bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Burnout and Interest in Wellness Programs in Physician Assistant Students
Authors: Johnson Aimee K. , Blackstone Sarah R. , Simmons Whitney , Skelly Ashley
Published: April 2020

Purpose

Burnout among health care professionals and preprofessional health care students is of growing concern because of its detrimental effects on performance, mental health, and physical health. Research to date has focused primarily on physicians and medical students. The purpose of this study was to assess burnout and the quality of life among physician assistant (PA) students and gauge their interest in specific wellness interventions that address those issues in their PA program.

Methods

An online survey consisting of validated measures for burnout and quality of life was completed by 320 PA students from all 8 Virginia PA programs (n = 8). Additionally, student interest in various wellness interventions was assessed, including preferences for timing and delivery, to inform development of a tailored well-being component in the PA curriculum to reduce burnout.

Results

We found burnout to be prevalent among PA students, with 79.69% reporting high levels of emotional exhaustion; 56.56% of students met the criteria for cynicism. Survey participants rated stress reduction (n = 290, 90.63%) and burnout (n = 299, 93.44%) as primary issues that need to be addressed in the PA student population. Furthermore, 77.50% of participants expressed interest in participating in a wellness intervention designed to reduce burnout.

Conclusion

Given the high prevalence of burnout in the PA students surveyed, resources and potential interventions that reduce burnout need to be identified. The current study identified PA students' perceived needs and interest in various aspects of potential wellness interventions in the PA program. Students preferred an emphasis on stress reduction and burnout, which can be used to develop a tailored well-being curriculum to promote work-life balance and stress management for PA students.
Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder
Authors: Rizzolo Denise , Smith Noël E. , McCall Timothy C. , Roberts Amy , Porta Kelly
Published: April 2020

Purpose

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers.

Methods

A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected.

Results

A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD.

Conclusion

The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.
Anogenital High-Grade Squamous Intraepithelial Lesion Comorbid With Vulvar Lichen Sclerosus and Lichen Planus
Authors: Lin Angela , Day Tania , Ius Yvette , Scurry James
Published: April 2020

Objective

The aim of the study was to describe the clinicopathologic features of vulvovaginal or anal high-grade squamous intraepithelial lesion (HSIL) comorbid with lichen sclerosus and/or lichen planus (LS/LP).

Methods

The local pathology database identified 37 consecutive cases from 2007 to 2019 of vulvar, vaginal, or anal HSIL among women who had a histopathologic diagnosis of vulvar LS/LP. Cases had p16 and p53 immunoperoxidase stains. Clinical data included age, relative location of HSIL and LS/LP, immune-modifying conditions, tobacco use, treatment type, and follow-up. Histopathologic data included HSIL morphology categorized as warty-basaloid or keratinizing, p16 and p53 patterns within HSIL, and features of LS/LP.

Results

The mean age was 69 years with a median follow-up up 42 months. Lichen sclerosus, alone or in combination with LP, was the comorbid dermatosis in 89%. Lichen sclerosus/lichen planus was overlapping or adjacent to HSIL in two-thirds of cases and located separately in the remainder. Rates of tobacco use and immunologic dysfunction were each 40%. In cases of co-located LS and HSIL, sclerosis was absent under the neoplasia in 57%. Twenty-four percent of HSIL cases showed keratinizing morphology; block-positive p16 and suprabasilar-dominant p53 helped distinguish HSIL from human papillomavirus–independent neoplasia.

Conclusions

Histopathologic identification of comorbid HSIL and LS/LP may be challenging because of keratinizing morphology and loss of diagnostic features of LS. Clinicopathologic correlation and use of p16 and p53 are essential to achieve an accurate diagnosis and enact disease-specific management plans.
The Relation of Sudden Sensorineural Hearing Loss in Pediatric Patients With Recurrent Otitis Media: A Nested Case-control Study Using a National Sample Cohort
Authors: Choi Hyo Geun , Min Chanyang , Lee Chang Ho , Kim So Young
Published: April 2020

Objective:

The risk of sudden sensorineural hearing loss (SSNHL) was suggested to be increased in chronic otitis media patients. This study expanded previous findings by using pediatric patients with recurrent otitis media.

Study Design:

A nested case-control study.

Setting:

Participants in the Korean National Health Insurance Service-National Sample Cohort that were less than 15 years old from 2002 to 2004 were included.

Patients:

Overall, 24,226 patients with ≥ 5 instances of otitis media were 1:1 matched with a group controlled for age, sex, income, and region of residence.

Main Outcome Measure:

The occurrence of SSNHL was followed until 2013. The hazard ratio (HR) for SSNHL was analyzed in the otitis media patients using a stratified Cox proportional hazard regression model. Matching variables were stratified. The histories of sinusitis and atopic dermatitis were adjusted. Subgroup analysis was performed according to age and sex.

Results:

Overall, 0.14% (33/24,226) of the otitis media group and 0.06% (14/24,226) of the control group had SSNHL (p = 0.006). The otitis media group had a higher adjusted HR for SSNHL than the control group (adjusted HR = 2.13, 95% CI = 1.13–4.02). According to age, the 10- to 14-year-old group showed a 9.07-fold higher HR for SSNHL than the control group (95% CI = 1.14–72.54). According to sex, the female group showed a 3.74-fold higher HR for SSNHL than the control group (95% CI = 1.24–11.29).

Conclusion:

Recurrent otitis media in children was related to the onset of SSNHL.
Treating the Individual Ear in Children: Results of Cochlear Implantation in Children With Asymmetric Sensory Hearing Loss
Authors: Perkins Elizabeth L. , Nguyen Michelle , Woodard Jennifer , O’Connell Brendan P. , Dedmon Matthew M. , Brown Kevin D.
Published: April 2020

Objective:

Determine speech outcomes of children undergoing cochlear implantation with severe-to-profound hearing loss in the implanted ear and moderate or better hearing loss in nonimplanted ear.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Forty-nine children with severe-to-profound hearing loss in the ear to be implanted (pure-tone average), and no worse than moderate hearing loss in the nonimplant ear.

Intervention:

Subjects underwent cochlear implantation from 2007 and 2017 in the ear with severe-to-profound hearing loss.

Main Outcome Measures:

Consonant Nucleus Consonant or Phonetically Balanced Kindergarten word scores pre- and postoperatively were compared in both the implanted ear and binaural setting. Comparisons were made between Phonetically Balanced Kindergarten scores pre- and postoperatively or Consonant Nucleus Consonant scores pre- and postoperatively.

Results:

The average pure-tone average for the implant ear was 92 ± 13 dB HL and 55 ± 12 dB HL in the nonimplant ear. Word scores for the implant ear increased an average of 58 (±27) % following cochlear implantation at 12 months and 62 (±20) % at 24 months. Binaural best-aided word scores increased an average of 36 (±29) % at 12 months and 49 (±24) % at 24 months.

Conclusion:

Children with asymmetric sensory hearing loss should have each ear treated individually as significant benefits can be gained not only in the implanted ear, but also in binaural hearing.
Development of a 60/60 Guideline for Referring Adults for a Traditional Cochlear Implant Candidacy Evaluation
Authors: Zwolan Teresa A. , Schvartz-Leyzac Kara C. , Pleasant Terrence
Published: April 2020

Objective:

To evaluate the effectiveness of a 60/60 referral guideline for identifying patients who should be referred for a cochlear implant candidacy evaluation (CICE), which states patients should be referred if they demonstrate a best ear unaided monosyllabic word score less than or equal to 60% correct and if they demonstrate an unaided pure-tone average in their better ear that is greater than or equal to 60 dB HL.

Study Design:

Retrospective review of data from adults who participated in a CICE.

Setting:

A single tertiary medical facility.

Patients:

Five hundred twenty-nine patients who participated in a CICE.

Intervention:

CICEs included unaided threshold assessment, unaided speech recognition, and aided word and sentence testing.

Main Outcome Measure:

Ninety-five percent of patients who met traditional indications for a cochlear implant (n = 250) had a pure-tone average that was greater than or equal to 60 dB, while 92% had a better ear unaided monosyllabic word score that was less than or equal to 60%.

Results:

If used as a screening measure, the 60/60 measure resulted in a 96% detection rate and a 34% false-positive rate for identifying adults who would meet traditional indications for a cochlear implant.

Conclusions:

Hearing professionals should consider referring patients for a CICE when they meet the 60/60 guideline. It is hoped that provision of this guideline will result in greater numbers of adults being referred for CICEs, improving access to cochlear implants for patients who may benefit from this important technology.
Importance of Video Head Impulse Test Parameters for Recovery of Symptoms in Acute Vestibular Neuritis
Authors: Lee Jung-Yup , Kim Min-Beom
Published: April 2020

Objective:

To examine the importance of video head impulse test parameter for recovery of symptoms in acute vestibular neuritis (AVN).

Study Design:

Prospective study.

Setting:

Tertiary referral hospital.

Patients/Interventions:

Twenty-seven patients with AVN were enrolled. We divided patients into two groups according to both dizziness handicap inventory (DHI) score and visual analog scale (VAS) at 6 months: Group F (symptoms free), DHI = 0 and VAS = 0; Group R (symptoms residual), DHI more than zero or VAS more than zero.

Main Outcome Measure:

All patients underwent video head impulse test paradigm (HIMP), and suppression head impulse test paradigm (SHIMP) initially and at 1 month. Patients were also asked to complete DHI and VAS initially, at 1 month and 6 months. We compared measured parameters between Group F and R.

Results:

In HIMP, Group F showed higher vestibular-ocular reflex (VOR) gain, higher occurrence of covert corrective saccade (CS), lower occurrence and peak velocity of overt CS, and lower PR score than Group R at 1 month. In SHIMP, Group F showed higher VOR gain, higher occurrence and peak velocity of anti-CS, and higher PR score than Group R at 1 month.

Conclusions:

Above parameters of both HIMP and SHIMP at 1 month would be important factors to predict the residual symptoms in chronic phase of AVN.
Ulcerative Colitis
Authors: Schöffel Norman , Brüggmann Dörthe , Klingelhöfer Doris , Bendels Michael H.K. , Groneberg David A.
Published: April 2020

Background and Aims:

Despite decades of effort, numerous aspects on ulcerative colitis (UC) remain unknown and require further investigation. Scientists experience numerous challenges to survey >40,000 items that have been published on UC since 1900, to evaluate their scientific impact or to identify collaborative networks publishing the most relevant work. Hence, no current, detailed and comprehensive knowledge regarding the worldwide research architecture of UC has been established until now.

Methods:

We conducted a scientometric study employing the previously validated NewQIS (New Quality and Quantity Indices in Science) platform to quantify the global research activity in the field of UC. Hereby, the total research productivity, scientific output of countries, individual institutions, authors, journals, their collaborative networks as well as semiqualitative aspects were assessed. Results were visualized via state-of-the-art density-equalizing mapping projections.

Results:

The United States, Germany, and the United Kingdom play leading roles regarding scientific activity, multilateral and bilateral cooperations. Within the past decades, research on UC diversified into a field covering numerous subject areas. Recently published studies predict that the scientific progress will be mainly depending on international cooperations; we can confirm that development by now.

Conclusions:

Scientometrics proofed to be a useful methodical approach to evaluate quantitative and semiqualitative aspects regarding UC. Also, we conclude that the influence of international cooperations on the scientific progress in the field of UC is constantly progressing.
Esophageal Function Abnormalities in Patients With Barrett’s Esophagus
Authors: Fass Ronnie , Teramoto Oscar , Kurin Michael , Khalessi Ali , Kitayama Yoshitaka , Shibli Fahmi
Published: April 2020

Various esophageal functional abnormalities have been described in patients with Barrett’s esophagus (BE). A significantly higher esophageal acid exposure especially in the supine position has been documented in BE, as compared with the other gastroesophageal reflux disease phenotypes. In addition, weakly acidic reflux and duodenogastroesophageal reflux are more common in BE patients. The presence of Barrett’s mucosa reduces esophageal mucosal impedance, occasionally to a level that prevents detection of reflux episodes. Reduced amplitude contractions and lower esophageal sphincter basal pressure are more common in BE patients as compared with the other gastroesophageal reflux disease groups. Ineffective esophageal motility is the most commonly defined motor disorder in BE. Reduced chemoreceptor and mechanoreceptor sensitivity to acid and balloon distention, respectively, have been suggested to explain lack or significantly less reports of reflux-related symptoms by BE patients.
Helping Experienced Pediatric Nurses Bridge the Gap Between Intermediate and Intensive Care
Authors: Gilroy Heidi , Maixner Michelle , Ziesemer-Girouard Yvette
Published: April 2020

The desire for career advancement has been identified as a cause of nurse turnover. In order to prevent nurses wanting to advance in their career from leaving the organization, a program was developed to transition nurses from pediatric acute and intermediate care to the intensive care unit. The intervention included classroom training, social support, and a formal orientation. Turnover rates are lower for participants in the program, and transitions to the intensive care unit have been successful.
Histologic and Immunohistochemical Evaluation of Infiltrating Inflammatory Cells in Kawasaki Disease Arteritis Lesions
Authors: Kobayashi Mikiko , Matsumoto Yuki , Ohya Maki , Harada Kenichi , Kanno Hiroyuki
Published: April 2020

Kawasaki disease (KD) is a systemic vasculitis of unknown etiology which predominantly affects medium- and small-sized muscular arteries. Histopathologic studies of KD vasculitis lesions have demonstrated characteristic T cell infiltration and an abundance of CD8+ T cells; however, the contribution of cytotoxic lymphocytes to KD vasculitis lesions has not been identified. Here, we histopathologically and immunohistochemically examined infiltrating inflammatory cells, particularly cytotoxic protein-positive cells, such as granzyme B+ cells and TIA-1+ cells, in KD vasculitis lesions. Three autopsy specimens with acute-phase KD were observed and contained 24 vasculitis lesions affecting medium-sized muscular arteries, excluding pulmonary arteries. Infiltrating neutrophils in vasculitis lesions were evaluated by hematoxylin and eosin staining, and monocytes/macrophages and lymphocytes were evaluated by immunohistochemistry. The predominant cells were CD163+ monocytes/macrophages and CD3+ T cells. CD8+ T cells, granzyme B+ cells, and TIA-1+ cells were also observed, but CD56+ natural killer cells were rare. To the best of our knowledge, the current study is the first histopathologic report confirming the infiltration of inflammatory cells with cytotoxic proteins in vasculitis lesions in patients with KD. Cytotoxic T cells may play a role in the development of vasculitis lesions in KD patients.
The Association Between Evidence-Based Decision Making and Accreditation of State Health Departments
Authors: Erwin Paul Campbell , Padek Margaret M. , Allen Peg , Smith Romario , Brownson Ross C.
Published: April 2020

Objective:

To assess the association between evidence-based decision making, including implementation of evidence-based interventions (EBIs), with accreditation of state health departments through the Public Health Accreditation Board (PHAB).

Design:

This was a cross-sectional, electronic survey of state health department practitioners. We utilized a survey instrument focused on evidence-based public health, de-implementation, and sustainability of public health programs. Survey questions were organized into 6 domains: (1) demographic information; (2) individual-level skills; (3) decision making on programs ending; (4) decision making on programs continuing; (5) organization/agency capacity; and (6) external influences.

Participants:

The targeted practitioners were randomly selected from the 3000-person membership of National Association of Chronic Disease Directors and program manager lists from key Centers for Disease Control and Prevention–supported programs in cancer and cancer risk factors. The final target audience for the survey totaled 1329 practitioners, representing all 50 states.

Main Outcome Measure(s):

The main outcome measures included the strength of association between a state's PHAB accreditation status and variables related to evidence-based public health and use of EBIs that fell within the individual participant skills, organization/agency capacity, and external influences domains.

Results:

We received 643 valid responses (response rate = 48.4%), representing all 50 states, with 35 states being PHAB accredited. There was a statistically significant association between PHAB accreditation and state health department use of quality improvement processes (P = .002), leadership plans to implement EBIs (P = .009), and leadership reactions to EBI implementation issues (P = .004). Respondents from PHAB-accredited states were significantly more likely than participants from nonaccredited states to report greater engagement with legislators and governors regarding EBIs and 14% less likely to report the inappropriate termination of programs in their work unit (P = .05).

Conclusions:

The importance of accreditation relates to both internally focused functions and externally focused activities, especially regarding policy-related impact.
Developing Future Public Health Leaders Trained in Long-term Care Administration
Authors: Little N. Ruth Gaskins , Welsh Polly , Sholar Adam
Published: April 2020

Background:

America's population is rapidly aging. Long-term care leaders have not been considered part of the public health workforce. The enumeration of long-term care into the public health workforce taxonomy has not occurred. This article examines the extent of graduate public health education oriented to long-term care and provides a case study of a successful curriculum at East Carolina University (ECU).

Method:

Web sites displaying the curriculum of 135 graduate programs/schools accredited by the Council on Education for Public Health (CEPH) were analyzed for graduate long-term care orientation. A case-study approach was used to describe the integration of long-term care into the Master of Public Health (MPH) Health Policy Administration & Leadership concentration at ECU.

Results:

A review of 135 CEPH graduate MPH programs from January to July 2019 found that only 8 institutions offered graduate courses in long-term care administration. Of the 8, ECU Brody School of Medicine Department of Public Health was the only program directly linking coursework to licensure as a long-term care administrator. Program graduates total 30, which include 5 MPH students currently completing their Administrator in Training. At time of graduation, 17 students had obtained North Carolina licensure.

Conclusions:

Because of increases in population aging, this requires a public health workforce with skills and training in the care of older adults. Formal recognition of long-term care workers as an integral part of the public health workforce is needed. The Institute of Medicine called for this action more than a decade ago.
Evaluation of Patient-Reported Outcomes in Burn Survivors Undergoing Reconstructive Surgery in the Rehabilitative Period
Authors: Sheckter Clifford C. , Carrougher Gretchen J. , McMullen Kara , Bamer Alyssa , Friedstat Jonathan , Pham Tam N. , Gibran Nicole S.
Published: April 2020

Background:

Health-related quality of life is decreased in burn survivors, with scars implicated as a cause. The authors aim to characterize the use of reconstructive surgery following hospitalization and determine whether patient-reported outcomes change over time. The authors hypothesized improvement in health-related quality of life following reconstructive surgery.

Methods:

Adult burn survivors undergoing reconstructive surgery within 24 months after injury were extracted from a prospective, longitudinal database from 5 U.S. burn centers (Burn Model System). Surgery was classified by problem as follows: scar, contracture, and open wound. The authors evaluated predictors of surgery using logistic regression. Short Form-12/Veterans RAND 12 health survey outcomes at 6, 12, and 24 months were compared at follow-up intervals and matched with nonoperated participants using propensity score matching.

Results:

Three hundred seventy-two of 1359 participants (27.4 percent) underwent one or more reconstructive operation within 24 months of injury. Factors that increased the likelihood of surgery included number of operations during index hospitalization (p < 0.001), hand (p = 0.001) and perineal involvement (p = 0.042), and range-of-motion limitation at discharge (p < 0.001). Compared to the physical component scores of peers who were not operated on, physical component scores increased for participants undergoing scar operations; however, these gains were only significant for those undergoing surgery more than 6 months after injury (p < 0.05). Matched physical component scores showed nonsignificant differences following contracture operations. Mental component scores were unchanged or lower following scar and contracture surgery.

Conclusions:

Participants requiring more operations during index admission were more likely to undergo reconstructive surgery. There were improvements in Short Form-12/Veterans RAND 12 scores for those undergoing scar operations more than 6 months after injury, although contracture operations were not associated with significant differences in Short Form-12/Veterans RAND 12 scores.
Childhood Adversity and Pubertal Development Among Puerto Rican Boys and Girls
Authors: Suglia Shakira F. , Chen Chen , Wang Shuang , Cammack Alison L. , April-Sanders Ayana K. , McGlinchey Eleanor L. , Kubo Ai , Bird Hector , Canino Glorisa , Duarte Cristiane S.
Published: April 2020

Objective

Evidence stemming largely from retrospective studies suggests that childhood adversity (CA) is associated with earlier age at menarche, a marker of pubertal timing, among girls. Little is known about associations with pubertal tempo among boys or racial/ethnic minorities. We examined the association between CA and timing and tempo of pubertal development among boys and girls.

Methods

The Boricua Youth Study is a longitudinal study of Puerto Rican youth residing in the San Juan metro area in Puerto Rico and the South Bronx, New York. CA was based on caretaker reports of parental loss and parental maladjustment and youth reports of child maltreatment and exposure to violence. Youth completed the Pubertal Development Scale (PDS) yearly for 3 years. In linear mixed models stratified by sex, we examined the association between CA and pubertal timing and tempo, adjusting for site, socioeconomic status, and age.

Results

Among the 1949 children who were 8 years or older by wave 3, cumulative CA was associated with higher PDS scores among girls compared with girls not exposed to CA (PDS score: 2.63 [95% confidence interval {CI} = 2.55–2.71] versus 2.48 [95% CI = 2.37–2.58]). In contrast, among boys, experiencing adversities was associated with lower pubertal developmental stage or later timing (PDS: 1.77 [95% CI = 1.67–1.87] versus 1.97 [95% CI = 1.85–2.10]) compared with those not exposed to adversities.

Conclusions

Associations between CA and pubertal development may vary by sex. Understanding the etiological role of adversities on pubertal development and identifying targets for intervention are of utmost importance in ameliorating the impact of CA on child health.
Acute infectious myelopathies
Authors: Isada Carlos M. , Miller Ryan
Published: April 2020

Purpose of review

The patient who presents with an acute spinal cord syndrome with weakness/paralysis of the limbs presents a diagnostic. Two important syndromes are acute transverse myelitis (ATM) and acute flaccid paralysis (AFP). Both can be caused by a number of infectious and noninfectious causes. Since 2014 there have been outbreaks of acute flaccid myelitis (a subgroup of AFP) in the United States, with a national surveillance program underway. In addition, there have been increasing reports of ATM from new and emerging pathogens, and opportunistic infections in immunocompromised hosts.

Recent findings

Infectious causes of ATM or AFP need to be ruled out first. There may be important clues to an infectious cause from epidemiologic risk factors, immune status, international travel, MRI, and laboratory findings. We summarize key features for the more common pathogens in this review. Advances in laboratory testing have improved the diagnostic yield from cerebrospinal fluid, including real-time polymerase chain reaction, metagenomic next-generation sequencing, and advanced antibody detection techniques. These tests still have limitations and require clinical correlation.

We present a syndromic approach to infectious myelopathies, focusing on clinical patterns that help narrow the diagnostic possibilities.
CNS infections in HIV
Authors: Thakur Kiran T.
Published: April 2020

Purpose of review

Central nervous system (CNS) infections associated with HIV remain significant contributors to morbidity and mortality, particularly among people living with HIV (PLWH) in resource-limited settings worldwide. In this review, we discuss several recent important scientific discoveries in the prevention, diagnosis, and management around two of the major causes of CNS opportunistic infections-tuberculous meningitis (TBM) and cryptococcal meningitis including immune reconstitution syndrome (IRIS) associated with cryptococcal meningitis. We also discuss the CNS as a possible viral reservoir, highlighting Cerebrospinal fluid viral escape.

Recent findings

CNS infections in HIV-positive people in sub-Saharan Africa contribute to 15–25% of AIDS-related deaths. Morbidity and mortality in those is associated with delays in HIV diagnosis, lack of availability for antimicrobial treatment, and risk of CNS IRIS. The CNS may serve as a reservoir for replication, though it is unclear whether this can impact peripheral immunosuppression.

Significant diagnostic and treatment advances for TBM and cryptococcal meningitis have yet to impact overall morbidity and mortality according to recent data. Lack of early diagnosis and treatment initiation, and also maintenance on combined antiretroviral treatment are the main drivers of the ongoing burden of CNS opportunistic infections. The CNS as a viral reservoir has major potential implications for HIV eradication strategies, and also control of CNS opportunistic infections.
Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial
Authors: Kuru Alici Nilgün , Zorba Bahceli Pınar
Published: April 2020

Purpose

This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes.

Design

A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT 03687788) with a pretest–posttest design was conducted.

Methods

There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale.

Findings

After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased.

Conclusions

Laughter therapy may reduce loneliness in older adults.

Clinical Relevance

Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Use in Temporizing Intra-Abdominal and Pelvic Hemorrhage: Physiologic Sequelae and Considerations
Authors: Brenner Megan , Moore Laura , Dubose Joseph , Scalea Thomas
Published: April 2020

REBOA has been used for several years by acute care surgeons for temporization of intra-abdominal, pelvic, and junctional hemorrhage. The physiology and consequences of aortic occlusion in these patients are largely unstudied.
A Randomized Comparison of Carbon Nanoparticles in Endoscopic Lymph Node Dissection Via the Bilateral Areola Approach for Papillary Thyroid Cancer
Authors: Zhang Daqi , Fu Yantao , Dionigi Gianlorenzo , Hu Yu , Zhang Jiao , Wang Tie , Xue Gaofeng , Sun Hui
Published: April 2020

Objective:

We assess the value of carbon nanoparticles (CNP) staining in patients undergoing endoscopic thyroidectomy and central compartment lymph node (CLN) dissection via the bilateral areola approach [endoscopic thyroidectomy via bilateral areola approach (ETBAA)].

Methods:

This was a prospective randomized study. Three hundred two consecutive early-stage thyroid cancer patients eligible for ETBAA were recruited at the Division of Thyroid Surgery, China-Japan Union Hospital, Jilin University, China. CLN were mapped and retrieved under the guidance of stained or unstained CNP. The location, detection rates, positive nodes, and number of stained lymph nodes were compared.

Results:

ETBAA patients were randomly divided into a CNP group (n=152) and a control group (n=150). In the CNP group, the imaging of lymphatic flow could be observed in 1016 (95.9%) lymph nodes, whereas 43 (4.1%) were unstained. The mean number of stained lymph nodes in each procedure was 6.68 (range, 3 to 12). The total number of dissected lymph nodes was 1059 in the CNP group and 872 in the control group (P=0.00). There was a significant difference of inadvertent parathyroidectomy between the 2 groups: 0.5% versus 3.9% in lobectomy (P=0.035) and 0.6% versus 5.2% in total thyroidectomy (P=0.012). However, the rates of hypoparathyroidism were not significantly different (P>0.05). There were no cases of CNP-related adverse effects.

Conclusions:

The lymphatic navigation by CNP increases the number of detected CLN without the involvement of radioactive isotopes. However, CNP did not lower hypocalcemia, did not improve parathyroid hormone range, and there was no significant difference in the percentage of metastatic lymph nodes between the 2 groups.
Does circadian rhythm influence gastrointestinal toxicity?
Authors: Hofmeister Elisa N. , Fisher Sophie , Palesh Oxana , Innominato Pasquale F.
Published: April 2020

Purpose of review

The current review outlines the existing research on the impact of circadian rhythm on gastrointestinal toxicity associated with cancer treatment and explores clinical evidence for utilizing circadian-based approaches in addressing gastrointestinal symptoms such as nausea, vomiting, diarrhea, mucositis, and hepatotoxicity.

Recent findings

Recent evidence highlights circadian control of gastrointestinal physiology of appetite, digestion, nutrient absorption, and cellular proliferation in the digestive system. In addition, animal models support the mechanistic rationale of using chronotherapy (a type of anticancer therapy delivered at specific times with the goal of producing less toxicity and greater treatment response) to minimize gastrointestinal-impact of systemic cancer treatments. In addition, earlier research demonstrates that many chemotherapeutic agents are responsive to circadian timing in animals. On the contrary, clinical trials focused on minimizing gastrointestinal toxicity using chronotherapy have been limited in recent years and have not yielded the efficacy initially hoped for. Instead, researchers focused on understanding circadian rhythm's influence on the gastrointestinal system at a mechanistic level as well as measuring circadian rhythm at an individual level.

Although using circadian timing is a promising target for reducing gastrointestinal toxicity, recent evidence suggests that more research is needed to understand circadian rhythm before circadian-based interventions can be developed that will result in lessening of gastrointestinal toxicity.
Does Living With Human Immunodeficiency Virus Increase Pelvic Reconstructive Surgery Perioperative Complication Risk? A Multicenter Retrospective Cohort Study
Authors: Petrikovets Andre , Weber Lebrun Emly E. , Carlos Daniela M. , Perlman Barry , Florian-Rodriguez Maria E. , Bochenska Katarzyna , Eto Chidimma u , Lespinasse Pierre , Mahajan Sangeeta T. , El-Nashar Sherif , Crisp Catrina C. , Sheyn David
Published: April 2020

Objective

To determine if women with human immunodeficiency virus (HIV) undergoing pelvic reconstructive surgery (PRS) have an increased risk of perioperative and postoperative complications compared with HIV-negative controls.

Study Design

Multicenter, retrospective matched cohort study of patients with and without HIV infection who underwent PRS between 2006 and 2016. Cases were identified using International Classification of Disease, 9th edition Clinical Modification and 10th edition Clinical Modification and current procedural terminology (CPT) codes encompassing HIV diagnoses and pelvic reconstructive surgeries. Controls were identified as patients without HIV who underwent similar procedures, performed by the same surgeon during the same 1-year period as surgeries performed on patients with HIV. Cases were matched to controls at a ratio of 1:3. The primary outcome was composite complication rate within 1 year of surgery.

Results

Sixty-three patients with HIV and 187 controls were identified. There was no difference in the composite complication rate between women with HIV and HIV-negative women (36.5% vs 30.0%, P = 0.15) over 1 year. However, 19.1% of patients with HIV compared with 5.4% controls had Clavien Dindo Grade I complications (P = 0.002), and 11.1% of HIV patients had urinary retention within 6 weeks of surgery compared with 3.2% of controls (P = 0.02). After multivariable logistic regression used to adjust for confounders, living with HIV was not associated with an increased risk of complications.

Conclusions

Patients living with HIV are not at an increased risk of complications within 1 year of PRS compared with patients without HIV.
The Geriatric Nutritional Risk Index is a powerful predictor of adverse outcome in the elderly emergency surgery patient
Authors: Jia Zhenyi , El Moheb Mohamad , Nordestgaard Ask , Lee Jae Moo , Meier Karien , Kongkaewpaisan Napaporn , Han Kelsey , El Hechi Majed W. , Mendoza April , King David , Fagenholz Peter , Saillant Noelle , Rosenthal Martin , Velmahos George , Kaafarani Haytham M.A.
Published: April 2020

BACKGROUND

The degree to which malnutrition impacts perioperative outcomes in the elderly emergency surgery (ES) patient remains unknown. We aimed to study the relationship between malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), and postoperative outcomes in elderly patients undergoing ES.

METHODS

Using the 2007 to 2016 American College of Surgeons National Surgical Quality Improvement Program database, all patients 65 years or older undergoing ES were included in our study. The GNRI, defined as (1.489 × albumin [g/L]) + (41.7 × [weight/ideal weight]) was calculated for each patient in the database. Patients with missing height, weight, or preoperative albumin data were excluded. Patients were divided into four malnutrition groups: very severe (GNRI < 73), severe (GNRI, 73–82), moderate (GNRI, 82–92), and mild (GNRI, 92–98). Geriatric Nutritional Risk Index greater than 98 constituted the normal nutrition group. Risk-adjusted multivariable logistic regressions were performed to study the relationship between malnutrition—measured using either GNRI, albumin level, or body mass index less than 18.5 kg/m2—and the following postoperative outcomes: 30-day mortality, 30-day morbidity (including infectious and noninfectious complications), and hospital length of stay. The relationship between GNRI score and 30-day mortality for six common ES procedures was then assessed.

RESULTS

A total of 82,725 patients were included in the final analyses. Of these, 55,214 were malnourished with GNRI less than 98 (66.74%). Risk-adjusted multivariable analyses showed that, as malnutrition worsened from mild to very severe, the risk of mortality, morbidity, and the hospital length of stay progressively increased (allp< 0.05). Patients with very severe malnutrition had at least a twofold increased likelihood of mortality (odds ratio [OR], 2.79; 95% confidence interval [CI], 2.57–3.03), deep vein thrombosis (OR, 2.07; 95% CI, 1.77–2.42), and respiratory failure (OR, 1.95; 95% CI, 1.81–2.11). Geriatric Nutritional Risk Index predicted mortality better than albumin or body mass index alone for ES.

CONCLUSION

Malnutrition, measured using GNRI, is a strong independent predictor of adverse outcomes in the elderly ES patient and could be used to assess the nutrition status and counsel patients (and families) preoperatively.

LEVEL OF EVIDENCE

Prognostic study, Level IV.
Noninvasive SpO2/FiO2 ratio as surrogate for PaO2/FiO2 ratio during simulated prolonged field care and ground and high-altitude evacuation
Authors: Batchinsky Andriy I. , Wendorff Daniel , Jones John , Beely Brendan , Roberts Teryn , Choi Jae Hyek , Harea George , Cancio Leopoldo C. , Davis Michael , Cannon Jeremy , Sams Valerie
Published: April 2020

BACKGROUND

Diagnosis of lung injury requires invasive blood draws to measure oxygen tension in blood. This capability is nonexistent in austere settings and during prolonged field care (PFC), that is, medical care characterized by inability to evacuate casualties from the point of injury for up to 72 hours. We analyzed pulse-oximeter–derived noninvasive SpO2 and assessed the SpO2/FiO2 ratio (SFR) as a surrogate for the PaO2/FiO2 ratio (PFR), an accepted marker of lung function. We hypothesized that SFR is a suitable surrogate for PFR in a data set from animal models of combat-relevant trauma, PFC, and aeromedical evacuation.

METHODS

Data from anesthetized swine (N = 30) subjected to combat relevant trauma, resuscitation, and critical care interventions were analyzed. Pairwise correlations and Bland-Altman and regression analyses were performed to compare PFR and SFR, based on averaged SpO2 values obtained from two monitoring devices.

RESULTS

We performed 683 pairwise correlations. SpO2/FiO2 ratio was numerically higher than PFR with a 313 cutoff values for acute respiratory distress syndrome (ARDS) (PFR ≥300). Sensitivity/specificity for detection of mild ARDS was 75%/73% with a 200 to 300 PFR range corresponding to 252 to 312 SFR range. For moderate ARDS, sensitivity/specificity was 61%/93% with a 100 to 200 PFR range corresponding to 191 to 251 SFR range. For severe ARDS, sensitivity/specificity was 49%/97% with a 0 to 100 PFR range corresponding to 0 to 190 SFR range. For all groups, areas under the receiver operating characteristic curves ranged from 0.76 to 0.98.

CONCLUSION

SpO2/FiO2 ratio is a useful surrogate for PFR when arterial blood gas testing is not available during dynamically changing physiologic conditions, for example, during austere conditions, PFC, or aeromedical evacuation, and may permit early detection of casualties in need of lung-specific life-saving interventions. Studies in critically ill humans are warranted.
Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma
Authors: Hanna Kamil , Bible Letitia , Chehab Mohamad , Asmar Samer , Douglas Molly , Ditillo Michael , Castanon Lourdes , Tang Andrew , Joseph Bellal
Published: April 2020

INTRODUCTION

Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.

METHODS

We analyzed the (2015–2016) Trauma Quality Improvement Program. We included adult (age, ≥18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.

RESULTS

A total of 8,494 patients were identified, of which 280 received WB-CT (WB, 1 [1–1]; pRBC, 16 [10–23]; FFP, 9 [6–16]; platelets, 3 [2–5]) and 8,214 received CT only (pRBC, 15 [10–24]; FFP, 10 [6–16]; platelets, 2 [1–4]). Mean ± SD age was 34 ± 16 years, 79% were male, Injury Severity Score was 33 (24–43), and 63% had penetrating injuries. Patients who received WB-CT had a lower 24-hour mortality (17% vs. 25%; p = 0.002), in-hospital mortality (29% vs. 40%; p < 0.001), major complications (29% vs. 41%; p < 0.001), and a shorter length of stay (9 [7–12] vs. 15 [10–21]; p = 0.011). On regression analysis, WB was independently associated with reduced 24-hour mortality (odds ratio [OR], 0.78 [0.59–0.89]; p = 0.006), in-hospital mortality (OR, 0.88 [0.81–0.90]; p = 0.011), and major complications (OR, 0.92 [0.87–0.96]; p = 0.013).

CONCLUSION

The use of WB as an adjunct to CT is associated with improved outcomes in resuscitation of severely injured civilian trauma patients. Further studies are required to evaluate the role of adding WB to massive transfusion protocols.

LEVEL OF EVIDENCE

Therapeutic, level IV.
Improved outcomes utilizing a novel pectin-based pleural sealant following acute lung injury
Authors: Kuckelman John , Conner Jeffrey , Zheng Yifan , Pierce Aidan , Jones Ian , Lammers Daniel , Cuadrado Dan , Eckert Matthew , Mentzer Steven
Published: April 2020

BACKGROUND

Persistent air leaks after thoracic trauma are associated with significant morbidity. To evaluate a novel pectin sealant in a swine model of traumatic air leaks, we compared a pectin biopolymer with standard surgical and fibrin-based interventions.

METHODS

A standardized lung injury was created in male Yorkshire swine. Interventions were randomized to stapled wedge resection (n = 5), topical fibrin glue (n = 5), fibrin patch (n = 5), and a pectin sealant (n = 6). Baseline, preintervention and postintervention tidal volumes (TV) were recorded. Early success was defined as the return to near-normal TV (>95% of baseline). Late success was defined as no detectable air leak in the chest tube after chest closure.

RESULTS

There were no differences in injury severity between groups (mean TV loss, 62 ± 17 mL, p = 0.2). Early success was appreciated in 100% (n = 6) of the pectin interventions which was significantly better than the fibrin sealant (20%, n = 1), fibrin patch (20%, n = 1), and stapled groups (80%, n = 4, p = 0.01). The percent of return to baseline TV after sealant intervention was significantly increased in the pectin (98%) and staple arms (97%) compared with the fibrin sealant (91%) and fibrin patch arms (90%) (p = 0.02; p = 0.03). Late success was also improved with the pectin sealant: no air leak was detected in 83% of the pectin group compared with 40% in the stapled group (p = 0.008)—90% of the fibrin-based interventions resulted in continuous air leaks (p = 0.001).

CONCLUSION

Pectin-based bioadhesives effectively seal traumatic air leaks upon application in a porcine model. Further testing is warranted as they may provide a superior parenchymal-sparing treatment option for traumatic air leaks.