < 0.001), working conditions (β = 0.307, P < 0.001), and perception of management (β = 0.282, P < 0.001) positively affected the safety climate. The safety climate and work-life balance could reduce the occurrence of emotional exhaustion, whereas a high-stress environment would cause a higher level of emotional exhaustion. Given these findings, hospitals should endeavor to help employees feel safe and not threatened, reduce stress, and advise them to maintain a good work-life balance.
Patterns of Medication Errors Involving Older Adults Reported to the French Medication Error Guichet
Authors: Azar Christine , Thomas Laure , Gras-Champel Valérie , Laroche Marie-Laure , Grau Muriel , Allué Delphine , Saleh Nadine , Maison Patrick
Published: May 2021

Objectives

The aims of the study were to describe medication errors (MEs) involving older adults reported to the French Medication Error Guichet and to compare them with MEs in younger adults, in each of the hospital and community settings.

Methods

Retrospective secondary data analysis of MEs reported throughout 2013 to 2017 was performed. Descriptive and multivariate analyses were performed to compare actual and potential ME reports between older adults (aged ≥60 y) and younger adults (aged ≥18, <60 y).

Results

We analyzed 4979 reports. In older adults, both in hospital (n = 1329) and community (n = 1264) settings, antithrombotic agents were frequently reported in MEs and were significantly more likely to be associated with reported MEs in older adults compared with younger adults. In hospital setting, antibacterials for systemic use (adjusted odds ratio [aOR] = 1.87, 95% confidence interval [CI] = 1.19–2.93) and antineoplastic agents (aOR = 2.22, 95% CI = 1.34–3.69), whereas in community setting, psycholeptics (aOR = 1.43, 95% CI = 1.04–1.98) and drugs used in diabetes (aOR = 6.01, 95% CI = 3.21–11.2) were more likely to be associated with reported MEs in older adults. In both settings, wrong dose and wrong drug were the most frequently reported error types in older adults; however, wrong technique error type (aOR = 2.06, 95% CI = 1.30–3.28) in hospital setting and wrong patient (aOR = 2.17, 95% CI = 1.30–3.60) in community setting were more likely to be associated with reported MEs in older adults.

Conclusions

We identified specific ME patterns for older adults, including antithrombotic agents in both settings; antibacterials for systemic use, antineoplastic agents, and wrong technique in hospital setting; and psycholeptics, drugs used in diabetes, and wrong patient in community setting. These findings inform future studies investigating population-specific medication safety strategies.
Medication Errors in the Operating Room: An Analysis of Contributing Factors and Related Drugs in Case Reports from a Japanese Medication Error Database
Authors: Suzuki Ryohei , Imai Tsuneo , Sakai Takamasa , Tanabe Kouichi , Ohtsu Fumiko
Published: May 2021

Objective

The aim of this study was to prevent drug-related medication errors in the operating room by clarifying the association between the medication error category with related drugs and contributing factors.

Methods

We used data from the Japan Council for Quality Health Care’s open database on the web. We researched the medication error category, related drugs, and contributing factors. We classified each medication error category into case groups and other medication error categories into control groups. We compared the medication error factors of the 2 groups using multivariate logistic regression analysis on the medication error factors.

Results

The total number of analyzed cases was 541. Incorrect dose was the most common medication error category in 170 cases, followed by incorrect drug in 152 cases. Medication error factors (odds ratio, 95% confidence interval) that were found to be significantly positively associated with incorrect dose were “pressor drugs” (3.0, 1.4–6.4), “anesthesia-inducing drugs” (6.3, 1.7–23.4), “lack of knowledge” (2.0, 1.3–3.3), and “drug administration” (3.4, 1.6–7.4). The medication error factors that were found to be significantly positively associated with incorrect drug were “preparation” (5.7, 3.1–10.5) and “medication passed or picked up” (102.2, 35.7–292.8).

Conclusions

Medication errors are frequently occurring during drug preparation and administration in the operating room. Medical staff should thoroughly learn about operating room–specific drugs and closely monitor every step of the drug preparation and administration process. It is also important to create a workflow and improve the environment so that it reduces the likelihood of medication errors.
Implementation of an Electronic Health Record–Based Messaging System in the Emergency Department: Effects on Physician Workflow and Resident Burnout
Authors: Luu Tiffany , Spiegelman Lindsey , Nykin David , Abido Kimberly , Roh Jennifer , Rudkin Scott , Toohey Shannon
Published: May 2021

Introduction

The traditional methods of communication between nurses and physicians through paging or phone calls have been known to cause patient care interruptions, increase stress and workload, and cause burnout. Our study assessed the impact of using an electronic health record–based messaging system (Epic Secure Chat) for nonemergent communication between nurses and physicians in the emergency department (ED).

Method

This study was performed at a large urban academic ED. Surveys were distributed through e-mail using Google forms. Preimplementation and postimplementation surveys were performed from May 2019 (presurvey) to August 2019 (postsurvey).

Result

The number of nonurgent phone calls from registered nurse staff decreased after intervention (P < 0.001). The frequency of nonurgent calls disrupting workflow decreased after the intervention (P = 0.029). The number of calls that were appropriately alerted to increased but was not significant (P = 0.120), whereas the degree of burnout from nonurgent calls remained relatively the same (P = 0.841).

Conclusions

The findings provide insight into the implementation of an EMR messaging system in an ED setting. These findings suggest the messaging system can decrease unnecessary nonurgent calls from registered nurses and medical doctors, allowing for more efficient workflow in the ED. These findings suggest further research especially regarding burnout implemented on a larger scale and yield redesign suggestions in the ED.
Lateral Hepatic Fissure Peritoneal Carcinomatosis as a Pitfall for Hepatic Metastasis of Advanced Ovarian Cancer
Authors: Gabiache Erwan , Chantalat Elodie , Zerdoud Slimane , Martinez Alejandra , Ferron Gwénaël
Published: May 2021

A 52-year-old woman previously treated for a stage IIIc high-grade ovarian serous carcinoma presented right upper quadrant abdominal pain, 3 years after extended surgery and chemotherapy. Abdominal CT, MRI, and 18F-FDG PET/CT showed a right hepatic mass, consistent for lone recurrence nearby the hepatic lateral fissure. Preoperative and histologic examination identified a peritoneal lateral fissure lesion. The patient underwent atypic segment 5 segmentectomy. She has been disease-free for 3 years now. Advanced ovarian cancer can be responsible for perihepatic sulcus lesions, such as this right fissure lesion. They should not be mistaken for inoperable parenchyma metastases.
Dissecting Mycotic RCA Aneurysm Detected on 67Ga Scintigraphy
Authors: Campos Rossana , Yung Grace , Russo Robert , Mansberg Robert
Published: May 2021

A 61-year-old man presented with pneumonia and myocardial infarction on a background of diabetes and end-stage renal failure. Methicillin-resistant Staphylococcus aureus bacteremia was confirmed in the setting of ongoing pyrexia. The patient was referred for a 67Ga study, which revealed Ga-avid active disease in the pericardial effusion. This was localized further on CT/MRI and coronary angiography to a dissecting right coronary artery aneurysm, which was treated with surgical repair and long-term antibiotic treatment.
Pelvic Plexiform Schwannoma on 18F-FDG PET/MRI
Authors: Zeng Yuping , Luo Jiandong , Nie Jieyu , Leng Xiaoming
Published: May 2021

Plexiform schwannoma (PS), a subtype of schwannoma, is a rare benign nerve sheath tumor characterized by a multinodular plexiform growth pattern. It is usually confined to the head and neck or skin. Pelvic PS is an extremely rare occurrence and signifies a challenge for the imaging diagnosis. In this work, we present a 42-year-old woman with pelvic PS, who was initially suspected of malignant tumor on 18F-FDG PET/MRI but confirmed as PS by postoperative pathology. We consider that this case would contribute to the literature and provide a further insight into diagnosing this kind of rare tumor.
Evaluation of Effects of Systemic Zoledronic Acid Application on Bone Maturation in the Consolidation Period in Distraction Osteogenesis
Authors: Akbulut Yasin , Gul Mehmet , Dundar Serkan , Ozcan Erhan Cahit , Ozercan Ibrahim Hanifi , Bozoglan Alihan , Karasu Necmettin , Acikan Izzet , Bingül Muhammet Bahattin
Published: May 2021

Distraction osteogenesis (DO) is a physiological process that generates new bone tissue formation, using progressively separated bone fragments. Recently, several techniques have been investigated to develop the maturation of the new bone tissue. Bisphosphonates was an effective material for the acceleration of bone formation in DO procedures. The purpose of this study was to evaluate the effects of the systemic zoledronic acid application at the beginning of the consolidation period on new bone genesis in a DO model of rat femurs. The rats were divided randomly into 3 groups, as follows: Control group (CNT group) (n = 10), zoledronic acid dosage-1 (n = 10), and dosage-2 (n = 10) groups (ZA-D-1 and ZA-D-2). No treatment was administered in controls, but DO was applied to the rat femurs. A single dose of 0.1 mg/kg and 0.2 mg/kg of zoledronic acid was administered systematically at the beginning of the consolidation period after the distraction in treatment groups, respectively. Histomorphometric analyses were performed on the original distracted bone area and the surrounding bone tissue. Osteoblasts, new bone formation, and fibrosis were scored. New bone formation in the ZA-D-1 and ZA-D-2 groups, when compared with the control group, was detected highly (P < 0.05). The numbers of osteoblasts in the ZA-D-1 and ZA-D-2 groups were higher when compared with the controls (P < 0.05). Fibrosis in the controls, when compared with the ZA-D-1 and ZA-D-2 groups, was found to be higher (P < 0.05). Zoledronic acid application is an effective method for bone maturation in consolidation period in DO.
Optimal Surgical Approach for the Dumbbell-Shaped Trigeminal Schwannoma
Authors: Liu Yong , Meng Qiang , Li Huanfa , Wu Hao , Dong Shan , Zhang Hua
Published: May 2021

Dumbbell-shaped trigeminal schwannoma afflicts the middle and posterior cranial fossa. Surgical approach for gross total resection remains highly challenging. The authors present a case of dumbbell-shaped trigeminal schwannoma treated successfully by using frontotemporal intradural approach with the removal of temporal pole. Subtotal resection was achieved as the schwannoma was closely adhered to trigeminal nerve. As a postoperative complication, abducens paralysis recovered significantly within the 3-month follow-up. No severe complication was observed. The authors suggest that frontotemporal intradural approach is optimal surgical approach as it is particularly convenient and safe.
Facilitating Success of the Early Stage Surgeon Scientist Trainee
Authors: Barker Jenny C. , Jalilvand Anahita , Onuma Amblessed , Shelby Rita , Shah Kejal , Daulton Robert , Bumgardner Ginny L.
Published: May 2021

Objective:

Surgeon scientists bring to bear highly specialized talent and innovative and impactful solutions for complicated clinical problems. Our objective is to inform and provide framework for early stage surgeon scientist training and support.

Summary of Background Data:

Undergraduate, medical student, and residency experiences impact the career trajectory of surgeon scientists. To combat the attrition of the surgeon scientist pipeline, interventions are needed to engage trainees and to increase the likelihood of success of future surgeon scientists.

Methods:

A surgery resident writing group at an academic medical center, with guidance from faculty, prepared this guidance document for early stage surgeon scientist trainees with integration of the published literature to provide context. The publicly available National Institutes of Health RePORTER tool was queried to provide data salient to early stage surgeon scientist training.

Results:

The educational path of surgeons and the potential research career entry points are outlined. Challenges and critical supportive elements needed to inspire and sustain progress along the surgeon scientist training path are detailed. Funding mechanisms available to support formal scientific training of early stage surgeon scientists are identified and obstacles specific to surgical careers are discussed.

Conclusions:

This guidance enhances awareness of essential education, communication, infrastructure, resources, and advocacy by surgery leaders and other stakeholders to promote quality research training in residency and to re-invigorate the surgeon scientist pipeline.