bluuebunny/crossref_metadata_2025 huggingface dataset:
Anal Intraepithelial Lesions in HIV-Negative Women With Cervical Neoplasia: A Cross-Sectional Study [12J]
Authors: Amorim Melania , Heraclio Sandra , Souza Alex Rolland , Katz Leila , Souza Paulo Roberto , Junior Sergio Lima
Published: May 2017

INTRODUCTION:

Evidence suggests a strong association between oncogenic human papillomavirus (HPV) infection, anal high-grade intraepithelial lesions and the development of anal cancer. The objective of this study was to evaluate the prevalence of anal intraepithelial lesions in women with cervical neoplasia.

METHODS:

A cross-sectional study was conducted with 324 HIV-negative women with intraepithelial or invasive cervical neoplasia to identify anal intraepithelial neoplasia (AIN) and risk factors associated. All the women were submitted to anal cytology and high-resolution anoscopy (HRA).

RESULTS:

The prevalence of AIN was 11% (n=37) with 4% of these cases consisting of high-grade lesions. The factors that remained associated with AIN in the multivariate analysis were age ≥36 (OR: 4.55; IC 95%:1.63-12.72; p< 0.001), ≤4 years of schooling (OR: 3.04; IC 95%:1.07-8.62; p=0.03), abnormal anal cytology (OR: 5.96; IC 95%:1.96-18.09 p < 0.001), a vulvoscopy finding of subclinical HPV lesion (OR: 6,94; IC 95%: 1.08-44.55; p= 0,04) and abnormal HRA findings (OR: 7.16; IC 95%:2.63-19.51; p < 0.001).

CONCLUSION:

The prevalence of AIN is high in HIV-negative women with cervical neoplasia. Screening for anal cancer in women with cervical neoplasia should be performed regardless of HIV status.
Racial, Geographic and Socioeconomic Risk Factors for Development of Advanced Stage Cervical Cancer [15J]
Authors: Dilley Sarah , Powell T. Clark , Bae Sejong , Straughn J. Michael , Leath Charles A. , Kim Kenneth H.
Published: May 2017

INTRODUCTION:

We investigated sociodemographic risk factors for developing advanced stage (AS) cervical cancer, as well as the impact of distance to a women’s health provider on stage at diagnosis.

METHODS:

Our institution tumor registry was queried to identify women treated for cervical cancer from 2005-2015. AS cancer was considered Stage II-IV. Utilizing American College of Obstetricians and Gynecologists data, we calculated minimum distance from patient to the nearest women’s health provider. Associations between stage and multiple factors were calculated using logistic regression.

RESULTS:

934 patients were included, 273 black and 661 white. Mean age at diagnosis: 49.8 (SD 14.7). 493 patients had AS cervical cancer. Average distance to a women's health provider (ACOG Fellow): 7.4 miles. 346 women had private insurance, 431 had public insurance, 128 were uninsured. Black race (OR 1.43) and age > 50 (OR 1.75) were associated with increased risk of AS cancer, however a shorter minimum distance to the nearest women’s health provider (OR 0.995) was not. When stratified by race, insurance status did not have a significant impact on stage at diagnosis for black women. Among white women, those who were uninsured (OR 1.69) or with public insurance (OR 1.93) were more likely to be diagnosed with AS cancer than those with private insurance.

CONCLUSION:

In our analysis, black race remains a strong predictor of diagnosis of AS cervical cancer. These results warrant further investigation into the socioeconomic, cultural and biological barriers to early diagnosis for black women, and highlight the importance of focusing on high-risk populations in efforts to improve cervical cancer screening and prevention.
Statins: A Possible Treatment or Prevention Strategy for Ovarian Cancer [18J]
Authors: Beltran Frans
Published: May 2017

INTRODUCTION:

Twenty-one thousand women are diagnosed with ovarian cancer yearly and fourteen thousand annually die from it. A promising drug-class with the potential to treat and prevent ovarian cancer is statins. One likely mechanism under investigation on statin’s anti-cancer properties is by inhibition of cell proliferation, migration and invasion through inhibition of Rho-A and Rho-C GTPases.

METHODS:

In a cohort of women diagnosed with epithelial ovarian cancer (EOC) at Hershey Medical Center, we compared cases on statin therapy at diagnosis to age and stage matched controls without statin use. Tissue pathology was immunohistochemically (IHC) stained for Rho-A and Rho-C. Tissue samples were examined under high resolution microscopy. Exact Mantel-Haenszel Chi-Square Test was used to analyze staining differences for Rho-A and Rho-C between cases and controls and between early stage disease (I-II) and advance stage disease (III-IV). Tissue sample stains were graded blindly and given a score and intensity.

RESULTS:

We identified 12 cases and 16 controls in an attempted 1:2 matching. There were no difference in score and intensity for Rho-C between cases and controls, nor between early and advanced stage disease. Differential IHC staining score was identified for Rho-A between cases and controls but no significant difference between the two groups.

CONCLUSION:

EOC stains for Rho-A and Rho-C, and Rho-A is differentially expressed in EOC. We were unable to find a significant difference in staining likely due to the small sample size. There remains strong potential for refashioning statins to treat and prevent deadly EOC and warrants further investigation.
Trends in Cervical Cancer Screening Versus National Guidelines [23J]
Authors: Polcari Ann M. , Hecht Eric
Published: May 2017

INTRODUCTION:

Guidelines for cervical cancer screening via pap smear changed in 2012. Previous studies suggest mixed opinions about extended screening intervals. This descriptive study relates trends in pap smear use with the new recommendations.

METHODS:

Self-reported pap smear information from 2012-2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys were weighted for the US population and subsequently analyzed using SPSS per The BRFSS Data User Guide. Age groups were determined by the 2012 cervical cancer screening guidelines.

RESULTS:

American women who reported “ever having a pap” declined 1.3% from 2012-2014. Specifically, Paps performed in 18-20 year olds decreased from 38.6% (n=2,580,856) to 27% (n=1,703,912). During this time period, the estimated percentage of women who “had a pap within the last year” declined from 53.6% (n=57,395,954) to 48.4% (n=49,965,054). In 2014 alone, approximately 70% (n=1,184,449) of 18-20 year olds and 23.6% (n=4,832,250) of women over 65 had their most recent pap within the previous year. Conversely, the number of women with a 3-year interval between Paps increased from 7.8% (n=8,327,940) to 9.5% (n=9,831,709) from 2012-2014.

CONCLUSION:

National Pap smear use is slowly aligning with 2012 guidelines, yet screening trends remain problematic. From 2012-2014, many women aged 18-20 or over 65 underwent a pap while no longer indicated, and few women utilized the extended interval. This can increase use of invasive follow-up procedures, anxiety, and cost, therefore contributing to excessive healthcare spending. Continued analysis of national pap testing will guide future studies that may unveil causes of excessive cervical cancer screening from the physician and patient perspective.
The 2012 Consensus Pap Test Guidelines: A Failure of Patient Education [24J]
Authors: O'Flynn O'Brien Katherine , Flynn Anne , Burkland Danielle , Karpin Karin , Krapf Jill , Haggerty Ashley
Published: May 2017

INTRODUCTION:

The 2012 consensus cervical cancer screening guidelines recommend longer intervals between Papanicolaou (Pap) tests. We evaluated the knowledge and attitudes of women regarding the purpose and frequency of Pap test screening.

METHODS:

A 13-question survey was available to patients 18 years and older presenting to three clinical sites for obstetrical or gynecological care. Survey topics included familiarity with the 2012 consensus screening guidelines, cervical cancer knowledge, and attitudes towards screening.

RESULTS:

Updated data from 752 patients was included for analysis. Participants were primarily age 20-29 (45%) or 30-39 (33%), African American (53%), and had completed at least a high school degree or equivalent (87%). Pap tests were correctly identified as a screening test for cervical cancer by 75% of participants and 72% named Human Papillomavirus as the cause of cervical cancer. However, only 9% of women selected the correct screening intervals for patients age 21-29 and only 3% selected the appropriate screening interval for patients age 30 and above. Overall, 52% were uncomfortable with lengthening screening intervals and 60% would prefer a yearly pap test. However, 62% of women believed that additional education would increase their comfort with less frequent screening.

CONCLUSION:

Across diverse clinical populations, women are knowledgeable about the purpose of Pap tests and about cervical cancer. However, consistent with our previous data analysis, most women are unaware of the updated screening guidelines and many feel uncomfortable with increased screening intervals. Further education regarding the timing of pap tests is necessary to improve women’s comfort with the consensus guidelines.
Effects of Race and Socioeconomic Factors on Emergency Department Management of Threatened Abortion [26J]
Authors: Cheng Connie , Bernstein Steven , Fan Linda , Evans Leigh
Published: May 2017

INTRODUCTION:

Among women presenting with pregnancy-related complications, demographically-based differences in incidence, outcomes, and treatment are known. Here we determine the effects of race, insurance, and hospital characteristics on threatened abortion management.

METHODS:

Patient record files from National Hospital Ambulatory Medical Care Survey with diagnosis of threatened abortion, hemorrhage in pregnancy, or incomplete or unspecified spontaneous abortion from 2002-2010 were examined using logistic regression. Primary outcomes were rates of admission and active management (surgical or pharmacological treatment). Covariates included race/ethnicity, age, insurance, and hospital location, ownership, and metropolitan status.

RESULTS:

Of 5,882,623 ED visits for threatened abortion, 15% were admitted; 1.3% were actively managed. Compared to white women, black women were less likely to be admitted (0.83, 95% CI 0.83-0.84), but more likely be actively managed (OR 4.37, 95% CI 4.25-4.50). Admission was more likely for “Other” women of color (OR 2.14, 95% CI 2.11-2.17), Medicaid/SCHIP (OR 1.24, 95% CI 1.22-1.25) and Self-paying women (OR 1.04, 95% CI 1.03-1.05). Historically-marginalized groups, including uninsured, black, and “Other” women, were more likely to be actively managed. Exceptions were Latina (OR 0.84, 95% CI 0.80-0.89) and Medicaid/SCHIP-insured women (OR 0.13, 95% CI 0.12-0.15).

CONCLUSION:

Black women are less likely than white women to be admitted for threatened abortion, but more likely to be actively managed. Other nonwhite and uninsured women are more likely to be admitted and actively managed, excepting Latinas. The etiology of these disparities is complex. Providers may seek to better understand their own preconceptions of patient risk, and to improve social support and shared decision-making.
Obstetrician/Gynecologists' Attitudes, Knowledge and Caring of Lesbian, Bisexual, and Transgender Patients [32J]
Authors: LaSota Emily , DiCorcia Mark , Daggy Joanne
Published: May 2017

INTRODUCTION:

This study assessed the attitudes, knowledge and experiences caring for lesbian, bisexual, and transgender (LBT) patients among members of a national group of obstetrician-gynecologists.

METHODS:

Members of the American College of Obstetricians and Gynecologists (the College) who attended College meetings in Denver and Indiana completed a survey assessing care practices, knowledge and attitudes toward LBT patients.

RESULTS:

196 out of 425 (46.1%) physicians completed the survey. Most physicians often or sometimes ask about sexual orientation, but they rarely ask about gender identity. Over 98% feel comfortable treating lesbian and bisexual patients, but 30% believe a provider should be allowed to decline to treat LBT patients if it conflicts with the provider’s religious beliefs. Over 84% agree that their workplace is a safe place for LGBT patients, but most do not have or know if they have office measures that would create a welcoming space, such as posted nondiscrimination policies or LGBT employee training. The majority screen LBT patients at the same rate as non-LBT patients for depression, substance abuse, and cervical cancer. Physicians reported that self-directed learning and experiences with LBT patients were more valuable forms of LBT education than formal training in medical school, residency or CME.

CONCLUSION:

Physicians in obstetrics and gynecology recognize and address issues regarding sexual orientation. Physicians feel comfortable treating LBT patients but are dissatisfied with formal training they receive on LBT health issues. While most believe that their workplaces are safe environments for LBT patients, much more can be done to ensure that patients perceive them to be safe.
Addressing Loss of Low Risk Obstetric Patients to Postpartum Care in an Inner City Hospital [11E]
Authors: Maher Lauren , Rose Marisa
Published: May 2017

INTRODUCTION:

Postpartum appointments after discharge from uncomplicated deliveries are integral to building patient-physician relationships, screening for complications, decreasing emergency department visits, and preventing readmissions. At Temple University Hospital, patients were responsible for scheduling their own follow-up appointments after delivery.

METHODS:

A retrospective chart review was performed to evaluate the rate of patient initiated postpartum follow up. A new approach to improving attendance at postpartum visit was instituted using an electronic scheduling system at the time of discharge. Patient return rates were prospectively monitored comparing patients using the old and new system.

RESULTS:

In 2012-2013, 62.5% of patients of patients attended self-initiated follow-up appointments. In 2013-2014, 23% of patients had their follow-up appointments scheduled through the electronic system and 62% of these women attended their follow-up appointments. In the same year, 84% of patients attended self- initiated follow-up appointments and the overall attendance rate was 63% of postpartum patients. In 2014-2015, 62.5% of patients had their follow-up appointments scheduled through the electronic system. Of these, 48% of patients attended their follow-up appointments compared to 88% who attended appointments they scheduled themselves, with an overall follow up rate of 56.5%.

CONCLUSION:

Implementation of a model where postpartum appointments are scheduled through the electronic system has not increased the rates of follow up for low risk obstetric patients. Future plans include a pilot study of scheduling postpartum appointments during a term prenatal visit and contacting patients the week of their scheduled appointments to remind them of the appointment date and time.
The Impact of Florida’s Prescription Drug Monitoring Program on Neonatal Abstinence Syndrome [39F]
Authors: Roussos-Ross Dikea , Triplett Kimberly
Published: May 2017

INTRODUCTION:

The Florida Prescription Drug Monitoring Program (PDMP), E-FORCSE, was implemented in response to the national opioid epidemic in 2011 as a way to decrease inappropriate prescribing and access to opioid medications.

METHODS:

A retrospective chart review was conducted at UF Health at the University of Florida in Gainesville, FL with IRB approval. Data was collected from January 1, 2012 to December 31, 2015. We investigated the in-hospital length of stay, hospital charges associated with observation and treatment of newborns affected by neonatal abstinence syndrome (NAS), type of treatment required (eg, pharmacologic, supportive), and type of opioid exposure during pregnancy.

RESULTS:

Three hundred twenty-three eligible newborns were included in the study. The average length of stay for newborns diagnosed with NAS, requiring only supportive measures was 4.6 days. The average length of stay for newborns diagnosed with NAS requiring pharmacologic management was 14.4 days. Over the four year study period, hospital charges related to the diagnosis and treatment of NAS increased from $1.7 million in 2012 to $2.5 million in 2015. The percentage of newborns diagnosed with NAS requiring pharmacologic management increased from 53.8% in 2012 to 64.5% in 2015.

CONCLUSION:

Despite the initiation of the PDMP in Florida, there was no noted decrease in the incidence of NAS. In fact, the incidence of NAS, hospital charges, and length of stay all increased over the length of the study. Encouraging use of contraception, including LARC, may decrease the incidence of unintended pregnancy and may play a part in decreasing in-utero exposure to opioids.
Quality of Web-Based Pregnancy and Fertility Health Information for LGBT Individuals [39H]
Authors: Kreines Fabiana M. , Mou Tsung , Razavi Armin , Chervenak Frank , Grunebaum Amos
Published: May 2017

INTRODUCTION:

There is little scientific pregnancy and fertility information available online for the lesbian, gay, bisexual, and transgender (LGBT) community. In an age where individuals acquire a significant portion of their medical information online, it is important to have validated and reliable medical information available, especially because of the unique family building obstacles faced by LGBT individuals. The purpose of this study is to evaluate the quality of web-based reproductive health information for LGBT individuals.

METHODS:

The first 25 relevant websites that resulted from a Google-based search and met specific LGBT family building search criteria were analyzed for health-related information using the National Quality Health Website Survey (NQHWS) instrument.

RESULTS:

76% of the websites (19/25) belonged to fertility clinics and constituted mostly vehicles for advertisements to the LGBT community for these clinics. No website identified source of funding, described medical, editorial, or quality review practices or policies. No website met more than 75% reliability criteria, and 76% (19/25) met less than 50%. Only 32% (8/25) mentioned adoption as an option or made any mention of reproductive options provided to transgender individuals. Additionally, only 48% (12/25) of websites made any mention of legal resources to help navigate LGBT family building in this country.

CONCLUSION:

This is the first study applying validated reliability criteria (NQHWS) to evaluate online information regarding LGBT reproductive options. Medically reliable websites for the LGBT community are greatly needed to provide sufficient information on family building for the LGBT community.
Efficacy of Intrauterine Lidocaine and Naproxen for Pain Control With Intrauterine Device Insertion [1A]
Authors: Miles Shana , Shvartsman Katerina , Dunlow Susan
Published: May 2017

INTRODUCTION:

One of the barriers to IUD insertion is discomfort during the placement of the device. This study was designed to compare the efficacy of intrauterine lidocaine and oral naproxen sodium on discomfort and pain of patients undergoing intrauterine device insertion.

METHODS:

This is a randomized, double-blind, placebo-controlled study where women were randomly assigned to receive either 5mL of intrauterine 2% lidocaine or saline and either 375mg of naproxen sodium or placebo tablet. Patients were randomized into one of four randomly assigned groups: A placebo/normal saline infusion; B placebo/lidocaine infusion; C: naproxen/normal saline; D: naproxen/lidocaine. We enrolled 80 women into the Mirena IUD arm of the study.

RESULTS:

There was no significant difference between the 4 groups in age, parity, chronic pelvic pain, menopausal status, or difficulty in placing the IUD. The mean pain scores of the women in the naproxen only (2.89+/-2.05), lidocaine only (2.37+/-1.98), and combined naproxen/lidocaine (3.55+/-2.46) groups were not significantly different as compared to placebo (3.2+/-2.25). Pain rated by the physician was not significantly lower in the treatment groups as compared to placebo.

CONCLUSION:

Oral naproxen and intrauterine lidocaine instillation does not appear to significantly decrease pain associated with Mirena IUD insertion.
Impact of Telemedicine Monitoring of Community ICUs on Interhospital Transfers*
Authors: Pannu Jasleen , Sanghavi Devang , Sheley Todd , Schroeder Darrell R. , Kashyap Rahul , Marquez Alberto , Daniels Craig E. , Brown Daniel R. , Caples Sean M.
Published: May 2017

Objectives:

To study the effects of tele-ICU monitoring on interhospital transfers from community-based ICUs to the quaternary care hospital at Mayo Clinic, Rochester, MN.

Design:

This is a retrospective review of data on interhospital transfers comparing trends prior to tele-ICU implementation to those following implementation.

Setting:

Tele-ICU programs are increasingly utilized to fill resource gaps in caring for critically ill patients. How such programs impact population and bed management within a healthcare system are not known. Mayo Clinic serves as quaternary referral care center for hospitals in the region within the Mayo Clinic Health System. In August 2013, we implemented tele-ICU monitoring at six Mayo Clinic Health System hospital ICUs.

Subjects:

All adult ICU admissions during the study period (preimplementation phase: January 1, 2012, to December 31, 2012; and postimplementation phase: January 1, 2014, to December 31, 2014) in any of the six specified community ICUs were included in the study.

Measurements and Main Results:

Interhospital transfers significantly increased post institution of tele-ICU (p = 0.040) and was attributed primarily to transfer from less specialized ICUs (p = 0.037) as compared with more resource-intensive ICUs (p = 0.88). However, for such patient transfers, there were no significant differences before and after severity of illness scores, ICU mortality, or inhospital mortality.

Conclusion:

In a regional healthcare system, implementation of a tele-ICU program is associated with an increase in interhospital transfers from less resourced ICUs to the referral center, a trend that is not readily explained by increased severity of illness.
What To Do With Lateral Nodal Disease in Low Locally Advanced Rectal Cancer? A Call for Further Reflection and Research
Authors: Kusters Miranda , Slater Andrew , Muirhead Rebecca , Hompes Roel , Guy Richard J. , Jones Oliver M. , George Bruce D. , Lindsey Ian , Mortensen Neil J. , Cunningham Chris
Published: May 2017

BACKGROUND:

There remains a lack of international consensus on the appropriate management of lateral nodal disease. Although the East manages this more aggressively with lateral lymph node dissections, the West aims to eradicate small-volume disease with neoadjuvant chemoradiotherapy and lateral nodal disease is not considered for routine surgical treatment. However, recent studies have shown that, despite neoadjuvant treatment, a significant number of patients with lateral nodal disease develop local recurrence in the lateral compartment after total mesorectal excision.

OBJECTIVE:

The aim of this study is to assess the role of the pretreatment features of lateral nodes on MRI in regard to local recurrence.

DESIGN:

All patients operated on for low locally advanced rectal cancer over a 5-year period were evaluated retrospectively.

SETTINGS:

This study was conducted at a single expert center.

PATIENTS:

The MRIs of a total of 313 patients were reviewed, and only those with rectal cancers up to 8 cm from the anorectal junction, measured on MRI, were selected. This left 185 patients; of these, 58 patients had clinical T1 or T2 tumors as assessed on MRI, identifying 127 patients who had cT3/T4 tumors that were included in this study.

MAIN OUTCOME MEASURES:

The primary outcomes measured were lateral local recurrence and multivariate analyses.

RESULTS:

The lateral local recurrence rate was significantly higher (33.3% 4-year rate) in patients with nodes larger than 10 mm than in patients with smaller nodes (10.1%, p = 0.03), despite patients being irradiated in the lateral compartment.

LIMITATIONS:

Because this is a relatively uncommon disease, patient numbers are low, and a multicenter study is needed to further address lateral nodal disease in low rectal cancer.

CONCLUSIONS:

Chemoradiotherapy with total mesorectal excision might not be sufficient in a selected group of patients. Further research is needed about which pretreatment features of the lateral nodes predict local recurrence and what is needed to prevent these from developing. See Video Abstract at http://links.lww.com/DCR/A338.
The Rationale for and Reality of the New National Accreditation Program for Rectal Cancer
Authors: Wexner Steven D. , Berho Mariana E.
Published: May 2017

BACKGROUND:

The treatment of rectal cancer has greatly evolved because of numerous diagnostic and therapeutic advances. More accurate staging by MRI has allowed more appropriate use of neoadjuvant therapy as well as more standardized high-quality total mesorectal excision. Lower rates of perioperative morbidity, permanent colostomy creation, and improved rates of oncologically acceptable rectal excision have led to lower recurrence and greater disease-free survival rates. The recognition of the need for pathologic assessment of the quality of total mesorectal excision, the status of the circumferential resection margins, and the finding of a minimum of 12 lymph nodes as well as identification of extramural vascular invasion has improved staging. These evolutions in imaging, surgical management, and pathologic specimen assessment are interdependent and have been repeatedly shown on national levels to be best operationalized in a multidisciplinary team environment.

OBJECTIVE:

The aim of this article is to evaluate the evidence leading to these important changes, including the imminent launch of the National Accreditation Program for Rectal Cancer.

DESIGN AND SETTING:

Based on the myriad confirmatory experiences in Europe and in the United Kingdom, a multidisciplinary team rectal cancer program was designed by the Consortium for Optimizing Surgical Treatment of Rectal Cancer and subsequently endorsed and accepted by the American College of Surgeons Commission on Cancer.

MAIN OUTCOME MEASURES:

The primary outcome measured is the adherence to the new program standards.

RESULTS:

Surgical treatment of rectal cancer consortium membership rapidly increased from 14 centers in August 2011 to more than 350 centers in April 2017.

LIMITATIONS:

The multidisciplinary team rectal cancer program has not yet launched; thus, its impact cannot yet be assessed.

CONCLUSIONS:

It is our hope and expectation that the outstanding improvement in quality outcomes repeatedly demonstrated within Europe, and extensively shown as much needed in the United States, will be rapidly achieved.
Systematic Review of Animal Models Used in Research of Origins and Treatments of Fecal Incontinence
Authors: Evers Judith , Jones James F. X. , O’Connell P. Ronan
Published: May 2017

BACKGROUND:

Fecal incontinence is a common disorder, but its pathophysiology is not completely understood.

OBJECTIVE:

The aim of this review is to present animal models that have a place in the study of fecal incontinence.

DATA SOURCES:

A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed in August 2016 revealed 50 articles of interest. Search terms included fecal/faecal incontinence and animal model or specific species.

STUDY SELECTION:

Articles not describing an animal model, in vitro studies, veterinary literature, reviews, and non-English articles were excluded.

MAIN OUTCOME MEASURES:

The articles described models in rats (n = 31), dogs (n = 8), rabbits (n = 7), and pigs (n = 4).

RESULTS:

Different fecal incontinence etiologies were modeled, including anal sphincter lesions (33 articles) ranging from a single anal sphincter cut to destruction of 50% of the anal sphincter by sharp dissection, electrocautery, or diathermy. Neuropathic fecal incontinence (12 articles) was achieved by complete or incomplete pudendal, pelvic, or inferior rectal nerve damage. Mixed fecal incontinence (5 articles) was modeled either by the inflation of pelvic balloons or an array of several lesions including nervous and muscular damage. Anal fistulas (2 articles), anal sphincter resection (3 articles), and diabetic neuropathy (2 articles) were studied to a lesser extent.

LIMITATIONS:

Bias may have arisen from the authors’ own work on fecal incontinence and the absence of blinding to the origins of articles.

CONCLUSIONS:

Validated animal models representing the main etiologies of fecal incontinence exist, but no animal model to date represents the whole pathophysiology of fecal incontinence. Therefore, the individual research questions still dictate the choice of model and species.
Physician Burnout and Well-Being: A Systematic Review and Framework for Action
Authors: Rothenberger David A.
Published: May 2017

BACKGROUND:

Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations.

OBJECTIVE:

The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions.

DATA SOURCES:

I completed a comprehensive MEDLINE search of the medical literature from January 1, 2000, through December 28, 2016, related to medical student and physician burnout, stress, depression, suicide ideation, suicide, resiliency, wellness, and well-being. In addition, I selectively reviewed secondary articles, books addressing the relevant issues, and oral presentations at national professional meetings since 2013.

STUDY SELECTION:

Healthcare organizations within the United States were studied.

RESULTS:

The literature review is presented in 5 sections covering the basics of defining and measuring burnout; its impact, incidence, and causes; and interventions and remediation strategies.

CONCLUSIONS:

All US medical students, physicians in training, and practicing physicians are at significant risk of burnout. Its prevalence now exceeds 50%. Burnout is the unintended net result of multiple, highly disruptive changes in society at large, the medical profession, and the healthcare system. Both individual and organizational strategies have been only partially successful in mitigating burnout and in developing resiliency and well-being among physicians. Two highly effective strategies are aligning personal and organizational values and enabling physicians to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them. More research is needed.
Effect of N-Desalkylquetiapine/Quetiapine Plasma Level Ratio on Anxiety and Depression in Bipolar Disoder: A Prospective Observational Study
Authors: Rovera Chiara , Mauri Massimo C. , Chiara Di Pace , Paletta Silvia , Reggiori Alessandra , Ciappolino Valentina , Cattaneo Dario , Baldelli Sara , Clementi Emilio , Altamura Alfredo C.
Published: May 2017

Background:

The aim of this study was to analyze the relationships between quetiapine and N-desalkylquetiapine plasma levels and clinical improvement, particularly, in regard to depressive and anxious symptoms and to hostility.

Methods:

This was a prospective observational study that involved 37 outpatients diagnosed as having bipolar disorder I or II. All the patients were observed during a clinical acute and postacute phase. Patients were prescribed 50–800 mg of quetiapine. Patients were evaluated at baseline, after 15 days and after 3 months using the Brief Psychiatry Rating Scale with particular reference to the dimensions of depression, anxiety, and hostility. The plasma concentrations of quetiapine and N-desalkylquetiapine were determined after 3 months using blood samples taken at steady state.

Results:

There was a significant relationship between the N-desalkylquetiapine/quetiapine ratio and the improvement in the depression dimension, and there was not a significant relationship between the N-desalkylquetiapine/quetiapine ratio and anxiety and hostility improvement. Quetiapine treatment was well tolerated, and there were no extrapyramidal, anticholinergic, or other side effects to note. There was no relationship between plasma quetiapine or N-desalkylquetiapine concentrations and side effects.

Conclusions:

Our findings confirm the efficacy of quetiapine on depressive symptoms, and the available data support that quetiapine's antidepressant activity is mediated by the active metabolite norquetiapine, and it exemplifies the case of an active metabolite that can make a drug like quetiapine originally introduced as an antipsychotic a useful antidepressant agent.
Oral Human Papillomavirus in Women With High-Grade Cervical Intraepithelial Neoplasia
Authors: Woelber Linn , Breuer Julia , Meyer Thomas , Vettorazzi Eik , Prieske Katharina , Bohlmann Inga , Busch Chia-Jung , Teudt Ingo , Brummer Oliver , Mueller Volkmar , Schmalfeldt Barbara , Grimm Donata
Published: May 2017

Objective

This study was designed to investigate the co-prevalence of cervical and oropharyngeal human papillomavirus (HPV) infection in patients with HPV-related high-grade disease of the uterine cervix (high-grade squamous intraepithelial lesion [HSIL]).

Materials and Methods

In a prospective cohort study, women with abnormal cervical cytology admitted to our colposcopy units received HPV testing of the uterine cervix and the oropharynx via smear. From a subset of patients, oral lavage was collected to compare detection rates of HPV DNA between lavage and swab. Patients with confirmed high-risk HPV (HR-HPV)–positive HSIL of the cervix were further investigated. Sexual behavior and lifestyle factors were documented with a standardized questionnaire.

Results

Two hundred thirty-five women were included in the study. Of the 235 women, 135 (57.5%) were cervically HR-HPV positive with histologically confirmed high-grade cervical intraepithelial lesion (median [range] age = 30 [21–45] years). Of these, only 6 (4.4%) also had a positive oral specimen. In 3 (50%) of the 6 cases, the same HPV type was detected in oral and cervical samples (HPV 16, 35, and 45). Oral HPV detection was not higher when combining swab and lavage compared with swab alone. A relation between sexual behavior and oral HPV detection could not be demonstrated.

Conclusions

Oral HPV prevalence in women with cervical HPV infection and HSIL is low. Simultaneous testing of oropharyngeal and cervical HPV infection does not seem promising as future screening strategy.
A Population Pharmacokinetic Analysis to Study the Effect of Therapeutic Hypothermia on Vancomycin Disposition in Children Resuscitated From Cardiac Arrest*
Authors: Zane Nicole R. , Reedy Michael D. , Gastonguay Marc R. , Himebauch Adam S. , Ramsey Evan Z. , Topjian Alexis A. , Zuppa Athena F.
Published: May 2017

Objectives:

Limited data exist on the effects of therapeutic hypothermia on renal function and pharmacokinetics in pediatric patients after cardiac arrest. The objective was to describe the differences in vancomycin disposition in pediatric patients following cardiac arrest treated with either therapeutic hypothermia or normothermia using population pharmacokinetic modeling.

Design:

Single-center, retrospective cohort study.

Setting:

A tertiary care hospital pediatric and cardiac ICU.

Patients:

Fifty-two pediatric patients (30 d to 17 yr old) who experienced a cardiac arrest, received vancomycin, and were treated with therapeutic hypothermia (32–34°C) or normothermia (36.3–37.6°C) between January 1, 2010, and September 30, 2014, were reviewed.

Interventions:

None.

Measurements and Main Results:

A two-compartment model with linear elimination, weight effects on clearance, intercompartmental clearance (Q), central volume of distribution (V1), and peripheral volume of distribution (V2) adequately described the data despite high variability due to the small sample size. The typical value of clearance in this study was 4.48 L/hr (0.19 L/hr/kg0.75) for a normothermic patient weighing 70 kg and a glomerular filtration rate of 90 mL/min/1.73 m2. Patients treated with normothermia but with reduced or poor renal function (≤ 90 mL/min/1.73 m2) had up to an 80% reduction in vancomycin clearance compared to those with normal renal function (90–140 mL/min/1.73 m2). Patients with normal renal function but treated with therapeutic hypothermia versus normothermia experienced up to 25% reduction in vancomycin clearance. Patients treated with therapeutic hypothermia and with poor renal function experienced up to an 84% reduction in vancomycin clearance.

Conclusions:

Patients receiving hypothermia and/or with decreased renal function had lower vancomycin clearances based on a retrospectively fitted two-compartment model in children who experience cardiac arrest.
Impact of Narrative Expressive Writing on Heart Rate, Heart Rate Variability, and Blood Pressure After Marital Separation
Authors: Bourassa Kyle J. , Allen John J.B. , Mehl Matthias R. , Sbarra David A.
Published: May 2017

Objective

Divorce is a common stressor that is associated with increased risk for poor long-term physical and mental health. Using an experimental design, the current study examined the impact of expressive writing (EW) on average heart rate (HR), HR variability (HRV), and blood pressure (BP) 7.5 months later.

Methods

Participants from a community sample of recently separated adults (N = 109) were assigned to one of three conditions: traditional EW, narrative EW, or a control writing condition, and were assessed three times for an average of 7.5 months. Each study visit included 27 minutes of physiological assessment; the primary outcomes at each assessment were mean-level HR, HRV, BP scores averaged across six different tasks.

Results

Participants in the traditional EW condition did not significantly differ from control participants in their later HR, HRV, or BP. However, relative to control participants, those in the narrative EW condition had significantly lower HR (B = −3.41, 95% confidence interval = −5.76 to −1.06, p = .004) and higher HRV 7.5 months later (B = 0.41, 95% confidence interval = 0.16 to 0.74, p = .001). When comparing narrative EW participants to those in the traditional EW and control writing as a single group, these effects remained and were moderately sized, Cohen d values of −0.61 and 0.60, respectively, and durable across all task conditions when analyzed in independent models. The writing condition groups did not differ in their later BP.

Conclusions

Narrative EW decreased HR and increased HRV after marital separation but did not affect BP. We discuss the possible disconnect between psychology and physiology in response to EW, as well as possible future clinical applications after marital separation.
The Association of Intracranial Vascular Calcification and Stenosis With Acute Ischemic Cerebrovascular Events
Authors: Quiney Brendan , Ying Stephen M. , Hippe Daniel S. , Balu Niranjan , Urdaneta-Moncada Alfonso R. , Mossa-Basha Mahmud
Published: May 2017

Objective

The aim of this article was to evaluate the association of intracranial artery calcification (IAC) with acute downstream ischemic stroke (dAIS)/transient ischemic attack while considering stenosis.

Methods

Consecutive stroke computed tomography angiography head/neck examinations from January 2010 to April 2010 were reviewed. Per-vessel IAC and stenosis of greater than or equal to 30% were documented by 2 neuroradiologists. Associations between calcification and dAIS were assessed using multivariate logistic regression, controlling for traditional risk factors and stenosis.

Results

A total of 1287 arterial segments from 99 patients were reviewed. Intracranial artery calcification was significantly associated with dAIS (odds ratio [OR], 2.2; P = 0.009). This association persisted among nonstenotic arteries, with significantly higher likelihood of dAIS for arteries with IAC than those without (OR, 2.5; P = 0.009). However, among stenotic arteries, calcified stenoses had a lower association of dAIS than noncalcified stenoses (OR, 0.55; 95% confidence interval, 0.17–1.8; P = 0.33).

Conclusions

Without concurrent stenosis, IAC is a significant risk factor for dAIS. When stenosis is present, IAC does not increase the association with dAIS. Stenotic and nonstenotic calcifications may represent different disease processes, as represented in the histology literature.
Genetic Instrumental Variable (GIV) regression: Explaining socioeconomic and health outcomes in non-experimental data
Authors: DiPrete Thomas A. , Burik Casper A.P. , Koellinger Philipp D.
Published: May 2017

Identifying causal effects in non-experimental data is an enduring challenge. One proposed solution that recently gained popularity is the idea to use genes as instrumental variables (i.e. Mendelian Randomization - MR). However, this approach is problematic because many variables of interest are genetically correlated, which implies the possibility that many genes could affect both the exposure and the outcome directly or via unobserved confounding factors. Thus, pleiotropic effects of genes are themselves a source of bias in non-experimental data that would also undermine the ability of MR to correct for endogeneity bias from non-genetic sources. Here, we propose an alternative approach, GIV regression, that provides estimates for the effect of an exposure on an outcome in the presence of pleiotropy. As a valuable byproduct, GIV regression also provides accurate estimates of the chip heritability of the outcome variable. GIV regression uses polygenic scores (PGS) for the outcome of interest which can be constructed from genome-wide association study (GWAS) results. By splitting the GWAS sample for the outcome into non-overlapping subsamples, we obtain multiple indicators of the outcome PGS that can be used as instruments for each other, and, in combination with other methods such as sibling fixed effects, can address endogeneity bias from both pleiotropy and the environment. In two empirical applications, we demonstrate that our approach produces reasonable estimates of the chip heritability of educational attainment (EA) and show that standard regression and MR provide upwardly biased estimates of the effect of body height on EA.
MotifMark: Finding Regulatory Motifs in DNA Sequences
Authors: Hassanzadeh Hamid Reza , Kolhe Pushkar , Isbell Charles L. , Wang May D.
Published: May 2017

The interaction between proteins and DNA is a key driving force in a significant number of biological processes such as transcriptional regulation, repair, recombination, splicing, and DNA modification. The identification of DNA-binding sites and the specificity of target proteins in binding to these regions are two important steps in understanding the mechanisms of these biological activities. A number of high-throughput technologies have recently emerged that try to quantify the affinity between proteins and DNA motifs. Despite their success, these technologies have their own limitations and fall short in precise characterization of motifs, and as a result, require further downstream analysis to extract useful and interpretable information from a haystack of noisy and inaccurate data. Here we propose MotifMark, a new algorithm based on graph theory and machine learning, that can find binding sites on candidate probes and rank their specificity in regard to the underlying transcription factor. We developed a pipeline to analyze experimental data derived from compact universal protein binding microarrays and benchmarked it against two of the most accurate motif search methods. Our results indicate that MotifMark can be a viable alternative technique for prediction of motif from protein binding microarrays and possibly other related high-throughput techniques.
CircMarker: A Fast and Accurate Algorithm for Circular RNA Detection
Authors: Li Xin , Chu Chong , Pei Jingwen , Măndoiu Ion , Wu Yufeng
Published: May 2017

While RNA is often created from linear splicing during transcription, recent studies have found that non-canonical splicing sometimes occurs. Non-canonical splicing joins 3’ and 5’ and forms the socalled circular RNA. It is now believed that circular RNA plays important biological roles such as affecting susceptibility in some diseases. within these few years, several experimental methods have been developed to enrich circular RNA while degrade linear RNA. Although several useful software tools for circRNA detection have been developed as well, these tools may miss many circular RNA. Also, existing tools are slow for large data because those tools often depend on reads mapping. In this paper, we present a new computational approach, named CircMarker, based on k-mers rather than reads mapping for circular RNA detection. CircMarker takes advantage of transcriptome annotation files to create k-mer table for circular RNA detection. Empirical results show that CircMarker outperforms existing tools in circular RNA detection on accuracy and efficiency in many simulated and real datasets. CircMarker can be downloaded fromhttps://github.com/lxwgcool/CircMarker.
Simulating the Dynamics of Targeted Capture Sequencing with CapSim
Authors: Cao Minh Duc , Ganesamoorthy Devika , Coin Lachlan J.M.
Published: May 2017

Motivation

Targeted sequencing using capture probes has become increasingly popular in clinical applications due to its scalability and cost-effectiveness. The approach also allows for higher sequencing coverage of the targeted regions resulting in better analysis statistical power. However, because of the dynamics of the hybridisation process, it is difficult to evaluate the efficiency of the probe design prior to the experiments which are time consuming and costly.

Results

We developed CapSim, a software package for simulation of targeted sequencing. Given a genome sequence and a set of probes, CapSim simulates the fragmentation, the dynamics of probe hybridisation, and the sequencing of the captured fragments on Illumina and PacBio sequencing platforms. The simulated data can be used for evaluating the performance of the analysis pipeline, as well as the efficiency of the probe design. Parameters of the various stages in the sequencing process can also be evaluated in order to optimise the efficacy of the experiments.

Availability

CapSim is publicly available under BSD license athttps://github.com/mdcao/capsim.