bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstetrics and Gynecology Residents' Perspectives on Wellness
Authors: Morgan Helen Kang , Winkel Abigail Ford , Nguyen Anh T. , Carson Sandra , Ogburn Tony , Woodland Mark B.
Published: February 2019

OBJECTIVE:

To examine U.S. obstetrics and gynecology residents' perceptions of wellness, burnout, and perceived effectiveness of wellness programming.

METHODS:

In January 2017, a six-item survey was administered at the time of the Council on Resident Education in Obstetrics and Gynecology in-training examination. Respondents voluntarily completed the survey electronically before starting the examination, and responses were anonymous and only linked to postgraduate year.

RESULTS:

Of the 5,376 eligible U.S. examinees, 4,999 (93%) completed the survey, provided residency year status, and were included in the analysis. There was a high prevalence of self-identified wellness problems (burnout 51.2%, depression 32.0%, binge drinking 12.6%, eating disorder 4.7%, drug use 1.1%, and suicide attempt 0.4%). First-year residents were most likely to state that wellness was a priority in their program. The number of residents reporting any problem with wellness increases significantly between the first year (49.8%) and second year (63.7%, P<.001), after which it remains elevated throughout training. Residents who responded that wellness was not a priority in their program were more likely to report wellness issues and burnout (P<.001). When asked what single intervention all residency programs should provide, 41.2% (2,059) felt that dedicated time for wellness maintenance was the most important intervention.

CONCLUSION:

These findings highlight the high prevalence of wellness problems in obstetrics and gynecology residents, and how essential it will be to engage learners in the development of effective, evidence-based interventions.
Gestational Weight Gain and Severe Maternal Morbidity at Delivery Hospitalization
Authors: Platner Marissa H. , Ackerman Christina , Howland Renata E. , Xu Xiao , Pettker Christian M. , Illuzzi Jessica L. , Reddy Uma M. , Chung Sophie , Lipkind Heather S.
Published: February 2019

OBJECTIVE:

To examine whether women who varied from recommended gestational weight gain guidelines by the Institute of Medicine (IOM, now known as the National Academy of Medicine) were at increased risk of severe maternal morbidity during delivery hospitalization compared with those whose weight gain remained within guidelines.

METHODS:

We conducted a retrospective cohort study using linked 2008–2012 New York City discharge and birth certificate data sets. Cases of severe maternal morbidity were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes based on the Centers for Disease Control and Prevention criteria, which consists of 21 indicators of possible life-threatening diagnoses, life-saving procedures, or death. Multivariable logistic regression was used to evaluate the association between gestational weight gain categories based on prepregnancy body mass index (BMI) and severe maternal morbidity adjusting for maternal demographics and socioeconomic status. The analysis was stratified by prepregnancy BMI categories.

RESULTS:

During 2008–2012, there were 515,148 term singleton live births in New York City with prepregnancy weight and gestational weight gain information. In 24.8%, 35.1%, 32.1%, and 8.0% of these births, women gained below, within, 1–19 lbs above, and 20 lbs or more above the IOM guidelines, respectively. After adjusting for maternal demographic and socioeconomic characteristics, women who had gestational weight gain 1–19 lbs above (adjusted odds ratio [AOR] 1.08, 95% CI 1.02–1.13) or 20 lbs or more above the IOM recommendations (AOR 1.21, 95% CI 1.12–1.31) had higher odds of overall severe maternal morbidity compared with women who gained within guidelines. Although the increased odds ratios (ORs) were statistically significant, this only resulted in an absolute rate increase of 2.1 and 6 cases of severe maternal morbidity per 1,000 deliveries for those who gained 1–19 and 20 lbs or more above recommendations, respectively. Women with gestational weight gain 20 lbs or more above recommendations had significantly higher ORs of eclampsia, heart failure during a procedure, pulmonary edema or acute heart failure, transfusion, and ventilation.

CONCLUSION:

Women whose gestational weight gain is in excess of IOM guidelines are at increased risk of severe maternal morbidity, although their absolute risks remain low.
Pessary Compared With Vaginal Progesterone for the Prevention of Preterm Birth in Women With Twin Pregnancies and Cervical Length Less Than 38 mm
Authors: Dang Vinh Q. , Nguyen Linh K. , Pham Toan D. , He Yen T. N. , Vu Khang N. , Phan Minh T. N. , Le Thanh Q. , Le Cam H. , Vuong Lan N. , Mol Ben W.
Published: February 2019

OBJECTIVE:

To compare the effectiveness of cervical pessary to vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and short cervix.

METHODS:

This randomized controlled trial was conducted at My Duc Hospital, Vietnam. Asymptomatic women with twin pregnancies and cervical length less than 38 mm were randomized to Arabin pessary or vaginal progesterone (400 mg once a day) group. The primary outcome was preterm birth at less than 34 weeks of gestation. Secondary outcomes were adverse maternal and perinatal complications. We planned a subgroup analysis according to quartile of cervical length. Analysis was conducted on an intention-to-treat basis. We estimated that the primary outcome would occur in 28.4% of women treated with progesterone. Thus a total sample size of 290 women divided equally into two groups was required to detect a 14% absolute risk difference in the primary outcome between the two groups (power 80%, alpha-error 5%, 10% loss to follow-up).

RESULTS:

Between March 2016 and June 2017, we randomized 300 women, 150 women in each group. Preterm birth at less than 34 weeks of gestation occurred in 24 (16%) women in the pessary group and 33 (22%) women in the progesterone group (relative risk [RR] 0.73, 95% CI 0.46–1.18). The use of pessary significantly reduced the composite of poor perinatal outcomes (19% vs 27%; RR 0.70, 95% CI 0.43–0.93). In women with cervical length of 28 mm or less (25th percentile), pessary significantly reduced the preterm birth rate at less than 34 weeks of gestation from 46% (16/35) to 21% (10/47) (RR 0.47, 95% CI 0.24–0.90) and significantly improved the composite of poor perinatal outcomes.

CONCLUSION:

Cervical pessary and 400 mg vaginal progesterone resulted in similar rates of preterm birth at less than 34 weeks of gestation in women with twin pregnancies and cervical length less than 38 mm.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02623881.
Elective Induction at 39 Weeks of Gestation and the Implications of a Large, Multicenter, Randomized Controlled Trial
Authors: Marrs Caroline , La Rosa Mauricio , Caughey Aaron , Saade George
Published: February 2019

On August 8, 2018, Grobman et al published the findings from the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, a large randomized controlled trial of elective induction of labor in nulliparous women at 39 weeks of gestation compared with expectant management. Conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, the trial found there was no difference between the two groups in the primary outcome, a composite of neonatal morbidity. Also, there was a reduction in rates of cesarean delivery and hypertensive disorders of pregnancy in the elective induction group. The topic of elective induction has been of interest to clinicians for decades, and research has yielded inconsistent results in the past. This trial offers the best evidence thus far to address this complex issue. Our objective is to briefly review the history and literature regarding elective induction of labor, discuss the recently published ARRIVE trial, and consider its implications on clinical practice and health policy.
Changing rates in fracture trends are temporally associated with declining testing and treatment: reality or ecologic fallacy?
Authors: Wright Nicole C. , Blackston J. Walker , Saag Kenneth G.
Published: February 2019

Purpose of review

The changing patterns of osteoporosis treatment and fragility fractures have led to what leaders are calling a ‘crisis in the osteoporosis.’ We address data on changing patterns in fractures, and highlight strengths and limitations of recently published data.

Recent findings

Declines in hip fracture rates have been shown in studies from around the world. However, recently, using national Medicare data, Michael Lewiecki and colleagues show a plateau in the decline of hip fracture incidence in the United States from 2012 to 2015. Population-based data is integral for evaluating temporal trends; however, researchers must consider the biases associated with them including: age effects, period effects, and cohort effects. Rosengren and colleagues conducted the most comprehensive evaluation of age, period, and birth cohort effects in their study of hip fracture trends from 1987 to 2010 in Denmark and Sweden, in which they identified changes in hip fracture rates based on age, period, and cohort effects.

Recent findings show clear temporal trends in changing fracture rates. Studies, which evaluated these biases largely attribute increased hip fracture rates to various age, period, and cohort effects, highlighting the importance of appropriate screening and treatment.
Outcomes After Extracorporeal Cardiopulmonary Resuscitation of Pediatric In-Hospital Cardiac Arrest: A Report From the Get With the Guidelines-Resuscitation and the Extracorporeal Life Support Organization Registries
Authors: Bembea Melania M. , Ng Derek K. , Rizkalla Nicole , Rycus Peter , Lasa Javier J. , Dalton Heidi , Topjian Alexis A. , Thiagarajan Ravi R. , Nadkarni Vinay M. , Hunt Elizabeth A.
Published: February 2019

Objectives:

The aim of this study was to determine cardiac arrest– and extracorporeal membrane oxygenation–related risk factors associated with unfavorable outcomes after extracorporeal cardiopulmonary resuscitation.

Design:

We performed an analysis of merged data from the Extracorporeal Life Support Organization and the American Heart Association Get With the Guidelines—Resuscitation registries.

Setting:

A total of 32 hospitals reporting to both registries between 2000 and 2014.

Patients:

Children younger than 18 years old who suffered in-hospital cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation.

Interventions:

None.

Measurements and Main Results:

Of the 593 children included in the final cohort, 240 (40.5%) died prior to decannulation from extracorporeal membrane oxygenation and 352 (59.4%) died prior to hospital discharge. A noncardiac diagnosis and preexisting renal insufficiency were associated with increased odds of death (adjusted odds ratio, 1.85 [95% CI, 1.19–2.89] and 4.74 [95% CI, 2.06–10.9], respectively). The median time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was 48 minutes (interquartile range, 28–70 min). Longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was associated with higher odds of death prior to hospital discharge (adjusted odds ratio for each 5 additional minutes of cardiopulmonary resuscitation prior to extracorporeal membrane oxygenation initiation, 1.04 [95% CI, 1.01–1.07]). Each individual adverse event documented during the extracorporeal membrane oxygenation course, including neurologic, pulmonary, renal, metabolic, cardiovascular and hemorrhagic, was associated with higher odds of death, with higher odds as the cumulative number of documented adverse events during the extracorporeal membrane oxygenation course increased.

Conclusions:

Outcomes after extracorporeal cardiopulmonary resuscitation reported by linking two national registries are encouraging. Noncardiac diagnoses, preexisting renal insufficiency, longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation, and adverse events during the extracorporeal membrane oxygenation course are associated with worse outcomes.
Study of the Effects of Epinephrine on Cerebral Oxygenation and Metabolism During Cardiac Arrest and Resuscitation by Hyperspectral Near-Infrared Spectroscopy
Authors: Nosrati Reyhaneh , Lin Steve , Mohindra Rohit , Ramadeen Andrew , Toronov Vladislav , Dorian Paul
Published: February 2019

Objectives:

Epinephrine is routinely administered to sudden cardiac arrest patients during resuscitation, but the neurologic effects on patients treated with epinephrine are not well understood. This study aims to assess the cerebral oxygenation and metabolism during ventricular fibrillation cardiac arrest, cardiopulmonary resuscitation, and epinephrine administration.

Design:

To investigate the effects of equal dosages of IV epinephrine administrated following sudden cardiac arrest as a continuous infusion or successive boluses during cardiopulmonary resuscitation, we monitored cerebral oxygenation and metabolism using hyperspectral near-infrared spectroscopy.

Settings:

A randomized laboratory animal study.

Subjects:

Nine healthy pigs.

Interventions:

None.

Measurements and Main Results:

Our study showed that although continuous epinephrine administration had no significant impact on overall cerebral hemodynamics, epinephrine boluses transiently improved cerebral oxygenation (oxygenated hemoglobin) and metabolism (cytochrome c oxidase) by 15% ± 6.7% and 49% ± 18%, respectively (p < 0.05) compared with the baseline (untreated) ventricular fibrillation. Our results suggest that the effects of epinephrine diminish with successive boluses as the impact of the third bolus on brain oxygen metabolism was 24.6% ± 3.8% less than that of the first two boluses.

Conclusions:

Epinephrine administration by bolus resulted in transient improvements in cerebral oxygenation and metabolism, whereas continuous epinephrine infusion did not, compared with placebo. Future studies are needed to evaluate and optimize the use of epinephrine in cardiac arrest resuscitation, particularly the dose, timing, and mode of administration.
Photobiomodulation therapy for acute radiodermatitis
Authors: Robijns Jolien , Lodewijckx Joy , Mebis Jeroen
Published: February 2019

Purpose of review

The number of clinical trials on the use of photobiomodulation therapy (PBMT) for the management of cancer therapy-related complications is growing steadily. One of the side-effects that is under investigation is acute radiodermatitis (ARD), an inflammatory skin reaction caused by radiotherapy. In this review, an overview is given on the state of art of the application of PBMT for the prevention and management of ARD.

Recent findings

Up to now about seven clinical trials have been performed, investigating the use of PBMT in the prevention and/or management of ARD. Results demonstrate that PBMT can effectively reduce the incidence of severe ARD, decrease the accompanying pain, and improve the patients’ quality of life. Moreover, the technique seems to be well tolerated in oncologic patients.

On the basis of the available evidence, there could be a strong recommendation to use PBMT in the prevention and management of ARD in cancer patients.
Optimizing the Aesthetic Result of Parotidectomy with a Facelift Incision and Temporoparietal Fascia Flap
Authors: Movassaghi Kiya , Lewis Matthew , Shahzad Farooq , May James W.
Published: February 2019

The 3 most common problems after a parotidectomy are cheek contour deformity, Frey syndrome (gustatory sweating), and a visible scar on the neck. These problems can potentially be prevented by (1) facelift type incisions, which eliminate the neck incision and (2) interposition of temporoparietal fascia at the parotidectomy site that fills the defect and provides a barrier to aberrant neuronal regeneration. We followed 11 patients who underwent parotidectomy (9 superficial and 2 total parotidectomies) for a variety of parotid tumors between December 2001 and January 2018. Facelift type incisions were used in all patients, and temporoparietal fascia flaps were used to fill the parotidectomy defects. The last 6 patients were tested for objective evidence of Frey syndrome with the Minor Starch Iodine test. Patients were then followed for up to 7 years (11 months to 7 years, average 3 years). All patients had well-hidden scars and good contour of the cheeks. None of the patients developed subjective or objective evidence of Frey syndrome. This small series suggests that the aesthetic result after parotidectomy can be improved by using a facelift incision and placement of a temporoparietal fascia flap into the parotidectomy defect. Additionally, the tissue barrier thus provided may also help to prevent Frey syndrome.
Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft
Authors: Ito Tomoyuki , Akazawa Satoshi , Ichikawa Yuichi , Yamamoto Yusuke , Aoyama Shohei , Kiuchi Tomoki , Nakao Junichi , Onitsuka Tetsuro , Araki Jun , Nakagawa Masahiro
Published: February 2019

Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts. In this article, we describe 2 cases of PAT grafting for the treatment of skin ulcers with exposed bone and artificial plate after mandible reconstruction. After negative-pressure wound therapy, PAT was used to covering exposed artificial plate for both cases, and a skin graft onto the PAT graft was performed in 1 case. The ulcers improved in both cases without recurrence. The gold-standard treatment of intractable ulcers and fistulas with an exposed tendon, bone, or artifact is coverage by a well-vascularized skin flap. However, PAT grafting has advantages in similar situations, occasionally together with skin grafting and/or negative-pressure wound therapy, because it is technically simple and less invasive.
Calculated Blood Loss and Transfusion Requirements in Primary Open Repair of Craniosynostosis
Authors: Lopez Marcos M. , Lee James , Morrison Kerry , Hoffman Caitlin , Souweidane Mark , Ascherman Jeffrey A.
Published: February 2019

Background:

Open surgical correction is effective in the treatment of craniosynostosis but may result in significant blood loss and transfusions. This study seeks to compare surgeon estimated blood loss with calculated blood loss and provide contemporary data that objectively quantify blood loss and transfusion rate associated with open repair of craniosynostosis.

Methods:

A retrospective review of patients undergoing primary open repair of craniosynostosis between May 2011 and November 2016 was performed. The medical records of 43 patients were reviewed to obtain the operative age, weight, affected suture, pre- and postoperative hematocrit, blood transfusion volume, estimated blood loss, and syndromic status. Estimated blood volume (EBV) and red cell mass were calculated for analysis.

Results:

The median age and weight at the time of surgery were 9 months and 8.6 kg, respectively. Mean surgeon estimated blood loss was 207.4 mL (28.1% of EBV). Mean calculated blood loss was 318 mL (44.3% of EBV). The mean transfusion volume was 188 mL (26.5% of EBV). The mean transfusion as a percent of estimated red cell mass was 59.1%. Fourteen percent of patients did not require any transfusion.

Conclusions:

We report intraoperative blood losses and transfusion requirements that are lower than those of many previous studies of open repair of craniosynostosis. Additionally, we found that calculated blood loss estimates may be more reliable than surgeon-derived estimated blood loss. We hope that these updated, objective data will be useful in comparisons of open repair to minimally invasive surgery or to new blood loss reducing procedures.
Nurses and Holistic Modalities
Authors: Wang Carol Chunfeng , Zhu Ruifang , Tan Jing-Yu
Published: February 2019

Holistic nursing practices holism and holistic modalities to create a healing space and optimize the healing process. Holistic nurses employ a complementary and integrative focus in their work and help patients access their greatest healing potential. This article supports that nursing professionals embrace acupuncture and alternative therapy as a great gift that inspire them to extend their already extraordinary healing power. An overview of the history of Traditional Chinese Medicine and the development and milestones of acupuncture and moxibustion in past dynasties is presented. In particular, the development of Traditional Chinese Medicine and acupuncture in the last 20 years, as well as how social and economic conditions have impacted their expansion, is discussed.
Spatial and Temporal Variations of Indoor Airborne Radon Decay Product Dose Rate and Surface-Deposited Radon Decay Products in Homes
Authors: Steck Daniel J. , Sun Kainan , William Field R.
Published: February 2019

The temporal variations of the airborne radon decay product dose rate and deposited radon decay product activities, as well as the within-house and house-to-house variations of radon concentrations, were evaluated through repeated field measurements. Long-term average radon and surface-deposited radon decay product concentrations were measured in 76 rooms of 38 houses. Temporal variation of radon, as well as airborne and surface-deposited radon decay products, were measured in 11 of the 38 houses during two different seasons. Environmental factors that have the potential to influence airborne dose rate and deposited radon decay products were also studied. Airborne dose rates were calculated from the unattached and attached potential alpha energy concentrations using two dosimetric models. For one model, the observed dose variations were 103%, 74%, 58%, and 60% for the total, house-to-house, within-house, and within-room temporal variations, respectively. For the other model, the dose variations were 100%, 66%, 61%, and 46%, respectively. Surface-deposited 214Po showed variations of 79%, 57%, 42%, and 48%, respectively. These substantial radon decay product concentration variations suggest that multiple locations and time-integrated measurements are needed to make an accurate assessment of the chronic radon-related doses in homes. Smoking was the environmental factor that had the largest temporal and spatial effect on airborne radon decay product dose rates.
Vision-Related Quality of Life in Keratoconus: A Save Sight Keratoconus Registry Study
Authors: Tan Jeremy C. K. , Nguyen Vuong , Fenwick Eva , Ferdi Alex , Dinh Amanda , Watson Stephanie L.
Published: February 2019

Purpose:

To assess vision-related quality of life using the Impact of Vision Impairment Questionnaire (IVI) in patients with keratoconus enrolled in the Save Sight Keratoconus Registry.

Methods:

In this cross-sectional study, data on 107 keratoconic patients were collected through a prospectively designed web-based registry from a quaternary referral eye hospital and 2 corneal subspecialty practices. Vision-related quality of life was evaluated using the IVI. Rasch analysis was used to transform the IVI responses into interval-level measures comprising reading, mobility, and emotional well-being subscales. Associations between best-corrected visual acuity (BCVA), maximum simulated keratometry (Kmax), steep keratometry (K2), and pachymetry for each eye and IVI subscale scores were evaluated with univariate (Pearson correlations) and multivariable regression adjusted for age and gender.

Results:

Of the 107 patients, 37 (34.5%), 41 (38.0%) and 29 (26.9%) had mild, moderate, and severe keratoconus, respectively. On uni- and multivariable analysis, BCVA in the better eye had the strongest association with reading [r = 0.51; 95% confidence interval (CI), 0.35–0.64, P = 0.004] and mobility (r = 0.55; 95% CI, 0.41–0.67, P < 0.001) subscale scores. BCVA in the better and worse eye, both had the joint strongest associations with emotional scores on univariate analysis, but only the latter was significant on multivariable analysis (r = 0.37; 95% CI, 0.20–0.53, P < 0.001). K2 and Kmax in the better eye also displayed significant associations with reading and mobility scores.

Conclusions:

In patients with keratoconus, BCVA in the better eye had the strongest correlation with reading and mobility scores, whereas BCVA in the worse eye was significantly correlated with emotional scores.
Factors Predicting the Development of Children With Mild Disabilities in Inclusive Preschools
Authors: Sucuoğlu Bülbin , Bakkaloğlu Hatice , Demir Şeyda , Atalan Derya
Published: February 2019

This study compared the developmental gains of preschool children with disabilities (CWD) and children without disabilities (CWOD) during a year they spent in preschools and examined the predictors of development in both groups (60 CWD and 57 CWOD) of children. Data on the social skills, problem behaviors, school adjustment level, student–teacher relationship, and the developmental functions of children were collected from the mothers and teachers, whereas trained assistants assessed the development of children. Analyses indicated that although all of the children made developmental gains, the psychomotor, language, and socioemotional developmental gains were greater for CWD than those for CWOD. Furthermore, social skills and school adjustment levels were found to be significant predictors of developmental gains of CWD. Implications of these findings were discussed in terms of the content of preschool curriculums, teacher preparedness related to inclusive practices, and the importance of and teaching social skills to CWD.
The medial temporal lobe in nociception: a meta-analytic and functional connectivity study
Authors: Ayoub Lizbeth J. , Barnett Alexander , Leboucher Aziliz , Golosky Mitchell , McAndrews Mary Pat , Seminowicz David A. , Moayedi Massieh
Published: February 2019

Recent neuroimaging studies implicate the medial temporal lobe (MTL) in nociception and pain modulation. Here, we aim to identify which subregions of the MTL are involved in human pain and to test its connectivity in a cohort of chronic low-back pain patients (CBP). We conducted 2 coordinate-based meta-analyses to determine which regions within the MTL showed consistent spatial patterns of functional activation (1) in response to experimental pain in healthy participants and (2) in chronic pain compared with healthy participants. We followed PRISMA guidelines and performed activation likelihood estimate (ALE) meta-analyses. The first meta-analysis revealed consistent activation in the right anterior hippocampus (right antHC), parahippocampal gyrus, and amygdala. The second meta-analysis revealed consistently less activation in patients' right antHC, compared with healthy participants. We then conducted a seed-to-voxel resting state functional connectivity of the right antHC seed with the rest of the brain in 77 CBP and 79 age-matched healthy participants. We found that CBP had significantly weaker antHC functional connectivity to the medial prefrontal cortex compared with healthy participants. Taken together, these data indicate that the antHC has abnormally lower activity in chronic pain and reduced connectivity to the medial prefrontal cortex in CBP. Future studies should investigate the specific role of the antHC in the development and management of chronic pain.
Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome
Authors: Bazika-Gerasch Bojana , Maier Christoph , Kumowski Nina , Fiege Carolin , Kaisler Miriam , Vollert Jan , Dietrich Johannes W.
Published: February 2019

Local osteopenia and altered bone metabolism are major complications of complex regional pain syndrome (CRPS), but quantitative assessment is difficult unless using X-ray or dual-energy X-ray absorptiometry. Ultrasound-based measurement of bone density (UBD) is a possible alternative but has never been used to detect unilateral disease such as CRPS. Therefore, the main outcome measure of this prospective study was the diagnostic utility of UBD in patients with lower-limb CRPS. Second, we compared the extent of unilateral and contralateral calcaneal bone density to that of other conditions with unilateral pain, general osteoporosis, and healthy subjects. Calcaneal osteodensitometry was bilaterally examined using ultrasound-based methodology. Bone mineral density values were converted to Z-scores based on age- and sex-dependent reference values. All patients completed a functional and an osteoporosis risk questionnaire. In patients with CRPS (n = 18), the bone mineral density values and Z-scores were significantly lower in both the affected (mean ± SD: 0.40 ± 0.08 and −1.1 ± 0.8, respectively) and nonaffected (0.46 ± 0.09 and −0.6 ± 0.9, respectively) limbs than in patients (n = 40) with other unilateral pain syndromes (affected: 0.51 ± 0.1 and −0.2 ± 1.1, respectively; nonaffected: 0.54 ± 0.11 and 0 ± 0.9, respectively) and healthy subjects (right side: 0.6 ± 0.1 and 0.1 ± 0.9, respectively). Conversely, in patients with known systemic osteoporosis, the Z-scores were lower bilaterally with smaller side-to-side differences than in those with CRPS (P < 0.05). Compared with subjects suffering from long-term CRPS (≥2.4 years), patients with shorter disease duration exhibited significantly lower Z-scores (P < 0.05). In conclusion, UBD revealed that CRPS is associated with both local and systemic alterations of bone metabolism.
Differential activation of ascending noxious pathways associated with trigeminal nerve injury
Authors: Okada Shinji , Katagiri Ayano , Saito Hiroto , Lee Jun , Ohara Kinuyo , Iinuma Toshimitsu , Bereiter David A. , Iwata Koichi
Published: February 2019

Trigeminal spinal subnucleus caudalis (Vc) neurons that project to the ventral posteromedial thalamic nucleus (VPM) and parabrachial nucleus (PBN) are critical for orofacial pain processing. We hypothesized that persistent trigeminal nerve injury differentially alters the proportion of Vc neurons that project to VPM and PBN in a modality-specific manner. Neuroanatomical approaches were used to quantify the number of Vc neurons projecting to VPM or PBN after chronic constriction injury of the infraorbital nerve (ION-CCI) and subsequent upper-lip stimulation. Male rats received injections of retrograde tracer fluorogold into the contralateral VPM or PBN on day 7 after ION-CCI, and at 3 days after that, either capsaicin injection or noxious mechanical stimulation was applied to the upper lip ipsilateral to nerve injury. Infraorbital nerve chronic constriction injury rats displayed greater forelimb wiping to capsaicin injection and mechanical allodynia of the lip than sham rats. Total cell counts for phosphorylated extracellular signal-regulated kinase-immunoreactive (pERK-IR) neurons after capsaicin or mechanical lip stimuli were higher in ION-CCI than sham rats as was the percentage of pERK-IR PBN projection neurons. However, the percentage of pERK-IR VPM projection neurons was also greater in ION-CCI than sham rats after capsaicin but not mechanical lip stimuli. The present findings suggest that persistent trigeminal nerve injury increases the number of Vc neurons activated by capsaicin or mechanical lip stimuli. By contrast, trigeminal nerve injury modifies the proportion of Vc nociceptive neurons projecting to VPM and PBN in a stimulus modality-specific manner and may reflect differential involvement of ascending pain pathways receiving C fiber and mechanosensitive afferents.
Attentional Bias, “Cool” and “Hot” Executive Functions in Obese Patients
Authors: Fang Ching-Tzu , Chen Vincent Chin-Hung , Ma Hsiang-Ting , Chao Hse-Huang , Ho Ming-Chou , Gossop Michael
Published: February 2019

Purpose/Background

Obesity is recognized as an important risk factor for many chronic diseases and is a major health issue. The current study examined attentional bias to food and the “cool” (inhibitory control and mental flexibility) and “hot” (affective decision making) executive functions (EFs) in obese patients preparing for bariatric surgery. In addition to body mass index (BMI), this study examined the impact of the binge-eating tendency and eating styles.

Methods

The study population comprised 21 morbidly obese patients preparing to undergo bariatric surgery (BMI ≥30 kg/m2) and 21 normal-weight controls (24 kg/m2> BMI ≥ 18.5 kg/m2). The Visual Probe Task was adopted to examine attentional bias toward food-related cues. The Stop-Signal Task and the Color Trails Test were used to assess inhibitory control and mental flexibility, respectively. The Iowa Gambling Task was administered to assess the affective decision making.

Results

(1) The obese patients showed poorer performances on cool EFs (for Color Trails Test,P= 0.016,ηp2= 0.136; for Stop-Signal Task,P= 0.049,ηp2= 0.093) and hot EF (for Iowa Gambling Task, normal controls showed progressed performance,P= 0.012,ηp2= 0.077, but obese patients did not show this progress,P= 0.111,ηp2= 0.089) compared with the normal controls; (2) participants with low binge-eating tendency had larger attentional biases at 2000 milliseconds than at 200 milliseconds on food-related cues (P= 0.003,ηp2= 0.363); and (3) low-restrained participants exhibited attentional bias toward the low-calorie food cues, compared with the high-restrained group (P= 0.009,ηp2= 0.158).

Conclusions

The current study contributes to the development of a different therapeutic focus on obese patients and binge eaters.
Nursing Students' Perceptions of Nursing Metaparadigms: A Phenomenological Study
Authors: DELIKTAS Ayse , KORUKCU Oznur , AYDIN Ruveyde , KABUKCUOGLU Kamile
Published: February 2019

Background:

The paradigm is a vital concept steering the development of a scientific discipline. Paradigms that shape the education, research, and practice steps of a discipline are defined as metaparadigms.

Purpose:

The purpose of this study was to explore the perception of nursing students regarding metaparadigms in nursing at Akdeniz University in Antalya, Turkey.

Methods:

This was designed as a descriptive phenomenological study, and data were collected from 13 fourth-year students who were chosen via a purposeful sampling method and interviewed face-to-face using a semistructured format. Data were analyzed using the data analysis steps of Giorgi, who is an expert in descriptive phenomenological studies.

Results:

Most of the participants in this study associated nursing with humanism. Some of the participants stated that a fundamental building block of the nursing profession is conscience, whereas others stated that nursing is a way to touch people's lives and is now regarded as a professional practice. It has been reported that students have difficulties identifying metaparadigms in nursing and that they believe that human beings have the potential to widen their horizons with wisdom and social skills. According to the participants, the health metaparadigm refers to the harmony between human beings and their environment and to the autonomy of the individual. Moreover, the participants emphasized the well-being of individuals.

Conclusions/Implications for Practice:

The participants in this study characterized humans with well-being, transcendence, adaptation and interaction skills with their environment, and harmony beyond physiological mechanisms, which was considered to be promising for the perception of future nurses. It is recommended for nursing educators to enable their students to raise their professional awareness and to internalize professional values.
Neuromuscular Training Improves Biomechanical Deficits at the Knee in Anterior Cruciate Ligament–Reconstructed Athletes
Authors: Nagelli Christopher V. , Wordeman Samuel C. , Di Stasi Stephanie , Hoffman Joshua , Marulli Tiffany , Hewett Timothy E.
Published: February 2019

Objective:

Athletes who return to sport after anterior cruciate ligament reconstruction (ACLR) demonstrate persistent biomechanical and neuromuscular deficits of the knee. There is limited evidence on what effect a neuromuscular training (NMT) program has on knee biomechanics in a cohort of athletes with ACLR. Therefore, the primary aim of this study was to quantify the effect of an NMT program on knee biomechanics in a cohort of ACLR athletes. Second, the post-training knee biomechanics were compared between the cohort of ACLR and control athletes.

Design:

Cohort study.

Setting:

Controlled laboratory setting.

Participants:

Eighteen athletes with ACLR and 10 control athletes.

Interventions:

Neuromuscular training.

Main Outcome Measures:

Knee kinematics and kinetics during a double-limb jump-landing task.

Results:

There were no significant interactions (P > 0.05) observed for the athletes with ACLR. However, there was a significant main effect of biomechanics testing session (P < 0.05) for knee flexion angle and moments; athletes with ACLR demonstrated greater knee flexion angle and lower knee flexion moment during the post-training biomechanics testing session. Post-training comparison between the ACLR and control athletes demonstrated no significant interactions (P > 0.05) between the groups. There was a significant main effect of group (P < 0.05) for knee frontal angle, as athletes with ACLR landed with greater knee adduction than the control athletes.

Conclusions:

Significant improvements in knee sagittal plane biomechanical measures were observed after the NMT program by the athletes with ACLR. In addition, post-training comparison of the ACLR and control groups demonstrates comparable knee biomechanics.
Educational preparation for the emergency nurse practitioner
Authors: Aungst Lesia A.
Published: February 2019

EDITOR'S NOTE

Following the recent JAANP article on Emergency Nurse Practitioner educational standards, one of our readers engaged with the authors to discuss the relationship between the urgent care setting and the emergency care setting. They provided this commentary to further enhance the understanding of this specialty area.
Impact of Medicaid on Cochlear Implant Access
Authors: Sorkin Donna L.
Published: February 2019

Objective:

The study documented the role of Medicaid in the provision of cochlear implants and identified access barriers due to states’ adopted rules. An historical review of federal legislation provided a basis for evaluating the original Congressional intent and how this national purpose aligns with how state programs are currently operating.

Study Design:

A SurveyMonkey questionnaire was used to facilitate data collection from 47 clinics across 35 states after an initial inquiry was made to each clinic to determine an appropriate point of contact, generally a cochlear implant audiologist. Respondents were from all regions of the United States and represented a diversity of clinic types of varying program size. Data were collected for two calendar years—2015 and 2016.

Results:

Medicaid was the funding source for an average of 55% of pediatric surgeries based on 36 US clinics. For the 23 clinics returning information on adults, Medicaid was the health insurer for an average (mean) of 22% of cochlear implants (CI) surgeries; the median was 13%. Four access concerns were identified: 1) equipment replacement and processor upgrade policies; 2) low reimbursement by state Medicaid for cochlear implant surgery and related services; 3) Medicaid Managed Care (MCO) and the complexity these providers can add for a specialized service like CI that is offered at a limited number of facilities; and 4) obtaining authorization for CI surgery and related services.

Conclusions:

The intent of the 1989 legislative changes in Medicaid was to ensure that children received appropriate healthcare services wherever they lived in the country. What has transpired over the years, vis-à-vis CI, is a Medicaid system that varies depending upon the state's individual rules.
Magnetically Controlled Capsule Endoscopy in Children
Authors: Gu Zhujun , Wang Yizhong , Lin Kai , Wang Xing , Cheng Weiwei , Wang Ling , Zhang Ting , Liu Haifeng
Published: February 2019

Objective:

Capsule endoscopy (CE) is a noninvasive diagnostic tool for the digestive tract. We aim to investigate the feasibility and safety of newly developed magnetically controlled capsule endoscopy (MCE) in children.

Methods:

A total of 129 children who underwent MCE in Shanghai Children's Hospital were retrospectively recruited between March 2016 and August 2018. The feasibility, positive findings, and safety of MCE were evaluated and systematically analyzed.

Results:

Of all those children, 68 were boys, and 61 were girls with a mean age of 9.8 ± 1.9 years (6–14 years). The MCE procedure was feasible in all children. The mean esophageal transit time was 6.0 ± 4.6 seconds. The mean gastric examination time was 14.4 ± 3.9 minutes, and the average gastric transit time was 83.9 ± 59.1 minutes. Positive findings were detected in 82 children (82/129, 63.6%), 1 had esophageal lesions, 30 had superficial gastritis, 14 had superficial gastritis with bile reflux, 18 had nodular gastritis, 1 had ulcers, and 2 had heterotopic pancreas. There were 5 patients who had duodenal bulbar ulcers. One had lymphatic follicle, 1 had celiac disease, 1 had blue rubber bleb nevus syndrome, and 2 polyps were detected in 16 patients who were examined the small bowel. No serious adverse event was reported during the MCE examination and follow‐up, and all subjects excreted the capsules spontaneously within 2 weeks.

Conclusions:

We showed that MCE is feasible and safe in children above 6 years. More studies are needed to further investigate the efficacy of MCE in children.
Computed Tomography Diagnostic Abilities for Open-Globe Injuries in Pediatric Versus Adult Patients
Authors: Dikci Seyhan , Yildirim İsmail Okan , Firat Murat , Firat Penpe Gül , Demirel Soner , Yilmaz Turgut , Tuncer İlknur , Genç Oğuzhan
Published: February 2019

Objectives

The aim of this study was to compare the role of computed tomography (CT) in the diagnosis of open-globe trauma and intraocular foreign body (IOFB) in pediatric and adult age groups.

Methods

Medical records of cases with open-globe trauma at Inonu University Hospital's Ophthalmology Emergency Service were retrospectively evaluated. Preoperative orbital CT images of the cases obtained at emergency services and their clinical and/or surgical findings were compared in pediatric and adult groups.

Results

We included 47 eyes of 47 cases aged 18 years and below (pediatric group) and 85 eyes of 82 cases over 18 years (adult group). The mean ± SD age was 10.80 ± 5.11 years (range, 2–18 years) in the pediatric group and 46.34 ± 19.01 years (range, 19–82 years) in the adult group. Computed tomography images revealed 21.7% of the cases with corneal lacerations, 55.5% with scleral lacerations, and 91.6% with corneoscleral lacerations in the pediatric group, whereas the respective numbers were 48.4%, 66.6%, and 61.9% in the adult group. The detection rates of corneal penetrations and vitreous hemorrhage with CT were significantly lower in the pediatric group than in the adult group (P < 0.05). The CT scans diagnosed 66.6% of the pediatric cases and 90% of the adult cases with an IOFB.

Conclusions

Corneal lacerations and IOFBs can be missed, especially in the pediatric group, because the eye is smaller in adults. Pediatric patients with a history of ocular trauma should undergo an examination under general anesthesia followed by surgical exploration if necessary.
Enhancing Epidemiology Capacity During the 2014-15 West Africa Ebola Outbreak: An Assessment of the Role of Applied Public Health Epidemiologists
Authors: Perrotta Dennis M. , Lemmings Jennifer , Maillard Jean-Marie
Published: February 2019

Context:

In late 2014, the Centers for Disease Control and Prevention requested the support of the Council of State and Territorial Epidemiologists to enhance epidemiologic capacity in the West African countries impacted or threatened by an outbreak of Ebola virus disease. In response, the Council of State and Territorial Epidemiologists recruited 36 senior epidemiologists who, collectively, made 45 deployments to West Africa, averaging 42 days each.

Objective:

To assess the self-reported experiences and contributions of the deployed epidemiologists, as well as the role of nonprofit public health organizations in large-scale emergency response.

Design:

Electronic assessment of the deployed epidemiologists.

Participants:

Experienced applied public health epidemiologists who volunteered to participate in the response to the West Africa Ebola virus disease emergency.

Main Outcome Measures:

Descriptive data.

Results:

The chief, reported functional contributions made during deployments include improving surveillance processes (reported by 73.3% of respondents), building meaningful relationships to facilitate response activities (66.7%), improving data quality (53.3%), and improving understanding of the disease/outbreak (40.0%). Among the professional benefits of deployment to West Africa to assist with Ebola virus disease outbreak response are stimulating enthusiasm for public health work (93.3%, n = 30), broadened perspective of global health (86.7%), and sharpened epidemiological skills (56.7%).

Conclusions:

Owing to their ability to access experienced, senior professionals, the Council of State and Territorial Epidemiologists and other nonprofit public health associations can play a meaningful role boosting surge capacity in a sustained, large-scale emergency response.
Unravelling the Prospective Associations Between Mixed Anxiety-Depression and Insomnia During the Course of Cognitive Behavioral Therapy
Authors: Thun Eirunn , Sivertsen Børge , Knapstad Marit , Smith Otto R.F.
Published: February 2019

Objective

Previous studies have suggested that there is a reciprocal relationship between anxiety/depression and insomnia. However, little is known about the prospective relationships between these constructs across the course of cognitive behavioral therapy (CBT). The aim of the study was to examine these relationships in clients who received short-term CBT in a primary care setting.

Methods

A total of 653 clients (mean [SD] age = 37.8 [12.9], 26.4% men) with mild to moderate levels of anxiety and depression and a treatment duration of at least 7 weeks were included for analyses. The clients completed questionnaires measuring mixed anxiety-depression (MAD – Patient Health Questionnaire Anxiety and Depression Scale) and insomnia (3 items derived from the Karolinska Sleep Questionnaire representing core DSM-V criteria) on a session-to-session basis. The data were analyzed using latent growth curve models and random intercept cross-lagged panel models.

Results

The results of the latent growth curve models showed that there was a significant decrease in both MAD (cubic slope; B = .002, p < .001, quadratic slope; B = .036, p < .001, linear slope; B = −.205, p < .001) and insomnia (linear slope; B = −.080, p < .001) across treatment. A strong correlation (r = .838, p < .001) between the linear slopes indicated co-occurring change processes. The cross-lagged panel model showed that insomnia significantly predicted MAD at the subsequent measurements (B = .190, p < .001), but not vice versa (B = .252, p = .343).

Conclusions

Changes in MAD and insomnia are co-occurring processes during the course of CBT. Changes in insomnia predicted prospectively changes in MAD, but not vice versa. Targeting insomnia in the context of brief CBT in clients with mild to moderate anxiety and depression may therefore further reduce not only symptoms of insomnia but also symptoms of anxiety and depression.