bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic single administration of anti‐inflammatory microRNA 146a‐5p loaded in polymeric nanomedicines with active targetability attenuates neointimal hyperplasia by controlling inflammation in injured arteries in a rat model
Authors: Sano Masaya , Akagi Daisuke , Naito Mitsuru , Hoshina Katsuyuki , Miyata Kanjiro , Kataoka Kazunori , Ishihara Soichiro
Published: August 2022

Neointimal hyperplasia (NIH) after revascularization is a key unsolved clinical problem. Various studies have shown that attenuation of the acute inflammatory response on the vascular wall can prevent NIH. MicroRNA146a‐5p (miR146a‐5p) has been reported to show anti‐inflammatory effects by inhibiting the NF‐κB pathway, a well‐known key player of inflammation of the vascular wall. Here, a nanomedicine, which can reach the vascular injury site, based on polymeric micelles was applied to deliver miR146a‐5p in a rat carotid artery balloon injury model. In vitro studies using inflammation‐induced vascular smooth muscle cell (VSMC) was performed. Results showed anti‐inflammatory response as an inhibitor of the NF‐κB pathway and VSMC migration, suppression of reactive oxygen species production, and proinflammatory cytokine gene expression in VSMCs. A single systemic administration of miR146a‐5p attenuated NIH and vessel remodeling in a carotid artery balloon injury model in both male and female rats in vivo. MiR146a‐5p reduced proinflammatory cytokine gene expression in injured arteries and monocyte/macrophage infiltration into the vascular wall. Therefore, miR146a‐5p delivery to the injury site demonstrated therapeutic potential against NIH after revascularization.
Near‐infrared II photobiomodulation augments nitric oxide bioavailability via phosphorylation of endothelial nitric oxide synthase
Authors: Yokomizo Shinya , Roessing Malte , Morita Atsuyo , Kopp Timo , Ogawa Emiyu , Katagiri Wataru , Feil Susanne , Huang Paul L. , Atochin Dmitriy N. , Kashiwagi Satoshi
Published: August 2022

There is solid evidence of the beneficial effect of photobiomodulation (PBM) with low‐power near‐infrared (NIR) light in the NIR‐I window in increasing bioavailable nitric oxide (NO). However, it is not established whether this effect can be extended to NIR‐II light, limiting broader applications of this therapeutic modality. Since we have demonstrated PBM with NIR laser in the NIR‐II window, we determined the causal relationship between NIR‐II irradiation and its specific biological effects on NO bioavailability. We analyzed the impact of NIR‐II irradiation on NO release in cultured human endothelial cells using a NO‐sensitive fluorescence probe and single‐cell live imaging. Two distinct wavelengths of NIR‐II laser (1064 and 1270 nm) and NIR‐I (808 nm) at an irradiance of 10 mW/cm2 induced NO release from endothelial cells. These lasers also enhanced Akt phosphorylation at Ser 473, endothelial nitric oxide synthase (eNOS) phosphorylation at Ser 1177, and endothelial cell migration. Moreover, the NO release and phosphorylation of eNOS were abolished by inhibiting mitochondrial respiration, suggesting that Akt activation caused by NIR‐II laser exposure involves mitochondrial retrograde signaling. Other inhibitors that inhibit known Akt activation pathways, including a specific inhibitor of PI3K, Src family PKC, did not affect this response. These two wavelengths of NIR‐II laser induced no appreciable NO generation in cultured neuronal cells expressing neuronal NOS (nNOS). In short, NIR‐II laser enhances bioavailable NO in endothelial cells. Since a hallmark of endothelial dysfunction is suppressed eNOS with concomitant NO deficiency, NIR‐II laser technology could be broadly used to restore endothelial NO and treat or prevent cardiovascular diseases.
The Impact of COVID-19 on Physician–Scientist Trainees and Faculty in the United States: A National Survey
Authors: Kwan Jennifer M. , Noch Evan , Qiu Yuqing , Toubat Omar , Christophers Briana , Azzopardi Stephanie , Gilmer Gabrielle , Wiedmeier Julia Erin , Daye Dania
Published: August 2022

Purpose

Physician–scientists have long been considered an endangered species, and their extended training pathway is vulnerable to disruptions. This study investigated the effects of COVID-19-related challenges on the personal lives, career activities, stress levels, and research productivity of physician–scientist trainees and faculty.

Method

The authors surveyed medical students (MS), graduate students (GS), residents/fellows (R/F), and faculty (F) using a tool distributed to 120 U.S. institutions with MD–PhD programs in April–June 2020. Chi-square and Fisher’s exact tests were used to compare differences between groups. Machine learning was employed to select variables for multivariate logistic regression analyses aimed at identifying factors associated with stress and impaired productivity.

Results

The analyses included 1,929 respondents (MS: n = 679, 35%; GS: n = 676, 35%; R/F: n = 274, 14%; F: n = 300, 16%). All cohorts reported high levels of social isolation, stress from effects of the pandemic, and negative impacts on productivity. R/F and F respondents were more likely than MS and GS respondents to report financial difficulties due to COVID-19. R/F and F respondents with a dual degree expressed more impaired productivity compared with those without a dual degree. Multivariate regression analyses identified impacted research/scholarly activities, financial difficulties, and social isolation as predictors of stress and impaired productivity for both MS and GS cohorts. For both R/F and F cohorts, impacted personal life and research productivity were associated with stress, while dual-degree status, impacted research/scholarly activities, and impacted personal life were predictors of impaired productivity. More female than male respondents reported increased demands at home.

Conclusions

This national survey of physician–scientist trainees and faculty found a high incidence of stress and impaired productivity related to the COVID-19 pandemic. Understanding the challenges faced and their consequences may improve efforts to support the physician–scientist workforce in the postpandemic period.
Enculturating a Community of Action: Health Professions Educators’ Perspectives on Teaching With Wikipedia
Authors: Martin Paolo C. , Maggio Lauren A. , Murray Heather , Willinsky John M.
Published: August 2022

Purpose

Health professions educators are increasingly called on to engage learners in more meaningful instruction. Many have used Wikipedia to offer an applied approach to engage learners, particularly learning related to evidence-based medicine (EBM). However, little is known about the benefits and challenges of using Wikipedia as a pedagogic tool from the collective experience of educators who have sought to improve their instructional practice with it. This study aims to synthesize the perspectives of health professions education (HPE) instructors on the incorporation of Wikipedia editing into their HPE courses.

Method

Applying a constructivist approach, the authors conducted semistructured interviews from July to December 2020, with 17 participating HPE instructors who had substantively integrated Wikipedia into their curriculum at 13 institutions. Participants were interviewed about their experiences of integrating Wikipedia editing into their courses. Thematic analysis was conducted on resulting transcripts.

Results

The authors observed 2 broad themes among participants’ expressed benefits of teaching with Wikipedia. First, Wikipedia provides a meaningful instructional alternative that also helps society and develops learners’ information literacy and EBM skills. Second, Wikipedia supports learners’ careers and professional identity formation. Identified challenges included high effort and time, restrictive Wikipedia sourcing guidelines, and difficult interactions with stakeholders.

Conclusions

Findings build on known benefits, such as providing a real-world collaborative project that contextualizes students’ learning experiences. They also echo known challenges, such as the resource-intensive nature of teaching with Wikipedia. The findings of this study reveal the potential of Wikipedia to enculturate HPE students within a situated learning context. They also present implications for HPE programs that are considering implementing Wikipedia and faculty development needed to help instructors harness crowd-sourced information tools’ pedagogic opportunities as well as anticipate their challenges.
Barriers to Colorectal Cancer Screening and Surveillance in Homeless Patients
Authors: Schwartz Hope E.M. , Abel Mary Kathryn , Lin Joseph A. , Decker Hannah C. , Kushel Margot B. , Wick Elizabeth C.
Published: August 2022

Patients experiencing homelessness face a high burden of chronic disease, including colorectal cancer. Access to colonoscopy is limited by many structural barriers in this population. In an exemplar case, we describe the barriers encountered by a homeless patient with a history of colorectal cancer who was lost to follow up and presented 11 years later with a new primary colon cancer. We provide policy solutions to increase the use of primary and secondary screening, including essential private bathroom access for colonoscopy preparation in patients who had a positive screening or require surveillance after diagnosis and treatment. We believe that increasing early detection and treatment may be cost-effective and could reduce disparities in morbidity and mortality in homeless patients.
Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy
Authors: Brown Lauryn , Cho Kevin M. , Tarawneh Omar H. , Quan Theodore , Malyavko Alisa , Tabaie Sean A.
Published: August 2022

Background:

Despite the many surgical interventions available for spastic hip dysplasia in children with cerebral palsy, a radical salvage hip procedure may still ultimately be required. The purpose of this study was to assess whether race is an independent risk factor for patients with cerebral palsy to undergo a salvage hip procedure or experience postoperative complications for hip dysplasia treatment.

Methods:

This is a retrospective cohort analysis utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database from 2012 to 2019. International Classification of Diseases, 9th and 10th Revisions, Clinical Modifications (ICD-9-CM, ICD-10-CM), and current procedural terminology (CPT) codes were used to identify patients with cerebral palsy undergoing hip procedures for hip dysplasia and to stratify patients into salvage or reconstructive surgeries.

Results:

There was a total of 3906 patients with cerebral palsy between the ages of 2 and 18 years undergoing a procedure for hip dysplasia, including 1995 (51.1%) White patients, 768 (19.7%) Black patients, and 1143 (29.3%) patients from other races. Both Black (P=0.044) and White (P=0.046) races were significantly associated with undergoing a salvage versus a reconstructive hip procedure, with Black patients having an increased risk compared to White patients [adjusted odds ratio (OR) 1.77, confidence interval (CI) 1.02-3.07]. Only Black patients were found to have an increased risk of any postoperative complication compared to White patients, with an adjusted OR of 1.26 (CI 1.02-1.56; P=0.033). Both White (P=0.017) and black (P=0.004) races were found to be significantly associated with medical complications, with Black patients having an increased risk (adjusted OR 1.43, CI 1.12-1.84) compared to White patients. There were no significant findings between the race and risk of surgical site complications, unplanned readmissions, or reoperations.

Conclusion:

This study demonstrates that patient race is an independent association for the risk of pediatric patients with cerebral palsy to both undergo a salvage hip procedure and to experience postoperative medical complications, with Black patients having an increased risk compared to White.

Level of Evidence:

Level III Retrospective Cohort Study.
A Modified Technique for Lateral Column Lengthening as Part of Adult Acquired Flatfoot Deformity Correction: An Intact Medial Calcaneal Cortex, a Low-Profile Locking Plate With a Combination of Autologous Calcaneal Bone Graft and Demineralized Human Bone Matrix
Authors: Siddiqui Bobby M. , Salem Hatem M. , Goyal Achal , Raglan Martin , Dhar Sunil
Published: August 2022

Adult acquired flatfoot deformity encompasses deformities of the entire foot and ankle, with most clinical presentations comprising of a flexible planovalgus deformity and forefoot abduction. Numerous operative procedures have been proposed, and a lateral column–lengthening procedure is advocated to correct the forefoot abduction. Autologous iliac crest bone graft is routinely inserted into the opening-wedge osteotomy at the anterior calcaneum. Fixation methods are also variable with increasing use of locking plates to achieve stability at this osteotomy. Harvesting the iliac crest graft exposes the patient to significant donor site morbidity. We describe a modified lateral column–lengthening technique, leaving the medial calcaneum cortex intact, packing a combination of autologous calcaneal bone graft, and demineralized bone matrix into the osteotomy site, fixed with a low-profile locking plate. In the short term, our technique offers reduced rates of wound complications, symptomatic hardware, nonunion, and deformity recurrence when compared with published rates.

Level of Evidence:

Level IV, Case Series (retrospective).
Cutaneous Ossifying Amyloidoma
Authors: Requena Celia , Diago Adrian , Traves Victor , Llombart Beatriz , Nagore Eduardo , Sanmartin Onofre
Published: August 2022

Amyloidoma, otherwise known as tumoral amyloidosis, is a localized deposition of amyloid (AL-type or AA type) without systemic amyloidosis. It is the rarest form of tissue amyloid deposition, and up to 7% of amyloidomas develop systemic amyloidosis.Cutaneous AL-type amyloidoma is considered by many authors as an unusual variant of primary cutaneous marginal zone lymphoma. Although cutaneous amyloidoma can form calcifications, ossification is extremely unusual, with only 1 case previously published to date.We report the case of a 75-year-old woman with voluminous and strikingly ossifying AL-type amyloidoma in the left pretibial skin. Her medical history included excision of hepatic hydatidic cysts 25 years prior and diffuse large B-cell lymphoma of the left parotid gland 8 years prior treated with chemotherapy and radiotherapy with complete response. After the diagnosis of amyloidoma, an extension study with cervical, chest, abdominal, and pelvic TC was performed, with no additional lesions found. Serum and protein electrophoresis revealed elevations in kappa light chain and IgA immunoglobulin levels but did not reveal monoclonal bands. In situ hybridization for immunoglobulin light chains showed monotypic kappa expression in plasma cells infiltrating the amyloidoma.Extensive ossification in amyloidomas can make diagnosis difficult; therefore, we describe an interesting case of this histopathologically peculiar amyloidoma.
Follicular Porokeratoma: Report of a New Variant of Porokeratoma (Porokeratotic Acanthoma) and Literature Review
Authors: Kanitakis Jean , Fournier Nicolas , Jullien Denis
Published: August 2022

Porokeratoma is a rare type of epidermal acanthoma, of which 22 cases have been published in the literature. It is characterized by the presence of multiple cornoid lamellae embedded within a single verrucous or keratotic nodule. Despite this histologic feature being shared with porokeratosis, the etiopathogenesis of porokeratoma and its relationship with porokeratosis remain unclear. We report a new case of porokeratoma involving hair follicles, a finding that has been reported in only one of the previously published cases. Analogous to follicular porokeratosis, a form of porokeratosis involving hair follicles, we have termed this lesion “follicular porokeratoma.” A review of all 23 published cases (including the present case) is also provided.
Polypharmacy and Major Adverse Events in Atrial Fibrillation
Authors: Tsagkaris Christos , Papazoglou Andreas S. , Kartas Anastasios , Samaras Athanasios , Moysidis Dimitrios V. , Vouloagkas Ioannis , Baroutidou Amalia , Bekiaridou Alexandra , Patsiou Vasiliki , Chatzisolomou Antreas , Panteris Eleftherios , Karagiannidis Efstratios , Karvounis Haralambos , Tzikas Apostolos , Giannakoulas George
Published: August 2022

Patients with atrial fibrillation (AF) often receive multiple medications daily. The purpose of this study was to examine the prognostic implications of polypharmacy in patients with AF. This is a retrospective post hoc analysis of 1113 AF patients, enrolled in a randomized trial during an acute hospitalization (MISOAC-AF, NCT02941978). The presence of polypharmacy (use of >4 drugs daily) was assessed at hospital discharge. Regression analyses were performed to identify clinical predictors of polypharmacy and compare the outcomes of patients with or without confirmed polypharmacy. The coprimary outcomes were all-cause and cardiovascular (CV) mortality. Among patients with polypharmacy, the difference in the risk of mortality was also assessed per each added drug as a numeric variable. Polypharmacy was found in 36.9% of participants. Dyslipidemia, coronary artery disease, lower left ventricular ejection fraction, and higher glomerular filtration rates were independent predictors of polypharmacy. Polypharmacy was an independent predictor for all-cause death (adjusted hazard ratio [aHR]: 1.29, 95% confidence interval [CI]: 1.01–1.64) and CV death (aHR: 1.39, 95% CI: 1.05–1.84). Among patients with polypharmacy, each additional concomitant medication was independently associated with a 4% increased risk of all-cause mortality (aHR = 1.04, 95% CI: 1.00–1.08) and a 5% increased risk of CV mortality (aHR = 1.05, 95% CI: 1.00–1.10). Polypharmacy was common among patients with AF hospitalized in a tertiary hospital and was incrementally associated with higher rates of mortality.
The Role of the Work Environment in the Relationship Between Shiftwork and Sickness Absence
Authors: Hoff Bernstrøm Vilde , Mehmetoglu Mehmet , Houkes Inge
Published: August 2022

Objective

The aim of this study was to investigate the role of four team-level work environment factors as potential mediators and moderators of the relationship between shiftwork and sickness absence.

Methods

In a longitudinal cohort study, we analyze data obtained from 11,842 employees in a large Norwegian hospital using generalized structural equation model estimations.

Results

The results did not support a moderation hypothesis. The results did support partial mediation, showing a significant indirect positive relationship between shiftwork and short-term sickness absence via participation, a significant indirect positive relationship between shiftwork and long-term sickness absence via control, and a significant indirect negative relationship between shiftwork and long-term sickness absence via commitment.

Conclusions

These results support that differences in available work environment resources may partially explain the increased level of sickness absence among shiftworkers.
Outcomes in Patients with Inflammatory Bowel Disease Transitioning from Pediatric to Adult Care: A Scoping Review
Authors: Bihari Allison , Olayinka Lily , Kroeker Karen I.
Published: August 2022

Purpose:

Approximately 25% of inflammatory bowel disease (IBD) patients are diagnosed in childhood and the incidence is increasing. Thus, more patients will transition to adult care in the future. Within the literature, transition readiness has been deemed important to achieving a successful transition; however, it is unclear what outcomes define success. This scoping review aims to summarize the literature on outcomes surrounding transition from pediatric to adult care in patients with IBD.

Methods:

A scoping review was conducted with the following steps: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, (5) collating, summarizing, and reporting results, and (6) consultation with an additional researcher. Studies were identified from 5 databases and were included in part if (1) IBD was a disease of interest, (2) referred to transition as the movement and adjustment from pediatric to adult care, and (3) evaluated patient outcomes up to 5 years after first adult appointment and/or defined a successful or unsuccessful transition.

Results:

Twenty-six peer-reviewed studies were included. Four studies defined transition success, while 2 studies defined an unsuccessful transition. Transition outcomes were categorized into these 6 themes: being comfortable in adult care (n = 4); health care utilization (n = 19); disease management (n = 15); knowledge (n = 5); quality of life (n = 6); self-efficacy (n = 7).

Conclusions:

Most studies evaluated transition outcomes by themes of health care utilization (n = 19) and disease management (n = 15). Future research should focus on engaging patients along with providers in order to create a consensus on indicators of transition success.
The Role of Manganese in Very Low Birth Weight Infants
Authors: Vetter‐Laracy Susanne , Tejedor Maria , Cobo Pilar , Bauça Josep Miquel , Robles Juan , Ortiz‐Montero Raul , Pastor Alicia , Beltrán Eva
Published: August 2022

Objectives:

High manganese (Mn) levels during fetal growth or prolonged parenteral nutrition (PN) may have adverse effects on neurodevelopment. We aim to report on Mn levels and their short‐term impact on clinical course in very low birth weight infants.

Methods:

An observational study including newborns with a gestational age (GA) ≤32 weeks and/or ≤1500 g of birth weight (BW). Newborns received intravenous supplementation of Mn at 1 µg/kg/day (Peditrace®) in PN and continued with fortified breast milk. Mothers answered surveys about dietary and other habits and blood levels of Mn in newborns were analyzed at days 1, 15, and 30 of life. Associations of Mn levels with mothers’ and newborns’ data were evaluated and adjusted for multiple comparisons.

Results:

One hundred and sixty premature infants were recruited. Median blood Mn levels at birth were 43.0 and 24.5 µg/L at day 30. No important association with mothers’ data was found. Median [interquartile range (IQR)] duration of PN was 8 days (7–14). A prolonged PN and late oral feeding showed a nonsignificant association with lower blood Mn levels at day 30 (P = 0.010, P threshold 0.003). Mn levels at day 15 and 30 were associated with increasing GA (P < 0.001). Low Mn was not a significant predictor of adverse outcomes such as retinopathy of prematurity, bronchopulmonary dysplasia, or respiratory distress syndrome after adjusting for potential confounders and multiple testing.

Conclusions:

Mn showed lower levels with decreasing GA and prolonged PN. Using a low Mn PN solution may not raise blood Mn levels in premature infants.
Association Between the Fatigue and Sleep Quality of Kidney Transplant Recipients
Authors: Zhang Ping , Liu Xiao-Li , Li Xin , Yang Jing-Hua , Zhang Rong-Mei
Published: August 2022

Sleep disorders persist in renal transplant patients. Previous studies have showed that fatigue and rumination are an important determinant of sleep quality. However, very few studies have explored the mediating role of rumination in the relationship between fatigue and sleep quality in kidney transplant recipients. A descriptive cross-sectional research design was implemented, and 192 kidney transplant patients completed the short questionnaire about their recent experiences of fatigue, rumination, and sleep quality. The prevalence of sleep disorders among kidney transplant recipients was 19.3%. With rumination as a partial mediator, fatigue indirectly affected the patients' sleep quality. This indirect effect was 0.10 (95% confidence interval, 0.154–0.419). Our results indicate that the incidence of sleep disorders after renal transplantation was high, and the more tired kidney transplant recipients become, the more likely they are to ruminate, which leads to a decline in sleep quality.
Levels of Anger Severity in Psychiatric Patients
Authors: Levin-Aspenson Holly Frances , Diehl Joseph M. , Boyd Simone Imani , Zimmerman Mark
Published: August 2022

Given anger's clinical relevance and adverse impact on functioning, there is a need to examine diagnostically heterogeneous individuals at different levels of anger severity to provide a basis for considering anger severity in clinical research and practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the validity of severity classifications based on the Clinically Useful Anger Outcome Scale (CUANGOS) in 1738 clinically heterogeneous psychiatric outpatients. We compared patients reporting no, mild, moderate, or severe anger with regard to demographics, psychosocial morbidity, functioning, and life satisfaction. Increasing anger severity was associated with elevated clinician-rated psychosocial morbidity and poorer self-rated functioning and life satisfaction. Results demonstrate that assessing anger severity yields crucial information about psychosocial functioning and morbidity. This provides additional validity evidence for self-reported anger in general and the CUANGOS in particular, in that the CUANGOS can validly distinguish among meaningfully different anger severity levels.
Academic-Practice Collaboration Using Virtual Telesimulation to Support Students' Clinical Practice
Authors: Rusli Khairul Dzakirin Bin , Lau Siew Tiang , Tan Jian Zhi , Liaw Sok Ying
Published: August 2022

Background:

Collaboration between academic institutions and clinical practice plays an important role in supporting students' learning in clinical practice. A virtual telesimulation was incorporated to provide academic-practice collaboration between academic educators and nurse preceptors to support students' clinical education.

Purpose:

The purpose was to evaluate the experiences of nursing students and academic educators on the perceived impact of virtual telesimulation in clinical education.

Methods:

A descriptive qualitative study using focus group discussions was conducted.

Results:

Four themes emerged: “coming together to know one another” for rapport building, “learning from different perspectives” to foster clinical learning and practice, “application of learning strategy” to stimulate case-based discussion, and “reaching out to more preceptors” to optimize its impact in clinical practice.

Conclusions:

Academic-practice collaboration using virtual telesimulation enabled students and academic educators to build rapport with clinical preceptors and learn from other practices, which in turn enhanced students' clinical learning experiences.
Use of Nursing Concepts in Program and Course Descriptions
Authors: Dickinson Jane K. , Juan Samantha , McGuane Arlene , McKenzie-Henry Isla A.
Published: August 2022

Background:

Ongoing discussions address how and when to introduce nursing concepts in nursing education.

Purpose:

To examine whether baccalaureate nursing programs use 4 nursing concepts in their program and course descriptions.

Methods:

Researchers explored websites of 300 US bachelor of science in nursing (BSN) programs and assigned scores based on how many of 4 nursing concepts (context, holism, health, and caring) were represented in program and 3 course descriptions.

Results:

Mean program and course scores were 2.51, 0.96, 1.17, and 1.18, respectively. Programs and courses included between 0 and 4 concepts in their descriptions. There was a significant difference in program scores between BSN programs in 4 US regions. The most frequently identified concept was “context” in program descriptions and “holism” in course descriptions.

Conclusions:

Discipline-specific concepts are missing in many baccalaureate programs and course descriptions, which raises questions about how and when nursing students are learning what nursing is.
Current Practices for Teaching Clinical Judgment
Authors: Nielsen Ann , Gonzalez Lisa , Jessee Mary Ann , Monagle Janet , Dickison Phillip , Lasater Kathie
Published: August 2022

Background:

Safe patient care is closely linked to clinical judgment. Concerns about inadequate practice readiness and the impending inclusion of clinical judgment items on the NextGen NCLEX have resulted in increasing interest and publications about teaching clinical judgment. However, little is known about actual current practices for teaching this skill.

Purpose:

This research describes findings about current strategies to teach clinical judgment used in US prelicensure nursing programs.

Methods:

Cross-sectional methodology was used to survey program deans and directors across the United States.

Results:

Programs are using multiple strategies to teach clinical judgment. The most common strategies used include case studies and simulation. Participants believed strategies have a positive impact on student thinking, practice readiness, and program outcomes. They described insights into implementation of teaching for clinical judgment.

Conclusion:

The results of this research provide foundational data to inform current teaching practices and further research for this essential skill.
Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis
Authors: Jones Jeb , Le Guillou Adrien , Gift Thomas L. , Chesson Harrell , Bernstein Kyle T. , Delaney Kevin P. , Lyles Cynthia , Berruti Andres , Sullivan Patrick S. , Jenness Samuel M.
Published: August 2022

Background

Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM.

Methods

Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence.

Results

Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%–6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%–11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection.

Conclusions

Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.
Cochlear Implantation and Perioperative Management in Autoimmune Inner Ear Disease
Authors: Deshpande Nikita , Aminpour Nathan , Cheng Hui , Johns J. Dixon , Hoa Michael
Published: August 2022

Objective:

To assess outcomes in autoimmune inner ear disease (AIED) after cochlear implantation (CI) through systematic review and meta-analysis.

Databases Reviewed:

PubMed, MedLine, Embase, and CINAHL

Methods:

Databases were queried for inclusion of AIED patients who underwent CI with outcomes recorded ≥3 months postoperatively. We examined demographics, pure-tone average (PTA), speech perception, preoperative imaging, intraoperative management, and postoperative complications.

Results:

Twenty-six articles encompassing 124 patients met inclusion criteria. Mean implantation age was 26.2 years (range 4–65 years) with average length of follow-up at 28.2 months (range 3–120 months). Meta-analysis demonstrated significant improvement in speech perception following CI. There was a statistically significant improvement in speech recognition score (SRS) (standard mean difference [SMD] = 6.5, 95% confidence interval [CI], 4.8-8.0, P < 0.0001) as well as word recognition score (WRS) (SMD = 5.5, 95% CI, 4.2-6.8, P < 0.0001) after CI. Anomalous preoperative radiologic manifestations were reported by 57.7% (15/26) studies. Disease activity–related intraoperative adjustment was noted in 57.7% (15/26) studies; common consequences were cochlear drill-out (53.3%), difficult round window insertion (26.7%), and scala vestibuli insertion (26.7%). Frequent postoperative complications noted in 26.9% (7/26) studies included systemic AIED flares (71.4%) and wound healing delay (42.9%).

Conclusion:

Findings of this systematic review of AIED cochlear implant literature demonstrate a lack of consistent reporting standards for PTA and speech perception as well as a lack of long-term follow-up. Despite these findings, meta-analysis suggests that CI is a viable treatment for improving speech perception in AIED patients.
The Laterality of Age-related Hearing Loss and Cognition
Authors: Chern Alexander , Irace Alexandria L. , Golub Justin S.
Published: August 2022

Objectives:

To analyze the association between neurocognitive performance and age-related hearing loss in the right and left ear, individually.

Design:

Subjects included 5277 participants (≥50 years) from the general Hispanic population who underwent audiometric testing in a US multicentered epidemiologic study. Linear regression was performed to assess the cross-sectional association between cognitive performance (Digit Symbol Substitution Test [DSST], Word Frequency Test, Spanish-English Verbal Learning Test [SEVLT] 3 Trials, SEVLT Recall, and Six-Item Screener) and hearing in each ear (4-frequency pure-tone average), adjusting for age, sex, education, cardiovascular disease, and hearing aid use.

Results:

Mean age was 58.4 ± 6.2 years; 3254 (61.7%) were women. Mean pure-tone averages were 20.2 ± 11.7 dB (right ear) and 20.2 ± 12.3 dB (left ear). Multivariable regression demonstrated significant associations between all cognitive tests and hearing loss in both ears.

Conclusions:

Worsening hearing loss in the right and left ear was associated with decreased performance across all tests. No laterality in the association was demonstrated.
A 3D Printed Human Ear Model for Standardized Testing of Hearing Protection Devices to Blast Exposure
Authors: Brown Marcus A. , Jiang Shangyuan , Gan Rong Z.
Published: August 2022

Hypothesis:

A 3D printed human temporal bone (TB) that is anatomically accurate would cost-effectively reproduce the responses observed in blast testing of human cadaveric TBs with and without passive hearing protection devices (HPDs).

Background:

HPDs have become critical personal protection equipment against auditory damage for service members. Acoustic test fixtures and human TBs have been used to test and develop HPDs; however, the lack of a cost-effective, standardized model impedes the improvement of HPDs.

Methods:

In this study, the 3D printed TB model was printed with flexible and rigid polymers and consisted of the ear canal, tympanic membrane (TM), ossicular chain, middle ear suspensory ligaments/muscle tendons, and middle ear cavity. The TM movement under acoustic stimulation was measured with laser Doppler vibrometry. The TB model was then exposed to blasts with or without HPDs and pressures at the ear canal entrance (P0) and near the TM in the ear canal (P1) were recorded. All results were compared with that measured in human TBs.

Results:

Results indicated that in the 3D printed TB, the attenuated peak pressures at P1 induced by HPDs ranged from 0.92 to 1.06 psi (170–171 dB) with blast peak pressures of 5.62–6.54 psi (186–187 dB) at P0, and measured results were within the mean and SD of published data. Vibrometry measurements also followed a similar trend as the published results.

Conclusions:

The 3D printed TB model accurately evaluated passive HPDs’ protective function during blast and the potential for use as a model for acoustic transmission was investigated.
Guidelines for Best Practice in the Audiological Management of Adults Using Bimodal Hearing Configurations
Authors: Holder Jourdan T. , Holcomb Meredith A. , Snapp Hillary , Labadie Robert F. , Vroegop Jantien , Rocca Christine , Elgandy Mohamed Salah , Dunn Camille , Gifford René H.
Published: August 2022

Clinics are treating a growing number of patients with greater amounts of residual hearing. These patients often benefit from a bimodal hearing configuration in which acoustic input from a hearing aid on 1 ear is combined with electrical stimulation from a cochlear implant on the other ear. The current guidelines aim to review the literature and provide best practice recommendations for the evaluation and treatment of individuals with bilateral sensorineural hearing loss who may benefit from bimodal hearing configurations. Specifically, the guidelines review: benefits of bimodal listening, preoperative and postoperative cochlear implant evaluation and programming, bimodal hearing aid fitting, contralateral routing of signal considerations, bimodal treatment for tinnitus, and aural rehabilitation recommendations.
Patient Factors Predicting Success in Lateral Graft Tympanoplasty
Authors: Momin Zoha K. , Yancey Kristen L. , Mitton Tanner J. , Kutz Joe Walter
Published: August 2022

Objective:

To compare the effects of preoperative medical comorbidities and operative findings on the success of lateral graft tympanoplasty.

Study Design:

Retrospective chart review.

Setting:

Tertiary medical center.

Patients:

Ninety-six patients undergoing lateral graft tympanoplasty from December 2008 to November 2020 with at least 2 months follow-up were included. Patient demographics, comorbidities including smoking status, intraoperative findings, and healing, and hearing outcomes were recorded.

Interventions:

Lateral graft tympanoplasty.

Main Outcome Measures:

The primary outcome was perforation closure. Secondary outcomes were postoperative complications and change in air-bone gap (ABG).

Results:

Ninety-nine ears (mean age 40.94 ± 18.44 years) were included. Tympanic membrane perforation closure was achieved in 92 (92.9%) ears. Perforation closure was not associated with diabetes (P > 0.99), smoking (P > 0.99), or the presence of cholesteatoma at the time of lateral graft tympanoplasty (P = 0.10). Increased age (odds ratio [OR] = 1.04, P = 0.31) was also not correlated with tympanic membrane closure rate. An absent malleus resulted in a higher rate of lateralization (31.3% versus 2.1%; OR = 18.41, 95% confidence interval [CI] = 3.09-95.95, P = 0.001) but not blunting (12.5% versus 4.8%; OR = 0.24, 95% CI = 0.49-12.93, P = 0.24). The mean ABG improved 6.82 ± 11.33 dB (P < 0.01). History of prior tympanoplasty was associated with smaller ABG improvement following surgery (ß = 4.038, R
2 = 0.262, P = 0.04) but not perforation closure (OR = 3.25, 95% CI = 0.63-16.81, P = 0.24).

Conclusions:

Diabetes, active smoking, and advancing age were not associated with adverse healing in patients undergoing lateral graft tympanoplasty. Lateralization was more common with an absent malleus.
“Surgical Treatment Strategies for Injuries of the “Unforgiving” Superficial Branch of the Radial Nerve.”
Authors: Brakkee Elisabeth M. , Stokvis Annemieke , DeVinney Erick , Ducic Ivica , Coert J. Henk
Published: August 2022

Background:

Neuropathic pain caused by adhesions or neuroma formation of the superficial branch of the radial nerve (SBRN) is difficult to treat. We evaluated the effectiveness of different routinely used surgical techniques for SBRN neuralgia to provide a basis for future studies on SBRN neuralgia. In addition, we explored the prognostic value of a pre-operative diagnostic nerve block.

Methods:

We performed a retrospective cohort study by reviewing surgical records for procedures on SBRN neuralgia. Patient satisfaction was scored as satisfied or unsatisfied and pain intensity was scored with the numerical rating scale (NRS).

Results:

We included 71 patients that had 105 surgeries on the SBRN. Patients with a neuroma (n=43) were most satisfied after proximal denervation with burying into the brachioradialis muscle (BRM) compared to burying elsewhere (53% versus 0%, p<0.001). Adhesions of the SBRN (n=28) were treated with neurolysis (39% was satisfied). If neurolysis or denervation did not suffice, an additional denervation of the LABCN or PIN led to satisfaction in 38%. Less than 3.5 points decrease in NRS after diagnostic nerve block led to higher post-operative NRS pain score (4.0 versus 7.5, p=0.014). We found that the outcome of the diagnostic nerve block can predict the outcome of SBRN denervation and burying into BRM.

Conclusions:

The most effective burying technique is burying the SBRN into the BRM. Future studies on the treatment of SBRN neuralgia should therefore compare newer techniques to burying the SBRN into the BRM as their control group.
"Does inclination of the toe proximal phalangeal head affect the outcomes of vascularized joint transfers?" Retrospective study of 22 vascularized joint transfers
Authors: Pae Woo Sik , Lin Yu-Te , Loh Charles Yuen Yung , Lee Che-Hsiung , Hsu Chung-Chen , Chen Shih-Heng , Lin Cheng-Hung
Published: August 2022

Background:

Different shapes of the proximal phalangeal head of toe PIPJs – oval shaped and circular are observed in the vascularized joint transfers (VJTs). The difference in shape implies the varying degrees of inclination of the articular surfaces between different toes. There have not been any reports in the literature that describe such a correlation. This study investigates the impact of articular inclination of toe proximal interphalangeal joints (PIPJs) on outcomes after toe VJTs for finger PIPJ reconstruction.

Methods:

21 patients (15 males and 6 females) who underwent VJT for finger PIPJ reconstruction from May 2009 to May 2018 were included. The mean age was 33.4 years and the mean follow-up period was 28.9 months. All patients were type I Te’s classification central slip. Articular surface inclination was measured on lateral radiographic views.

Results:

The passive ROM of the toe PIPJ before VJT was 71.1° ± 9.6°. The functional ROM of the reconstructed PIPJ was 60.0° ± 17.0°. The extensor lag (the amount of ROM change) after the VJT was 9.4° ± 19.6°. The articular inclination of toe PIPJ was 71.9° ± 9.7°. A Pearson’s correlation analysis of all variables including age, pre-OP ROM of toe PIPJ, post-OP ROM of reconstructed PIPJ, articular inclination of toe PIPJ and extensor lag of reconstructed PIPJ with toe articular inclination was performed. There was no significant correlation between articular inclination of toe PIPJ and extensor lag of reconstructed PIPJ. (p=0.226)

Conclusions:

The articular surface of the toe PIPJ did not affect the functional ROM after VJT.
Study on application of YAG laser-assisted ear correction model to Congenital Auricular Deformities
Authors: Gu Qinmei , Yang Yang , Zhou Weihao , Chen Jianwu , Qi Xiangdong
Published: August 2022

Background:

To compare the clinical effects of long-pulse-width 1064nm Nd:YAG laser assisted ear correction model and simple ear correction model in the treatment of congenital auricular deformities in over-aged ears.

Methods:

129 children (179 ears) with congenital auricular deformities aged more than 2 months were included in the study. Among them, 84 cases (observation group, 119 ears) were treated with the ear correction model after long-pulse-width 1064nm Nd:YAG laser irradiation, while 45 cases (60 ears) were treated with the ear correction model only. The affected ears of the two groups were measured, the correction time was calculated, and the family members of the patients filled in the satisfaction questionnaire before and after the treatment.

Results:

The level of satisfaction of the two groups after the treatment improved. The level of satisfaction of the observation group was higher than that of the control group. The days of correction in the observation group was less than that in the control group (P＜0.05). The measurements of the affected ears in the two groups were significantly different after treatment. The difference after treatment of each measurement in the observation group was higher than that in the control group. The therapeutic effect of the observation group was significantly better than that of the control group, and the differences were statistically significant.

Conclusion:

Long-pulse-width 1064nm Nd:YAG laser combined with the ear correction model can effectively improve the success rate of correction of congenital auricular deformities in over-aged ears.
Glutathione in the Pons Is Associated With Clinical Status Improvements in Subacute Spinal Cord Injury
Authors: Wyss Patrik O. , Richter Johannes K. , Zweers Peter , Brust Anne K. , Funk Corinne , Zoelch Niklaus , Vallesi Vanessa , Verma Rajeev K. , Hock Andreas , Berger Markus F. , Scheel-Sailer Anke , Henning Anke
Published: August 2022

Objectives

In spinal cord injury (SCI), the primary mechanical injury is followed by secondary sequelae that develop over the subsequent months and manifests in biochemical, functional, and microstructural alterations, at the site of direct injury but also in the spinal cord tissue above and below the actual lesion site. Noninvasive magnetic resonance spectroscopy (MRS) can be used to assess biochemical modulation occurring in the secondary injury phase, in addition to and supporting conventional MRI, and might help predict and improve patient outcome. In this article, we aimed to examine the metabolic levels in the pons of subacute SCI by means of in vivo proton MRS at 3 T and explore the association to clinical scores.

Materials and Methods

In this prospective study, between November 2015 and February 2018, single-voxel short-echo MRS data were acquired in healthy controls and in SCI subjects in the pons once during rehabilitation. Besides the single-point MRS examination, in addition, in participants with SCI, the clinical status (ie, motor, light touch, and pinprick scores) was assessed twice: (1) around the MRS session (approximately 10 weeks postinjury) and (2) before discharge (at approximately 9 months postinjury). The group differences were assessed with Kruskal-Wallis test, the post hoc comparison was assessed with Wilcoxon rank sum test, and the clinical correlations were conducted with Spearman rank correlation test. Bayes factor calculations completed the statistical part providing relevant evidence values.

Results

Twenty healthy controls (median age, 50 years; interquartile range, 41–55 years; 18 men) and 18 subjects with traumatic SCI (median age, 50 years; interquartile range, 32–58 years; 16 men) are included. Group comparison showed an increase of total N-acetylaspartate and combined glutamate and glutamine levels in complete SCI and a reduction of total creatine in incomplete paraplegic SCI. The proton MRS-based glutathione levels at baseline correlate to the motor score improvement during rehabilitation in incomplete subacute SCI.

Conclusions

This exploratory study showed an association of the metabolite concentration of glutathione in the pons assessed at approximately 10 weeks after injury with the improvements of the motor score during the rehabilitation. Pontine glutathione levels in subjects with traumatic subacute incomplete SCI acquired remote from the injury site correlate to clinical score and might therefore be beneficial in the rehabilitation assessments.