bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics of early and late drug-eluting stent in-stent restenosis and mid-term prognosis after repeated percutaneous coronary intervention
Authors: Zheng Jian-Feng , Guo Ting-Ting , Tian Yuan , Wang Yong , Hu Xiao-Ying , Chang Yue , Qiu Hong , Dou Ke-Fei , Tang Yi-Da , Yuan Jin-Qing , Wu Yong-Jian , Yan Hong-Bing , Qiao Shu-Bin , Xu Bo , Yang Yue-Jin , Gao Run-Lin
Published: October 2020

Background:

The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis (DES-ISR) have not been fully clarified. Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap.

Methods:

A total of 250 patients who underwent initial stent implantation in our hospital, and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved. The patients were categorized as early ISR (<12 months; E-ISR; n = 32) and late ISR (≥12 months; L-ISR; n = 218). Associations between patient characteristics and clinical performance, as well as clinical outcomes after a repeated percutaneous coronary intervention (PCI) were evaluated. Primary composite endpoint of major adverse cardiac events (MACEs) included cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR).

Results:

Most baseline characteristics are similar in both groups, except for the period of ISR, initial pre-procedure thrombolysis in myocardial infarction, and some serum biochemical indicators. The incidence of MACE (37.5% vs. 5.5%; P < 0.001) and TLR (37.5% vs. 5.0%; P < 0.001) is higher in the E-ISR group. After multivariate analysis, E-ISR (odds ratio [OR], 13.267; [95% CI 4.984–35.311]; P < 0.001) and left ventricular systolic dysfunction (odds ratio [OR], 6.317; [95% CI 1.145–34.843]; P = 0.034) are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months.

Conclusions:

Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients. The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.
Nationwide Study of Short-term Exposure to Fine Particulate Matter and Cardiovascular Hospitalizations Among Medicaid Enrollees
Authors: deSouza Priyanka , Braun Danielle , Parks Robbie M. , Schwartz Joel , Dominici Francesca , Kioumourtzoglou Marianthi-Anna
Published: October 2020

Background:

Fine particulate matter (PM2.5) has been consistently linked to cardiovascular disease (CVD). Although studies have reported modification by income, to our knowledge, no study to date has examined this relationship among adults in Medicaid, which provides health coverage to low-income and/or disabled Americans.

Methods:

We estimated the association between short-term PM2.5 exposure (average of PM2.5 on the day of hospitalization and the preceding day) and CVD admissions rates among adult Medicaid enrollees in the continental United States (2000–2012) using a time-stratified case–crossover design. We repeated this analysis at PM2.5 concentrations below the World Health Organization daily guideline of 25 μg/m3. We compared the PM2.5–CVD association in the Medicaid ≥65 years old versus non-Medicaid-eligible Medicare enrollees (≥65 years old).

Results:

Using information on 3,666,657 CVD hospitalizations among Medicaid adults, we observed a 0.9% (95% CI = 0.6%, 1.1%) increase in CVD admission rates per 10 μg/m3 PM2.5 increase. The association was stronger at low PM2.5 levels (1.3%; 95% CI = 0.9%, 1.6%). Among Medicaid enrollees ≥65 years old, the association was 0.9% (95% CI = 0.6%, 1.3%) vs. 0.8% (95% CI = 0.6%, 0.9%) among non-Medicaid-eligible Medicare enrollees ≥65 years old.

Conclusion:

We found robust evidence of an association between short-term PM2.5 and CVD hospitalizations among the vulnerable subpopulation of adult Medicaid enrollees. Importantly, this association persisted even at PM2.5 levels below the current national standards.
Quantifying Lifecourse Drivers of International Migration
Authors: Zeki Al Hazzouri Adina , Zhang Lanyu , Murchland Audrey R. , Grasset Leslie , Torres Jacqueline M. , Jones Richard N , Wong Rebeca , Glymour M. Maria
Published: October 2020

Background:

Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder–mediators of the effect of migration on health.

Methods:

We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

Results:

Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

Conclusions:

Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.
SUSPECTED INTRAUTERINE INJURY CAUSING ABUSIVE OCULAR TRAUMA
Authors: Bakhsh Saaquib R. , Reddy Devasis N. , Wa Christianne A. , Lee Ramon , Faia Lisa , Trese Michael T.
Published: October 2020

Purpose:

The purpose of this report is to describe a patient who has fluorescein angiographic evidence and retinal changes suspicious for intrauterine abusive ocular trauma.

Methods:

A case report of a premature ward of the state with no prenatal care and a presentation suspicious for intrauterine abusive ocular trauma. We performed serial ophthalmologic examinations, reviewed available prenatal history with the infant's social worker, and all relevant hospital notes, laboratory results, and imaging results.

Results:

After initial empiric treatment for possible viral retinitis in the setting of a positive urine cytomegalovirus, repeat examinations demonstrated fluorescein angiographic evidence and clinical findings suspicious for abusive ocular trauma including neovascularization and no evidence of retinitis; therefore, the child was treated with laser photocoagulation.

Conclusion:

At-risk newborns will benefit from an examination of the retinal periphery and wide field fluorescein angiography. Intrauterine abusive ocular trauma should be included in the differential of retinal hemorrhage and avascular retinal periphery. It is imperative for clinicians to recognize this presentation to prevent progression of associated visual morbidity.
Simple Oral Mucosal Epithelial Transplantation in a Patient With Bilateral Limbal Stem Cell Deficiency
Authors: Kara Necip , Dogan Levent
Published: October 2020

Purpose:

To present management of a patient with bilateral limbal stem cell deficiency (LSCD) by using “simple oral mucosal epithelial transplantation” (SOMET) technique.

Methods:

Case report.

Results:

A 65-year-old female diagnosed with bilateral LSCD based on clinical findings. After stabilizing the ocular surface, we performed SOMET in the right eye. At 13 months postoperatively, visual acuity improved from counting fingers to 10/100 and a stable epithelium with regressed corneal vascularization was observed.

Conclusions:

This report showed that SOMET seems to be an alternative technique in LSCD.
Novel Method to Determine Target Refraction in Cataract Surgery for Patients Dependent on Therapeutic Scleral Lenses
Authors: Ma Kevin K. , Luo Zhonghui K.
Published: October 2020

Objectives:

To evaluate a novel approach to determine the refractive target for patients undergoing cataract surgery who are dependent on therapeutic scleral lenses, to avoid the need for postoperative scleral lens replacement.

Methods:

Retrospective single-surgeon case series. The target refraction for intraocular lens selection was determined by considering the effective scleral lens system power. This was calculated by adding the known scleral lens spherical power to the difference between the scleral lens base curve and the average keratometry value.

Results:

Six eyes from three patients with moderate myopia or emmetropia with ocular graft versus host disease dependent on therapeutic scleral lenses underwent cataract surgery with intraocular lens selection based on this method. All six eyes had corrected visual acuities of 20/30 or better while wearing their previous scleral lenses at the postoperative week 1 visit. All six eyes resumed full-time scleral lens use 1 week after phacoemulsification and did not require scleral lens replacement.

Conclusions:

Using this method, patients requiring therapeutic scleral lenses can quickly experience optimal vision, comfort, and ocular surface protection 1 week after cataract surgery. These patients can continue to use their existing scleral lenses and avoid the costs and burdens associated with lens replacement.
Scleral Lens Use in Neurotrophic Keratopathy: A Review of Current Concepts and Practice
Authors: Witsberger Emily , Schornack Muriel
Published: October 2020

Objective:

Neurotrophic keratopathy (NK) is a rare corneal condition characterized by epitheliopathy, which is associated with reduced or absent corneal sensation. The main goal of treatment of this condition is the preservation of ocular surface integrity. Contact lenses provide a nonsurgical and reversible option to provide the necessary corneal protection. The purpose of this review was to summarize the available literature regarding the use of contact lenses in the management of NK, with particular emphasis on the use of scleral lenses.

Methods:

Literature related to both soft and scleral contact lens use as treatment options for NK was reviewed.

Results:

As of yet, randomized clinical trials have compared neither the efficacy of contact lens therapy for NK to other therapeutic alternatives nor outcomes of therapy with different contact lens modalities. However, clinical case reports and limited case series have suggested that scleral lenses may be a safe and effective treatment option for NK at any stage of the disease, preserving epithelial integrity and even improving visual function in patients with this condition.

Conclusions:

Scleral lenses may be effective in reducing the need for surgical intervention and improving the quality of life in patients with NK.
The Role of Antifungal Prophylaxis After Receipt of a Positive Donor Rim Fungal Culture: The Case for Not Routinely Treating Prophylactically
Authors: Price Francis W.
Published: October 2020

Studies conducted in the United States suggest that 1% to 2% of corneal donor rims culture positive for fungus; the fungal agent is usually Candida, and the risk of an endothelial keratoplasty recipient developing an intraocular fungal infection is approximately 7% (1 in 15) if the donor rim was culture-positive. Routine culturing of corneal donor rims is useful because a positive fungal culture alerts the surgeon to carefully monitor the keratoplasty recipient for any signs of fungal infection. However, routine implementation of antifungal prophylaxis on receipt of a positive culture is problematic because there is a lack of definitive data regarding the optimal route of administration, necessary duration of prophylaxis, and relative efficacy of different antifungal agents. The use of topical prophylaxis alone has not been proven to be effective, and the systemic agents that are effective against Candida typically involve an azole, which has many side effects, including liver toxicity and potential interactions with other drugs. The data suggest that routine antifungal prophylaxis would needlessly expose 14 patients to systemic side effects for each person who would directly benefit. Treatment of postkeratoplasty fungal infection typically involves graft replacement, but selective removal of the involved area(s) has been used successfully with Descemet membrane endothelial keratoplasty.
Anatomical Changes in the Anterior Chamber Volume After Descemet Membrane Endothelial Keratoplasty
Authors: Onouchi Hiromi , Hayashi Takahiko , Shimizu Toshiki , Matsuzawa Akiko , Suzuki Yasuyuki , Kato Naoko
Published: October 2020

Purpose:

To evaluate changes in the anterior chamber of eyes that have undergone Descemet membrane endothelial keratoplasty (DMEK) and to identify factors that affect these changes.

Methods:

This retrospective study included 25 pseudophakic eyes of 25 patients who underwent DMEK. We determined the preoperative and postoperative values of the best spectacle-corrected visual acuity, spherical equivalent (SE), anterior chamber volume (ACV), anterior chamber depth (ACD), central corneal thickness (CCT), and scleral spur angle (SSA) evaluated using anterior segment optical coherence tomography and iris damage score and iris posterior synechiae score. We defined ∆ as the average change rate from the preoperative to postoperative value for each factor at 1 month (SE at 6–12 months) postoperatively. We also analyzed correlations between ∆ACV, ∆SE, and other preexisting factors.

Results:

Compared with the preoperative ACV value (128 ± 28 mm3), the postoperative value significantly increased to 155 ± 21 mm3 (P < 0.001); ∆SE was +1.01 ± 1.09 diopters. ∆ACV was negatively correlated with preoperative ACD (R = 0.643, P < 0.001) and SSA (R = 0.555, P = 0.001) and positively correlated with ∆ACD (R = 0.799, P < 0.001) and ∆SSA (R = 0.608, P < 0.001). ∆CCT, iris damage score, and iris posterior synechiae score were not significantly correlated with ∆ACV. ∆SE was positively correlated with ∆ACV, ∆ACD, and ∆SSA (R = 0.680, 0.455, and 0.478; P < 0.001, <0.05, and <0.05, respectively).

Conclusions:

An increase in the ACV and hyperopic change was noted after successful DMEK, especially in eyes with narrow-angled shallow anterior chambers.
Limbal Stem Cell Deficiency Associated With Herpes Keratitis
Authors: Carreno-Galeano Jimena Tatiana , Dohlman Thomas H. , Yin Jia , Dana Reza
Published: October 2020

Purpose:

To describe the demographic features and clinical characteristics of patients with herpes keratitis (HK) and limbal stem cell deficiency (LSCD) and identify possible factors associated with development of LSCD after HK.

Methods:

In this retrospective case-series study, records of patients with a clinical diagnosis of HK seen at Massachusetts Eye and Ear over a 5-year period were reviewed for evidence of LSCD. Patient demographics, medical history, treatment, and best-corrected visual acuities (BCVAs) were recorded.

Results:

We identified 626 patients with HK. Fifty-seven had been diagnosed with LSCD (9.3%). Thirteen percent of patients with herpes zoster keratitis (N= 25) and 7% of patients with herpes simplex keratitis (N= 32) had LSCD (P = 0.01). Keratitis caused by herpes zoster virus [odds ratios (OR), 1.77; 95% confidence interval (CI), 0.97–3.19; P = 0.01], stromal involvement (OR, 2.28; 95% CI, 1.27–4.18; P = 0.02), and the use of topical antihypertensives (OR, 2.28; 95% CI, 1.27–4.18; P = 0.02) were found to be associated with a higher likelihood of developing LSCD. The final logarithm of the minimum angle of resolution (LogMAR) BCVA was significantly lower in patients with LSCD compared with those without LSCD with a mean BCVA of 1.34 ± 1.52 LogMar (∼20/200) as compared to 0.18 ± 0.54 LogMar (∼20/30 ± 20/60) in those patients without LSCD (P = 0.005).

Conclusions:

Our data suggest that HK may be a risk factor for development of LSCD. Patients with HK should be monitored for the development of LSCD to reduce the risk of chronic ocular surface morbidity.
Efficacy of 3D digital visualization in minimizing coaxial illumination and phototoxic potential in cataract surgery: pilot study
Authors: Rosenberg Eric D. , Nuzbrokh Yan , Sippel Kimberly C.
Published: October 2020

Purpose:

To compare the coaxial light intensity required during cataract surgery and rate of postoperative visual recovery, with surgical visualization achieved with a traditional analog operating microscope compared with a 3D digital visualization system.

Setting:

Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York.

Design:

Retrospective, consecutive, single-surgeon series.

Methods:

Patients undergoing femtosecond laser–assisted cataract surgery were retrospectively grouped into either: (1) visualization using the binoculars of a standard operating microscope (traditional group) or (2) visualization using a 3D digital visualization system affixed to the same operating microscope (digital group). Note was made in each case of light intensity used, light exposure time, intraoperative and/or postoperative complications, and postoperative visual acuities.

Results:

The study comprised 24 eyes in the traditional group and 27 eyes in the digital group. There were no intraoperative or postoperative complications in either group and no difference in mean light exposure time, but the mean light intensity used in the digital group was significantly less (18.5% ± 1.5%) than that in the traditional group (43.3% ± 3.7%; P < .001). Furthermore, the digital group achieved a postoperative day 1 visual acuity that was within 2 lines of the postoperative month 1 visual acuity a greater percentage of time than that in the traditional group (81.5% of eyes vs 54.2% of eyes; P = .04).

Conclusions:

Light intensity was significantly decreased in patients who underwent cataract surgery assisted by the 3D digital visualization platform without an increase in complications or surgical time and possibly with a faster postoperative visual recovery.
Economic evaluation of prevention of cystoid macular edema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4
Authors: Simons Rob W.P. , Wielders Laura H.P. , Dirksen Carmen D. , Veldhuizen Claudette A. , van den Biggelaar Frank J.H.M. , Winkens Bjorn , Schouten Jan S.A.G. , Nuijts Rudy M.M.A. ,   on behalf of the ESCRS PREMED Study Group
Published: October 2020

Purpose:

To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema (CME) after cataract surgery in patients without diabetes.

Setting:

Seven ophthalmology clinics in the Netherlands and Belgium.

Design:

Prospective cost-effectiveness analysis using data from a European multicenter randomized clinical trial (ESCRS PREMED).

Methods:

Patients without diabetes planned for expected uneventful cataract surgery were randomized to topical bromfenac (Yellox, n = 242), topical dexamethasone (n = 242), or a combination treatment (n = 238). All relevant resources from a healthcare perspective were included in the cost analysis within a time horizon of 12 weeks postoperatively. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) based on the cost per QALY.

Results:

The study comprised 722 patients without diabetes. Total healthcare costs and QALYs were € 447 (US $562) and 0.174 in the bromfenac group, €421 (US $529) and 0.179 in the dexamethasone group, and €442 (US $565) and 0.182 in the combination group. Bromfenac was most costly and least effective (ie, strongly dominated). The ICER was €6544 (US $8221) per QALY for the combination group compared with the dexamethasone group. Assuming that the willingness to pay is € 20 000 (US $25 126) per QALY, the cost-effectiveness probability was 3%, 32%, and 65% in the bromfenac, dexamethasone, and combination groups, respectively.

Conclusions:

In patients without diabetes, combination treatment with topical bromfenac and dexamethasone was effective and cost-effective in preventing CME after cataract surgery compared with treatment with either drug alone.
Randomized Controlled Crossover Trials of the Pharmacokinetics of PRC-063, a Novel Multilayer Extended-Release Formulation of Methylphenidate, in Healthy Adults
Authors: Katzman Martin A. , Mattingly Greg , Klassen Larry J. , Cataldo Marc J. , Donnelly Graeme A. E.
Published: October 2020

Purpose/Background

PRC-063 is a once-daily, extended-release oral formulation of methylphenidate hydrochloride developed to provide early and prolonged symptom improvement in patients with attention-deficit/hyperactivity disorder.

Methods/Procedures

We conducted 3 randomized, open-label crossover studies of the pharmacokinetics of PRC-063 in healthy, nonobese men and women aged 18 to 45 years. PRC-063 (100 mg/d) was compared with immediate-release methylphenidate (20 mg, 3 times daily) when administered on a single day under fasted and fed conditions and at steady state (day 5 of repeat dosing under fasted conditions). The pharmacokinetics of PRC-063 administered as capsule contents sprinkled on apple sauce, yoghurt, or ice cream were also investigated.

Findings/Results

PRC-063 demonstrated biphasic absorption, with 2 distinct peak plasma concentrations. Intake of a high-fat, high-calorie meal did not increase the peak plasma methylphenidate concentration (C
max) or extent of absorption (area under the curve), however; it resulted in slower uptake versus a fasted state. During repeated dosing, steady state was reached with no further accumulation of methylphenidate from day 3. At steady state, PRC-063 gave higher evening and trough plasma methylphenidate levels than immediate-release methylphenidate (3 times daily). The pharmacokinetics of PRC-063 sprinkled on food were comparable to that of intact capsules. Reported adverse events (AEs) were consistent with the established safety profile of methylphenidate. There were no serious AEs, but 3 subjects discontinued the repeat-dosing study because of AEs assessed as possibly related to study treatment.

Implications/Conclusions

Our data indicate that PRC-063 can be taken with or without food or by sprinkling capsule contents on food.
Delirium Tremens in the Older Adult
Authors: Mulkey Malissa A. , Olson DaiWai M.
Published: October 2020

INTRODUCTION: Caring for patients experiencing alcohol withdrawal syndrome can be challenging. Patients 65 and older are at increased risk for alcohol withdrawal syndrome related complications. The higher prevalence of co-morbidities, including cognitive impairment, longer drinking history and greater sensitivity to alcohol withdrawal syndrome treatment are the result of decreased ability of the brain to adapt to stressors such as illness, trauma, or surgery. DELIRIUM TREMENS: Symptoms may appear earlier from the last drink and present with a wide range of symptoms. The most effective interventions require high-quality nursing care delivery to prevent, decrease the severity and shorten the duration of delirium. NURSING IMPLICATIONS: Strategies that help minimize these challenges starts with obtaining the patient’s selfreport of their alcohol use history. Nurses should be diligent in their monitoring for signs of active alcohol withdrawal. Screening and assessment tools such as the Clinical Institute Withdrawal Assessment for Alcohol–Revised should guide pharmacological management. To support nurses in identifying delirium tremens, this manuscript seek to describe the underlying pathophysiology, key assessment components and nursing management of delirium tremens in the older adult.
Impact of Training Based on Orem's Theory on Self-Care Agency and Quality of Life in Patients With Coronary Artery Disease
Authors: TOK YILDIZ Fatma , KAŞIKÇI Mağfiret
Published: October 2020

Background

Coronary artery disease (CAD) is a primary cause of death worldwide. CAD negatively affects individuals because it reduces their functional skills and self-care abilities and disrupts quality of life.

Purpose

This study was designed to assess the impact of a training program based on Orem's self-care deficit nursing theory (SCDNT) on self-care abilities and quality of life in patients with CAD.

Methods

This study was conducted using a randomized, controlled, pretest/posttest experimental design. One hundred two patients with CAD were divided evenly into either the intervention or control group, with sample randomization based on gender, age, low-density lipoprotein cholesterol level, and Self-Care Agency Scale scores. For both groups, interviews were conducted in two sessions held, respectively, at the hospital and at home. Study data were collected using the patient information form, Self-Care Agency Scale, MacNew Heart Disease Health-Related Quality of Life Questionnaire (MacNew), Quality of Life Questionnaire (15D), and training booklet.

Results

A highly significant difference was found between the two groups in terms of the average posttest scores on the Self-Care Agency Scale, MacNew, and 15D. For the intervention group, the posttest scores on the Self-Care Agency Scale, MacNew, and 15D were significantly higher than the pretest scores, whereas average pretest and posttest scores on these measures were similar for the control group.

Conclusions

The training program developed in this study based on Orem's SCDNT improved self-care agency as well as disease-specific and overall quality of life in patients with CAD. Nurses should pay attention to the CAD-related educational level of patients when teaching them how to live with their disease. Moreover, nurses should use Orem's SCDNT to strengthen the self-care agency of these patients to increase quality of life and the effectiveness of related education efforts. Finally, medical institutions and governments should develop appropriate education policies for patients at risk of CAD and for those with CAD.
International Experiences in Physical Therapist Education: A Descriptive Study
Authors: Hartman Jeff , Magnusson Dawn
Published: October 2020

International service and learning are growing phenomena in physical therapist education (PTE) and programs are developing new opportunities in all corners of the world. With this growth comes risks of duplicative efforts and harmful consequences.

Purpose.

This study is seeking to describe: 1) the proportion of US-based PTE programs sponsoring international experiences; 2) the number of physical therapist students participating in these activities annually; 3) the location of these programs; and 4) whether outcomes are formally collected.

Methods.

A 36-item survey was distributed to the American Physical Therapy Association's list of 243 accredited programs. A total of 109 programs responded (44.9%).

Results.

Seventy-three percent of respondent programs reported offering international experiences in 60 different countries during one academic year. It is estimated that 2,316 students participated in these experiences. Most international experiences were offered in low- and middle-income countries, with 24 different experiences being hosted in Guatemala alone. Student outcomes were collected for nearly all experiences, whereas host community outcomes were collected by less than 20% of programs.

Discussion and Conclusion.

This study confirms a growing trend of physical therapist students traveling the world. The high concentration of experiences in specific countries, regions, and low-resourced communities magnifies the importance of working alongside community and academic partners to share ideas and resources. Although the collection of student outcomes is critically important to academic programs, the collection of community outcomes should be considered equally, if not more important in assessing the potential benefit of international experiences.
Aerophagia Study in Indonesia
Authors: Oswari Hanifah , Alatas Fatima S. , Hegar Badriul , Cheng William , Pramadyani Arnesya , Benninga Marc A. , Rajindrajith Shaman
Published: October 2020

Background:

Aerophagia is a functional gastrointestinal disorder characterized by repeated air swallowing leading to chronic abdominal distension. Symptoms can be long lasting, lead to frustration, and distress. This study describes prevalence, related factors, and symptomatology of aerophagia, together with its relationship with emotional stress.

Materials and Methods:

Cross-sectional study. Adolescents aged 10 to 17 years from selected state schools by convenient sampling from Jakarta, Indonesia, were recruited. Rome III self-administered questionnaire was used to compile data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal and extraintestinal symptoms, and stressful life events were collected using a separate questionnaire.

Results:

A total of 1796 questionnaires were included in the analysis [males 732 (40.8%), mean age 13.58 (SD 0.992) years]. There were 81 (4.5%) subjects diagnosed with aerophagia. When the criterion of belching was removed from the diagnosis of aerophagia, the prevalence drops to only 2 (0.1%). subjects. Bivariate analysis showed that sociodemographic factors have no correlation with aerophagia. In subjects with aerophagia, among the intestinal-related and extraintestinal symptoms, only loss of appetite was significantly more common in the aerophagia population (33.3%) when compared with controls (22.8%). Death of a close family member [adjusted odds ratio (OR), 2.78; 95% confidence interval (CI), 1.46-5.31; P=0.002], divorce or separation of parents (adjusted OR, 2.54; 95% CI, 1.38-4.66; P=0.003), and divorce followed by separate individual remarriage of parents (adjusted OR, 2.01; 95% CI, 1.01-3.98; P=0.046) were found to be significantly associated with aerophagia by multivariate analysis.

Conclusions:

The prevalence of aerophagia was found in 4.5% of Indonesian school-aged children according to Rome III criteria, but the prevalence was found only 0.1% if the belching is removed from the criteria. Besides the main symptoms, only loss of appetite was significantly more common in aerophagia among intestinal-related and extraintestinal symptoms. Family-related stress showed a significant correlation with aerophagia.
Shock Index, Coronary Perfusion Pressure, and Rate Pressure Product As Predictors of Adverse Outcome After Pediatric Cardiac Surgery
Authors: Hagel Jonathon A. , Sperotto Francesca , Laussen Peter C. , Salvin Joshua W. , Bachu Akash , Kheir John N.
Published: October 2020

Objectives:

To determine whether shock index, coronary perfusion pressure, or rate pressure product in the first 24 hours after congenital heart surgery are independent predictors of subsequent clinically significant adverse outcomes.

Design:

A retrospective cohort study.

Setting:

A tertiary care center.

Patients:

All patients less than 18 years old who underwent cardiac surgery at Boston Children's Hospital between January 1, 2010, and December 31, 2018.

Interventions:

None.

Measurements and Main Results:

Shock index (heart rate/systolic blood pressure), coronary perfusion pressure (diastolic blood pressure–right atrial pressure), and rate pressure product (heart rate × systolic blood pressure) were calculated every 5 seconds, and the median value for the first 24 hours of cardiac ICU admission for each was used as a predictor. The composite, primary outcome was the occurrence of any of the following adverse events in the first 7 days following cardiac ICU admission: cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation, mechanical circulatory support, unplanned surgery, heart transplant, or death. The association of each variable of interest with this outcome was tested in a multivariate logistic regression model. Of the 4,161 patients included, 296 (7%) met the outcome within the specified timeframe. In a multivariate regression model adjusted for age, surgical complexity, inotropic and respiratory support, and organ dysfunction, shock index greater than 1.83 was significantly associated with the primary outcome (odds ratio, 6.6; 95% CI, 4.4–10.0), and coronary perfusion pressure greater than 35 mm Hg was protective against the outcome (odds ratio, 0.5; 0.4–0.7). Rate pressure product was not found to be associated with the outcome. However, the predictive ability of the shock index and coronary perfusion pressure models were not superior to their component hemodynamic variables alone.

Conclusions:

Both shock index and coronary perfusion pressure may offer predictive value for adverse outcomes following cardiac surgery in children, although they are not superior to the primary hemodynamic variables.
Traumatic Brain Injury Practice Guidelines: Variability in U.K. PICUs
Authors: Kanthimathinathan Hari Krishnan , Mehta Hiren , Scholefield Barnaby R. , Morris Kevin P.
Published: October 2020

Objectives:

Traumatic brain injury in children is a leading cause of morbidity and mortality. Lack of high-quality evidence may lead to variation in management within and between PICUs. We examined U.K. pediatric traumatic brain injury management guidelines for extent of variability.

Design:

Analysis of U.K. PICU traumatic brain injury guidelines for areas of consistency and variation among each other and against the second edition of Brain Trauma Foundation pediatric traumatic brain injury guidelines.

SETTING:

Not applicable.

SUBJECTS:

Not applicable.

INTERVENTIONS:

Textual analysis of U.K. PICU guidelines.

Measurements and Main Results:

Twelve key clinical topics in three traumatic brain injury management domains were identified. We performed textual analysis of recommendations from anonymized local guidelines and compared them against each other and the Brain Trauma Foundation pediatric traumatic brain injury guidelines. Fifteen guidelines used by 16 of the 20 U.K. PICUs that manage traumatic brain injury were analyzed. Relatively better consistency was observed for intracranial pressure treatment thresholds (10/15), avoiding prophylactic hyperventilation (15/15), cerebrospinal fluid drainage (13/15), barbiturate (14/15), and decompressive craniectomy (12/15) for intracranial hypertension. There was less consistency in indications for intracranial pressure monitoring (3/15), cerebral perfusion pressure targets (2/15), target osmolarities (7/15), and hyperventilation for intracranial hypertension (2/15). Variability in choice and hierarchy of the interventions for intracranial hypertension were observed, albeit with some points of consistency.

Conclusions:

Significant variability in pediatric traumatic brain injury management guidelines exists. Despite the heterogeneity, we have highlighted a few points of consistency within the key topic areas of pediatric traumatic brain injury management. We anticipate that this provides impetus for further work around standardization.
Closing the Loop
Authors: Goldman Michael P. , Query Lindsey A. , Wong Ambrose H. , Gross Isabel T. , Emerson Beth L. , Auerbach Marc A. , Tiyyagura Gunjan K.
Published: October 2020

Objectives

Follow-up and feedback foster improvement. General emergency medicine providers working in community hospitals desire follow-up and feedback on pediatric patients transferred to children's hospitals. We implemented a novel program to provide these data to our colleagues. The objective of this study was to explore stakeholder perspectives of our program.

Methods

We provided secure, electronic reports on transfers from 7 general emergency departments (GEDs). Patient follow-up and feedback data were delivered to the GED's pediatric emergency care coordinator. Seven pediatric emergency care coordinators and 2 children's hospital liaisons participated in semistructured interviews. Five researchers coded and analyzed transcribed data using the constant comparative method of grounded theory. Codes were refined and clustered to develop themes.

Results

Perceived values of the program included GED appreciation of closing the loop on transferred patients, providing education, and informing quality improvement. Participants valued the concise and timely nature of the reports and their empathetic delivery. Facilitators of program implementation included established professional relationships between the GED and the children's hospital liaisons and a GED's culture of self-inquiry. Barriers to program implementation included potential medicolegal exposure and the time burden for report generation and processing. Suggested programmatic improvements included focusing on generalizable, evidence-based learning points and analyzing care trends.

Conclusions

Stakeholders of our pediatric posttransfer follow-up and feedback program reported many benefits and provided key suggestions that may promote successful dissemination of similar programs nationwide. Examining data trends in transferred children may focus efforts to improve the care of children across all emergency care settings.
Influence of Residency Training on Research Productivity and Plastic Surgery Career
Authors: Roy Eva , Egro Francesco M. , Zalewski Adrian , Smith Brandon T. , Losee Joseph E. , Nguyen Vu T.
Published: October 2020

Background

The impact of residency training on academic productivity and a career in academic plastic surgery remains uncertain. Previous literature has explored the influence of training institutions on academic careers in surgery. The aims of the study were to assess research productivity during plastic surgery residency training and to illustrate how differences in training programs impact resident research productivity.

Methods

Academic plastic surgery faculty that graduated in the past 10 years were identified through an Internet search of all Accreditation Council for Graduate Medical Education–accredited residency and fellowship training programs. Research productivity was compared based on h-index, number, and quality of peer-reviewed articles published during residency.

Results

Three hundred seventy-five academic plastic surgeons were identified and produced 2487 publications during residency. The 10 most productive training institutions were Johns Hopkins, Georgetown, University of Michigan, Stanford, University of California Los Angeles, Northwestern, Harvard, New York University, University of Pennsylvania, and Baylor. Academic productivity was higher among integrated residents (integrated = 8.68 publications, independent = 5.49 publications, P < 0.0001). The number of publications positively correlated to faculty size (r = 0.167, P = 0.0013), National Institute of Health (NIH) funding (r = 0.249, P < 0.0001), residency graduation year (r = 0.211, P < 0.0001), and negatively correlated with Doximity ranking (r = −0.294, P < 0.0001). H-index was positively correlated with number of publications (r = 0.622, P < 0.0001), faculty size (r = 0.295, P < 0.0001), and NIH funding (r = 0.256, P < 0.0001) and negatively correlated with Doximity ranking (r = −0.405, P < 0.0001) and residency graduation year (r = −0.163, P < 0.0001).

Conclusions

Our study has found that there is an elite cohort of programs that are the most productive research institutions. Resident research productivity is higher among integrated residents, recent graduates, and programs that are larger in size, with a higher Doximity ranking and NIH funding. This study can guide medical students and future applicants who are interested in a career in academic plastic surgery in the selection of programs that match their career aspirations.
Efficacy of Low Power, Pure Cut Mode of Monopolar Electrosurgery and Quilting Sutures for Preventing Seroma Formation After Latissimus Dorsi Myocutaneous Flap Harvest
Authors: Tashima Hiroki , Tomita Koichi , Kurita Tomoyuki , Kubo Tateki
Published: October 2020

Background

Latissimus dorsi myocutaneous (LD) flaps are widely used in breast reconstruction surgery. However, seromas often form postoperatively at the donor site as a complication. This study aimed to determine the impact of different electrocautery modes during flap elevation, with or without subsequent quilting sutures, on postoperative seroma formation.

Methods

Subjects were 112 patients who underwent immediate breast reconstruction with LD flaps after breast-conserving surgery between April 2015 and January 2019. Group A consisted of 21 patients who underwent LD flap elevation using the fulgurate mode, and group B consisted of 25 patients who underwent flap elevation using the lower power, pure cut mode. Group C consisted of 66 patients who underwent flap elevation with the lower power, pure cut mode combined with quilting sutures for wound closure.

Results

Mean 1-week postoperative back drain volume and the mean number of days to drain removal in group B were significantly reduced relative to those in group A (group A, 752.3 mL and 16.9 days, respectively; group B, 552.2 mL and 10.6 days, respectively; P < 0.001 for both). Group C, which included quilting sutures, had even lower values than group B (459.7 mL and 7.4 days, respectively; group B vs group C: P = 0.03 and P < 0.001, respectively). Significant differences were observed between groups for postoperative seroma formation at the flap donor site (group A, 16 [76.2%] of 21 patients; group B, 11 [44%] 25 patients; group C, 4 [6.1%] of 66 patients; A vs B: P < 0.001, B vs C: P < 0.001).

Conclusions

The use of low power, pure cut mode for LD flap harvest, combined with quilting sutures, effectively shortened the time to drain removal and suppressed seroma formation. Given that specialized devices and materials are not required, this combination may reduce both patient burden and medical costs.
The Inverted V-Shaped Fasciocutaneous Advancement Flap Effectively Solves the Complication of Tracheostomal Stenosis
Authors: Karonidis Athanasios , Tsoutsos Dimosthenis
Published: October 2020

Tracheostomal stenosis after laryngectomy is a distressing complication. We present a retrospective study on sequential 9 patients who underwent stomaplasty with inverted V-shaped fasciocutaneous advancement flap. This procedure effectively solves tracheostomal stenosis, providing large stoma for breathing with no need for further stenting and low revision rates.
Hand Surgery Referral Pattern Preferences Among Primary Care Physicians in Academic Centers in the Southeastern United States
Authors: Jain Abhishek , Hermiz Steve , Suliman Ahmed , Herrera Fernando A.
Published: October 2020

Background

Board-certified hand surgeons undergo an additional 1 year of fellowship training after completing 1 of 3 residencies, either orthopedic surgery (OS), plastic surgery (PS), or general surgery (GS). The purpose of our study was to examine primary care physician's referral patterns for hand surgery in the Southeastern United States.

Methods

Primary care physicians across 38 academic medical institutions in the Southeastern United States were queried. A survey questionnaire was sent to their corresponding email address. The Questionnaire allowed the surveyor to enter demographic information and their choice in referral, either to OS, PS, or GS, for each particular hand pathology.

Results

Two-hundred twenty-eight of 1526 surveys were completed (15% response rate). One-hundred twenty-four were male respondents, and 105 were female. For treatment of arthritis, 94.7% selected OS; 5.3%, PS; and 0%, GS. For treatment of nerve decompression, 84.0% selected OS; 14.4%, PS; and 1.6%, GS. For treatment of nerve injuries, 64.2% selected OS; 34.6%, PS; and 1.2%, GS. For treatment of tendon injuries, 84.4% selected OS; 15.6%, PS; and 0%, GS. For treatment of congenital deformities, 55.1% selected OS; 44.9%, PS; and 0%, GS. For treatment of fractures, 98.8% selected OS; 1.2%, PS; and 0%, GS. For treatment of sports-related injuries, 99.2% selected OS; 0.4%, PS; and 0.4%, GS. For treatment of soft tissue masses, 65.5% selected OS; 23.0%, PS; and 11.5%, GS. For treatment of soft tissue coverage, 8.6% selected OS; 87.7%, PS; and 3.7%, GS. For treatment of skin cancer–related problems, 8.2% selected OS; 72.4%, PS; and 19.4%, GS.

Conclusions

Referrals for arthritis, nerve decompressions, tendon injuries, fractures, and sports injuries are more likely to be referred to OS. Referrals for soft tissue coverage and skin cancers are more likely to be referred to PS. Nerve injuries and congenital deformities referrals were similar between orthopedic and PS. Further research should be conducted to determine why referral patterns vary among specialties with similarly trained hand surgeons.
Persistent metabolomic alterations characterize chronic critical illness after severe trauma
Authors: Horn Dara L. , Bettcher Lisa F. , Navarro Sandi L. , Pascua Vadim , Neto Fausto Carnevale , Cuschieri Joseph , Raftery Daniel , O’Keefe Grant E.
Published: October 2020

BACKGROUND

Following trauma, persistent inflammation, immunosuppression, and catabolism may characterize delayed recovery or failure to recover. Understanding the metabolic response associated with these adverse outcomes may facilitate earlier identification and intervention. We characterized the metabolic profiles of trauma victims who died or developed chronic critical illness (CCI) and hypothesized that differences would be evident within 1-week postinjury.

METHODS

Venous blood samples from trauma victims with shock who survived at least 7 days were analyzed using mass spectrometry. Subjects who died or developed CCI (intensive care unit length of stay of ≥14 days with persistent organ dysfunction) were compared with subjects who recovered rapidly (intensive care unit length of stay, ≤7 days) and uninjured controls. We used partial least squares discriminant analysis, t tests, linear mixed effects regression, and pathway enrichment analyses to make broad comparisons and identify differences in metabolite concentrations and pathways.

RESULTS

We identified 27 patients who died or developed CCI and 33 who recovered rapidly. Subjects were predominantly male (65%) with a median age of 53 years and Injury Severity Score of 36. Healthy controls (n = 48) had similar age and sex distributions. Overall, from the 163 metabolites detected in the samples, 56 metabolites and 21 pathways differed between injury outcome groups, and partial least squares discriminant analysis models distinguished injury outcome groups as early as 1-day postinjury. Differences were observed in tryptophan, phenylalanine, and tyrosine metabolism; metabolites associated with oxidative stress via methionine metabolism; inflammatory mediators including kynurenine, arachidonate, and glucuronic acid; and products of the gut microbiome including indole-3-propionate.

CONCLUSIONS

The metabolic profiles in subjects who ultimately die or develop CCI differ from those who have recovered. In particular, we have identified differences in markers of inflammation, oxidative stress, amino acid metabolism, and alterations in the gut microbiome. Targeted metabolomics has the potential to identify important metabolic changes postinjury to improve early diagnosis and targeted intervention.

LEVEL OF EVIDENCE

Prognostic/epidemiologic, level III.