bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of sudden brain metastases progression after temporary targeted therapy discontinuation: when to regret a drug holiday
Authors: Indini Alice , Rijavec Erika , Mandalà Mario , Castiglioni Simona , Beltramo Giancarlo , Grossi Francesco
Published: February 2021

Targeted therapy improves outcomes in BRAF V600-mutant metastatic melanoma with active brain metastases. We present the case of a patient with rapid brain disease progression upon temporary targeted therapy discontinuation and unusual rapid disease response upon treatment resumption. This report presents a 78-year-old woman with metastatic BRAF V600E positive melanoma (bladder and brain localizations). The patient started first-line dabrafenib and trametinib with good tolerability and evidence of complete response (CR). After 8 months of maintained CR, the patient took a drug holiday for 14 days. Brain MRI performed after treatment pause showed extensive disease progression, whereas extracranial staging was negative. The patient was asymptomatic: she restarted targeted therapy and underwent evaluation for whole-brain radiotherapy. Brain computed tomography scan and subsequent MRI performed to plan radiotherapy showed brain CR after only 10 days of targeted therapy resumption. The patient continued treatment, and radiotherapy indication was withheld. Repeated brain MRI confirmed maintained CR. Treatment with dabrafenib and trametinib is ongoing with excellent tolerability. Rapid intracranial progression is a well-known finding after discontinuation of combined targeted therapy in the case of extracranial progressive disease. This is the first report of documented disease progression upon temporary treatment discontinuation for reasons other than toxicity, with an unusual response after retreatment. Caution should be used in tailoring treatment during targeted therapy, allowing pauses for reasons other than toxicity. Strict adherence to treatment is paramount to guarantee disease control.
Risks of metabolic syndrome and diabetes with integrase inhibitor-based therapy: Republication
Authors: Shah Shahini , Hill Andrew
Published: February 2021

Purpose of review

A growing body of evidence suggests that integrase inhibitors (INSTIs) are significantly associated with weight gain and obesity. Obesity is a significant risk factor for metabolic syndrome and diabetes. This article comprehensively reviews recent available evidence weight gain and the risks of metabolic syndrome and diabetes associated with INSTIs.

Recent findings

Recent evidence continues to contribute to the evidence for weight gain associated with INSTIs, especially when used with newer nucleoside reverse transcriptase inhibitor, tenofovir alafenamide (TAF). Although the literature suggests a neutral effect on lipids, there is evidence that INSTIs are associated with metabolic syndrome due to treatment-emergent obesity. The literature for short-term treatment-emergent diabetes and insulin resistance remains inconsistent, but there is some evidence that weight gain could lead to an increased risk of developing diabetes in the future.

Longer term studies are required to understand the metabolic impact of INSTIs, secondary to weight gain. Evidence suggests that INSTIs, when used with TAF, contribute to metabolic syndrome and may have long-term risks of diabetes. INSTIs, when used with tenofovir disoproxil fumarate, have fewer metabolic implications. Clinicians must monitor for weight gain and metabolic effects, especially in those with underlying risk factors.
Association of genetic polymorphisms NCF4 rs1883112, CBR3 rs1056892, and ABCC1 rs3743527 with the cardiotoxic effects of doxorubicin in children with acute lymphoblastic leukemia
Authors: Gándara-Mireles Jesús Alonso , Lares-Asseff Ismael , Reyes Espinoza Elio Aarón , Blanco Javier G. , González Font Antonio Emilio , Córdova Hurtado Lourdes Patricia , Castañeda Verónica Loera , Fierro Ignacio Villanueva , Romero Leslie Patrón , Reyes Horacio Almanza
Published: February 2021

Objectives

Cardiotoxicity is a frequent complication secondary to the use of anthracyclines for cancer chemotherapy. Evidence suggests that certain polymorphic genetic variants modify the risk for anthracycline-related cardiotoxicity. Reports documenting the impact of genetic polymorphisms on anthracycline-cardiotoxicity risk in pediatric patients with cancers from Latin American countries are scarce. The objective of this study was to evaluate associations between NCF4 rs1883112, CBR3 rs1056892 and ABCC1 rs3743527 genotype status and echocardiographic parameters indicative of anthracycline-cardiotoxicity in a group of Mexican children with acute lymphoblastic leukemia (ALL).

Methods

Sixty-seven children (2–18 years old) with ALL were treated at the State Cancer Center in Durango, Mexico. NCF4, CBR3, and ABCC1 genotypes were examined by real-time PCR. Left ventricular ejection fraction and diastolic filling ratio were examined as markers of systolic and diastolic anthracycline-toxicity.

Results

NCF4 rs1883112 genotype status was significantly associated with the risk of doxorubicin cardiotoxicity [odds ratio (OR) = 10.80, 95% confidence interval (CI) 1.69–68.98, P = 0.01]. There was a significant association between heterozygous CBR3 rs1056892 genotype status and anthracycline-cardiotoxicity risk (OR = 9.91, 95% CI 1.07–91.47, P = 0.04). Heterozygosis for the ABCC1 rs3743527 allele was associated with protection from anthracycline-cardiotoxicity (OR = 0.30, 95% CI 0.09–0.91, P = 0.03).

Conclusion

This pilot study suggests that selected polymorphic variants may impact the risk for anthracycline-cardiotoxicity in pediatric patients with ALL treated with a contemporary chemotherapeutic regimen in Mexico.
Postpartum headaches after epidural or spinal anesthesia
Authors: Joudi Noor , Ansari Jessica
Published: February 2021

Purpose of review

Postpartum headache is a common occurrence with various obstetric, neurologic, and anesthetic etiologies. Post dural puncture headache (PDPH) after neuraxial anesthesia is a culprit that may be less familiar to obstetricians. In this review, authors will discuss the differential diagnosis and management of postpartum headache, review PDPH, and explore evidence suggesting that PDPH may have greater implications than previously considered.

Recent findings

Emerging evidence suggests that PDPH, previously believed to be benign and self-limited, is associated with significant acute and chronic sequelae. A recent large database study links PDPH to subdural hematoma and cerebral venous sinus thrombosis. The authors also identified associations between PDPH and bacterial meningitis, depression, and back pain. A growing body of literature also links PDPH or unintentional dural puncture with an epidural needle (UDP) with development of chronic headaches.

Patients who experience UDP or PDPH should be counseled to return for evaluation for new or worsening headache. In the immediate postpartum setting, clinicians assessing these patients should have a low threshold to obtain brain imaging. In addition, obstetricians should be alerted that patients who suffer UDP may be prone to develop chronic headache disorders and consider referral to pain specialists.
Genetics of recurrent pregnancy loss: a review
Authors: Tise Christina G. , Byers Heather M.
Published: February 2021

Purpose of review

Human reproduction is remarkably inefficient; with pregnancy loss occurring in 10–30% of clinically recognized pregnancies. Of those, 3–5% of couples experience recurrent pregnancy loss (RPL), more than 50% of who never receive an underlying diagnosis. Herein, we review evidence that genetic changes, including pathogenic variant(s) in highly penetrant genes, may provide an explanation for a proportion of couples with pregnancy loss.

Recent findings

Genetic abnormalities that may predispose to pregnancy loss include chromosomal aneuploidy, copy number variants, single-gene changes and others. Although previously limited by the need for hypothesis-driven assessment, advancement of various molecular technologies have sheparded in the opportunity to identify molecular cause of highly heterogeneous conditions, including RPL. The identification of causative genetic aberrations associated with RPL demonstrates a promising area of further research.

The journey of human development from a single-cell zygote to a term infant is complex process. Early research into copy number variants and highly penetrant single-gene changes may provide diagnosis for a proportion of couples with RPL as well as inform genes critical for early human development.
The Divine Proportion: Origins and Usage in Plastic Surgery
Authors: Hwang Kun , Park Chan Yong
Published: February 2021

Background:

The aim of this study was to summarize the existing literature on the origin of the concept of the divine proportion and its usage in the plastic surgery field.

Methods:

In PubMed, the search terms [golden ratio AND (plastic surgery OR aesthetic surgery OR face)] were used, resulting in 65 articles. Among them, 15 articles were excluded and 50 abstracts were reviewed, of which 45 were excluded. The remaining 5 full articles and 11 other mined articles were reviewed.

Results:

No evidence was found that the golden ratio had been used in any architecture or paintings before Pacioli’s Divina proportione (Divine proportion) (1509), after which painters begin to use this ratio in their art. Fechner (1876) found that the golden ratio (1:1.618) was more aesthetically pleasing than any other proportion of rectangles. Recently Marquardt invented a facial mask containing decagons and pentagons that embody φ in all dimensions, and claimed that this mask yielded the most beautiful shape of the human face. However, it did not fit the average facial features of northwestern Europeans or their perceptions of ideal femininity.

Conclusions:

Mathematical regularity can be found in nature and in the human body. However, this does not necessarily mean that a “formula of beauty” exists in mathematics. From the contributions of modern aestheticians, we now know that the so-called “essence of beauty” cannot be derived from the mathematical “formula of beauty” in the object itself. Therefore, it is suggested that beauty is based on biology, rather than on mathematics.
Getting Better Results in Flexor Tendon Surgery and Therapy
Authors: Ayhan Egemen , Tuna Zeynep , Oksuz Cigdem
Published: February 2021

Recently, better outcomes have been reported when up-to-date developments in flexor tendon surgery and therapy were followed. Slightly tensioned multistrand repairs, judicious venting of pulleys, and early active motion are widely accepted principles. In addition to these principles, tailoring of the repair according to intraoperative active movement with wide awake local anesthesia no tourniquet (WALANT) surgical setting is recommended for better results. We aimed to describe our up-to-date approach to flexor tendon surgery and therapy with the help of visual communication tools of this age. The ideal primary repair of flexor tendons, the management of delayed presentation flexor tendon injuries, the key steps to achieve better results with flexor tendon therapy, and the tele-rehabilitation experience during COVID-19 pandemic will be highlighted. Zone 2 flexor tendon injuries are the most demanding part and will be focused on.
Emergent expansion of clinical epigenetics in patients with cardiovascular diseases
Authors: Napoli Claudio , Coscioni Enrico , de Nigris Filomena , Donatelli Francesco
Published: February 2021

Purpose of review

Cardiovascular diseases (CVDs) are typically caused by multifactorial events including mutations in a large number of genes. Epigenetic-derived modifications in the cells are normal but can be amended by aging, lifestyle, and exposure to toxic substances. Major epigenetic modifications are DNA methylation, histone modification, chromatin remodeling as well as the noncoding RNAs. These pivotal players are involved in the epigenetic-induced modifications observed during CVDs. Nevertheless, despite impressive efforts capitalized in epigenetic research in the last 50 years, clinical applications are still not satisfactory.

Recent findings

Briefly, we present some of the recent steps forward in the epigenetic studies of CVDs. There is an increased appreciation for the contribution of epigenetic alterations in the development of CVDs. Now, we have novel epigenetic biomarkers and therapeutic trials with the use of statins, metformin, and some compounds affecting epigenetic pathways including a BET inhibitor apabetalone. The new knowledge of epigenetic regulation is also discussed in the light of precision medicine of CVDs.

Epigenetic studies of CVDs have the promise to yield both mechanistic insights as well as adjunct treatments (repurposed drugs and apabetalone). The overall concept of precision medicine is not widely recognized in routine medical practice and the so-called reductionist approach remains the most used way to treat CVD patients.
Radiation and the Skeptical Public: Tips and Tools for Communicating Effectively
Authors: Caffrey Emily
Published: February 2021

Public communication about radiation is tricky business. Members of the public are frequently skeptical about messages from scientific sources, particularly when it comes to radiation. As radiation protection professionals, it is our job to relay scientifically sound information in a simple, clear, and concise manner. This paper discusses the Health Physics Society’s “Ask The Experts” feature, the society’s most successful public education endeavor with over one million visitors annually. The keys to effective communication of technical information are demonstrating empathy and compassion, keeping the language simple and concise, and offering sources of additional information to empower the individual to learn more on their own. The two most common categories of questions—radiation exposures from diagnostic imaging procedures and radiation exposures to the fetus—are discussed in detail, and some general information on how to respond to these types of questions is provided. A template for responding to public questions is provided, along with some examples.
Trends, Associations, and Impact of Atrial Fibrillation in Patients With Light-chain Cardiac Amyloidosis
Authors: Abe Temidayo , Olanipekun Titilope , Khoury Mtanis , Egbuche Obiora , Effoe Valery , Ghali Jalal
Published: February 2021

Background:

In this study, we investigated the temporal trends in the prevalence and prognostic implication of atrial fibrillation (AF) in patient with light-chain cardiac amyloidosis (AL-CA).

Methods:

We identified 3030 patients with AL-CA from the 2015 to 2017 National Inpatient Sample, of which 1577 (52%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF by subtype from 2015 to 2017. We compared inhospital mortality, acute on chronic heart failure, stroke, length of stay (LOS), and total cost in patients with to those without AF, stratified by subtype of AF.

Results:

The prevalence of AF among patients with AL-CA was unchanged from 2015 to 2017 (50%–53%; adjusted odds ratio, 1.1 [0.9–1.5]; P = 0.3). The trend was unchanged in the stratified analysis by subtype of AF. Patients with AF were older and had more comorbidities. After propensity matching, acute on chronic heart failure was significantly higher in patients with AL-CA and AF, compared with those with AL-CA alone (55.6% vs. 48.3%; P < 0.0001). There was no difference in inhospital mortality (7.5% vs. 7.5%; P = 0.9), stroke (2.0% vs. 2.5%; P = 0.5), median LOS (5 [3–9] vs. 5 [3–8]; P = 0.3), and median total hospital cost $42,469 ([$21,309–$92,855] vs. $44,008 [$22,889–$94,200]; P = 0.6). In the stratified analysis, acute on chronic heart failure remained significant higher in patients with paroxysmal and nonparoxysmal AF, while LOS became significantly longer in patients with paroxysmal AF.

Conclusions:

Among patients with AL-CA, AF is associated with a higher risk of acute on chronic heart failure.
BASELINE PREDICTORS ASSOCIATED WITH 3-YEAR CHANGES IN DARK ADAPTATION IN AGE-RELATED MACULAR DEGENERATION
Authors: Lains Ines , Pundlik Shrinivas J. , Nigalye Archana , Katz Raviv , Luo Gang , Kim Ivana K. , Vavvas Demetrios G. , Miller Joan W. , Miller John B. , Husain Deeba
Published: February 2021

Purpose:

To assess the relationship between baseline age-related macular degeneration (AMD) and disease stage, as well as optical coherence tomography features seen in AMD, with 3-year changes in dark adaptation (DA).

Methods:

Prospective longitudinal study including patients with AMD and a comparison group (n = 42 eyes, 27 patients). At baseline and 3 years, we obtained color fundus photographs, spectral-domain optical coherence tomography, and rod-mediated DA (20 minutes protocol). Multilevel mixed-effect models were used for analyses, with changes in rod intercept time at 3 years as the primary outcome. As some eyes (n = 11) reached the DA testing ceiling value at baseline, we used 3-year changes in area under the DA curve as an additional outcome.

Results:

Baseline AMD, AMD stage, and hyperreflective foci on optical coherence tomography were associated with larger changes in rod intercept time at 3 years. When change in area under the DA curve was used as an outcome, in addition to these features, the presence of retinal atrophy and drusenoid pigment epithelial detachment had significant associations. New subretinal drusenoid deposits at 3 years were also associated with more pronounced changes in rod intercept time and area under the DA curve.

Conclusion:

Specific optical coherence tomography features are associated with DA impairments over time, which supports that structural changes predict functional loss over 3 years.
Metabolic syndrome and the aging retina
Authors: Roddy Gavin W.
Published: February 2021

Purpose of review

This review explores metabolic syndrome (MetS) as a risk factor that accelerates aging in retinal neurons and may contribute to the neurodegeneration seen in glaucomatous optic neuropathy (GON) and age-related macular degeneration (AMD).

Recent findings

Both animal model experiments and epidemiologic studies suggest that metabolic stress may lead to aberrant regulation of a number of cellular pathways that ultimately lead to premature aging of the cell, including those of a neuronal lineage.

GON and AMD are each leading causes of irreversible blindness worldwide. Aging is a significant risk factor in the specific retinal neuron loss that is seen with each condition. Though aging at a cellular level is difficult to define, there are many mechanistic modifiers of aging. Metabolic-related stresses induce inflammation, oxidative stress, mitochondrial dysfunction, endoplasmic reticulum stress, alterations to the unfolded protein response, defects in autophagy, alterations to the microbiome, and deposition of advanced glycation end products that can all hasten the aging process. Due to the number of variables related to metabolic health, defining criteria to enable the study of risk factors at a population level is challenging. MetS is a definable constellation of related metabolic risk factors that includes enlarged waist circumference, dyslipidemia, systemic hypertension, and hyperglycemia. MetS has been associated with both GON and AMD and may contribute to disease onset and/or progression in each disease.
Current and future therapies for persistent corneal epithelial defects and neurotrophic keratopathy
Authors: Ong Erin S. , Jeng Bennie H.
Published: February 2021

Purpose of review

The corneal epithelium is a crucial barrier against pathogens, and when disrupted in the setting of certain underlying risk factors such as neurotrophic keratopathy (NK), may result in persistent epithelial defects (PEDs) of the cornea. Management is challenging and may require a variety of different approaches ranging from conservative medical therapy to surgical intervention. The purpose of this review is to provide an update on current and potential future therapeutic options for PEDs and NK.

Recent findings

Recent research has yielded promising results for numerous novel therapies aimed at treating PEDs. Many of these attempt to stimulate healing at the cellular level, via signaling of corneal epithelial differentiation, migration, and proliferation. Considerable advances have also been made regarding medical and surgical promotion of corneal re-innervation and restoration of corneal sensitivity to directly address the underlying NK condition.

Together with the current well established therapeutic options available for PEDs and NK, growing research on newer alternatives suggest increasing potential for both more effective and more convenient therapies for these difficult situations.
Childhood Outcomes Following Parechovirus Infections in a US Young Infant Cohort
Authors: Kilbride Howard , Jackson Mary Anne , Selvarangan Rangaraj
Published: February 2021

Background:

Parechovirus A type 3 (PeV-A3) is associated with central nervous system infection in young infants. There are limited data regarding long-term outcomes, mostly reported from Australia and European populations. The objective of this study was to assess frequency of neurodevelopmental impairment (NDI) following PeV-A3 infection in our US cohort.

Methods:

Infants hospitalized during the 2014 outbreak with laboratory-confirmed PeV-A3 infection were evaluated with medical history, neurologic examination, parental completion of Ages and Stages Questionnaire and developmental assessment using Bayley Scales of Infant and Toddler Development, Third Edition cognitive, motor and language quotients. Determination of NDI was based on published criteria. Relationship of severity of PeV disease to outcome measures was determined using Fisher exact, χ2 and Mann-Whitney U test as appropriate.

Results:

Nineteen children, term gestation, were evaluated at ~3 years of age; PeV-A3 illness was uncomplicated for 6 (32%), complex, non-neurologic for 9 (47%) and encephalitis/seizures for 4 (21%). No differences were noted in mean Bayley Scales of Infant and Toddler Development, Third Edition quotients between infants by clinical presentation. Quotients for all were within 1 SD of population norms. Two (11%) children had mild NDI; 1 with mild cerebral palsy. Ages and Stages Questionnaire results included 11% at referral level and 37% suspect concern. Parents of 6 (32%) noted behavior concerns. These findings were unrelated to severity of the PeV-A3 illness.

Conclusions:

Parent concerns were identified frequently following infant PeV-A3 disease. Eleven percent had neurodevelopmental impairment at 3 years of age. Severity at presentation did not correlate with adverse childhood outcomes. Longitudinal developmental monitoring following infantile PeV-A3 disease is warranted.
Etiology of Infectious Diseases in Acutely Ill Children at a Pediatric Hospital in Finland
Authors: Pöyry Hilla , Raappana Anna , Kiviniemi Minttu , Pokka Tytti , Honkila Minna , Paalanne Niko , Valmari Pekka , Renko Marjo , Tapiainen Terhi
Published: February 2021

This is a brief report of the etiology of infectious diseases in a pediatric emergency department. Our cohort study of 4647 children demonstrated rhinovirus as the most common etiology in a pediatric emergency department (23%) and intensive care (48%). The population-based incidence of rhinovirus-related visits was 1796/100,000/yr in children <5 years. The most common bacterial pathogen was Escherichia coli (5%).
Intrapartum Cesarean Delivery Due to Nonreassuring Fetal Heart Rate and the Risk of Pediatric Infectious Morbidity-related Hospitalizations of the Offspring
Authors: Leybovitz-Haleluya Noa , Wainstock Tamar , Pariente Gali , Sheiner Eyal
Published: February 2021

Objectives:

One of the most common indications for intrapartum cesarean delivery (CD) is nonreassuring fetal heart rate (NRFHR) patterns. We aimed to study the long-term effect of CD due to NRFHR on the risk for subsequent childhood infectious morbidity-related hospitalizations of the offspring.

Study Design:

A population-based cohort study was performed, comparing total and different subtypes of infectious morbidity-related pediatric hospitalizations among offspring born by CD due to NRFHR versus labor dystocia (failure of labor to progress during the 1st or 2nd stage). The analysis included all singletons born between the years 1999–2014 at a single tertiary regional medical center. Infectious-related morbidities included hospitalizations involving a predefined set of International Classification of Diseases, 9th revision codes, as recorded in hospital computerized files. Infants with congenital malformations, multiple gestations, vaginal deliveries and vacuum failure were excluded from the analysis. Perinatal mortality cases were excluded from the long-term analysis. A Kaplan-Meier survival curve was used to compare the cumulative morbidity, and a Cox proportional hazards model was constructed to adjust for confounders.

Results:

The study population included 9956 newborns who met inclusion criteria; among them, 5810 (58%) were born by CD due to NRFHR, and 4146 (42%) were born via CD following labor dystocia with normal fetal heart rate (comparison group). Offspring born following NRFHR had higher rates of infectious morbidity-related hospitalizations (11.4% vs. 9.1%; odds ratio, 1.3; 95% confidence interval, 1.1–1.5; P < 0.01; Kaplan-Meier survival curve P < 0.01). The association remained significant and independent while adjusting for gestational age, maternal age and comorbidities, using a Cox proportional hazards model (adjusted hazard ratio, 1.3; 95% confidence interval, 1.2–1.4; P < 0.01).

Conclusions:

In our population, CD due to NRFHR is a risk factor for pediatric infectious morbidity-related hospitalizations of the offspring.
Shared Book Reading Effects on Number Naming in Preschoolers at Risk for Numeracy Delays
Authors: Alfes Clarissa , Missall Kristen , Artman Meeker Kathleen
Published: February 2021

Number naming, or knowledge of math numerals, has been described as a gatekeeper skill in preschool math development because it is necessary for later math tasks such as calculation. This article describes a small group intervention piloted with 10 preschoolers found to be at risk for delays in early numeracy development during universal screening. Target numerals were assigned randomly to one of three conditions (book, activity, and control). Using an adapted alternating treatment design, intervention conditions were delivered to small groups in 15-min sessions three times per week for 8 weeks. Each intervention session included a manualized counting book and activity, which were delivered in random order each session, but included the same numerals for number identification, verbal counting during one-to-one correspondence, and number naming. Across the 8 weeks of intervention, some preschoolers exhibited growth in number naming in intervention conditions as compared to control; participants varied in whether the book or activity intervention condition was more effective for their learning.
Early Intervention Increased Food Acceptance in Children With Visual Impairment
Authors: Clark Alena M. , Ferrell Kay A. , Smyth Catherine , Spicer Carol L. , Morgese Zoe L. , Puchalski Carol B. , Pickler Laura , Dewald Hong P. , Erskine Jamie
Published: February 2021

Limited literature exists documenting mealtime challenges and evidence for early intervention for children with visual impairment (VI). The objective of this pilot study was to determine whether a mealtime routines intervention for children with VI from 6 to 24 months would affect food texture, variety, and healthy food choices. The intervention occurred in homes/childcare settings involving children with VI, their caretakers, and their early interventionists. The intervention group scored higher than the control group for acceptance of food textures at 6–24 months (p ≤ .005) and at 13–24 months (p ≤ .007) and for consuming a greater variety of foods between 6 and 12 months (p ≤ .04). Assessment scores for positive caregiver and child mealtime behaviors were higher for the intervention group, p = .0000. The intervention showed promise for enhancing positive mealtime behaviors, feeding skills, and food acceptance.
Core outcome set for pediatric chronic pain clinical trials: results from a Delphi poll and consensus meeting
Authors: Palermo Tonya M. , Walco Gary A. , Paladhi Unmesha Roy , Birnie Kathryn A. , Crombez Geert , de la Vega Rocio , Eccleston Christopher , Kashikar-Zuck Susmita , Stone Amanda L.
Published: February 2021

Appropriate outcome measures and high-quality intervention trials are critical to advancing care for children with chronic pain. Our aim was to update a core outcome set for pediatric chronic pain interventions. The first phase involved collecting providers', patients', and parents' perspectives about treatment of pediatric chronic pain to understand clinically meaningful outcomes to be routinely measured. The second phase was to reach consensus of mandatory and optional outcome domains following the OMERACT framework. A modified Delphi study with 2 rounds was conducted including 3 stakeholder groups: children with chronic pain (n = 93), their parents (n = 90), and health care providers who treat youth with chronic pain (n = 52). Quantitative and qualitative data from round 1 of the Delphi study were summarized to identify important outcomes, which were condensed to a list of 10 outcome domains. Round 2 surveys were analyzed to determine the importance of the 10 domains and their relative ranking in each stakeholder group. A virtual consensus conference was held with the steering committee to reach consensus on a set of recommended outcome domains for pediatric chronic pain clinical trials. It was determined, by unanimous vote, that pain severity, pain interference with daily living, overall well-being, and adverse events, including death, would be considered mandatory domains to be assessed in all trials of any type of intervention. Emotional functioning, physical functioning, and sleep were important but optional domains. Last, the research agenda identifies several important emerging areas, including biomarkers. Future work includes selecting appropriate validated measures to assess each outcome domain.
Cardiovascular Consequences of Excessive Alcohol Drinking via Electrocardiogram
Authors: Farinelli Lisa A. , Piacentino Daria , Browning Brittney D. , Brewer Barbara B. , Leggio Lorenzo
Published: February 2021

There is a link between excessive alcohol drinking and an increased risk to develop cardiovascular disease, including alcoholic cardiomyopathy. This association warrants further research on the potential utility for the electrocardiogram (ECG) in the participatory management of the chronic consequences of alcohol use disorder (AUD). Our goal is to enhance understanding about the pernicious role alcohol plays on cardiac health using the ECG, an accessible, cost-effective, validated tool to inform novel targeted treatments for AUD. In this systematic review of human studies, we examine the relationship between abnormal clinically significant changes to ECG variables and excessive alcohol drinking with the goal of identifying key patterns specific to quantity of alcohol consumed. Three independent reviewers and one consensus reviewer, adhering to the PRISMA guidelines, conducted an initial review on studies published from database inception to April 19, 2019, using PubMed, Embase, CINAHL and COCHRANE databases. The initial search generated 2,225 articles. The final selected number included 153 original articles. This systematic review provides evidence of patterns of clinically significant changes to ECG variables as a consequence of excessive alcohol consumption. Future directions include investigating whether a real-time assessment, such as the ECG, in conjunction with other key behavioral and cardiac measures, can help clinicians and patients realize the progressive and insidious cardiac damage because of excessive alcohol consumption. This theory-guided nurse science review supports the development of personalized symptom monitoring to deliver tailored feedback that illuminate risk factors as a potentially transformative approach in the management of AUD.
Psychosocial Needs of the Parents With Teenagers on Drugs
Authors: Daryoushi Hooman , Jalali Amir , Ezzatei Ebrahim , Dinmohammadi Mohammadreza
Published: February 2021

Background

Dependence on drugs causes several problems for the individual, family, and society. Such problems are more evident in teenagers and deeply affect the parents. Perceiving these parents' problems and needs is a way to help them with such problems and enable them to provide more support to their children. This study is an attempt to elaborate on the psychological needs of the parents with adolescents who use drugs.

Methods

The participants were 19 parents with an adolescent with drug use disorder who were selected purposefully. In-depth and semistructured interviews were conducted face-to-face with the participants. All the interviews were recorded and analyzed by conventional content analysis. Guba and Lincoln's four measures of trustworthiness were observed throughout the study.

Results

Analyses of the interviews revealed three themes, seven categories, and 17 subcategories. The themes were receiving support, need for self-confidence, and need for welfare.

Conclusion

For different reasons, parents of adolescents who use drugs find it incumbent upon themselves to support and treat their adolescents. Given the many problems, these parents need a variety of social, educational, emotional, interpersonal, and financial supports.
Medical Marijuana
Authors: Kameg Brayden , Kameg Kirstyn
Published: February 2021

As of 2019, 33 states, in addition to three territories and the District of Columbia, have approved medical marijuana programs. In the United States, the 12-month prevalence of medical marijuana use increased by 34.2% between 2013 and 2015. The rapid dissemination of medical marijuana use, in conjunction with conflicting data regarding its safety and efficacy, renders mental health providers in an ethical and legal quandary. The purpose of this article was to highlight emerging evidence regarding the efficacy and risks of medical marijuana and to describe medical–legal issues of such use regarding liability for mental health providers. Mental health care providers must be prudent to ensure that they are providing patients with the most accurate, up-to-date information regarding medical marijuana. This is not only to ensure protection from medical liability but also to promote best outcomes for patients experiencing mental health problems.
Hope, Sociodemographic and Clinical Characteristics as Predictors of Stigma-Related Negative Discrimination Experiences of Patients With Primary Malignant Brain Tumor
Authors: Baksi Altun , Arda Sürücü Hamdiye , Genç Hasan
Published: February 2021

BACKGROUND: A brain tumor can cause specific dysfunctions including psychosocial problems, and neurological, cognitive, mental, personality, behavioral, body image, and self-concept changes. Hope is reported in previous studies as an important and protective factor during the difficult duration of the disease. The purpose of this study is to examine hope and related factors as predictors of the stigma-induced negative discrimination experience of patients with primary malignant brain tumor. METHODS: The relational research method was used. The study was conducted in neurosurgery and oncology clinics and outpatient clinics of a university hospital in Southeastern Turkey between July 2018 and March 2020. The research data were collected using an information form, the Discrimination and Stigma Scale, and the Dispositional Hope Scale. The research sample consisted of 124 patients with primary malignant brain tumor. The data were analyzed by stepwise multiple linear regression analysis. RESULTS: The average age of the patients with primary malignant brain tumor was 46.64 (±12.00) years. Of all the patients, 61.3% were male, and 25% received radiotherapy. When the negative discrimination experience of patients with primary malignant brain tumor was examined, age (β = −0.244, P = .004), total dispositional hope (β = −0.225, P = .009), and currently receiving radiotherapy (β = 0.169, P = .048) were determined to be significant predictors. CONCLUSION: This study demonstrates the importance of hope, age, and treatment type in the negative discrimination experience of patients with primary malignant brain tumor. Initiatives taking hope into account should be planned by nurses and healthcare professionals to reduce patients' experience of negative discrimination.
Impacts of a Re-designed Care Path for Back Pain Directing Patients to Physiotherapists
Authors: Kiljańska Małgorzata , Soszyński Piotr , Motyl Agnieszka , Walewska-Zielecka Bożena
Published: February 2021

Objective:

To evaluate impact of directing patients with back pain for first visit to a physiotherapist on sick leaves, healthcare utilization, and patient satisfaction.

Methods:

Pre–post intervention study of 70,138 patients treated in Poland for back pain: 27,034 before the care pathway redesign and 43,104 after.

Results:

After the redesign, all per-patient measures (mean ± SD) significantly decreased over the 12-month follow-up: sick leaves number from 0.32 ± 0.87 to 0.29 ± 0.86, sick leaves days from 2.78 ± 11.56 to 2.56 ± 11.25, doctors’ visits from 2.02 ± 1.70 to 1.51 ± 1.63, diagnostic imaging services from 0.63 ± 0.79 to 0.43 ± 0.71 and rehabilitation services from 7.55 ± 14.90 to 4.70 ± 12.61.

The Net Promoter Score was higher for physiotherapist (83), than for orthopedists (59), primary care (74), or neurologists (67).

Conclusions:

Involving physiotherapists early in the back pain care may result in benefits for patients and healthcare organizations.
Determining the Best Time to Integrate Opioid Use Disorder Training into the Curriculum Based on Student Perceptions
Authors: Brown Sheena D. , Solh Tia M.
Published: February 2021

Purpose

The clinical phase of physician assistant (PA) education has been reported to be the best time period to deliver opioid prescribing education (OPE) and opioid addiction education (OAE); however, there are no current published studies that evaluate the timing of OPE and OAE instruction in PA curricula.

Methods

This pilot study compared didactic and clinical phase cohorts' perceived confidence in their ability to evaluate patients with opioid use disorder (OUD) after receiving identical training at different time points within the curriculum.

Results

As expected, clinical phase students displayed high confidence levels in their abilities both before and after implementation of OUD-focused patient simulations. Interestingly, didactic phase students' confidence levels were comparable to clinical phase students' confidence levels after participating in the patient simulations.

Conclusions

Our findings suggest that students can benefit from this training in both phases of the curriculum, which may encourage and help PA programs to insert this important and timely information into their curriculum.
Technical Report: Gait Performance at Two Speeds and Carrying Capacity by Men with an Osteomyoplastic Transfemoral Limb and Comparable Controls
Authors: Dionne Carol P. , Regens James L. , Day Jonathan D. , Fagg Andrew H. , Bryant Douglas J. , Veirs Kimberly P. , Ertl William J.J.
Published: February 2021

Introduction

With advances in surgical approach like osteomyoplastic amputation, it is unknown whether outcomes of walking at different speeds or carrying performance by men with an osteomyoplastic transfemoral limb (OTFL) are comparable with those of intact controls.

Materials and Methods

Otherwise healthy men with unilateral OTFL and intact controls consented to participate. All were independent walkers without history of diabetes or other dysvascular condition. All underwent 2-minute walk tests (2MWTs) at self-paced and brisk-paced speeds and 25-ft carry-to-capacity testing as part of a multiyear work performance study. For the current report, investigators compared walking and carrying baseline outcomes between OTFL and control groups.

Results

Six men with OTFL (mean age, 33.7 ± 14.8 years) and 20 controls (mean age, 31.7 ±11.1 years) completed the study. No initial differences between groups were found in age, height, weight, heart rate, blood oxygen saturation, hemoglobin A1c, overall reported pain, or report of perceived exertion scores. However, the OTFL group walked shorter mean distances at self-paced (137.2 ±18.1 m) and brisk-paced (167.8 ± 20.3 m) 2MWTs than the controls did (self-paced, 155.7 ± 19.9 m, P = 0.015; brisk paced, 211.7 ± 3.0 m, P < 0.0001) and demonstrated less 25 ft-carry capacity (18.1 ± 9.7 kg) than the controls did (26.8 ± 3.1 kg; P = 0.001). Reported pain by the OTFL group was greater only during carry testing (P < 0.046).

Conclusions

Despite receiving similar, well-fitted prosthetic limbs and standard rehabilitation after osteomyoplastic amputation, the OTFL group demonstrated lower walking and carrying capacities than a comparable control group. Results may reflect that the OTFL group may still be at risk of injury, demonstrating the need for further investigation of gait and other work performance outcomes by work-eligible men with OTFL and standard rehabilitation approaches.
Can an Outpatient Exercise Program for Pregnancy-Related Pelvic Girdle Pain Improve Pain and Function Versus Education? A Feasibility Study
Authors: Guan Jennifer , Hamnett Claire , Jakucionis Samantha , Hameed Farah , Chiarello Cynthia
Published: February 2021

Introduction:

Pregnancy-related pelvic girdle pain (PRPGP) is a type of low back pain located between the posterior iliac crest and the gluteal fold that is exacerbated with load transfer activities and may be due to inadequate muscle activation and laxity. PRPGP affects a high percentage of pregnant women and can continue to persist postpartum.

Objectives:

The purpose of this study was to determine the feasibility for women with PRPGP to perform exercises designed to target core musculature throughout their pregnancy. Exercise and education (EE) was compared with education alone (EA).

Study Design:

This pilot study is a longitudinal, 2-group, repeated-measure, time series design.

Methods:

Women with PRPGP were randomly assigned to the EE group or the EA group. Pain and function were measured with the Numeric Pain Rating Scale and the Pelvic Girdle Questionnaire (PGQ), respectively, beginning at 20 to 28 weeks' gestation for 5 total sessions.

Results:

There was a significant main effect of session for group, as both EE and EA demonstrated a decrease in current pain (P = .019), worst pain (P = .007), and an increase in the PGQ (P = .0001) over time. There was no statistical difference between the groups. Best pain was not significant (P = .174).

Conclusions:

Women with PRPGP improved in pain and function from their second trimester to 6 weeks postpartum regardless of group assignment. This suggests that this population may benefit from additional education and a targeted exercise program for core musculature. Future research is needed to confirm these findings.

(see the Video, Supplemental Digital Content 1, which is the video abstract, available at: http://links.lww.com/JWHPT/A42).
Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care
Authors: Carpenter Joan G. , Ersek Mary
Published: February 2021

Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve geriatric NPs' knowledge and skills related to palliative care and to provide a structured protocol for integrating palliative care encounters into NPs' practice. It comprised three phases consisting of asynchronous online learning modules, a 1-day face-to-face communication skills and patient simulation workshop, and ongoing monthly virtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. Through an online survey and face-to-face feedback, NPs reported satisfaction with the curriculum and expressed it as valuable to their clinical practice. Future work will focus on sustaining implementation of the program, measuring patient level outcomes, and refining the curriculum based on NP feedback.
Clinical Challenges in Managing Cervical Intraepithelial Neoplasia 2: A Report From a Cross-sectional Survey
Authors: Bradbury Melissa , Centeno Cristina , Pérez-Benavente Assumpció , Gil-Moreno Antonio
Published: February 2021

Objectives

The aims of the study were to determine the management strategies offered to women with cervical intraepithelial neoplasia 2 (CIN 2) and the attitude of colposcopists toward its histological diagnosis and to identify the criteria used to select women for conservative management.

Methods

Colposcopists working in Spain were invited to participate in an online questionnaire via the Spanish Gynecology and Colposcopy Societies. The survey included 42 questions covering the 3 objectives of the study. One hundred eighty-two colposcopists representing all autonomous regions in Spain responded. The response rate was 26.2%, considering the total number of members.

Results

Most colposcopists offer conservative management in selected cases (153/182). The preferred follow-up interval is 6 months (65%), followed by 3–4 months (30%). Observation was considered no longer appropriate after 24 months (29.5%) and 12 months (26.3%), and 24.3% expressed that it depended on women's plan to conceive. During conservative management, 93.9% always perform a cytology, 62.7% human papillomavirus testing, 96.8% colposcopy, 47.9% cervical biopsy, and 28.1% endocervical curettage. Forty-five percent consider that CIN 2 merely represents a misclassified CIN 1 or CIN 3, whereas 46.2% think that CIN 2 lesions are unlikely to regress. Most respondents considered that age older than 40 years (81.3%), human papillomavirus 16 infection (62.1%), HIV infection (76.8%), positive p16 immunostaining (60.2%), a large lesion occupying more than 50% of the cervix (87%), endocervical involvement (91.6%), and previous treatment for CIN 2–3 (77%) are contraindications for conservative management.

Conclusions

Management of CIN 2 remains challenging for colposcopists, and a lack of consensus still exists in clinical practice. A better understanding of the natural history of CIN 2 and its clinical outcomes is still necessary to guide clinicians in its management.