bluuebunny/crossref_metadata_2025 huggingface dataset:
A Scoping Review of Predictors of Community Integration Following Traumatic Brain Injury: A Search for Meaningful Associations
Authors: Kersey Jessica , Terhorst Lauren , Wu Chao-Yi , Skidmore Elizabeth
Published: November 2018

Objective:

The purpose of this scoping review was to identify predictors of community integration for adults with traumatic brain injury.

Data Sources:

We searched the PubMed and PsycINFO databases and reviewed references of included studies. We selected studies exploring multiple components of community integration, including instrumental activities of daily living, leisure activities, and social activities. A total of 53 studies were included.

Data Extraction:

We extracted data on sample size and sample characteristics (stage of injury and recovery, severity) and examined predictor variables, outcome measures for community integration, and significant findings, reported as correlations.

Data Synthesis:

We found that the predictors of community integration fell into 4 categories: demographics, injury characteristics, disability and impairments, and environmental factors. There was large variability in reported relationships for demographics (r = 0.01-0.43), injury characteristics (r = 0.01-0.58), disability/functional impairments (r = 0.003-0.98) and environmental factors (r = 0.11-0.58). Cognition, disability, mobility/physical functioning, mood, social support, and length of posttraumatic amnesia had the strongest relationships with community integration outcomes.

Conclusions:

Strategies for the management of cognitive, physical, and emotional functioning, and building and training a strong support system, may facilitate community integration outcomes. Additional work is warranted to further explore the discrepancies found among studies.
High-Sensitivity C-Reactive Protein: Retrospective Study of Potential Blood Biomarker of Inflammation in Acute Mild Traumatic Brain Injury
Authors: Shetty Teena , Cogsil Taylor , Dalal Aashka , Kim Esther , Halvorsen Kristin , Cummings Kelianne , Nguyen Joseph T.
Published: November 2018

Objective:

A panel of biomarkers is needed to definitively diagnose mild traumatic brain injury (mTBI). There is a clear role for the inclusion of an inflammatory biomarker. This study looked to find a relationship between high sensitivity C-reactive protein (hsCRP), an inflammatory biomarker, and mTBI.

Setting:

Neurology department of high-volume tertiary orthopedic hospital.

Participants:

Individuals diagnosed with mTBI (n = 311, age 21 ± 12 years, 53% female).

Design:

Retrospective cohort study.

Main Measures:

hsCRP levels; postconcussive symptoms; demographics.

Results:

Continuous hsCRP levels were transformed into quartiles, as defined by less than 0.200 mg/L for quartile 1 (Q1); 0.200 to 0.415 mg/L for quartile 2 (Q2); 0.415 to 1.100 mg/L for quartile 3 (Q3); and greater than 1.100 mg/L for quartile 4 (Q4). Mean hsCRP was elevated in the cohort of individuals who presented within 1 week of injury and was found to significantly decrease between the first visit and 4 weeks postinjury (P = .016). Initial hsCRP level was positively correlated with age (r = 0.163, P = .004), and age significantly increased between quartiles (P = .013). Patients with increased age (odds ratio: 3.48) and those who endorsed headache (odds ratio: 3.48) or fatigue (odds ratio: 2.16) were significantly associated with increased risk of having an hsCRP level in Q4.

Conclusion:

hsCRP may be a viable addition to acute and longitudinal biomarker panels for diagnosis and prognosis of mTBI.
Association of Iris Damage With Reduction in Corneal Endothelial Cell Density After Penetrating Keratoplasty
Authors: Ibrahim Osama , Yagi-Yaguchi Yukari , Kakisu Koji , Shimazaki Jun , Yamaguchi Takefumi
Published: November 2018

Purpose:

To evaluate the effect of iris damage on endothelial cell loss in the early phase after penetrating keratoplasty (PKP).

Methods:

This prospective consecutive study included 74 patients who underwent PKP without graft rejection during the follow-up period. Endothelial cell density (ECD) was measured using specular microscopy at 1, 3, 6, and 12 months after PKP. Iris damage scores (IDSs) were determined on the basis of slit-lamp microscopy or anterior segment optical coherence tomography imaging. Graft survival rates were compared among the different IDSs. Using multivariate analysis, the factors influencing postoperative ECD were assessed, taking into consideration the presence of glaucoma, history of graft failure, donor age, and graft ECD as independent variables.

Results:

Graft ECD decreased from 2674 ± 329 cells/mm2 to 2114 ± 570 at 1 month, 1907 ± 629 at 3 months, 1669 ± 738 at 6 months, and 1404 ± 792 at 12 months (all, P < 0.0001). ECD at 12 months was associated with the IDS (β = −0.444, P < 0.0001), graft ECD (β = 0.309, P = 0.003), and history of graft failure (β = −0.251, P = 0.016). The IDS was significantly correlated with %ECD loss at 1 month (r = 0.427, P = 0.003), at 3 months (r = 0.376, P = 0.002), at 6 months (r = 0.301, P = 0.013), and at 12 months (r = 0.517, P < 0.0001). The graft survival rates in eyes with severe iris damage were significantly lower than those in eyes with either no or mild iris damage (P < 0.0001).

Conclusions:

Severe iris damage is associated with rapid reduction in ECD and graft endothelial failure after PKP.
High-density Bacterial Nasal Carriage in Children Is Transient and Associated With Respiratory Viral Infections—Implications for Transmission Dynamics
Authors: Thors Valtyr , Christensen Hannah , Morales-Aza Begonia , Oliver Elizabeth , Sikora Paulina , Vipond Ian , Muir Peter , Finn Adam
Published: November 2018

Background:

This longitudinal study describes the associations between respiratory viral infections, rhinitis and the prevalence and density of the common nasopharyngeal bacterial colonizers, Streptococcus pneumoniae (Sp), Moraxella catarrhalis (Mc), Haemophilus influenzae (Hi) and Staphylococcus aureus.

Methods:

In an observational cohort study, 161 children attending day care centers in Bristol, United Kingdom, were recruited. Monthly nasopharyngeal swabs were taken and stored frozen in Skim-milk, tryptone, glucose and glycerin broth (STGG) broth. Quantitative polymerase chain reaction was used for detection of respiratory viruses and 4 bacterial species. t tests and logistic regression models were used for analysis.

Results:

The frequent colonisers, Sp, Mc and Hi were more frequently found at high density in contrast to Staphylococcus aureus although temporally, high-density carriage was short lived. Respiratory viral infections and symptoms of rhinitis were both independently and consistently associated with higher bacterial density with an observed 2-fold increase in density for Sp, Mc and Hi (P = 0.004–0.017).

Conclusions:

For Sp and Hi, the association between young age and higher bacterial DNA density was explained by more frequent viral infection and increased nasal discharge, while the associations between some viral specie’s and some bacterial species’ density appear to be stronger than others. Increased colonization density and rhinitis may promote transmission of these commonly carried organisms.
Psychometric Testing of a Measure of Patient Experience in an Ambulatory Surgery Setting
Authors: Fulton Bradley R. , Sternke Elizabeth A. , Ayala Louis , Malott Donald L.
Published: November 2018

The purpose of this research was to develop a psychometrically sound survey for use with the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Services (OAS CAHPS) survey. Both an exploratory pilot and a confirmatory pilot were conducted in hospital outpatient departments and freestanding ambulatory surgery centers eligible for participation in the OAS CAHPS program. Analyses indicated an internally consistent and valid 18-item survey with 6 measures, including Access, Moving Through the Visit, Nurses, Anesthesiologist, Doctor, and Coordinated Care. The measures are small, maximizing the number that can be used along with the OAS CAHPS survey, given Centers for Medicare & Medicaid Services restrictions.
Mathematical Models of Sleep and Circadian Rhythms: A Case for Using the 2-Process Model in Neuroscience Nursing
Authors: Mithani Sara , Fink Anne M.
Published: November 2018

Acute and chronic neurological disorders impair sleep. Despite the availability of theoretical/mathematical frameworks about sleep, the nursing profession rarely incorporates these models. The purpose of this article was to analyze the 2-process model of sleep regulation using Fawcett and DeSanto-Madeya’s method, a systematic approach for determining whether a theory is relevant to nursing. The 2-process model has 3 concepts: process S (sleep-dependent process), process C (circadian-timing–dependent process), and total sleep propensity (summation of processes S and C). Nonnursing theories do not explicitly incorporate nursing metaparadigm concepts—person, health, environment, and nursing—but the 2-process model is congruent with nursing’s philosophy. The model guided studies quantifying sleep and circadian patterns in other fields, and nurses could use this framework to measure the impact of nursing interventions. Strengths of the 2-process model include parsimony (conciseness without oversimplification) and the ability to empirically test propositions related to processes S and C. The 2-process model is relevant to neuroscience nursing—by measuring sleep/circadian-related variables (electroencephalogram, core body temperature, salivary melatonin). Nurses have opportunities to design, test, and use interventions that improve sleep in patients with neurological conditions.
Alcohol Consumption as a Moderator of Anxiety and Sleep Quality
Authors: CHUEH Ke-Hsin , GUILLEMINAULT Christian , LIN Chia-Mo
Published: November 2018

Background:

Although people who sleep poorly may attempt to relieve anxiety for better sleep quality, whether daily alcohol consumption is a factor that moderates anxiety and sleep disturbance is not known.

Purpose:

The aim of the study was to explore (a) the association between anxiety and sleep quality and (b) whether daily alcohol consumption acted as a moderator between anxiety and sleep quality in those who reported sleeping poorly.

Methods:

Eighty-four participants aged 20–80 years who reported poor sleep (Pittsburgh Sleep Quality Index > 5) in northern Taiwan were enrolled in this cross-sectional study. A structured questionnaire covering demographics (including daily alcohol consumption), level of anxiety, level of depression, and perceived sleep quality was used to collect data.

Results:

The participants were mostly women (72.6%). The mean age was 41.81 (SD = 12.62) years; 51.2%, 19.0%, 13.1%, and 14.3%, respectively, had minimal, mild, moderate, and severe anxiety. After adjusting for factors related to sleep quality using multiple regression analysis, receiving sleep therapy, consuming alcohol on a daily basis, and having anxiety were found to be predictors of poor sleep quality. Moreover, daily alcohol consumption was found to moderate the relationship between anxiety and sleep quality.

Conclusions/Implications for Practice:

People who sleep poorly should avoid misusing alcohol to self-treat poor sleep quality or anxiety and should instead utilize sleep hygiene education and mental healthcare. Daily alcohol consumption may be a moderator between anxiety status and sleep quality.
Prosthetic Limb User Experiences With Crossover Feet: A Pilot Focus Group Study to Explore Outcomes That Matter
Authors: McDonald Cody L. , Cheever Sarah M. , Morgan Sara J. , Hafner Brian J.
Published: November 2018

Introduction

Many different prosthetic feet are available to meet the diverse needs of people with lower-limb amputation. Current methods used to assess comparative effectiveness of prosthetic feet may not align with outcomes that are most important to people with lower-limb amputation. User participation in qualitative research is one approach to guide selection of outcome measures for clinical practice and quantitative research studies. This pilot study examined outcomes of importance to people who have used both energy storing and crossover prosthetic feet.

Materials and Methods

An in-person focus group of people with lower-limb amputation was conducted. Inclusion criteria were as follows: 18 years of age or older, lower-limb amputation, previous use of an energy storing foot and crossover foot, and a minimum of 1 year prosthesis use.

Results

Five participants with lower-limb amputation (4 males/1 female), aged 41 to 59 years (mean, 45.6 ± 7.7 years), participated in the focus group. Three participants had unilateral transtibial amputations; one had bilateral transtibial amputations; and another had bilateral involvement with a transtibial and partial-foot amputation. All participants reported daily use of a prosthesis (mean, 15.2 ± 1.1 hours). Three categories of themes arose from this focus group: direct outcomes, external influences, and indirect outcomes. Direct outcomes included balance and stability, endurance and sustained gait quality, and naturalness. External influences included peer and prosthetist interactions. Indirect outcomes included increased confidence and expanded mobility. Outcome measures available to assess identified constructs were suggested.

Conclusions

Engagement of prosthesis users through qualitative research methods can inform the choice of outcome measures used to assess clinical outcomes or evaluate the effectiveness of prosthetic devices.
Computed Tomography–Estimated Right Ventricular Function and Exercise Capacity in Patients with Continuous-Flow Left Ventricular Assist Devices
Authors: Mirza Kiran K. , Jung Mette H. , Sigvardsen Per E. , Kofoed Klaus F. , Elming Marie B. , Rossing Kasper , Gustafsson Finn
Published: November 2018

Using four-dimensional (4D) cardiac computed tomography (CCT) scans at rest and immediately after exercise, we examined the right heart chamber sizes and systolic function and its association with exercise capacity in left ventricular assist device (LVAD) recipients. Fifteen patients with HeartMate (HM) II or 3 underwent echocardiography and maximal cardiopulmonary exercise test. Subsequently, contrast-enhanced CCT scans were performed at rest and immediately after two minutes of supine 25 Watt ergometer bike exercise. Patients were (60 ± 12 years of age) 377 ± 347 days postimplant. Peak oxygen uptake (pVO2) was 15 ± 5 ml/kg/min. LV ejection fraction measured by echocardiography was 15 ± 9%. Pump speed was 9500 ± 258 in HM II and 5518 ± 388 rpm in HM 3 recipients. Resting right atrial ejection fraction (RAEF) was 18 ± 9%, and right ventricular ejection fraction (RVEF) was 36 ± 8%. During stress, RAEF was 19 ± 10%, and RVEF was 37 ± 8%. RAEF and RVEF did not correlate significantly with pVO2 at rest or during stress. Resting-RAEF and stress RAEF correlated significantly: r = 0.87, p < 0.01 as did resting RVEF and stress RVEF: r = 0.76, p < 0.01. In conclusion, resting-EF predicted stress-EF for both RA and RV in patients with an LVAD. Neither RVEF nor RAEF correlated with pVO2.
Crystalloid fluid administration was associated with outcomes in pediatric patients with severe sepsis or septic shock
Authors: Zhang Shan , Dai Xiaoke , Guo Chunbao
Published: November 2018

Intravenous fluid prescription plays an important role in sepsis management, which may be associated with patient prognosis. The objective of the present study was to determine if the administration of crystalloid fluids is associated with clinical outcome for patients with severe sepsis and septic shock.

The medical records of 79 patients with severe sepsis or septic shock at an academic tertiary care hospital between 2011 and 2016 were reviewed retrospectively. The patients were dichotomized based on the median 3-day amount of corrected crystalloid fluids as low (<193 mL/kg) versus high (>193 mL/kg). The primary outcome measure was mortality. Secondary outcome measures included length of stay in the pediatric intensive care unit (PICU), usage of mechanical ventilation, etc.

The most common bacterial pathogens were Escherichia coli and Klebsiella spp. with a strikingly high number of multidrug-resistant infections (10.1%). The most common site of infection was of abdominal origin. Patients who received larger amounts of crystalloids were more likely to have lower weight and underlying comorbidities (high PRISM score). Although fluid intake was different in the 2 groups, output volumes were almost the same; therefore, a positive fluid balance was present in the high crystalloid patients. The incidence of mortality increased as the accumulated 3-day amount of crystalloid fluids administered increased. The total length of stay in the PICU was longer for patients who received high volume crystalloid fluid (15.8 ± 7.8 days) than for patients who received the lower volume (9.7 ± 5.3 days, P = .026).

A higher amount of 3-day crystalloid administration was unfavorable for postoperative outcomes in children with sepsis and septic shock; these patients experienced higher PICU mortality, longer PICU stays, and more ventilator days. More study on the benefits and harms of fluid in children are needed to improve patient safety and the quality of care that would facilitate better outcomes.
Clinical and imaging features of vertebrobasilar dolichoectasia combined with posterior circulation infarction
Authors: Wang Feng , Hu Xiao-Yun , Wang Tao , Fang Xiang-Ming , Dai Zheng , Guo Dao-liu , Mao Xu-Qiang , Cui Zhi-Ming
Published: November 2018

This study aims to analyze the clinical and imaging features of vertebrobasilar dolichoectasia (VBD) combined with posterior circulation infarction, and to explore risk factors for the occurrence of posterior circulation infarction in VBD patients.

VBD patients were divided into 2 groups, according to the results of the imaging examination: posterior circulation infarction group and nonposterior circulation infarction group. The demographics, vascular risk factors, imaging, and other clinical data of the VBD patients were collected and retrospectively compared, and the risk factors for the occurrence of posterior circulation infarction in VBD patients were analyzed. The relationship between imaging features of the VBD blood supply artery and the infarct site was also analyzed.

A total of 56 VBD patients were included into the analysis. Among these patients, 26 patients had posterior circulation infarction. Infarction occurred in the blood supply area of the posterior cerebral artery in 14 patients. The difference in the height of the basilar artery bifurcation between patients with vertebrobasilar artery blood supply area infarction and patients with posterior cerebral artery supply area infarction was statistically significant. Hypertension and posterior circulation intracranial atherosclerosis were the risk factors for posterior circulation infarction in VBD patients.

Elevated basilar artery bifurcation is a risk factor for infarction in the posterior cerebral artery supply area in VBD patients. Posterior circulation infarction in VBD may be the comprehensive result of multiple factors, such as congenital defects of the basilar artery wall, hypertension, and atherosclerotic lesions.
Enhanced recovery care versus traditional care following laminoplasty
Authors: Li Jun , Li Hao , Xv Zheng-kuan , Wang Jian , Yu Qun-fei , Chen Gang , Li Fang-cai , Ren Ying , Chen Qi-xin
Published: November 2018

Enhanced recovery after surgery (ERAS) has been shown to shorten length of hospital stay and reduce perioperative complications in many types of surgeries. However, there has been a paucity of research examining the application of ERAS to major spinal surgery. The current study was performed to compare complications and hospital stay after laminoplasty between an ERAS group and a traditional care group.

The ERAS group included 114 patients who underwent laminoplasty managed with an ERAS protocol between January 2016 and June 2017. The traditional care group included 110 patients, who received traditional perioperative care between November 2014 and December 2015. Postoperative hospital stay (POPH), physiological function, postoperative visual analogue scale (VAS) pain score, and postoperative complications were compared between the 2 groups.

The mean POPH was significantly shorter in the ERAS group than traditional care group (5.75 ± 2.46 vs. 7.67 ± 3.45 d, P < .001). ERAS protocol significantly promoted postoperative early food-taking (8.45 ± 2.94 h vs 21.64 ± 2.66 h, P < .001), reduced the first time of assisted walking (30.79 ± 14.45 vs. 65.24 ± 25.34 h, P < .001), postoperative time of indwelling urinary catheters (24.76 ± 12.34 vs. 53.61 ± 18.16 h, P < .001), and wound drainage catheters (43.92 ± 7.14 vs. 48.85 ± 10.10 h, P < .001), as compared with the traditional care group. Pain control was better in the ERAS group than traditional care group in terms of mean VAS score (2.72 ± 0.46 vs. 3.35 ± 0.46, P < .001) and mean maximum VAS score (3.76 ± 1.12 vs. 4.35 ± 1.15, P < .001) in 3 days after surgery. The morbidity rate was 21.05% (24 of 114 patients) in the ERAS group and 20.90% (23 of 110 patients) in the control group (P = .75).

The ERAS protocol is both safe and feasible for patients undergoing laminoplasty, and can decrease the length of postoperative hospitalization without increasing the risk of complications.
A new classification of parathyroid glands to evaluate in situ preservation or autotransplantation during thyroid surgery
Authors: Su Anping , Gong Yanping , Wei Tao , Gong Rixiang , Li Zhihui , Zhu Jingqiang
Published: November 2018

The indication for autotransplantation of parathyroid glands is still controversial. A new classification of parathyroid glands based on the positional relationship among parathyroid glands, thyroid gland and thymus was created to decide in situ preservation or autotransplantation during thyroid surgery.

A retrospective study included patients with papillary thyroid cancer who underwent total thyroidectomy with bilateral central lymph node dissection between November 2014 and November 2016. According to the application of the new classification (December 2015–November 2016) or traditional method (preservation of all functional parathyroid glands in situ, November 2014–November 2015), the patients were divided into new classification and traditional groups.

The traditional method was utilized in 288 patients who underwent surgery during the first half of the study, while the new classification was applied to 249 patients during the latter half of the study. The incidence of transient hypoparathyroidism was 43.0% (107/249) in new classification group and 35.8% (103/288) in the traditional group, respectively (P = .093). The corresponding incidence of permanent hypoparathyroidism was 0.4% (1/249) and 4.5% (13/288) (P = .002).

The new classification of parathyroid glands potentially reflects the difficulty of preservation and helps to make a reasonable decision on preservation or autotransplantation of a parathyroid gland, which may minimize the incidence of permanent hypoparathyroidism.
Combination of meshed dermis graft and cultured epithelial autograft for massive burns
Authors: Hayashi Minoru , Yoshitake Kotaro , Tokunaka Ryohei , Yoshida Yuki , Oshima Mikiko , Tatsuta Sayo , Hamada Taishi , Kamitomo Ayako , Hamajima Akito
Published: November 2018

Rationale:

This study reviewed the use of a combination of meshed dermis graft and cultured epithelial autografts (CEA) made in Japan “JACE” (JACE; Japan Tissue Engineering Co., Ltd. Japan) for the treatment of massively burns. JACE is a Green-type CEA. We recently described a method in which we prepare the wound bed for burned patients by using artificial dermis and graft with JACE on a meshed 6:1 split-thickness autograft. In this report, we used a meshed 3:1 split-thickness dermis graft without epithelial cells. There are several reports of combination of using CEA on meshed split-thickness autograft, however this is the first report of using CEA on meshed split-thickness dermis graft.

Patient concerns and diagnosis:

Between March 2015 and August 2017, 3 burn patients were enrolled in this study. The patients ranged in age from 51 to 66 years. All 3 patients suffered severe burn injury that caused by flame. % Total Body Surface Area (TBSA) burned were ranged from 37.5% to 69%.

Interventions:

All patients received surgical treatment with tangential excision within a week from admission. We implanted artificial dermis immediately after debridement. Basically, we applied meshed 6:1 split-thickness autografts to the wound bed and covered with JACE. However, in the absence of split-thickness autografts, we used a meshed 3:1 split-thickness dermis graft instead of a meshed 6:1 split-thickness autograft.

Outcomes:

At 3 weeks after the transplantation of JACE, the take rate for JACE sheets was >60% on the meshed 3:1 split-thickness dermis graft. Furthermore, almost all of the burn wounds had healed at 6 weeks after surgery.

Lessons:

We observed good results by grafting JACE on meshed 3:1 dermis graft. With this new method, it is possible to cover a large burn wound by harvesting tissue from only a small site.
Comparison of the effects of different positive end-expiratory pressure levels on respiratory mechanics and oxygenation in laparoscopic surgery
Authors: Wang Min , Geng Nan , Gao Ya , Zhang Yan , Wang Yingbin , Shen Xiping , Tian Jinhui , Wang Bo
Published: November 2018

Background:

Several studies have observed the good effects of positive end-expiratory pressure (PEEP) application in laparoscopic surgeries, such as counteracted intraoperative atelectasis, improved respiratory mechanics, and gas exchange. However, evidence of systematic comparisons of different PEEP levels is short, and the optimal level of PEEP during laparoscopy remains unknown and controversial. The study aims to compare the effects of different PEEP levels on respiratory mechanics and oxygenation in laparoscopic surgery using network meta-analyses.

Methods:

To identify relevant studies, a systematic search will be conducted among electronic databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. We will include randomized controlled trials (RCTs). The risk of bias in the included RCTs will be assessed using the Cochrane bias risk tool. Network meta-analysis will be performed using STATA 15.0, and R 3.4.1 software.

Results:

This study is ongoing and the results will be published in a peer-reviewed journal.

Conclusion:

The results of this study will be sent to clinicians and healthcare providers in the National Health Service, which is expected to help clinicians make more informed treatment decisions and facilitate further research on the use of PEEP during surgery.

PROSPERO registration number:

CRD42018093537.
Endoscopic repair of spontaneous esophageal rupture during gastroscopy
Authors: He Feiyun , Dai Mugen , Zhou Jiwang , He Jiansheng , Ye Bin
Published: November 2018

Rationale:

Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy.

Patient concerns:

A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. During the gastroscopy, he vomited severely, which was followed by severe left chest pain radiating into the back and upper abdomen. The diagnosis was made by computed tomography (CT) scan without delay. Enhanced CT showed extensive mediastinal emphysema, a small amount of left pleural effusion, and a 6 cm tear was confirmed in the lower esophagus posteriorly.

Diagnoses:

The patient was diagnosed with an intrathoracic rupture type of spontaneous esophageal rupture.

Interventions:

The patient received endoscopic suturing techniques under endotracheal intubation, titanium clip clamping, and over the scope clip (OTSC) sealing.

Outcomes:

The procedure was smooth and the patient recovered well after operation.

Lessons:

During gastroscopy, the risk of esophageal rupture should be considered due to sudden pain caused by severe nausea and vomiting. Esophageal rupture can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.
Management of placental site trophoblastic tumor
Authors: De Nola Rosalba , Schönauer Luca Maria , Fiore Maria Grazia , Loverro Matteo , Carriero Carmine , Di Naro Edoardo
Published: November 2018

Rationale:

Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000–100,000 pregnancies representing only 0.23% to 3.00% of all GTDs.

Patient concerns:

Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second one originated 5 years after a miscarriage in 43-year-old woman, para 1031 with a previous diagnosis of breast cancer, and shared some features with placental site nodule (PSN), a benign condition.

Diagnosis:

The first case had a difficult diagnosis because there was an amenorrhea of 11th week with high serum beta-human chorionic gonadotropin (beta-HCG) and an initial ultrasound image of vesicular mole. After the Dilatation and Curettage, histology confirmed the previous hypothesis. However, the final histology of PSTT was obtained after major surgery. On the contrary, the diagnosis of the second case was less challenging but surprising, thanks to a routine trans-vaginal ultrasound showing a suspicious endometrial thickness positive for PSTT at a subsequent hysteroscopic guided biopsy.

Interventions:

The treatment consisted of hysterectomy and subsequent follow up. Lymphadenectomy or lymph node sampling were not performed due to the initial stage of the disease.

Outcomes:

In the first case, there were high values of serum beta-HCG that plummeted after the surgery, whereas in the second one they had been always negative. Hereafter, both went through a follow up with periodic serum oncological markers, imaging studies and clinical evaluation, which have showed negative result for 3 years and 15 months, respectively.

Lessons:

A detailed gynecological ultrasound examination could be extremely helpful to understand the next diagnostic step of echo-guided D&C or hysteroscopic biopsy and for a pre-operative staging assessment. On the contrary, determining the serum beta-HCG's curve is crucial just in case of an initial positive value to pursue clinical evaluation and follow-up. In case of good prognostic factors, the main therapy remains hysterectomy.
Outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar and transforaminal approaches in the treatment of L5-S1 disc herniation
Authors: Hua Wenbin , Zhang Yukun , Wu Xinghuo , Gao Yong , Li Shuai , Wang Kun , Zeng Xianlin , Yang Shuhua , Yang Cao
Published: November 2018

The purpose of this retrospective study was to assess the clinical outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar approach versus the transforaminal approach under general anesthesia in the treatment of L5-S1 disc herniation.

Sixty patients with L5-S1 disc herniation were non-randomly recruited and assigned into two groups. One group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the interlaminar approach under general anesthesia, while the other group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the transforaminal approach under general anesthesia. The operative time, fluoroscopy time, and perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 18 months postoperatively.

The mean operative time and fluoroscopy time in the interlaminar group were significantly shorter compared with those in the transforaminal group. The mean VAS and ODI postoperative scores were significantly improved over the preoperative scores in both groups. According to the MacNab classification system, more than 90.0% of the patients achieved an excellence/good rating in both groups. An intraoperative epineurium injury occurred in both groups. The total recurrence rate during 18 months follow-up was 3.3% in the interlaminar group and 0% in the transforaminal group.

It is efficient and safe to perform discectomy by using full-endoscopic visualization technique via both interlaminar and transforaminal approaches under general anesthesia in patients with L5-S1 disc herniation. Discectomy performed by using full-endoscopic visualization technique via the interlaminar approach requires a shorter operative time and suffers less radiation exposure than the transforaminal approach.
Importance of prognostic value of neutrophil to lymphocyte ratio in patients with ST-elevation myocardial infarction
Authors: Park Jin-Sun , Seo Kyoung-Woo , Choi Byoung-Joo , Choi So-Yeon , Yoon Myeong-Ho , Hwang Gyo-Seung , Tahk Seung-Jea , Shin Joon-Han
Published: November 2018

The ratio between the absolute number of neutrophils and the number of lymphocytes (NLR) has recently emerged as a potential new biomarker predicting worse clinical conditions ranging from infectious disease to cardiovascular disease. Prognostic significance of NLR in patients with ST-elevation myocardial infarction (STEMI) is not established. This study aimed to investigate prognostic impact of NLR in patients with STEMI.

We analyzed the data and clinical outcomes of 30-day survivors with STEMI who received successful coronary intervention from 2006 to 2010. NLR was computed from the absolute values of neutrophils and lymphocytes from the complete blood count at admission. Occurrence of major adverse cardiovascular events (MACEs; death, recurrent MI, target vessel revascularization (TVR)) at 5 years was evaluated.

We enrolled 326 patients and mean follow-up duration was 68 ± 36 months. The mean NLR was 4.7 ± 5.2. Among all patients, all-cause mortality occurred in 46 patients (14%). Initial NLR was higher in patients who experienced all-cause mortality (6.39 ± 8.9 vs 4.2 ± 3.1, P = .004). In a multivariate regression model, the higher NLR was independently associated with increased risk for all-cause mortality (Hazard ratio, 1.085; 95% confidence interval, 1.002–1.174, P = .044).

Increased NLR was associated increased rate of all-cause mortality in 30-day survivors after index STEMI, who received successful coronary intervention.
Genetic Profile and Microsatellite Instability in a Case of Secondary Esophageal Squamous Cell Carcinoma 12 Years After Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia
Authors: Akiyama Masaharu , Yamaoka Masayoshi , Ohyama Wataru , Yokoi Kentaro , Ashizuka Shuichi , Aizawa Daisuke , Ikegami Masahiro , Suzuki Hideaki , Ozaki Koji , Ida Hiroyuki , Yuza Yuki
Published: November 2018

We report on a 16-year-old Japanese boy in whom an esophageal squamous cell carcinoma (ESCC) developed 12 years after allogeneic hematopoietic stem cell transplantation was performed for aplastic anemia. A high frequency of microsatellite instability was detected in samples of ESCC. Moreover, the detection of pathogenic variants, including single nucleotide substitution of TP53 (c.346C>T) and BRCA2 (c.6952C>T) and splicing of KDM6A (c.1194+2T>G), suggest that the development of ESCC in the patient was triggered by impairment of checkpoint and repair for DNA damage and epigenetic modification through accumulation of gene mutations induced by chronic graft-versus-host disease and prolonged administration of tacrolimus.
Management of a Patient With Congenital Biallelic CSF3R Mutation With GM-CSF
Authors: Yilmaz Karapinar Deniz , Özdemir Hamiyet Hekimci , Akinci Burcu , Yaşar Akkiz Şahin , Siviş Zuhal Önder , Onay Hüseyin , Özkinay Ferda
Published: November 2018

Severe Congenital Neutropenia (SCN) is a rare inherited disease characterized by an absolute neutrophil count (ANC) lower than 500/μL. Genetic heterogeneity and biallelicCSF3Rmutation has rarely been identified as an underlying genetic defect in SCN. The majority of SCN patients respond to granulocyte colony stimulating factor treatment; however, in patients with inheritedCSF3Rmutation, ANC cannot generally be increased with granulocyte colony stimulating factor treatment. In such cases, granulocyte macrophage colony stimulating factor presents as an effective treatment option. Herein, we report a case of a 5-year-old SCN girl with homozygous c610-611 del ins AG (p.Q204R) mutation in theCSF3Rgene, who was successfully treated with granulocyte macrophage colony stimulating factor.
Choosing Medicare Advantage Plans Versus Traditional Fee-for-Service: Is This Change the Tipping Point?
Authors: Powell Suzanne K.
Published: November 2018

Beginning in 2019, the Centers for Medicare & Medicaid Services is expanding the definition of “primarily health-related.” Under the new definition, Medicare Advantage Plans allow beneficiaries supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency department utilization. At the discretion of the plan, this could expand the scope of permitted services to include things such as nonskilled in-home workers, portable wheelchair ramps, and other assistive devices.
Constructing a Sensitizing Definition of Certification in Nursing for Research Purposes
Authors: Chappell Kathy , Jeong Dahn , ElChamaa Rima , Lundmark Vicki , Kendall-Gallagher Deborah , Salt Elizabeth , Newhouse Robin , Johantgen Meg , Reeves Scott , Moore Donald , Olson Curtis , Van Hoof Thomas , Price David , Campbell Craig , Danilovich Natalia , Kitto Simon
Published: November 2018

OBJECTIVE

The aim of this study was to construct a sensitizing definition of certification in nursing for research purposes that can provide a foundation from which to further develop a coherent research program building evidence about the impact of certification on healthcare outcomes.

BACKGROUND

The lack of a single definition of certification in nursing makes it difficult to draw conclusions about the relationship between specialty certification and patient outcomes.

METHODS

This study was guided by the Delphi-Chaffee hybrid methodology proposed by Grant et al.

DISCUSSION

Constructing a single, sensitizing definition of certification: 1) provides coherency for direction of certification research; 2) serves as a guide for researchers; and 3) facilitates multimethodological approaches to exploring the relationship among the different components of the definition of certification.

CONCLUSION

A sensitizing definition of certification provides an opportunity for researchers to study the relationship between nursing certification and patient outcomes.
Assessing Compassion Fatigue Risk Among Nurses in a Large Urban Trauma Center
Authors: Wijdenes Kati L. , Badger Terry A. , Sheppard Kate G.
Published: November 2018

OBJECTIVE

This study evaluated the prevalence and severity of compassion fatigue (CF) risk among nurses employed in a large southwestern hospital system.

BACKGROUND

Compassion fatigue is defined as multifaceted exhaustion stemming from untreated distress that leads to physical and emotional problems. Low morale, increased medication errors, and higher turnover can result.

METHODS

A descriptive design was used to identify: 1) the prevalence and severity of CF risk among a sample of registered nurses; and 2) the differences in demographic characteristics correlated with CF risk.

RESULTS

Forty-six percent of nurses reported moderate to high CF risk. Compassion fatigue risk was significantly associated with years of employment, unit worked, job changes, and use of sick days.

CONCLUSION

This study reports new knowledge about compassion fatigue, established risk profiles across clinical units, and clarified optimal timing for interventions for those at the highest risk for CF.
Pilot Evaluation of a Functional Pain Assessment Scale
Authors: Halm Margo , Bailey Christie , St. Pierre Jeanne , Boutin Nancy , Rojo Susan , Shortt Melissa , Theobald Lisa , Pettycrew Elena
Published: November 2018

Purpose/Aims:

Common pain assessment tools measure intensity, ignoring other dimensions of pain like function. The aim of this study was to test the psychometric properties of a newly developed functional pain assessment scale (FPAS) for use in clinical practice.

Design/Methods:

In this descriptive correlational study, an FPAS was developed and then evaluated against 2 validated pain tools in 68 hospitalized adult patients experiencing acute and/or chronic pain. These tools included the numeric pain rating scale and a 100-mm visual analog scale.

Results:

The FPAS was significantly correlated (ρ= 0.72–0.87;P< .001) with the numeric pain rating scale and visual analog scale in cognitively intact patients but not the cognitively impaired (ρ= 0.22–0.34;P> .05). Test-retest reliability coefficients for the 3 scales were high (ρ= 0.82–0.94;P< .001), demonstrating stability of the measures. Overall, patients preferred the FPAS; this preference was significantly greater in patients older than 40 years.

Conclusions:

This pilot study provided support for the reliability and validity of the FPAS in cognitively intact patients experiencing pain. Although more research is needed, clinicians may consider using the FPAS with cognitively intact adults to assess the functional impact of pain on pain intensity. Clinical nurse specialists play a pivotal role in role modeling and guiding the introduction and testing of new assessment approaches into clinical practice settings across the continuum of care.
Novel PLAG1 Gene Rearrangement Distinguishes a Subset of Uterine Myxoid Leiomyosarcoma From Other Uterine Myxoid Mesenchymal Tumors
Authors: Arias-Stella Javier A. , Benayed Ryma , Oliva Esther , Young Robert H. , Hoang Lien N. , Lee Cheng-Han , Jungbluth Achim A. , Frosina Denise , Soslow Robert A. , Antonescu Cristina R. , Ladanyi Marc , Chiang Sarah
Published: November 2018

Genetic alterations in uterine myxoid leiomyosarcoma are unknown. We investigate the clinicopathologic features of 19 uterine tumors previously diagnosed as myxoid leiomyosarcomas in which tumoral RNA was subjected to targeted RNA sequencing.PLAG1,BCOR,BCORL1,HMGA2, andALKbreak-apart fluorescence in situ hybridization (FISH) and BCOR, PLAG1, and ALK immunohistochemistry were performed in cases which failed or lacked fusions by sequencing. The diagnosis of myxoid leiomyosarcoma was confirmed in 15 cases after exclusion of 4 tumors withBCORandALKrearrangements. These 15 patients presented at a median age of 50 years with stage I (3), II (2), III (2), and IV (1) tumors, respectively; stage was unknown in 7 cases. Tumor size ranged from 10 to 24 cm. Matrix was myxoid in all tumors and also eosinophilic in 2. Cells were spindled, epithelioid, and both in 10, 2, and 3 tumors and showed mild, moderate, and severe nuclear atypia in 3, 8, and 4 tumors, respectively. Mitotic index ranged from <1 to 14/10 HPF, while tumor necrosis was present in 6 (40%). NovelTRPS1-PLAG1orRAD51B-PLAG1fusions were detected by sequencing in 4 tumors, 3 of which were also confirmed by FISH. Diffuse PLAG1 expression was seen in 7 tumors, including 4 withPLAG1rearrangement. No morphologic differences were seen amongPLAG1fusion-positive and fusion-negative tumors. NoPLAG1,HMGA2,ALK,BCOR, orBCORL1rearrangements were detected by FISH in 11 tumors. On the basis of sequencing and FISH results,PLAG1rearrangements resulting in PLAG1 expression underpin ~25% of myxoid leiomyosarcomas and may serve as a useful diagnostic biomarker. Immunohistochemistry, targeted RNA sequencing, and/or FISH may distinguish myxoid leiomyosarcoma from its morphologic mimics.
Percutaneous Aponeurotomy and Lipofilling versus Limited Fasciectomy for Dupuytren’s Contracture: 5-Year Results from a Randomized Clinical Trial
Authors: Selles Ruud W. , Zhou Chao , Kan Hester J. , Wouters Robbert M. , van Nieuwenhoven Christianne A. , Hovius Steven E. R.
Published: November 2018

Background:

In the Dupuytren Rotterdam randomized controlled trial, percutaneous aponeurotomy with lipofilling (PALF) was as effective as limited fasciectomy in correcting primary Dupuytren’s contracture after 1 year. The authors report the 5-year results of this trial, with a special focus on recurrence of contractures.

Methods:

The authors invited all patients who had undergone PALF or limited fasciectomy to participate in a posttrial follow-up assessment. Thirty-one PALF patients and 21 limited fasciectomy patients were assessed by an independent examiner for the degree of contracture and whether patients had undergone a secondary procedure. The primary composite endpoint was recurrence rate, defined as either 20 degrees or greater worsening in contracture (relative to week 3) or as having undergone a secondary procedure for a new or worsening contracture.

Results:

At 5 years, more joints in the PALF group than in the limited fasciectomy group had a recurrence (74 percent versus 39 percent; p = 0.002). When redefining recurrence as a worsening in total extension deficit of at least 30 degrees for treated digits as often reported, this was 77 percent versus 32 percent (p = 0.001). Total extension deficit was also worse for PALF-reated digits (53 degrees versus 31 degrees; p < 0.010).

Conclusions:

Although the authors previously reported that PALF offers a shorter convalescence and fewer long-term complications but a similar degree of contracture correction at 1-year follow-up, at 5 years, the corrections were less durable than those for limited fasciectomy. This again highlights that limited fasciectomy and different types of needle aponeurotomy have specific advantages and disadvantages to weigh by patients and clinicians.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Caregiver-Reported Outcomes and Barriers to Care among Patients with Cleft Lip and Palate
Authors: Bennett Katelyn G. , Ranganathan Kavitha , Patterson Anne K. , Baker Michaella K. , Vercler Christian J. , Kasten Steven J. , Buchman Steven R. , Waljee Jennifer F.
Published: November 2018

Background:

For children with cleft lip and/or palate, access to care is vital for optimizing speech, appearance, and psychosocial outcomes. The authors posited that inadequate access to care negatively impacts outcomes in this population.

Methods:

Sixty caregivers of children with cleft lip and palate were surveyed to assess perceived barriers using the validated Barriers to Care questionnaire. The questionnaire includes 39 items divided into five subscales, with higher scores indicating fewer barriers. Caregiver-reported outcomes were assessed using the Cleft Evaluation Profile, which captures cleft-specific appearance- and speech-related outcomes. Higher scores correspond to less satisfactory outcomes. Desire for revision surgery was assessed as a binary outcome among caregivers. Multivariable regression was used to evaluate the relationship of barriers to care, caregiver-reported outcomes, and desire for revision, adjusting for clinical and demographic covariates.

Results:

Sixty percent of caregivers perceived barriers to care, and caregivers who reported poorer access to care described poorer cleft-related outcomes (r
2 = 0.19, p = 0.024). Caregivers with poorer skills (r
2 = 0.17, p = 0.037), expectations (r
2 = 0.17, p = 0.045), and pragmatics (r
2 = 0.18, p = 0.026) subscale scores were associated with worse Cleft Evaluation Profile scores. Barriers were also negatively associated with aesthetic item scores (r
2 = 0.11, p = 0.025). Finally, caregivers reporting fewer barriers were 21.2 percent less likely to express interest in revision surgery.

Conclusions:

Barriers to care were associated with poorer appearance-related outcomes and increased interest in revision among caregivers of cleft patients. Enhancing access to care is critical in order to effectively meet goals of care for these families.