bluuebunny/crossref_metadata_2025 huggingface dataset:
Mobile Ecological Momentary Assessment of Postconcussion Symptoms and Recovery Outcomes
Authors: Sufrinko Alicia M. , Howie Erin K. , Charek Daniel B. , Elbin R. J. , Collins Michael W. , Kontos Anthony P.
Published: March 2019

Objective:

Evaluate mobile ecological momentary assessment (mEMA) as an approach to measure sport-related concussion (SRC) symptoms, explore the relationships between clinical outcomes and mEMA, and determine whether mEMA was advantageous for predicting recovery outcomes compared to traditional symptom report.

Setting:

Outpatient concussion clinic.

Participants:

20 athletes aged 12 to 19 years with SRC.

Methods:

Prospective study of mEMA surveys assessing activity and symptoms delivered via mobile application (3 time blocks daily) and clinical assessment at visit 1 (<72 hours postinjury) and visit 2 (6-18 days postinjury). Linear mixed models examined changes in mEMA symptoms over time and relationships among simultaneous report of activity type (cognitive, physical, sedentary, vestibular) and symptoms. Linear regressions evaluated the association among symptoms for activity types and clinical outcomes.

Main Measures:

mEMA symptom scores, Post-Concussion Symptom Scale, neurocognitive testing, vestibular/oculomotor screening (VOMS).

Results:

mEMA response rate was 52.4% (N = 1155) for prompts and 50.4% per participant. Symptoms were lower in the morning (P < .001) compared with afternoon and evening. Higher mEMA symptoms were reported during vestibular compared with physical (P = .035) and sedentary (P = .001) activities. mEMA symptoms were positively associated with Post-Concussion Symptom Scale (PCSS) (P = .007), VOMS (P = 0.001-0.002), and recovery time (P < .001), but not neurocognitive scores. mEMA symptom score (P = .021) was a better predictor of recovery time than PCSS at either clinic visit.

Conclusion:

mEMA overcomes barriers of traditional symptom scales by eliminating retrospective bias and capturing fluctuations in symptoms by time of day and activity type, ultimately helping clinicians refine symptom management strategies.
CLINICOPATHOLOGIC CORRELATION OF GEOGRAPHIC ATROPHY SECONDARY TO AGE-RELATED MACULAR DEGENERATION
Authors: Li Miaoling , Dolz-Marco Rosa , Huisingh Carrie , Messinger Jeffrey D. , Feist Richard M. , Ferrara Daniela , Freund K. Bailey , Curcio Christine A.
Published: March 2019

Purpose:

In an eye with geographic atrophy (GA) secondary to age-related macular degeneration, we correlated ex vivo histologic features with findings recorded in vivo using optical coherence tomography (OCT), near-infrared reflectance imaging, and fundus autofluorescence.

Methods:

In the left eye of an 86-year-old white woman, in vivo near-infrared reflectance and eye-tracked OCT B-scans at each of 6 clinic visits and a baseline fundus autofluorescence image were correlated with high-resolution histologic images of the preserved donor eye.

Results:

Clinical imaging showed a small parafoveal multilobular area of GA, subfoveal soft drusen, refractile drusen, hyperreflective lines near the Bruch membrane, subretinal drusenoid deposit (reticular pseudodrusen), and absence of hyperautofluorescent foci at the GA margin. By histology, soft drusen end-stages included avascular fibrosis with highly reflective cholesterol crystals. These accounted for hyperreflective lines near the Bruch membrane in OCT and plaques in near-infrared reflectance imaging. Subretinal drusenoid deposit was thick, continuous, extracellular, extensive outside the fovea, and associated with distinctive retinal pigment epithelium dysmorphia and photoreceptor degeneration. A hyporeflective wedge corresponded to ordered Henle fibers without cellular infiltration. The external limiting membrane descent, which delimits GA, was best visualized in high-quality OCT B-scans. Retinal pigment epithelium and photoreceptor changes at the external limiting membrane descent were consistent with our recent histologic survey of donor eyes.

Conclusion:

This case informs on the extent, topography, and lifecycle of extracellular deposits. High-quality OCT scans are required to reveal all tissue features relevant to age-related macular degeneration progression to GA, especially the external limiting membrane descent. Histologically validated signatures of structural OCT B-scans can serve as references for other imaging modalities.
SUTURELESS CLOSURE OF 23- AND 25-GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE
Authors: Felfeli Tina , Altomare Filiberto , Mandelcorn Efrem D.
Published: March 2019

Purpose:

To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery.

Methods:

A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed.

Results:

A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P < 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period.

Conclusion:

The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF CONGENITAL RETINAL MACROVESSEL WITH ANOMALOUS RETINAL ANASTOMOSIS ASSOCIATED WITH CONTRALATERAL MYELINATED NERVE FIBERS AND RETINAL VASCULAR ABNORMALITIES
Authors: Preziosa Chiara , Milani Paolo , Ciasca Paola , Bergamini Fulvio , Staurenghi Giovanni , Pellegrini Marco
Published: March 2019

Purpose:

To describe a case of congenital retinal macrovessel complicated by cystoid macular edema associated with contralateral myelinated retinal nerve fibers and retinal vascular abnormalities studied with optical coherence tomography angiography (OCTA).

Methods:

Case report.

Results:

A healthy 25-year-old woman with decreased vision in her right eye was found to have a congenital retinal venous macrovessel in the macula associated with cystoid edema. In the contralateral amblyopic eye, the examination revealed a tuft of myelinated retinal nerve fibers along the superotemporal vascular arcade associated with superficial vascular abnormalities. A complete multi-imaging examination was obtained, including fundus color photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), and optical coherence tomography angiography. At 1-week follow-up, the optical coherence tomography displayed spontaneous resolution of the edema that remained stable at consecutive 1-month follow-up.

Conclusion:

Congenital retinal macrovessels can be associated with other ocular developmental anomalies. Vascular complications can occur, leading to macular edema and retinal ischemia. Optical coherence tomography angiography can be useful for the diagnosis and follow-up of this condition.
Preventive hypothermia as a neuroprotective strategy for paclitaxel-induced peripheral neuropathy
Authors: Beh Suet Theng , Kuo Yu-Min , Chang Wun-Shaing Wayne , Wilder-Smith Einar , Tsao Chia-Hui , Tsai Chia-Hua , Chen Li-Tzong , Liao Lun-De
Published: March 2019

Chemotherapy-induced peripheral neuropathy (CIPN) is a severe adverse effect that occurs secondary to anticancer treatments and has no known preventive or therapeutic strategy. Therapeutic hypothermia has been shown to be effective in protecting against central and peripheral nervous system injuries. However, the effects of therapeutic hypothermia on CIPN have rarely been explored. We induced lower back hypothermia (LBH) in an established paclitaxel-induced CIPN rat model and found that the paclitaxel-induced impairments observed in behavioral, electrophysiological, and histological impairments were inhibited by LBH when applied at an optimal setting of 24°C to the sciatic nerve and initiated 90 minutes before paclitaxel infusion. Lower back hypothermia also inhibited the paclitaxel-induced activation of astroglia and microglia in the spinal cord and macrophage infiltration into and neuronal injury in the dorsal root ganglia and sciatic nerves. Furthermore, LBH decreased the local blood flow and local tissue concentrations of paclitaxel. Finally, in NOD/SCID mice inoculated with cancer cells, the antiproliferative effect of paclitaxel was not affected by the distal application of LBH. In conclusion, our findings indicate that early exposure to regional hypothermia alleviates paclitaxel-induced peripheral neuropathy. Therapeutic hypothermia may therefore represent an economical and nonpharmaceutical preventive strategy for CIPN in patients with localized solid tumors.
Psychiatric Nurse Practitioner Residents Improve Quality and Mental Health Outcomes for Veterans Through Measurement-Based Care
Authors: McGuinness Teena M. , Richardson Jessica W. , Nicholson W. Chance , Carpenter Jennifer , Cleveland Cynthia , Rodney Kanini Z. , Harper Doreen C.
Published: March 2019

Introduction:

Measurement-based care (MBC) is commonly used to manage medical illness, whereas only about 20% of psychiatric care providers use MBC. One aim of the partnership between the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UAB SON) is to provide MBC to Veterans. The goal is to describe the efficacy of MBC in the treatment of Veterans by psychiatric-mental health nurse practitioner (PMHNP) residents.

Purpose:

By teaching PMHNP residents evidence-based assessment, they gain tools to shorten time to remission of depression, anxiety, and posttraumatic stress disorder.

Methods:

Residents administered the Patient Stress Questionnaire (PSQ), an MBC tool that assesses depression, anxiety, trauma-related symptoms, and alcohol use, to patients of the Residency Continuity Clinic (RCC). Patient Stress Questionnaire scores from March 2016 to May 2018 were analyzed using paired t tests.

Results:

Analysis revealed a downward trend in PSQ scores over time, suggesting improvement in psychiatric symptoms. Depressive and anxiety symptoms decreased significantly.

Conclusions/Implications:

This quality project highlights the utility of MBC by PMHNP residents in an RCC. Measurement-based care tools can be quickly and easily administered with little impact on workflow. Use of validated screening tools can enhance care, engage patients, and improve patient outcomes.
Contextual Factors Associated With Quality Improvement Success in a Multisite Ambulatory Setting
Authors: Douglas Lindsey C. , Heo Moonseong , Azad Namita , Racine Andrew D. , Rinke Michael L.
Published: March 2019

The Model for Understanding Success in Quality (MUSIQ) is a framework of contextual factors for quality improvement (QI) projects. We sought to determine which MUSIQ contextual factors were associated with successful QI initiatives. In a cross-sectional survey study, at a 21-site, ambulatory, urban primary care network, a modified MUSIQ survey tool questionnaire was administered to QI team members. The primary analysis associated objective measures of QI success with MUSIQ contextual factors. Objective QI success was defined as reaching goal percentages of adult patients with diabetes achieving glycated hemoglobin less than 8% and/or pediatric patients who had received combination toddler vaccines. Objective outcomes were compared with a subjective, self-reported outcome measure of QI success because previous literature found subjective outcomes were associated with specific MUSIQ factors. In the 143 survey responses collected, across 21 sites, no contextual factors from the MUSIQ survey were associated with either the adult or pediatric objective measure of QI project success. In a post hoc analysis, objective and subjective measures of success were often not associated and/or negatively correlated. In conclusion, contextual factors were not associated with objective measures of QI outcomes, in contrast to previous studies finding associations with subjective QI outcome measures.
PD-1 immunotherapy in pancreatic cancer: current status
Authors: Pu Ning , Lou Wenhui , Yu Jun
Published: March 2019

Pancreatic ductal adenocarcinoma is the known kind of tumor biologically featured as high malignant degree, lack of effective methods for diagnosis and treatment, which reflects its unpleasant prognosis. Recently, with the breakthrough of burgeoning therapeutic methods, the flush of dawn for pancreatic cancer nearly arrives. Nowadays, besides surgery, neoadjuvant chemoradiotherapy, tumor vaccine therapy, and immunotherapy all show their active situation and obtain certain clinical efficacy, but that is still limited to pancreatic cancer. However, the appearance and development of programmed cell death-1 (PD-1) immune checkpoint inhibitor may final improve survival of pancreatic cancer. This article aims to deeply understand the value of PD-1 immune checkpoint inhibitor in pancreatic cancer and validly provide the evidence for treatment by means of performing a systematic review on the current status in the fields of the mechanism and application of anti-PD-1 in pancreatic cancer, associations with surgery, PD-1-related side effects and prospections.
Recommendations to Increase Neuromuscular Electrical Stimulation Training Intensity During Quadriceps Treatments for Orthopedic Knee Conditions
Authors: Bremner Cody B. , Holcomb William R. , Miller Michael G.
Published: March 2019

Neuromuscular electrical stimulation (NMES) is often used by clinicians as a therapeutic adjunct to improve quadriceps strength deficits following orthopedic knee conditions. The efficacy of NMES treatments is primarily dependent on the NMES training intensity, which is a direct result of NMES-induced torque production. The importance of NMES training intensity is well known, yet adequate NMES training intensities are often difficult to achieve due to a variety of limitations associated with NMES (eg, fatigue and patient discomfort). This article provides recommendations that a clinician can use to increase NMES training intensity when strengthening the quadriceps with NMES for orthopedic knee conditions. These recommendations should allow forceful contractions that can be sustained over a treatment with multiple repetitions without the rapid decline in force that is typically seen when NMES is used.
Improving perceptions of patient safety through standardizing handoffs from the emergency department to the inpatient setting: a systematic review
Authors: Alimenti Darcy , Buydos Sarah , Cunliffe Lindsay , Hunt Alexandra
Published: March 2019

Background and purpose:

Patient handoffs have long been identified as a potentially challenging time for patients because poor communication produces numerous complications. This is especially true with regards to patient care handoffs between areas such as the emergency department (ED) and inpatient setting. The purpose of this systematic review is to analyze existing literature pertaining to standardized handoffs between the ED and inpatient setting and its effect on perceived patient safety to guide future research, clinical practice, and patient safety.

Methods:

A review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected using predetermined inclusion/exclusion criteria: primary research and patient handoff from the ED to the inpatient setting. Quality assessment of the studies was completed using The Joanna Briggs Institute critical appraisal tool.

Conclusion:

Existing studies demonstrate the potential for increased perception of patient safety as well as provider satisfaction when appropriate staff education and standardized handoff tools are implemented. There is a lack of data on the standardization of handoff tools between the ED and inpatient setting and their impact on perceived patient safety.

Implications for practice:

The combination of provider education and implementation of standardized handoff tools in the ED positively affects perceptions of patient safety and provider satisfaction. Hospital administrations should strongly consider incorporating standardized handoff tools into practice.
Thematic analysis of nurse practitioners use of clinical decision support tools and clinical mobile apps for prescriptive purposes
Authors: Dodson Crystal Heath , Baker Elizabeth , Bost Kirsten
Published: March 2019

Background and purpose:

An obstacle to clinical implementation of precision medicine is the absence of easily accessible peer-reviewed, comprehensive clinical practice guidelines. Therefore, an easily accessible format is needed to propel the adoption of these guidelines by healthcare providers. An understanding of the process providers take to prescribe medications will inform development of clinical decision support tools, specifically related to precision medicine. Successful use of mobile applications will depend on the buy-in from healthcare providers. The purpose of this study was to assess perceptions of trustworthiness surrounding clinical decision support tools and mobile applications through interviews with nurse practitioners.

Methods:

A descriptive, qualitative research design was used. A sample of 10 nurse practitioners who actively prescribe medication was used within the study.

Conclusions:

The participants mentioned both negative and positive attitudes regarding these prescribing techniques. Overall four themes emerged from this thematic analysis: the use of pharmacists to help with current prescribing practices, reliance on the EMR as a clinical decision support tool, lack of mobile app use in clinical practice, but the desire to have these resources if they were affordable and reliable.

Implications for practice:

The participants were aware of the use of mobile apps for clinical decision support, but the adoption of these tools was limited due to the perceived lack of affordability and reliability. Therefore, to overcome these barriers to adoption of a mobile app related to precision medicine, affordability and transparent construction of an app grounded in credible sources must be developed.
Efficacy of the Well-Being Index to identify distress and stratify well-being in nurse practitioners and physician assistants
Authors: Dyrbye Liselotte N. , Johnson Pamela O. , Johnson LeAnn M. , Halasy Michael P. , Gossard Andrea A. , Satele Daniel , Shanafelt Tait
Published: March 2019

Background and purpose:

To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover.

Methods:

A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job.

Conclusions:

Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p < .0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job.

Implications for practice:

The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover.
Management of ketosis-prone type 2 diabetes mellitus
Authors: Smolenski Stefan , George Nancy M.
Published: March 2019

Diabetic ketoacidosis (DKA) has largely been considered unique to type 1 diabetes because of the absolute lack of insulin production secondary to beta-cell dysfunction. However, a relatively new diabetes subtype known as ketosis-prone type 2 diabetes mellitus (DM) may also elicit diabetic ketoacidosis. Ketosis-prone type 2 DM shares a similar pathophysiology as type 2 DM, but presents initially with signs and symptoms consistent with type 1 DM. Patients with ketosis-prone type 2 DM often present with elevated glucose levels of 500–700 mg/dl, elevated ketone levels, and elevations in hemoglobin A1C. Unlike DKA seen in type 1 DM, they do not exhibit autoantibodies to beta cells. The similarity with type 1 DM exists in their impaired insulin secretion, which, when combined with extreme insulin resistance, will lead to ketoacidosis. Despite the initial clinical presentation that resembles type 1 DM, patients may not require lifelong insulin and achieve appropriate glycemic control with oral agents. Nurse practitioners must recognize the clinical picture of ketosis-prone type 2 DM and use a multifaceted approach, encouraging dietary changes, increased physical activity, and medication adherence to build the self-management skills of the patient and ultimately decrease the long-term disease burden.
Evaluating quality metrics of patients with type 2 diabetes managed by nurse practitioners in two family nurse practitioner-owned clinics
Authors: Wright Wendy L. , Bachmann Jade P. , Murphy Nicole , Gifford Lauren , Strowman Shelley , White Patricia
Published: March 2019

Background:

Diabetes is a major health concern in the U.S. with increasing prevalence. There are limited data on nurse practitioner (NP) roles in diabetes management and clinical patient outcomes in relation to national standards of care. This project aimed to identify rates of American Diabetes Association (ADA) guideline adherence of two NP-owned and operated practices during an ongoing four-year quality improvement project.

Methods:

Methods: Electronic health records of 83 – 112 patients (depending on the year) ages > 18 years with type 2 diabetes were reviewed. Mean A1C and rates of adherence to ADA standards were compared from 2013 to 2017 and to national and state data.

Conclusions:

Findings demonstrated that diabetes management provided by NPs consistently adhered to national ADA standards of care and met or exceeded national data. This four-year ongoing quality improvement project has led to the implementation of practice modifications that continue to improve patient outcomes through increased adherence to ADA guidelines.

Implications for practice:

Strategies which improve adherence to ADA standards of care by NPs are essential. Identifying rates of adherence and implementing quality improvement strategies can significantly improve the quality of care provided to patients with diabetes.
Using a Laryngeal Mask Airway During Percutaneous Dilatational Tracheostomy is Safe and Obviates the Need for Paralytics
Authors: Sonti Rajiv , Sanley Michael , Vinayak Ajeet
Published: March 2019

Background:

Bedside percutaneous tracheostomy (PT) placement in critically ill patients is performed in a variety of ways, largely driven by institutional preference. We have recently transitioned to primarily extubating the patient and placing a laryngeal mask airway (LMA) before tracheostomy insertion in lieu of retracting the endotracheal tube (ETT) in place. This allows for lower sedative use and provides a superior view of the operative field. Here, we seek to describe the safety and efficiency of that approach.

Methods:

This is a single-center cross-sectional study from 2014 to 2016 comparing patients who underwent PT with the ETT in place retracted to the proximal larynx versus those who were extubated and had a LMA placed. Procedural length, sedative totals, and safety outcomes were recorded.

Results:

In total, 125 patients underwent PT during the study period, 75 via a LMA and 50 via existing ETT. There was no difference in procedural duration (LMA: 53.5±21.4 min vs. ETT: 50.4±16.8; P=0.41), total complications (LMA: 29.3% vs. 16%; P=0.09) or major complications (4% in both groups). Cisatracurium use was significantly lower in the LMA arm (LMA: 1.0±3.6 mg vs. ETT: 11.5±5.9 mg; P<0.01).

Conclusion:

Replacing the ETT with an LMA before PT is equally safe, does not increase total procedural duration, and all but eliminates the need for paralytic agents.
Fiberoptic Bronchoscopic Balloon Dilatation of Bronchial Stenosis in Children
Authors: Köse Mehmet , Hangül Melih , Erkan Gözde Nur , Narin Nazmi
Published: March 2019

Background:

Bronchial stenosis and treatment with balloon dilatation are rarely experienced in children. The aim of this study was to investigate the results of fiberoptic bronchoscopic balloon dilatation (BBD) in children.

Methods:

Between January 2016 and March 2018, 7 children diagnosed as having bronchial stenosis and who underwent BBD as the first treatment option were enrolled in the study.

Results:

A total of 10 BBDs were performed in 7 patients with a median age of 10 months. Underlying causes were as follows: prolonged intubation and prematurity in 4 patients, extubation failure in 2 patients, and recurrent pneumonia and malignancy in 1 patient. The only complication was laceration, seen in 2 patients. The patients were symptom free for 11 months.

Conclusion:

BBD is safe, effective, and might be the first-line treatment option for children with bronchial stenosis.
First Implant-Induced Changes in Rostral Brainstem Impair Second Implant Outcomes in Sequential Bilateral Cochlear Implant Children With Long Inter-Implant Delay
Authors: Kishimoto Ippei , Yamazaki Hiroshi , Naito Yasushi , Moroto Saburo , Yamazaki Tomoko
Published: March 2019

Hypothesis:

Long-term unilateral use of a cochlear implant (CI) induces abnormal maturation of the rostral brainstem innervating the contralateral ear.

Background:

In sequential bilateral CI children with long inter-implant delay, both sides of auditory cortices were dominantly activated by the first CI, but mechanisms of this abnormal development of the auditory system remain unclear.

Methods:

Fifteen sequential bilateral CI children with long delay (mean ± SD, 28.7 ± 12.1 mo) underwent electrically evoked auditory brainstem response (EABR) testing using each of the first and second CI (CI1 and CI2, respectively), immediately after the second implantation. CI1 and CI2 were implanted at age of 23.7 ± 9.6 and 53.1 ± 12.1 months (mean ± SD), respectively. Apical-to-basal difference in electrically evoked interwave III-V latencies (eIII-eV slope) which decreases with implant use was compared between the CI1 and CI2 sides. Their speech perception scores were evaluated 3 years after the second implantation.

Results:

eIII-eV slopes evoked by the CI2 showed less mature pattern than those by the CI1. This CI2 versus CI1 difference in eIII-eV slopes, however, reduced as the inter-implant delay was prolonged, suggesting CI1-induced maturation of the rostral brainstem innervating the second ear before the second implantation. The smaller CI2 versus CI1 difference in eIII-eV slopes at the second implantation was correlated to poorer outcomes using the CI2 than the CI1.

Conclusions:

In this population, long-term unilateral CI use induced re-organization of the rostral brainstem innervating the second ear, which affected hearing outcomes using the CI2. Evaluation of eIII-eV slopes at the second implantation may be useful to predict hearing outcomes with CI2.
Video Head Impulse Test in Vestibular Schwannoma: Relevance of Size and Cystic Component on Vestibular Impairment
Authors: Constanzo Felipe , Teixeira Bernardo Corrêa de Almeida , Sens Patricia , Ramina Ricardo
Published: March 2019

Objectives:

Tumor factors that influence vestibular function in vestibular schwannoma (VS) have not been properly described. We evaluated whether cystic VSs have different vestibular function than solid VS. Tumor size on vestibular function was also evaluated.

Study Design:

Cross-sectional study.

Setting:

Tertiary referral center.

Patients:

Forty-one cases of sporadic, untreated VS.

Intervention:

Evaluation with video head impulse test and MRI.

Main Outcome Measures:

Tumors were classified as solid, heterogeneous, or cystic and by size using the Hannover classification. Vestibulo-ocular reflex (VOR) gain was correlated to tumor size and cystic status.

Results:

Large VS had worse VOR gain than small lesions (p < 0.001). Cystic lesions had lower VOR gain than all other tumors (p = 0.001), Hannover T3 and T4 (p = 0.014), Hannover T4 (p = 0.015), solid tumors (p < 0.001), solid Hannover T3 and T4 (p = 0.003), and solid Hannover T4 (p = 0.008). Heterogeneous VSs had lower VOR gain compared to solid tumors (p = 0.02), solid Hannover T3 and T4 (p = 0.08), and solid Hannover T4 (p = 0.14). Heterogeneous and cystic VSs had lower VOR gain than solid tumors (p < 0.001), solid Hannover T3 and T4 (p = 0.004), and solid Hannover T4 (p = 0.02). VOR gain of solid T4 lesions was not significantly lower than solid Hannover T1-T3 (p = 0.33).

Conclusion:

Cystic status is directly associated with a worse vestibular dysfunction. Size did not significantly impact vestibular function in solid VS.
Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed
Authors: Cohen Helen S. , Mulavara Ajitkumar P. , Stitz Jasmine , Sangi-Haghpeykar Haleh , Williams Susan P. , Peters Brian T. , Bloomberg Jacob J.
Published: March 2019

Objectives:

Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders.

Study Design:

Case-control study.

Setting: Out-patient tertiary care.

Subjects and Methods:

Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials.

Results:

Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found.

Conclusion:

Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
The Significance of a Pale Area Via Flexible Spectral Imaging Color Enhancement in the Diagnosis of Esophageal Precancerous Lesions and Early-stage Squamous Cancer
Authors: Li Yuan , Yangjin Ciren , Shi Yanyan , Wen Yue , Jin Zhu , Cui Rongli , Zhang Hejun , Ding Shigang
Published: March 2019

Goals:

The main aim of this study was to investigate the significance of a pale area via flexible spectral imaging color enhancement (FICE) in the diagnosis of esophageal dysplasia and cancer.

Background:

The early diagnosis of esophageal squamous cancer is challenging, and the indication of Lugol’s chromoendoscopy has not yet been well established.

Study:

The esophageal mucosa of patients at our endoscopic center were sequentially evaluated with white-light endoscopy and FICE during insertion of the endoscope, followed by staining with Lugol’s solution during withdrawal. Patients were divided into 2 groups depending on whether esophageal leukoplakia was detected by white-light endoscopy and 2 groups depending on whether a pale area was detected by FICE. We compared cases of patients with abnormal iodine staining, and cases of dysplasia or cancer in esophageal leukoplakia—or pale area—positive and negative groups.

Results:

Cases of abnormal staining in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000). Cases of esophageal dysplasia and cancer in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000).

Conclusions:

Iodine staining should be performed in patients with esophageal leukoplakia or pale areas. Esophageal dysplasia and early-stage cancer were more easily detected in those with esophageal leukoplakia or pale areas.
Does Helicobacter pylori Eradication Reduce the Incidence of Metachronous Gastric Cancer After Curative Endoscopic Resection of Early Gastric Cancer
Authors: Zhao Bochao , Zhang Jiale , Mei Di , Luo Rui , Lu Huiwen , Xu Huimian , Huang Baojun
Published: March 2019

Background:

Whether Helicobacter pylori eradication could reduce the risk of metachronous gastric cancer remain controversial. In the present study, we performed a systematic review and meta-analysis to evaluate the preventive effect of H. pylori eradication on the occurrence of metachronous gastric cancer after curative endoscopic resection of early gastric cancer.

Methods:

The related studies were identified by searching PubMed and Embase databases. According to the H. pylori infection status and subsequent treatment, all patients were classified into H. pylori negative group, H. pylori eradication group and noneradication group. The relevant data were extracted and pooled effect size was assessed using a fixed effect model or a random effect model.

Results:

A total of 11 retrospective cohort studies and 3 randomized controlled trials were included in this meta-analysis. The results based on the cohort studies indicated that the risk of metachronous gastric cancer was significantly lower in H. pylori eradication group than in noneradication group (hazard ratios: 0.65, 95% confidence interval: 0.50-0.86, P=0.002; I
2=0%). The pooled result of 2 randomized controlled trials demonstrated that the patients receiving anti-H. pylori treatment had a lower risk of metachronous gastric cancer than those who did not receive H. pylori eradication treatment (hazard ratios: 0.43, 95% confidence interval: 0.26-0.70, P=0.001; I
2=0%). In addition, the occurrence of metachronous gastric cancer in H. pylori eradication group was not significantly different from that in H. pylori negative group.

Conclusions:

Successful H. pylori eradication may be useful for the prevention of metachronous gastric cancer after curative endoscopic resection of early gastric cancer. Thus, anti-H. pylori treatment should be considered for those patients with H. pylori infection after curative endoscopic resection.
Lower 90-day Hospital Readmission Rates for Esophageal Variceal Bleeding After TIPS
Authors: Rush Barret , Deol Navjot , Teriyaki Anour , Sey Michael , Jairath Vipul , Walley Keith R. , Celi Leo A. , Brahmania Mayur
Published: March 2019

Objective:

Hospital readmission rates following a transjugular intrahepatic portosystemic shunt (TIPS) insertion after an episode of esophageal variceal bleeding (EVB) has not been well studied. We aimed to address this gap in knowledge on a population level.

Methods:

The Nationwide Readmission Database (NRD) was used to study the readmission rates for patients with decompensated cirrhosis who had a TIPS insertion performed for EVB. The NRD is a national database that tracks patients longitudinally for hospital readmissions. A propensity score matching model was created to match patients who received TIPS with those who did not.

Results:

A total of 42,679,001 hospital admissions from the 2012 to 2014 NRD sample were analyzed. There were 33,934 patients with EVB who met inclusion criteria for the study, of whom, 1527 (4.5%) received TIPS after EVB and were matched with 1527 patients with EVB who did not undergo TIPS. With a uniform follow-up of 3 months, patients with TIPS were less likely to be readmitted to hospital with a recurrent EVB [odds ratio (OR): 0.33, 95% confidence interval (CI): 0.24-0.47, P<0.01], although were more likely to be readmitted with hepatic encephalopathy (OR: 1.66; 95% CI: 1.31-2.11, P<0.01). At 3 months, there was no difference in all cause hospital readmission rate between the 2 groups (OR: 38.8%; 95% CI: 38.1-44.9 TIPS vs. OR: 41.5%; 95% CI: 34.1-43.3 non-TIPS: P=0.17).

Conclusions:

In this large nationally representative study, TIPS insertion after an episode of EVB was associated with a significantly lower risk of 3-month readmission for recurrent EVB compared with patients who did not receive TIPS. Although those receiving TIPS had a higher rate of hepatic encephalopathy the overall readmission remained unchanged.
QT Interval Prolongation in the Pediatric Oncologic Population on Methadone
Authors: Piccininni Jenna A. , Killinger James S. , Hammad Hoda T. , Gerber Linda M. , Dayton Jeffrey D.
Published: March 2019

Studies have been conducted on adults prescribed with methadone to determine the necessary frequency of QTc monitoring but no consensus has been reached and no similar research has been conducted in the pediatric population. The objective of this retrospective study was to determine the occurrence rate of QTc interval prolongation associated with methadone use in a pediatric oncologic population. In total, 18% of patients developed QTc interval prolongation. These patients had longer baseline QTc intervals and were on more QTc interval-prolonging medications. Our data suggest that these variables may be able to risk stratify patients who require more frequent monitoring.
A Home-Based Older Person Upstreaming Prevention Physical Therapy (HOP-UP-PT) Program Utilizing Community Partnership Referrals
Authors: Wilson Christopher M. , Arena Sara K. , Adcock Karen , Colling Debra
Published: March 2019

Traditional home healthcare reimbursement models emphasize intervention after a medical or functional issue occurs, and there is little evidence of preventative home-based physical therapy services for those at highest risk of becoming homebound due to illness, injury, or functional limitation. The purpose of this study was to describe the development and initial pilot results of the Home-based Older Person Upstreaming Prevention Physical Therapy (HOP-UP-PT) Program. The prospective observational pilot study included five participants referred from a community center. The HOP-UP-PT Program utilized fall risk, functional, environmental, cognitive, and health-related assessments. Two males and three females aged 73 to 92 years were enrolled. Outcomes suggest that health, functional, and environmental benefits may be achieved when an older person participates in the HOP-UP-PT Program. Safety and health benefits gained by two individuals referred to the program, but who did not meet inclusion criteria, are also reported. Evidence emerging from this pilot study suggests trends toward improved functional outcomes associated with reduced fall risk and customized home-based safety recommendations among older adults participating in the HOP-UP-PT Program.
Colostomy Care
Authors: Berti-Hearn Linda , Elliott Brenda
Published: March 2019

Surgical creation of a colostomy can have significant physical, emotional, and social effects. Adapting to a new ostomy can be overwhelming and interventions aimed at decreasing barriers to self-care should be a priority for home care patients. Advances in surgical procedures, coupled with decreased length of hospital stays, require home care clinicians to have the skills and knowledge to care for this population through postoperative recovery and the initial phases of learning self-care. This article will focus on the care of patients with a colostomy in the home care setting.
Ethical and Clinical Considerations in Treating Infections at the End of Life
Authors: Vaughan Leigh , Duckett Ashley A. , Adler Mary , Cain Joan
Published: March 2019

Patients often affirm the goal to pursue comfort at the end of life, although clinicians may struggle with how best to provide comfort and face the ethical dilemma of treating or allowing a suspected infection to unfold. Treating an infection at the end of life does not allow for uniform improvement in symptoms and more time with family and friends. Additionally, there is potential for burden to the patient or health care system and treatment may occur to the exclusion of other comfort measures. Currently, the practice of providing or forgoing antibiotics at the end of life is variable, and literature supporting best practices can be contradictory. Data to support the use or withholding of treatment have been scant and vary across settings and patient populations. We review common obstacles providers face, prognostication tools that may assist in clinical decision making, the ethical support for withholding therapy, and how to factor in potential burdens of treatment. We propose that nurses, whether at the bedside in an acute care or nursing facility or in the home setting as a member of the interdisciplinary home hospice team, are uniquely qualified to help patients and families navigate this challenging clinical decision.
Transitioning a Nonclinical House Administrator to a Nurse-Led Hospital Operations Role
Authors: Quigley Michelle Ann , Martin Amber M. , Morrow Shonda W. , Magat-Domingo Esperanza , Shay-Hadley Constance L. , Franklin Aaron D.
Published: March 2019

Nurse leaders must utilize diverse operational skills in today's healthcare delivery system. Thus, the purposes of this article are to describe 1 institution's experience in expanding the role of a nonclinical house administrator to a nurse-led Hospital Operations Administrator team. The skills reflective of the American Organization of Nurse Executives competencies needed to successfully implement the newly configured role are discussed. The expansion of this role has been beneficial in showcasing the unique contributions of nurse leaders.
Optimizing Registered Nurse Bedside Shift Report
Authors: Elgin Kimberly W. , Poston Rebecca D.
Published: March 2019

Compliance with evidence-based shift report practices varies, and handoff processes are often inconsistent, increasing the risk for compromised patient safety. This pilot study evaluated registered nurse adherence to and self-efficacy with evidence-based shift report practices presimulation and postsimulation. Statistically significant increases in adherence to and self-efficacy with shift report practices after simulation were noted. Simulation offers nursing professional development practitioners a feasible method to enhance practice competency and standardization of care during registered nurse shift report.
Innovative Evaluation of the Graphic Depiction of a System Professional Practice Model
Authors: Winslow Susan A. , Cutrell Susan D. , Downs Pamela M. , McGee Genemarie W. , Winslow Kelly F.
Published: March 2019

Nursing professional development practitioners led the evaluation of the graphic representation of a health system’s professional practice model (PPM) based on evolving expectations and key constructs of a PPM. The aim was to capture direct care nurse perceptions to guide adoption of a revised graphical depiction of the PPM. The specific benefit for nursing professional development practitioners is the ongoing relatability of the PPM to nursing for sustainability of clinical excellence.
Best Practices for Obtaining Genomic Consent in Pediatric Traumatic Brain Injury Research
Authors: Schnur Kaylee C. , Gill Eliana , Guerrero Alejandro , Osier Nicole , Reuter-Rice Karin
Published: March 2019

Background

Precision health relies on large sample sizes to ensure adequate power, generalizability, and replicability; however, a critical first step to any study is the successful recruitment of participants.

Objectives

This study seeks to explore how the enrollment strategies used in a parent study contributed to the high consent rates, establish current best practices that can be used in future studies, and identify additional factors that contribute to consent into pediatric traumatic brain injury biobanks.

Methods

Retrospective secondary analysis of data from a parent study with high consent rates was examined to explore factors affecting consent into biobanking studies.

Results

Of the 76 subjects who were approached, met the eligibility criteria, and reviewed the consent form, only 16 (21.1%) declined to participate. The consented group (n = 60) represents 64.5% of those who met the eligibility criteria upon initial screening (n = 93) and 78.9% of those with confirmed eligibility (n = 76). Analysis of screening data suggested there were no major barriers to consenting individuals into this pediatric traumatic brain injury biobank.

Discussion

There were no demographic or research-related characteristics that significantly explained enrollment. Ethically, to obtain true informed consent, parents need to understand only their child’s diagnosis, prognosis, and medical care, as well as the purpose of the proposed research and its risks and benefits. Researchers need to implement best practices, including a comprehensive review of census data to identify eligible participants to approach, a prescreening protocol, and effective consenting process to obtain informed consent so that precision care initiatives can be pursued.
The Immunohistochemical Pattern of Epithelial-Mesenchymal Transition Markers In Endometrial Carcinoma
Authors: Rubeša-Mihaljević Roberta , Babarović Emina , Vrdoljak-Mozetič Danijela , Štemberger-Papić Snježana , Klarić Marko , Krašević Maja , Jonjić Nives
Published: March 2019

The majority of endometrial carcinoma are diagnosed at an early stage and exhibit a favorable prognosis. However, 10% to 15% of ECs recur and the majority are type II tumors which are high-grade carcinomas. The epithelial-mesenchymal transition (EMT) has been considered as a fundamental step for the development of the invasive phenotype of cancer cells. During EMT, many of epithelial surface markers, primarily E-cadherin disappear, and mesenchymal markers including N-cadherin gain. This feature resides predominantly at the invasive front (IF) of the tumor. Therefore, we examined the immunohistochemical expression of E-cadherin and N-cadherin at the IF, in central areas of the tumor and lymphovascular space, in type I and type II endometrial carcinoma. The association of each protein with the clinicopathologic features was also evaluated. Our results confirmed a stronger E-cadherin immunostaining in type I tumors indicating that the loss of E-cadherin may be responsible for a more aggressive behavior of type II ECs. In both types, E-cadherin was strongly expressed in central areas and the reactivity decreased toward the IF. On contrary, N-cadherin was overexpressed at the IF confirming an inverse relationship between these markers. In addition, a decrease in E-cadherin expression was observed in cells within the lymphovascular space. Downregulation of E-cadherin was associated only with high-grade tumors while no correlations between both markers and other clinicopathologic features were found. Our results confirm that EMT occurs at the IF that represents a critical interface between the tumor and the host.