bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States
Authors: Kozhimannil Katy B. , Hung Peiyin , Henning-Smith Carrie , Casey Michelle M. , Prasad Shailendra
Published: August 2018

(Abstracted from JAMA 2018;319(12):1239–1247)

In the decade from 2004 to 2014, hospital-based obstetric services in rural US counties declined from 55% to 46%. Loss of hospital-based obstetric care may worsen existing maternal and child health challenges, prolonging travel distances and times and affecting access to peripartum care.
Single Modified Ilioinguinal Approach for the Treatment of Acetabular Fractures Involving Both Columns
Authors: Chen Kaifang , Ji Yanhui , Huang Zhenfei , Navinduth Ramphul , Yang Fan , Sun Tingfang , Xiong Zekang , Yao Sheng , Ahn Jaimo , Guo Xiaodong
Published: August 2018

Objectives:

To report the technical aspects, radiographic results, and complications of a modified ilioinguinal approach for the treatment of bicolumnar acetabular fractures, especially involving the quadrilateral plate.

Design:

Retrospective review.

Setting:

Level I Trauma Center, Wuhan Union Hospital, China.

Patients/Participants:

Data from all acetabular fractures (n = 96) treated surgically were collected between January 2012 and June 2015. According to the exclusion criteria, 22 patients who had undergone a single supra-ilioinguinal approach with a minimum of 1-year follow-up were included in the study.

Intervention:

The supra-ilioinguinal approach was used to treat bicolumnar acetabular fractures by modifying the ilioinguinal approach, using the navel, anterior superior iliac spine, and the symphysis pubis as landmarks.

Main Outcome measurements:

The surgical exposure and reduction of fractures is expected to become more direct and convenient, with shorter surgical time, less blood loss, and fewer complications.

Results:

Of the 22 consecutive patients, 5 were anterior column with posterior hemi-transverse, 11 were associated both column, 3 were transverse and 3 were T-type patterns. Average length of incision, operative time, and intraoperative blood loss were 10.7 ± 1.1 cm, 182 ± 40 minutes, and 793 ± 228 mL, respectively. Seventeen cases of the reductions were graded excellent; 4, good; and 1, poor. In the last follow-up, the Merle d ′Aubigné scores showed that 14 cases were excellent; 6, good; and 2, poor. Postoperative deep vein thrombosis occurred in 1 patient and lateral femoral cutaneous nerve injury in 3 patients.

Conclusions:

For the treatment of bicolumnar acetabular fractures, the supra-ilioinguinal approach provides direct visualization and convenient access to the quadrilateral plate, and allows for appropriate reduction and fixation with few complications.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Review of Measuring the Cognitive Workload of Electronic Health Records
Authors: Wilbanks Bryan A. , McMullan Susan P.
Published: August 2018

The To Err Is Human report stated that 98 000 patients die yearly because of medical errors, and that medication errors kill more people than workplace injuries. The inadequate design and utilization of the electronic health record have been identified as major contributing factors to medical errors. Increased cognitive workload of clinicians has consistently been linked to the occurrence of medical errors. The purpose of this article was to synthesize the current state of the science on measuring clinicians' cognitive workload associated with using electronic health records in order to inform evidence-based guidelines. The major considerations identified in the literature involve the use of psychometric instruments, using efficiency as a proxy for cognitive workload, and eye tracking. The National Aeronautics and Space Administration Task Load Index was the most used psychometric instrument, but reliability measures were not reported. It is important to evaluate reliability of psychometric instruments because the consistency of the instrument can change when administered to different populations. Efficiency is an observable measure defined by the total time to complete a task and the total number of physical interactions with the user interface. Efficiency can allow the use of statistical modeling, but it does not directly evaluate the mental activity associated with using an electronic health record interface. Eye tracking has been used extensively in the literature to measure cognitive workload via changes in pupil size related to mental activity, but it is not often used to measure the cognitive workload associated with using the electronic health record. Eye tracking is very useful for continuous monitoring of cognitive workload.
Impact of Exercise Training on Cardiac Function Among Patients With Type 2 Diabetes
Authors: Anand Vidhu , Garg Sushil , Garg Jalaj , Bano Shah , Pritzker Marc
Published: August 2018

Purpose:

Type 2 diabetes (T2D) is associated with subclinical abnormalities in left ventricular function and an increased downstream risk for heart failure. Exercise training has been associated with significant improvement in cardiorespiratory fitness among these patients. However, its impact on cardiac function is not well established.

Methods:

We conducted a meta-analysis including all randomized and nonrandomized trials that evaluated effects of exercise training on cardiac function among patients with T2D. Primary outcomes were measures of left ventricular systolic (global longitudinal strain) and diastolic (early diastolic velocity [é]) function. The effects of exercise training on peak oxygen uptake; other markers of diastolic dysfunction: mitral peak early-to-late diastolic filling velocity (E/A), mitral inflow to annular ratio (E/é), and deceleration time (DT); and systolic velocity were also assessed.

Results:

Our study included 441 patients enrolled in 6 trials. Exercise training significantly improved early diastolic velocity (standardized mean difference [SMD], 0.58; 95% CI, 0.09-1.07), global longitudinal strain (SMD, 0.62; 95% CI, 0.04-1.21), and peak oxygen uptake (SMD, 1.43; 95% CI, 0.51-2.35) as compared with control group. However, no significant changes were observed in other markers of diastolic function (E/A, E/é and DT) and systolic velocity.

Conclusion:

Exercise training in patients with T2D is associated with a significant improvement in some echocardiographic indicators of systolic and diastolic function and cardiorespiratory fitness. These findings suggest that exercise training may improve subclinical systolic and diastolic dysfunction in patients at risk for clinical heart failure.
Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome
Authors: Serón Pamela , Gaete Mónica , Oliveros María-Jose , Román Claudia , Lanas Fernando , Velásquez Monica , Reveco Roberto , Bustos Luis , Rojas Rubén
Published: August 2018

Purpose:

To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile.

Methods:

A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings.

Results:

Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state.

Conclusion:

Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.
LAMELLAR MACULAR HOLE WITH LAMELLAR HOLE–ASSOCIATED EPIRETINAL PROLIFERATION IN FAMILIAL EXUDATIVE VITREORETINOPATHY
Authors: Liu Jingjing , Zhao Peiquan
Published: August 2018

Purpose:

To present a clinical case of lamellar macular hole with lamellar hole–associated epiretinal proliferation in a pediatric familial exudative vitreoretinopathy patient. Retinal findings are described, and spectral domain optical coherence tomography documentation is provided. The efficacy of surgical intervention is also discussed.

Methods:

A 4-year-old girl presented with poor vision in her right eye, which was discovered during routine physical examination. Clinical examination revealed familial exudative vitreoretinopathy in both eyes and a lamellar macular hole in the right eye. Both of the patient's parents were also examined, which revealed familial exudative vitreoretinopathy in the girl's father. The patient underwent vitrectomy, inner limiting membrane and lamellar hole–associated epiretinal proliferation peeling, and air–fluid exchange.

Results:

Images obtained with optical coherence tomography revealed lamellar hole–associated epiretinal proliferation at the lamellar defect edge in the patient's right eye. Postoperative examination showed that the lamellar macular hole had closed.

Conclusion:

Pediatric familial exudative vitreoretinopathy patients may develop lamellar macular hole with lamellar hole–associated epiretinal proliferation. Vitreoretinal surgery effectively closes this type of macular hole.
Biocidal Efficacy of a Hydrogen Peroxide Lens Care Solution Incorporating a Novel Wetting Agent
Authors: Gabriel Manal M. , McAnally Cindy , Bartell John , Walters Rhonda , Clark Linda , Crary Monica , Shannon Stephen
Published: August 2018

Purpose:

To compare the antimicrobial effects of CLEAR CARE, a 3% hydrogen peroxide (H2O2) solution formulated for simultaneous cleaning, daily protein removal, disinfection, and storage of soft (hydrophilic) hydrogel, silicone hydrogel, and gas-permeable contact lenses, and CLEAR CARE PLUS, consisting of the 3% H2O2 solution plus a novel wetting agent, polyoxyethylene-polyoxybutylene (EOBO-21).

Methods:

Three lots each of the 2 solutions were incubated with 5 compendial microorganisms required by the Food and Drug Administration (FDA) 510(k) and International Organization for Standardization (ISO) 14729 stand-alone procedures, 4 clinical isolates of Gram-positive and Gram-negative bacteria, and trophozoites and cysts of 2 Acanthamoeba strains that are associated with microbial keratitis. Microbial loads were evaluated after disinfection and neutralization.

Results:

Both solutions exceeded the FDA/ISO stand-alone primary criteria against Gram-positive and Gram-negative compendial bacteria, yeast, and mold after only 1.5-hr disinfection/neutralization. At the recommended minimum disinfection time, bacteria were reduced by 4.4 to 5.1 logs, yeast by 4.4 to 4.9 logs, and mold by 2.9 to 3.5 logs with and without organic soil. In addition, both solutions eliminated or effectively reduced populations of clinically relevant ocular bacterial isolates (4.5–5.0 logs), Acanthamoeba trophozoites (3.4–4.2 logs), and cysts (1.5–2.1 logs).

Conclusion:

Both solutions eliminated or reduced populations of FDA/ISO compendial bacteria and fungi as well as clinically relevant microorganisms and Acanthamoeba trophozoites and cysts. The addition of EOBO-21 to the 3% H2O2 lens care solution had no impact on antimicrobial activity.
Fatal Central Nervous System Lymphocytic Vasculitis after Treatment for Burkitt Lymphoma in a Patient with a SH2D1A Mutation
Authors: Neves João Farela , Raga Lamberto Torralba , Chiang Samuel C. C. , Tesi Bianca , Vieira José Pedro , Cordeiro Ana Isabel , Borrego Luis , Bryceson Yenan T.
Published: August 2018

Very rarely, patients with X-linked lymphoproliferative syndrome type 1 present central nervous system vasculitis. We report a patient carrying a SH2D1A mutation that, after treatment for lymphoma developed fatal central nervous system vasculitis. He lacked signs of ongoing Epstein–Barr virus infection. We propose that impaired T cell homeostasis caused by SAP deficiency facilitates aberrant CD8+ T cell activation against vascular antigens promoting clinical manifestations.
Depressive Symptoms in Women With Coronary Heart Disease
Authors: Buckland Sydney A. , Pozehl Bunny , Yates Bernice
Published: August 2018

Background:

Interpreting studies about women with coronary heart disease and depressive symptoms is challenging: women continue to be underrepresented in research; data are often not presented separately by sex; many studies do not examine depressive symptoms longitudinally, leaving our understanding incomplete; and the use of multiple depressive symptom assessment instruments makes comparisons between studies problematic.

Purpose:

The authors of this systematic review examined 20 longitudinal descriptive studies on women with coronary heart disease and depressive symptoms, including prevalence of elevated symptoms, changes in symptoms over time, findings in women versus men, and findings based on assessment instruments.

Conclusions:

The prevalence of elevated depressive symptoms in women was 35.75% at baseline (hospitalization). The Beck Depression Inventory II yielded the highest baseline prevalence (40.3%), slightly higher than the Depression Interview and Structured Hamilton Scale (36%). The Hospital Anxiety and Depression Scale and the Kellner questionnaire yielded much lower prevalence (21.45% and 23%, respectively). Higher prevalence was linked to inclusion of somatic symptoms on measurement instruments except in post-coronary bypass surgery patients. Symptoms trended toward improvement, particularly in the first 6 months, although a few studies measured beyond this time. Women demonstrated higher prevalence than men initially (35.75% vs 23.46%, respectively) and over 24 months (22.71% vs 19.82%, respectively).

Clinical Implications:

Women experienced significantly more depressive symptoms than men initially and over time, although most women’s symptoms improved. Measurement varies widely based on instrument and the inclusion/exclusion of somatic symptoms. More longitudinal studies beyond 6 months with prevalence data and analysis by sex/gender are needed.
Management of Lung Transplant Bronchial Stenosis With Mitomycin C
Authors: Davidson Kevin R. , Elmasri Mary , Wahidi Momen M. , Shofer Scott L. , Cheng George Z. , Mahmood Kamran
Published: August 2018

Background:

Bronchial stenosis is a significant source of morbidity among lung transplant recipients, with etiologies including infection and ischemia of the airways. Current management with balloon bronchoplasty and stents is imperfect and a subset of patients requires multiple procedures to maintain airway patency. Mitomycin C (MMC) has been utilized for its antifibrotic properties in nonmalignant tracheobronchial stenosis but its application is not well studied in post–lung transplant stenosis. We performed this study to assess if MMC application decreases the need for repeated balloon bronchoplasty in lung transplant–related airway stenosis.

Methods:

This is a retrospective cohort study of all lung transplant recipients who developed airway stenosis and who were treated with MMC over 4 years. MMC was injected submucosally into the stenotic airway. We compared the rate of bronchoscopic dilation at intervals of 3 and 6 months before and after MMC therapy.

Results:

Eleven lung transplant recipients, with airway stenosis were included in our study, who required recurrent balloon dilation, despite airway stents in place in 73% of these patients. At 3 months after MMC treatment the median number of dilations decreased from 3 to 1 (P=0.023), and at 6 months from 3 to 2 dilations (P=0.004). There was a trend toward improvement in forced expiratory volume in one second and forced vital capacity, although it was not statistically significant. No adverse events related to MMC therapy was observed

Conclusion:

Application of MMC is safe and is associated with a reduction in frequency of bronchoscopic balloon dilation in patients with post–lung transplant airway stenosis.
When might transferrin, hemopexin or haptoglobin administration be of benefit following the transfusion of red blood cells?
Authors: Buehler Paul W. , Karnaukhova Elena
Published: August 2018

Purpose of review

After transfusion, a percentage of red blood cells undergo hemolysis within macrophages. Intravascular exposures to hemin and hemoglobin (Hb) can occur after storage bag hemolysis, some transfusion reactions, during use of medical assist devices and in response to bacterial hemolysins. Proteins that regulate iron, hemin and Hb either become saturated after iron excess (transferrin, Tf) or depleted after hemin (hemopexin, Hpx) and Hb (haptoglobin, Hp) excess. Protein saturation or stoichiometric imbalance created by transfusion increases exposure to non-Tf bound iron, hemin and Hb. Tf, Hpx and Hp are being developed for hematological disorders where iron, hemin and Hb contribute to pathophysiology. However, complexed to their ligands, each represents a potential iron source for pathogens, which may complicate the use of these proteins.

Recent findings

Erythrophagocytosis by macrophages and processes of cell death that lead to reactive iron exposure are increasingly described. In addition, the effects of transfusion introduced circulatory hemin and Hb are described in the literature, particularly following large volume transfusion, infection and during concomitant medical device use.

Supplementation with Tf, Hpx and Hp suggests therapeutic potential in conditions of extravascular/intravascular hemolysis. However, their administration following transfusion may require careful assessment of concomitant disease.
In pursuit of control and elimination: update on hepatitis A and B epidemiology and prevention strategies
Authors: Chi Victoria , Cleary Shannon , Bocchini Joseph A.
Published: August 2018

Purpose of review

This review describes the impact of recommendations for routine immunization of infants and children against hepatitis A and hepatitis B, the changing epidemiology of these infections, and the remaining challenges to controlling or eliminating these diseases in the United States.

Recent findings

Rates of hepatitis A and B have significantly declined because of childhood vaccination programs and long-term protection provided by infant immunization. However, hepatitis A immunization rates remain lower than other vaccines, and outbreaks continue to occur in part due to a growing number of susceptible adults. The Advisory Committee on Immunization Practice has updated pre and postexposure prophylaxis and travel recommendations for hepatitis A prevention in young infants, as well as recommendations to reduce ongoing perinatal transmission of hepatitis B.

Pediatric healthcare providers should continue to immunize all infants against hepatitis A and B and ensure that no child outgrows the pediatric practice without being vaccinated. To address hepatitis A, providers should be aware of new recommendations for unimmunized travelers, use vaccines to prevent and control outbreaks, and ensure postexposure prophylaxis. Universal vaccination of infants against hepatitis B should begin before hospital discharge. The prevention of perinatal transmission is critical for control and possible eradication of hepatitis B.
Facial recognition software in clinical dysmorphology
Authors: Hurst Anna C.E.
Published: August 2018

Purpose of review

The current review aims to discuss the incorporation of facial recognition software into the clinical practice of dysmorphology and medical genetics.

Recent findings

Facial recognition software has improved the process of generating a differential diagnosis for rare genetic syndromes, and recent publications demonstrate utility in both research and clinical applications. Software programs are freely available to verified medical providers and can be incorporated into routine clinic encounters.

As facial recognition software capabilities improve, two-dimensional image capture with artificial intelligence interpretation may become a useful tool within many areas of medicine. Geneticists and researchers can use such software to enhance their differential diagnoses, to study similarities and differences between patient cohorts, and to improve the interpretation of genomic data. Pediatricians and subspecialists may use tools to identify patients who may benefit from a genetic evaluation, and educators can use these tools to interest students in the study of dysmorphoplogy and genetic syndromes.
Genetic evaluation of patients with congenital heart disease
Authors: Geddes Gabrielle C. , Earing Michael G.
Published: August 2018

Purpose of review

The aim of this study is to review genetics of congenital heart disease (CHD) with a focus on clinical applications, genetic testing and clinical challenges.

Recent findings

With improved clinical care, there is a rapidly expanding population of adults, especially women, with CHD who have not undergone contemporary genetic assessment and do not understand their risk for having a child with CHD. Many patients have never undergone assessment or had genetic testing. A major barrier is medical geneticist availability, resulting in this burden of care shifting to providers outside of genetics. Even with current understanding, the cause for the majority of cases of CHD is still not known. There are significant gaps in knowledge in the realms of more complex causes such as noncoding variants, multigenic contribution and small structural chromosomal anomalies.

Standard assessment of patients with CHD, including adult survivors, is indicated. The best first-line genetic assessment for most patients with CHD is a chromosomal microarray, and this will soon evolve to be genomic sequencing with copy number variant analysis. Due to lack of medical geneticists, creative solutions to maximize the number of patients with CHD who undergo assessment with standard protocols and plans for support with result interpretation need to be explored.
Stem cell-based approaches to enhance nerve regeneration and improve functional outcomes in vascularized composite allotransplantation
Authors: Tung Thomas H. , Mackinnon Susan E.
Published: August 2018

Purpose of review

The current review will discuss the current understanding of nerve regeneration in vascularized composite allotransplantation (VCA). The success of proximal arm and leg transplants has been hampered by the limitations of nerve regrowth across long distances resulting in poor regeneration and functional recovery. Relevant research in stem-cell therapies to overcome these issues will be reviewed.

Recent findings

The effect of rejection on nerve regeneration in the VCA may be unpredictable and may be quite different for the nerve allograft. The issues that limit functional outcome are likely common to both VCA and proximal nerve injuries or replantation. Stem-cell therapies have focused on augmenting Schwann cell function and appear promising.

A better understanding of the effects of transplant rejection on nerve regeneration and function, as well as the factors that affect regeneration over long distances may inform further therapeutic approaches for improvement.
Aligning Evidence-Based Practice With Translational Research
Authors: Weiss Marianne E. , Bobay Kathleen L. , Johantgen Meg , Shirey Maria R.
Published: August 2018

Magnet® and other organizations investing resources in evidence-based practice (EBP) are ideal laboratories for translational nursing research. Translational research, the study of implementation of evidence into practice, provides a unique opportunity to leverage local EBP work for maximum impact. Aligning EBP projects with rigorous translational research can efficiently meet both EBP and research requirements for Magnet designation or redesignation, inform clinical practice, and place organizations at the leading edge of practice-based knowledge development for the nursing discipline.
The Effects of Occupational Violence on the Well-being and Resilience of Nurses
Authors: Rees Clare , Wirihana Lisa , Eley Rob , Ossieran-Moisson Rebecca , Hegney Desley
Published: August 2018

OBJECTIVE

This article reports findings from a 2016 survey exploring the working life of nurses/midwives in Queensland, Australia. Responses related to occupational violence (OV) are reported.

BACKGROUND

OV is linked to high rates of burnout. It is imperative to continue efforts to understand how to avoid burnout and build nurse/midwives' resilience.

METHODS

A total of 2397 nurse/midwives working in Queensland responded to the survey and were asked to answer 8 questions related to OV.

RESULTS

In the last 3 months, 53% of nurses/midwives had experienced OV. Those respondents had significantly higher rates of burnout and lower resilience and rated the practice environment lower than their counterparts who had not experienced violence.

CONCLUSIONS

The experience of OV significantly impacts nurse resilience and levels of burnout. To retain nurses, attention must be given to reduce OV and support nurses who have experienced it.
Effect of Psychoacoustic Learning on Cardiac Auscultation Proficiency in Nurse Practitioner Students
Authors: Cyphers Natalie A. , Mest Carol G. , Doyle-Tadduni Mary Elizabeth
Published: August 2018

Background

Assessment is a vital role of all nurses, yet cardiac murmur identification remains difficult for students. Cardiac auscultation is a technical, not intellectual, skill, and a psychoacoustic approach to learning is recommended. A psychoacoustic approach involves repetition of cardiac sounds to facilitate auditory perceptual learning.

Purpose

The purpose of this study was to determine the effectiveness of a psychoacoustic learning modality for identification of cardiac murmurs by nurse practitioner (NP) students.

Methods

A repeated-measures design was used. Following a pretest, NP students listened to repetitions of heart sounds, then took a posttest. Students were instructed to listen to the heart sounds weekly, then given posttests at 1 and 3 months.

Results

All posttest scores were higher than pretest scores; no significant difference in scores was noted between posttests.

Conclusions

Psychoacoustic learning may improve cardiac assessment. Further research is recommended with prelicensure nursing and NP students.
Appreciative Advising Pilot Study
Authors: Hande Karen , Christenbery Tom , Phillippi Julia
Published: August 2018

Background

Traditional advising may not meet the needs of doctor of nursing practice (DNP) students. Founded on the principles of appreciative inquiry, appreciative advising serves as a promising alternative model.

Purpose

The purpose of this pilot study was to determine feasibility of a DNP appreciative advising model to advise students through the rigors of DNP education and improve student and faculty satisfaction.

Methods

Faculty were oriented to the model and provided comprehensive guidebooks. Survey data were collected at 4 time points. Quantitative survey data were analyzed using descriptive statistics. Qualitative responses were analyzed using qualitative content analysis.

Results

Twenty-six students and 7 faculty who participated reported satisfaction with the model and commented that the model allowed for early identification of needs and was helpful and worthwhile.

Conclusion

The model may hold promise as a solution to assist students in adjusting to DNP education and deserves further exploration as an advising approach.
Validation of a New HPV Self-Sampling Device for Cervical Cancer Screening: The Cervical and Self-Sample in Screening (CASSIS) Study
Authors: El-Zein Mariam , Bouten Sheila , Louvanto Karolina , Gilbert Lucy , Gotlieb Walter , Hemmings Robert , Behr Marcel A. , Franco Eduardo L. , Liang Victoria , Martins Claudia , Duarte Silvy , Sarban Natalia , Geddes Patricia , Massa Ana , Samios Kathrin , Aboufadl Siham , Verdon Sophie , Pereria Cynthia , Lacroix Isabelle
Published: August 2018

(Abstracted from Gynecol Oncol 2018;149:491–497)

Over the past 10 years, there has been growing interest in cervical cancer screening programs using cervicovaginal self-sampling to test for human papillomavirus (HPV) nucleic acid. The overall accuracy of the self-collected HPV test results is superior to that of physician-collected Pap smears for identification of cervical precancerous lesions.
Inconsistent Weight Communication Among Prenatal Healthcare Providers and Patients: A Narrative Review
Authors: Weeks Ashley , Liu Rebecca H. , Ferraro Zachary M. , Deonandan Raywat , Adamo Kristi B.
Published: August 2018

Importance

Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy.

Objective

The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged.

Evidence Acquisition

A literature review was conducted by searching Ovid Medline, CINAHL, and Embase databases. All relevant primary research articles in English that assessed GWG discussions were included, whereas intervention studies were excluded.

Results

A total of 54 articles were included in this review. Although the overall prevalence and content of GWG counseling varied between studies, counseling was often infrequent and inaccurate. Healthcare providers tended to focus more on women experiencing obesity and excessive GWG, as opposed to the other body mass index categories or inadequate GWG. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity, and those categorized as overweight/obese were more likely to receive GWG advice. Patients also reported receiving conflicting facts between different HCP disciplines.

Conclusions

The evidence regarding GWG counseling in prenatal care remains variable, with discrepancies between geographic regions, patient populations, and HCP disciplines.

Relevance

Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.

Target Audience

Obstetricians and gynecologists, family physicians, midwives, and prenatal healthcare providers.

Learning Objectives

After completing this activity, the learner should be better able to critique the gaps in prenatal health education regarding GWG, assess the impact that various HCPs have on a patient's weight gain practices, and distinguish factors that contribute to useful and helpful GWG counseling.
Antibiotics for the Prevention and Treatment of Postsurgical Obstetric Infections
Authors: DeNoble Anna E. , Kuller Jeffrey A. , Phillips Heine R. , Dotters-Katz Sarah
Published: August 2018

Importance

Infectious complications contribute significantly to maternal morbidity and mortality. Antibiotics are a cornerstone of prevention and management of postsurgical infections in obstetrics. However, antibiotic resistance from inappropriate use of antibiotics is an emerging global health threat.

Objective

The aim of this study was to review the evidence and provide recommendations for antibiotic selection for prevention and treatment of postsurgical infections in obstetrics.

Evidence Acquisition

Published literature was retrieved through a search of PubMed. Relevant original research articles, systematic reviews, review articles, and practice guidelines were identified and included.

Results

Available evidence supports the use of a first-generation cephalosporin for an unlabored cesarean delivery, with the addition of adjunctive azithromycin for women undergoing labored cesarean delivery. Limited data also support the use of a second-generation cephalosporin at the time of obstetric anal sphincter injury repair. Limited retrospective studies suggest against the use of prophylactic antibiotics for manual removal of the placenta. Data are insufficient to recommend prophylactic antibiotics for postpartum dilation and curettage. Evidence from a systematic review supports clindamycin and gentamicin as the optimal regimen for the treatment of postpartum endometritis. Original obstetric research for the treatment of other postsurgical obstetric infections is limited, and recommendations provided are based on expert opinion.

Conclusions and Relevance

Obstetric providers should be familiar with available evidence and guidelines regarding antibiotic selection for the prevention and treatment of obstetric infections. Widespread selection of the narrowest effective antibiotic regimen has the potential to combat the rising threat of antibiotic resistance while ensuring appropriate prevention and treatment of postsurgical infections in obstetrics.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to (1) categorize the most common bacterial isolates responsible for obstetric postsurgical infections; (2) determine which obstetric operative interventions warrant antibiotic prophylaxis based on evidence-based guidelines; and (3) select appropriate, effective, and targeted antibiotics for the treatment of postsurgical infections in obstetrics patients.
Impact of Late-Follicular Phase Elevated Serum Progesterone on Cumulative Live Birth Rates: Is There a Deleterious Effect on Embryo Quality?
Authors: Racca A. , Santos-Ribeiro S. , De Munck N. , Mackens S. , Drakopoulos P. , Camus M. , Verheyen G. , Tournaye H. , Blockeel C.
Published: August 2018

(Abstracted from Hum Reprod 2018;33:860–868)

Multiple treatment attempts are generally required to achieve a live birth in women receiving assisted reproductive techniques. To provide patients with better prognostic information, increasing efforts have been made to report in vitro fertilization (IVF) success rates as cumulative live-birth rates (LBRs).
Tenofovir Versus Placebo to Prevent Perinatal Transmission of Hepatitis B
Authors: Jourdain Gonzague , Ngo-Giang-Huong Nicole , Harrison Linda , Decker Luc , Khamduang Woottichai , Tierney Camlin , Salvadori Nicolas , Cressey Tim R. , Sirirungsi Wasna , Achalapong Jullapong , Yuthavisuthi Prapap , Kanjanavikai Prateep , Na Ayudhaya Orada P. , Siriwachirachai Thitiporn , Prommas Sinart , Sabsanong Prapan , Limtrakul Aram , Varadisai Supang , Putiyanun Chaiwat , Suriyachai Pornnapa , Liampongsabuddhi Prateung , Sangsawang Suraphan , Matanasarawut Wanmanee , Buranabanjasatean Sudanee , Puernngooluerm Pichit , Bowonwatanuwong Chureeratana , Puthanakit Thanyawee , Klinbuayaem Virat , Thongsawat Satawat , Thanprasertsuk Sombat , Siberry George K. , Watts Diane H. , Chakhtoura Nahida , Murphy Trudy V. , Nelson Noele P. , Chung Raymond T. , Pol Stanislas , Chotivanich Nantasak
Published: August 2018

(Abstracted from N Engl J Med 2018;378:911–923)

(Pregnant women with an elevated viral load (>200,000 IU/mL) of hepatitis B virus (HBV), or with a positive Hg e antigen (HBeAg) status, have a risk of transmitting infection to their infants, despite the infants' receiving hepatitis B immune globulin (HBIG). Antiviral agents that inhibit HBV replication, such as lamivudine, tenofovir disoproxil fumarate (TDF), and telbivudine, when administered to pregnant women with a high HBV viral load, may reduce the risk of mother-to-child transmission.
Use of Telemedicine During Interhospital Transport of Children With Operative Intracranial Hemorrhage*
Authors: Jackson Eric M. , Costabile Philomena M. , Tekes Aylin , Steffen Katherine M. , Ahn Edward S. , Scafidi Susanna , Noje Corina
Published: August 2018

Objectives:

To analyze the impact of an intervention of using telemedicine during interhospital transport on time to surgery in children with operative intracranial hemorrhage.

Design:

We performed a retrospective chart review of children with intracranial hemorrhage transferred for emergent neurosurgical intervention between January 1, 2011 and December 31, 2016. We identified those patients whose neuroimaging was transmitted via telemedicine to the neurosurgical team prior to arrival at our center and then compared the telemedicine and nontelemedicine groups. Mann-Whitney U and Fisher exact tests were used to compare interval variables and categorical data.

Setting:

Single-center study performed at Johns Hopkins Hospital.

Patients:

Patients less than or equal to 18 years old transferred for operative intracranial hemorrhage.

Interventions:

Pediatric transport implemented routine telemedicine use via departmental smart phones to facilitate transfer of information and imaging and reduce time to definitive care by having surgical services available when needed.

Measurements and Main Results:

Fifteen children (eight in telemedicine group; seven in nontelemedicine group) met inclusion criteria. Most had extraaxial hemorrhage (87.5% telemedicine group; 85.7% nontelemedicine group; p = 1.0), were intubated pre transport (62.5% telemedicine group; 71.4% nontelemedicine group; p = 1.0), and arrived at our center’s trauma bay during night shift or weekend (87.5% telemedicine group; 57.1% nontelemedicine group; p = 0.28). Median trauma bay Glasgow Coma Scale scores did not differ (eight in telemedicine group; seven in nontelemedicine group; p = 0.24). Although nonsignificant, when compared with the nontelemedicine group, the telemedicine group had decreased rates of repeat preoperative neuroimaging (37.5% vs 57%; p = 0.62), shorter median times from trauma bay arrival to surgery (33 min vs 47 min; p = 0.22) and from diagnosis to surgery (146.5 min vs 157 min; p = 0.45), shorter intensive care stay (2.5 vs 5 d) and hospitalization (4 vs 5 d), and higher home discharge rates (87.5% vs 57.1%; p = 0.28).

Conclusions:

Telemedicine use during interhospital transport appears to expedite definitive care for children with intracranial hemorrhage requiring emergent neurosurgical intervention, which could contribute to improved patient outcomes.
Hypothesis Testing in Superiority, Noninferiority, and Equivalence Clinical Trials
Authors: Kumbhare Dinesh , Alavinia Mohammad , Furlan Julio
Published: August 2018

In medical research, it is important to be able to examine whether there is a significant difference between two samples. With this, establishing an appropriate hypothesis is a critical, basic step for correct interpretation of results in inferential statistical data analysis. It is important to note that the aim of hypothesis testing is not to “accept” or “reject” the null hypothesis but to gauge the likelihood that the observed difference is genuine if the null hypothesis is true.

Traditionally, the null hypothesis assumes that there is no statistically significant difference between the two groups. It has become more difficult to develop new treatments that are better than the standard of care. This review article summarizes and explains the methodology of the different types of clinical trials regarding the relevant basic statistical concepts and hypothesis testing.
Cryotherapy Reduces Muscle Spasticity But Does Not Affect Proprioception in Ischemic Stroke
Authors: Garcia Luccas Cavalcanti , Alcântara Carolina Carmona , Santos Gabriela Lopes , Monção João Victor Almeida , Russo Thiago Luiz
Published: August 2018

Objective

The aim of the study was to evaluate the immediate effects of cryotherapy (using an ice pack) on ankle joint position sense and the degree of spasticity after chronic hemiparetic stroke.

Design

We used a sham-controlled crossover design. Sixteen chronic hemiparetic patients were randomly assigned to two groups: (1) those who received cryotherapy followed by a control intervention 15 days later (cryotherapy group) and (2) those who received the control intervention followed by cryotherapy 15 days later (control intervention group). Ankle joint position sense was measured on the paretic side using a Biodex Multi-joint System 3 dynamometer before and after 20 mins of either application on the calf muscles. Lower absolute error scores were calculated for data analyses and were used to determine joint position sense. The degree of spasticity of the plantar flexor muscles was scored according to the Modified Ashworth Scale.

Results

Sixteen patients completed the crossover experiment; however, data analysis was successfully conducted in 15 participants. Cryotherapy reduced the degree of spasticity of the plantar flexor muscles without altering ankle joint position sense.

Conclusions

Cryotherapy (using an ice pack) may reduce plantar flexor spasticity without influencing proprioception.
Abdominal Wall Reconstruction Risk Stratification Tools: A Systematic Review of the Literature
Authors: Bernardi Karla , Adrales Gina L. , Hope William W. , Keith Jerrod , Kuhlens Heidi , Martindale Robert G. , Melin Alyson A. , Orenstein Sean B. , Roth John Scott , Shah Shinil K. , Tsuda Shawn , Liang Mike K. ,   Ventral Hernia Outcomes Collaborative Writing Group
Published: August 2018

Background:

Ventral hernias are a common pathology encountered by surgeons. Multiple risk stratification tools have been developed in attempts to predict a patient’s postoperative risk for complication. The aim of this systematic review was to identify published stratification tools, to assess their generalizability, and develop an ensemble risk score model.

Methods:

A systematic review of the literature was performed using PubMed and following the PRISMA guidelines. Two independent reviewers identified articles describing hernia stratification tools or validating an established tool. Inclusion criteria included articles that studied ventral hernia risk score models developed through expert consensus or from data of at least 500 subjects, performed a multivariable analysis of at least 500 patients, or assessed a previously reported model. Studies were grouped by primary outcome, and the odds ratios for correlated variables were compiled. Outcomes described in 4 or more articles were then stacked to generate a cumulative risk score model for patients undergoing abdominal wall repair.

Results:

A total of 20 articles were found to meet our inclusion criteria and used to develop our ensemble model. Surgical-site infection, surgical-site occurrence, and hernia recurrence were the 3 primary outcomes used to calculate our stacked cumulative risk stratification score.

Conclusions:

There are multiple risk score tools published; however, all have their strengths and limitations. For this reason, we created a composite score model with data from major articles to predict a patient’s risk for postoperative complications. This model aims to ease the shared-decision making process for patients, surgeons, and institutions.
Evidence-Based Strategies for the Prehabilitation of the Abdominal Wall Reconstruction Patient
Authors: Joslyn Nichole A. , Esmonde Nick O. , Martindale Robert G. , Hansen Juliana , Khansa Ibrahim , Janis Jeffrey E.
Published: August 2018

It is inherently challenging to achieve successful surgical outcomes for ventral hernia repairs. For complex ventral hernias, attempts to reconstruct the abdomen in patients who are overweight, deconditioned, malnourished, chronically infected or inflamed, have previous hernia recurrence, or otherwise carry a number of serious comorbidities affecting their surgical fitness are a major undertaking requiring careful preparation and planning. As the rate of abdominal wall reconstructions rises, so does the complexity of these procedures. One could argue that the prehabilitation of these patients is equally, if not more, important than the surgical technique itself. To achieve desirable outcomes and avoid surgical-site occurrences (SSOs), the surgeon must familiarize him/herself with ways to optimize a patient preoperatively. Understanding and identifying the aforementioned modifiable risk factors for SSOs is crucial. It is also important to recognize the impact that acute changes in the microbiome perioperatively can have on the postoperative success. Familiarizing oneself with the available literature for these patients is imperative. This review presents discussion and guidance for understanding the challenges and best practices for providing hernia surgery and abdominal wall reconstruction and achieving durable outcomes, with minimal SSOs.
Obesity and Abdominal Wall Reconstruction: Outcomes, Implications, and Optimization
Authors: Pearson David G. , Carbonell Alfredo M.
Published: August 2018

It has never been more important for surgeons to effectively and efficiently perform ventral hernia repairs, which optimize outcomes and the value of care. Surgical patients in the United States are becoming increasingly complex. The comorbid diseases each unique patient brings to the operation further complicate the effort to optimize surgical outcomes. Obesity poses specific challenges to surgeons who deal with abdominal wall reconstruction. Herein, we discuss the impact of obesity and its associated comorbidities on the outcome of abdominal wall reconstruction and offer suggestions on how to optimize patients for best results.
A Current Review of Synthetic Meshes in Abdominal Wall Reconstruction
Authors: Cobb William S.
Published: August 2018

The use of mesh materials for reinforcement of the abdominal wall has revolutionized the approaches to hernia repair. Whether it’s a permanent, synthetic mesh, a biologically derived collagen graft, or a synthetic, bioresorbable construct, data demonstrate improved outcomes with respect to recurrence with their use. Numerous advances and development of component separation techniques of the abdominal wall musculature have provided surgeons the ability to close large fascial defects and reestablish the linea alba for midline hernias. Augmentation of the these repairs with a mesh helps to offset the tension on the fascial closure and provide biomechanical strength to the native tissue. However, the use of mesh materials as either permanent or temporary scaffolds is not without potential complications. Abdominal wall surgeons must have knowledge of the mesh composition and structure in an effort to mitigate these concerns. This chapter will review the polymers and characteristics of the currently available synthetic meshes for abdominal wall reconstruction in an effort to provide guidance to surgeons.
A Current Review of Hybrid Meshes in Abdominal Wall Reconstruction
Authors: Reid Chris M. , Jacobsen Garth R.
Published: August 2018

Complex abdominal wall defects remain a common problem, though there has been significant advancement in technique and biomaterials over the last decade. The newly developed hybrid meshes are targeted to address several shortcomings of other meshes. Specifically, the marriage of biosynthetic or biologic materials with permanent prosthetic material is designed so that each will counteract the other’s negative attributes. There are reports of permanent meshes having been associated with chronic pain, stiffness, and inflammation. However, their utility in maintaining biomechanical strength, thus limiting recurrence, makes them of value. In hybrid meshes, biosynthetic or biologic materials are coupled with permanent prosthetics, potentially protecting them from exhibiting deleterious effects by promoting and hastening tissue ingrowth. The various hybrid meshes currently available and investigational data are reviewed.