bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of In-utero Exposure to Selective Serotonin Reuptake Inhibitors and Opioids on Neonatal Opioid Withdrawal Syndrome
Authors: Bhatt-Mehta Varsha , Richards Jessika , Sturza Julie , Schumacher Robert E.
Published: November 2018

Objective:

The objective of this study was to compare short-term outcomes of neonatal opioid withdrawal syndrome (NOWS) treatment in infants exposed in-utero to opioids and selective serotonin reuptake inhibitors (SSRIs) or opioids alone.

Methods:

This was a retrospective cohort study of mother-infant dyads, 34 weeks or greater gestation, receiving opioids and/or SSRIs during pregnancy. Intravenous or oral methadone was administered according to a pre-existing protocol for NOWS treatment guided by withdrawal scores. Primary outcome was length of treatment (LOT). Secondary outcomes included length of stay (LOS), total methadone exposure, time to symptom control, need for a second agent, and NOWS medications at discharge.

Results:

Fifty-five mother-infant dyads were included in the study. LOT was longer in the infants in the SSRI plus opioid group but not significantly different [24 ± 23 days (SSRI plus opioid) vs 20 ± 14 days (opioid alone); P = 0.78]. There was a trend towards shorter LOS (30 ± 22 day vs 27 ± 15 days; P = 0.86), lower total methadone exposure (3.2 ± 4.3 mg/kg vs 2.7 ± 5.1 mg/kg; P = 0.66), less time to control symptoms (1 ± 1.7 days vs 0.5 ± 0.36 days; P = 0.31) and less need for a second agent (OR 2.65, 95% CI 0.69–10.5) in the opioid only group, although these observations also did not reach statistical significance.

Conclusions:

This study could not demonstrate a statistically significant difference in short-term NOWS outcome of LOT between the 2 groups. However, there was a trend towards longer LOT and LOS in the SSRI plus opioid group which could be clinically significant. A larger cohort may detect a true significant difference in these short-term outcomes.
Lack of Sleep and Sports Injuries in Adolescents: A Systematic Review and Meta-analysis
Authors: Gao Burke , Dwivedi Shashank , Milewski Matthew D. , Cruz Aristides I.
Published: November 2018

Background:

Although sleep has been identified as an important modifiable risk factor for injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. The objective of this study was to quantitatively and qualitatively review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep.

Methods:

PubMed (includes MEDLINE) and EMBASE databases were systematically searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported statistics regarding the relationship between sleep and sports injury in adolescents aged 19 years or younger published between January 1, 1997 and December 21, 2017. From these included studies, the following information was extracted: bibliographic and demographic information, reported outcomes related to injury and sleep, and definitions of injury and decreased sleep. A random effects model was then created to quantify the odds of injury with decreased sleep in adolescents.

Results:

Of 907 identified articles, 7 met inclusion criteria. Five studies reported that adolescents who chronically slept poorly were at a significantly increased likelihood of experiencing a sports or musculoskeletal injury. Two studies reported on acute sleep behaviors. One reported a significant positive association between acutely poor sleep and injury, whereas the other study reported no significant association. In our random effects model, adolescents who chronically slept poorly were more likely to be injured than those who slept well (OR, 1.58; 95% CI, 1.05-2.37; P=0.03).

Conclusions:

Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries. Current evidence cannot yet definitively determine the effect of acute lack of sleep on injury rates.

Level of Evidence:

Level IV—systematic review of level II studies and one level IV study.
Natural Killer Cell Homing and Persistence in the Bone Marrow After Adoptive Immunotherapy Correlates With Better Leukemia Control
Authors: Grzywacz Bartosz , Moench Laura , McKenna David , Tessier Katelyn M. , Bachanova Veronika , Cooley Sarah , Miller Jeffrey S. , Courville Elizabeth L.
Published: November 2018

Cellular immunotherapy using allogeneic natural killer (NK) cells may overcome chemotherapy-refractory acute myeloid leukemia. Our goal was to document NK cell homing/persistence in the bone marrow following adoptive immunotherapy. Our cohort included 109 patients who received NK cell therapy for refractory acute myeloid leukemia following lymphodepleting conditioning +/− denileukin diftitox, +/− low-dose total body irradiation. We evaluated the NK cell density in bone marrow core biopsies performed an average of 14 days after NK cell transfer using a CD56 immunohistochemical stain. The NK cell density in core biopsies showed only moderate correlation with NK cell percentage in bone marrow aspirates evaluated by flow cytometry (r
s=0.48) suggesting that distribution of CD56+ cells in the bone marrow niche offers unique insight into NK cell homing. Better leukemia control was associated with increased NK cell density, such that patients with <5% blasts had a higher NK cell density (P=0.01). As well, NK cell density above the median of reference group was significantly associated with morphologic remission of leukemia (P=0.01). Moreover, the NK cell density varied significantly between conditioning protocols. Our findings suggest that the use of low-dose irradiation or CD25-targeting immunocytokine (denileukin diftitox, IL2DT) as part of conditioning results in increased NK cell homing/persistence in the bone marrow. These novel results will help guide future immunotherapy with NK cells.
Simultaneous long-lasting regression of multiple nevi and melanoma metastases after ipilimumab therapy
Authors: Plaquevent Marthe , Greliak Anna , Pinard Camille , Duval-Modeste Anne-Benedicte , Joly Pascal
Published: November 2018

We report a case of major regression of multiple atypical melanocytic nevi with a vitiligoid reaction in a patient with metastatic melanoma who achieved long-lasting complete remission after ipilimumab therapy. In 2008, a 54-year-old man presented with a dysplastic nevus syndrome. The patient was diagnosed with a scalp ulcerated melanoma (Breslow index 5.1 mm and Clark level IV), which was removed surgically. Four years later in April 2012, the patient was diagnosed with a right parietal skin metastasis, brain, lymph nodes, and bilateral lung metastases. The patient was first treated with vemurafenib, which had to be stopped because of renal toxicity. Disease stabilization was achieved after the second line of treatment with immunotherapy (ipilimumab, four infusions). However, 6 months later, the lung metastases had progressed. The patient was treated with pulmonary stereotactic radiotherapy associated with a second cycle of ipilimumab. After 6 months, he achieved complete remission. Simultaneously, the patient presented a generalized regression of his nevi with a vitiligoid reaction, or halo nevus, associated with a vitiligo located on the hands and inguinal areas. Vitiligo is a frequent immune-related adverse event of immunotherapy. Immunotherapy-induced halo nevus reaction is much less frequent than vitiligo. It was associated in the two case reports from the literature and in our patient with a quick and long-lasting complete remission of nodes and visceral metastases. Therefore, it might correspond to a stronger antimelanocyte immune reaction, associated with a favorable prognosis. The generalized halo nevi reaction in our patient could be more important because of the two cycles of ipilimumab compared with a single one. In conclusion, this case report suggests that a major regression of multiple nevi on ipilimumab might be associated with immunotherapy response.
Impact of Nursing Education on Phlebotomy Blood Loss and Hospital-Acquired Anemia
Authors: Jones Stacy , Spangler Paris , Keiser Megan , Turkelson Carman
Published: November 2018

Background

Phlebotomy blood loss resulting in hospital-acquired anemia remains a significant problem in the critically ill population. A quality improvement project focused on decreasing phlebotomy blood loss and increasing nursing knowledge regarding blood conservation strategies was undertaken in the intensive care unit of a community hospital.

Methods

The project followed a quasi-experimental design. Data were gathered using electronic chart review and surveys before and after educational sessions. Intensive care unit nurses attended educational sessions focused on increasing knowledge regarding phlebotomy blood loss, hospital-acquired anemia, blood conservation strategies, and utilization of blood conservation devices.

Results

The study showed a statistically significant increase in nursing knowledge regarding hospital-acquired anemia, phlebotomy blood loss, and blood conservation device use (P < .001) and a statistically significant change in blood conservation device application practice in the posteducation period when compared with the preeducation period (P = .016).

Conclusion

The findings of this project support the added value of dedicated blood conservation education to nurses to promote increased knowledge, increased blood conservation device utilization, and decreases in phlebotomy blood loss.
The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan
Authors: Alja’afreh Mahmoud A. , Mosleh Sultan M. , Habashneh Sakhaa S.
Published: November 2018

Purpose

This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score.

Methods

A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet.

Results

The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients’ oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system.

Conclusion

Health care teams should ensure that effective care protocol is implemented among patients.
Construct Validity and Responsiveness of the Abdominal Surgery Impact Scale in the Context of Recovery After Colorectal Surgery
Authors: Balvardi Saba , Pecorelli Nicolò , Castelino Tanya , Niculiseanu Petru , Liberman A. Sender , Charlebois Patrick , Stein Barry , Carli Franco , Mayo Nancy E. , Feldman Liane S. , Fiore Julio F.
Published: November 2018

BACKGROUND:

The Abdominal Surgery Impact Scale is a patient-reported outcome measure that evaluates quality of life after abdominal surgery. Evidence supporting its measurement properties is limited.

OBJECTIVE:

This study aimed to contribute evidence for the construct validity and responsiveness of the Abdominal Surgery Impact Scale as a measure of recovery after colorectal surgery in the context of an enhanced recovery pathway.

DESIGN:

This is an observational validation study designed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist.

SETTING:

This study was conducted at a university-affiliated tertiary hospital.

PATIENTS:

Included were 100 consecutive patients undergoing colorectal surgery (mean age, 65; 57% male).

INTERVENTION:

There were no interventions.

MAIN OUTCOME MEASURES:

Construct validity was assessed at 2 days and 2 and 4 weeks after surgery by testing the hypotheses that Abdominal Surgery Impact Scale scores were higher 1) in patients without vs with postoperative complications, 2) with higher preoperative physical status vs lower, 3) without vs with postoperative stoma, 4) in men vs women, 5) with shorter time to readiness for discharge (≤4 days) vs longer, and 6) with shorter length of stay (≤4 days) vs longer. To test responsiveness, we hypothesized that scores would be higher 1) preoperatively vs 2 days postoperatively, 2) at 2 weeks vs 2 days postoperatively, and 3) at 4 weeks vs 2 weeks postoperatively.

RESULTS:

The data supported 3 of the 6 hypotheses (hypotheses 1, 5, and 6) tested for construct validity at all time points. Two of the 3 hypotheses tested for responsiveness (hypotheses 1 and 2) were supported.

LIMITATIONS:

This study was limited by the risk of selection bias due to the use of secondary data from a randomized controlled trial.

CONCLUSIONS:

The Abdominal Surgery Impact Scale was responsive to the expected trajectory of recovery up to 2 weeks after surgery, but did not discriminate between all groups expected to have different recovery trajectories. There remains a need for the development of recovery-specific, patient-reported outcome measures with adequate measurement properties. See Video Abstract at http://links.lww.com/DCR/A814.
Randomized Clinical Trial Comparing Laparoscopic Versus Ultrasound-Guided Transversus Abdominis Plane Block in Minimally Invasive Colorectal Surgery
Authors: Zaghiyan Karen N. , Mendelson Brian J. , Eng Matthew R. , Ovsepyan Gayane , Mirocha James M. , Fleshner Phillip
Published: November 2018

BACKGROUND:

Transversus abdominis plane block may improve analgesia after colorectal surgery; however, techniques remain unstandardized and results are conflicting.

OBJECTIVE:

The purpose of this study was to compare laparoscopic and ultrasound-guided transversus abdominis plane block with no block in minimally invasive colorectal surgery.

DESIGN:

This was a randomized controlled trial.

SETTINGS:

The study was conducted at an urban teaching hospital.

PATIENTS:

Patients undergoing laparoscopic colorectal surgery were included.

INTERVENTIONS:

The intervention included 2:2:1 randomization to laparoscopic, ultrasound-guided, or no transversus abdominis plane block.

MAIN OUTCOME MEASURES:

Morphine use in the first 24 hours after surgery was measured.

RESULTS:

The study cohort included 107 patients randomly assigned to laparoscopic (n = 41), ultrasound-guided (n = 45), or no transversus abdominis plane block (n = 21). Mean age was 50.4 years (SD ± 18 y), and 50 patients (47%) were men. Laparoscopic transversus abdominis plane block was superior to ultrasound-guided (p= 0.007) and no transversus abdominis plane block (p= 0.007), with median (interquartile range) total morphine used in the first 24 hours postoperatively of 17.6 mg (6.6–33.9 mg), 34.0 mg (16.4–44.4 mg), and 31.6 mg (18.4–44.4 mg). At 48 hours, laparoscopic transversus abdominis plane block remained superior to ultrasound-guided (p= 0.03) and no transversus abdominis plane block (p= 0.007) with median (interquartile range) total morphine used at 48 hours postoperatively of 26.8 mg (15.5–45.8 mg), 44.0 mg (27.6–70.0 mg), and 60.8 mg (34.8–78.8 mg). Mean hospital stay was 5.1 ± 3.1 days without any intergroup differences. Overall complications were similar between groups.

LIMITATIONS:

Treatment teams were not blinded and there was operator dependence of techniques and variable timing of the blocks.

CONCLUSIONS:

Laparoscopic transversus abdominis plane block is superior to ultrasound-guided and no transversus abdominis plane block in achieving pain control and minimizing opioid use in the first 24 hours after colorectal surgery. A large, multicenter, randomized trial is needed to confirm our findings. SeeVideo Abstractat http://links.lww.com/DCR/A822.
Do Post-breast Cancer Diagnosis Toenail Trace Element Concentrations Reflect Prediagnostic Concentrations?
Authors: O’Brien Katie M. , White Alexandra J. , Sandler Dale P. , Jackson Brian P. , Karagas Margaret R. , Weinberg Clarice R.
Published: November 2018

Background:

Exposure to trace elements may affect health, including breast cancer risk. Trace element levels in toenails are potentially useful biomarkers of exposure, but their reliability is not established. We assessed the reproducibility of toenail element concentrations over time and whether concentrations change following a breast cancer diagnosis.

Methods:

We assessed trace element levels in toenails collected at two time points from 221 women (111 with and 110 without an intervening breast cancer diagnosis). We measured levels of arsenic, cadmium, chromium, cobalt, copper, iron, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, tin, vanadium, and zinc using inductively coupled plasma mass spectrometry in samples collected at baseline and 4–10 years later. We compared trace element concentrations over time using Spearman’s rank correlation coefficient (R). We used linear models to examine the magnitude and direction of changes and the influence of a breast cancer diagnosis.

Results:

Overall, we observed positive correlations (R = 0.18–0.71) between paired samples for all trace elements. However, nickel (R = −0.02) and antimony (R = 0.12) were not correlated among cases. We observed decreases in cadmium, chromium, mercury, manganese, molybdenum, nickel, and lead between baseline and follow-up, but case status was unrelated to these changes. The declines are consistent with decreases over calendar time rather than age time.

Conclusions:

Toenail trace element concentrations were correlated over time, but many elements showed systematic decreases by calendar year. Aside from nickel and antimony, postdiagnostic toenail levels correlated with prediagnostic levels, providing support for using postdiagnostic toenail samples in retrospective studies.
Diesel Exhaust, Respirable Dust, and Ischemic Heart Disease: An Application of the Parametric g-formula
Authors: Neophytou Andreas M. , Costello Sadie , Picciotto Sally , Brown Daniel M. , Attfield Michael D. , Blair Aaron , Lubin Jay H. , Stewart Patricia A. , Vermeulen Roel , Silverman Debra T. , Eisen Ellen A.
Published: November 2018

Background:

Although general population studies of air pollution suggest that particulate matter—diesel exhaust emissions in particular—is a potential risk factor for cardiovascular disease, direct evidence from occupational cohorts using quantitative metrics of exposure is limited. In this study, we assess counterfactual risk of ischemic heart disease (IHD) mortality under hypothetical scenarios limiting exposure levels of diesel exhaust and of respirable mine/ore dust in the Diesel Exhaust in Miners Study cohort.

Methods:

We analyzed data on 10,779 male miners from 8 nonmetal, noncoal mines—hired after diesel equipment was introduced in the respective facilities—and followed from 1948 to 1997, with 297 observed IHD deaths in this sample. We applied the parametric g-formula to assess risk under hypothetical scenarios with various limits for respirable elemental carbon (a surrogate for diesel exhaust), and respirable dust, separately and jointly.

Results:

The risk ratio comparing the observed risk to cumulative IHD mortality risk at age 80 under a hypothetical scenario where exposures to elemental carbon and respirable dust are eliminated was 0.79 (95% confidence interval [CI]: 0.64, 0.97). The corresponding risk difference was -3.0% (95% CI: -5.7, -0.3).

Conclusion:

Our findings, based on data from a cohort of nonmetal miners, are consistent with the hypothesis that interventions to eliminate exposures to diesel exhaust and respirable dust would reduce IHD mortality risk.
Drug-induced Sialorrhoea
Authors: Haastrup Maija Bruun , Henriksen Daniel P. , Christensen Mette Marie H.
Published: November 2018

Sialorrhoea is a common adverse effect of a range of medicines, primarily clozapine. At least a third of patients treated with clozapine suffer from sialorrhoea, and the consequences of this can be socially stigmatising and lead to non-adherence. The treatment options are limited and primarily centered around muscarinic antagonism. We suggest non-pharmacological interventions followed by locally applied atropine or glycopyrrolate. If systemic treatment is necessary, amisulpride, benztropine, or terazosin may be attempted.
Darunavir Population Pharmacokinetic Model Based on HIV Outpatient Data
Authors: Daskapan Alper , Tran Quynh T.D. , Cattaneo Dario , Gervasoni Cristina , Resnati Chiara , Stienstra Ymkje , Bierman Wouter F.W. , Kosterink Jos G. W. , van der Werf Tjip S. , Proost Johannes H. , Alffenaar Jan-Willem C. , Touw Daniel J.
Published: November 2018

Background:

Darunavir is a second-generation protease inhibitor and is registered for the treatment of HIV-1 infection. The aim of this study was to develop and validate a darunavir population pharmacokinetic model based on data from daily practice.

Methods:

Data sets were obtained from 2 hospitals: ASST Fatebenefratelli Sacco University Hospital, Italy (hospital A), and University Medical Center Groningen, the Netherlands (hospital B). A pharmacokinetic model was developed using data from the largest data set using the iterative two-stage Bayesian procedure within the MWPharm software package. External validation was conducted using data from the smaller data set with Passing–Bablok regression and Bland–Altman analyses.

Results:

In total, data from 198 patients from hospital A and 170 patients from hospital B were eligible for inclusion. A 1-compartment model with first-order absorption and elimination resulted in the best model. The Passing–Bablok analysis demonstrated a linear correlation between measured concentration and predicted concentration with r2 = 0.97 (P < 0.05). The predicted values correlated well with the measured values as determined by a Bland–Altman analysis and were overestimated by a mean value of 0.12 mg/L (range 0.23–0.94 mg/L). A total of 98.2% of the predicted values were within the limits of agreement.

Conclusions:

A robust population pharmacokinetic model was developed, which can support therapeutic drug monitoring of darunavir in daily outpatient settings.
Depression, Socioeconomic Factors, and Ethnicity as Predictors of Cardiorespiratory Fitness Before and After Cardiac Rehabilitation
Authors: Mikkelsen Nicolai , Dall Christian Have , Frederiksen Marianne , Holdgaard Annette , Rasmusen Hanne , Prescott Eva
Published: November 2018

Purpose:

To determine whether cardiac patients with psychosocial or socioeconomic problems have lower peak oxygen uptake (

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2peak) and whether these factors modify the effect of cardiac rehabilitation (CR).

Methods:

A retrospective cohort study of patients with ischemic heart disease, valvular heart disease, or heart failure referred for CR.

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2peak was assessed by a maximal cardiopulmonary exercise test. Pre-existing depression was defined by use of antidepressants and new-onset depression by a modified Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire at CR intake. Socioeconomic status was defined by educational attainment and working status; ethnicity as Western European or non-Western European. Full data from baseline assessment were available on 1217 patients and follow-up on 861 patients.

Results:

Mean ± SD

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2peak before CR was 21.8 ± 6.8 mL/kg/min. After multivariable adjustment, lower

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2peak was associated with lower educational attainment, not working, and non-Western ethnicity but not with depression. Mean improvement of

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2peak following CR was 2.4 ± 4.3 mL/kg/min. After multivariable adjustment educational attainment, employment status and ethnicity were significant predictors of improvement of

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2peak while depression was not.

Conclusion:

Education, attachment to the workforce, and ethnicity were all associated with lower

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2peak before CR, and the disparity was increased following CR. Having pre-existing depression and new-onset depression did not influence

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2peak either before or after CR. These results point to important subgroups in need of specially-tailored rehabilitation programs.
Evaluation of Repurposing Archetypal Preventive Radiological/Nuclear Detectors for the Consequence Management Mission
Authors: Musolino Stephen V. , Buddemeier Brooke , Finfrock Charles , Gomera Jose , Klemic Gladys , Moskowitz Joseph , Roberts Thomas , Schaefer Lance
Published: November 2018

In the first hours or days after an unplanned release of radioactive material to the environment, the radiation detection instruments most widely available to local first responders may be those currently fielded for interdiction missions. This study investigated how such preventative radiological/nuclear detection instruments could perform if repurposed for consequence management missions. A representative sample of three archetypes (body-worn, human-carried, and other/large-detection-volume equipment) encompassed six categories: personal radiation detector, extended-range personal radiation detector, personal emergency radiation detector, radioisotope identification device, human-portable detector/backpack, and vehicle-mounted large-detection-volume detector. Overall 19 models of equipment were included in the study. Laboratory evaluations were designed to assess the capabilities of the instruments in four consequence management missions: exposure rate, integrated exposure, radiation survey, and contamination screening. As applicable, the evaluations included measurement of exposure rate, integrated exposure, overrange response, and angular response. The results were compared to benchmarks from the American National Standards Institute N42.49A. The performance of the instruments for initial screening for contamination was assessed by an automated radioactive source moving past the detectors at various speeds and distances. The results demonstrate that if the equipment is used in accordance with the mission analysis and categories and within the original equipment manufacturer specifications, it is possible to achieve sufficient accuracy to estimate and document doses to responders, plan entries into contaminated areas, detect contamination, and protect the public until such time as outside resources arrive with sufficient numbers of standard health physics instruments and personnel dosimetry to replace the preventative radiological/nuclear detection instruments. This evaluation campaign was conducted to complement the National Council on Radiation Protection and Measurements Report 179, Guidance for Emergency Response Dosimetry.
A Contingency Plan for Catastrophic Loss of Bioassay Services
Authors: Carbaugh E.H. , Antonio C.L. , Lynch T.P. , Nelsen L.A.
Published: November 2018

The catastrophic loss of direct or indirect bioassay services can severely impact a site or facility’s radiation protection program. While highly unlikely, circumstances such as fire, hurricane, other extreme weather conditions, unanticipated events, or contractual business decisions could result in the loss of either the onsite or offsite measurement capabilities for direct or indirect radiobioassay services. The process and elements that need to be addressed in obtaining alternate or replacement bioassay services can be described in relatively simple terms, but can be very complex and time consuming to implement. The contingency plan developed for one large, complex radiobioassay program is a good example for addressing these items.
A Comparison of 2 Online Parent Skills Training Interventions for Early Childhood Brain Injury: Improvements in Internalizing and Executive Function Behaviors
Authors: Aguilar Jessica M. , Cassedy Amy E. , Shultz Emily L. , Kirkwood Michael W. , Stancin Terry , Yeates Keith Owen , Taylor H. Gerry , Wade Shari L.
Published: November 2018

Objective:

To examine the effectiveness of a web-based parenting intervention (Internet-Based Interacting Together Everyday: Recovery After Childhood TBI [I-InTERACT]) and an abbreviated version (Express) in reducing executive dysfunction and internalizing problems among young children following traumatic brain injury (TBI).

Method:

Parents of 113 children (ages 3-9 years) who had sustained a TBI were randomized to 1 of 3 treatment groups: I-InTERACT, Express, or an Internet Resource Comparison (IRC) group. Parents who participated in either I-InTERACT or Express completed self-guided web sessions and received live coaching of their parenting skills via videoconferencing with a therapist. I-InTERACT included additional psychoeducation, stress management, and family communication skills (eg, marriage, grief, pain, and sleep). Analyses of covariance were utilized to compare the groups on parent-reported executive function behaviors (ie, Behavior Rating Inventory of Executive Function) and internalizing symptoms (ie, Child Behavior Checklist) at baseline and 6 months.

Results:

Parents who participated in Express reported significantly lower levels of executive dysfunction than those in I-InTERACT, β = −0.49; t(2, 73) = −2.47, P = .048, and significantly lower levels of withdrawal than those in the IRC group, β = −0.44; t(2, 74) = −2.22, P = .03. The Express group did not significantly differ from the IRC group on executive function behaviors or the I-InTERACT group on internalizing problems, all P > .05. Children with more problems at baseline, families with lower education levels, and parents with more symptoms of depression benefited most.

Conclusion:

A brief, online parent training intervention may be efficacious in improving executive dysfunction and internalizing problems following early TBI, particularly among children of lower socioeconomic status or with existing behavioral concerns.
A Comparison of Satisfaction With Life and the Glasgow Outcome Scale–Extended After Traumatic Brain Injury: An Analysis of the TRACK-TBI Pilot Study
Authors: Kreitzer Natalie P. , Hart Kimberly , Lindsell Christopher J. , Manley Geoffrey T. , Dikmen Sureyya S. , Ratcliff Jonathan J. , Yue John K. , Adeoye Opeolu M.
Published: November 2018

Objective:

To evaluate the relationship between satisfaction with life (SWL) and functional outcome after traumatic brain injury (TBI).

Setting and Participants:

The Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study (TRACK-TBI Pilot) enrolled patients at 3 US Level I trauma centers within 24 hours of TBI.

Design:

Patients were grouped by outcome measure concordance (good-recovery/good-satisfaction, impaired-recovery/impaired-satisfaction) and discordance (good-recovery/impaired-satisfaction, impaired-recovery/good-satisfaction). Logistic regression was utilized to determine predictors of discordance.

Main Measures:

Functional outcome: Glasgow Outcome Scale–Extended (GOSE); SWL: Satisfaction with Life Scale (SWLS).

Results:

Of the 586 enrolled subjects, 298 had completed both outcome measures at 6-month follow-up; the correlation between GOSE and SWLS was 0.380. Patients with impaired-recovery (GOSE < 7)/impaired-satisfaction (SWLS < 20) were more likely to have mild TBI (83% vs 62%, P = .012), baseline depression (42% vs 15%, P < .0001), and 6-month depression (59% vs 21%, P < .0001) when compared with patients with impaired-recovery/good-satisfaction. Patients with good-recovery/impaired-satisfaction were more likely to have baseline depression (31% vs 13%, P < .0001) and 6-month depression (33% vs 6%, P < .0001) compared with good-recovery/good-satisfaction.

Conclusion:

Correlation between SWL and functional outcome was not strong, and depression may modulate the association. Future research should account for functional, mental health, and patient-centered outcomes when assessing TBI recovery.
Influence of Treating Ocular Surface Disease on Intraocular Pressure in Glaucoma Patients Intolerant to Their Topical Treatments: A Report of 10 Cases
Authors: Dubrulle Pierre , Labbé Antoine , Brasnu Emmanuelle , Liang Hong , Hamard Pascale , Meziani Lyes , Baudouin Christophe
Published: November 2018

Purpose:

The purpose of this study was to evaluate the effect of treating ocular surface disease (OSD) in patients with medically uncontrolled primary open-angle glaucoma (POAG) associated with OSD.

Methods:

We compiled a retrospective observational case series of 10 patients with POAG that remained uncontrolled with topical treatments and who were referred for filtering glaucoma surgery. All patients underwent a complete assessment of their glaucoma and ocular surface for both eyes. The main treatments were change of topical antiglaucoma medications to preservative-free equivalents, removal of allergenic treatments or those identified as causing side effects, switch to another therapeutic class with the same efficacy but with a better safety profile and treatment of OSD.

Results:

After a minimum follow-up of 6 months, we observed improved ocular surface in all patients, associated with an intraocular pressure (IOP) decrease or stabilization even if some antiglaucoma medications were removed. The mean IOP significantly decreased from 23.75±9.98 mm Hg to 15.15±4.75 mm Hg (−36.2%; P=0.0001). The mean number of IOP-lowering medications was 3.7±1.06 at presentation and 2.8±0.63 after treatment (P=0.01). The Oxford score also decreased from a mean 1.7±0.67 to 0.4±0.51 (−76.5%; P<0.001). For 2 patients, IOP was not sufficiently reduced after treatment and they finally underwent filtering surgery.

Conclusions:

The prevalence of OSD in POAG patients is very high, particularly in patients with uncontrolled glaucoma with multiple topical medications. Careful management of the ocular surface associated with a reduction of the toxicity of eyedrops may result in improvement of ocular surface health and better IOP control.
Technique and Results of Permanent Medial Tarsorrhaphy for Complex Eyelid Malposition
Authors: Segal Kira L. , Elner Susan G. , Elner Victor M.
Published: November 2018

Purpose:

To evaluate the results of permanent medial tarsorrhaphy and to describe the surgical technique.

Methods:

Medial tarsorrhaphy was performed on 30 eyelids with symptomatic exposure keratopathy secondary to eyelid malposition. Observational, retrospective review of preoperative and postoperative examination findings was performed.

Results:

Average age of the cohort was 66 years (31–91). Medial tarsorrhaphy was performed to correct eyelid retraction (100%), exposure keratopathy (80%), lagophthalmos (57%), and ectropion (17%) in patients with cranial nerve VII palsy (47%), Graves eye disease (13%), eczema (7%), floppy eyelid syndrome (7%), after Mohs reconstruction (7%), orbital myositis (3%), and neurofibromatosis (3%). Seventy-three percent (73%) of patients had an average of 3 surgeries (N = 22, standard deviation = 1.12, range = 2–7) before undergoing medial tarsorrhaphy. Medial tarsorrhaphy was performed in combination with another procedure in 53% of cases. Palpebral fissure decreased postoperatively an average of 1.1 mm (N = 20; p = 0.005), inferior scleral show decreased 0.72 mm (N = 22; p = 0.03), lagophthalmos decreased 0.4 mm (N = 15; p = 0.27), and superficial punctate keratopathy improved by 61% (N = 27; p = 0.009). Ectropion completely resolved in 4 of 10 patients (40%). Seven patients (23%) required additional surgery following tarsorrhaphy an average of 8 months later (range = 2–16). In 1 patient (3%), a tarsorrhaphy opened prematurely, and 1 patient (3%) requested partial opening of the tarsorrhaphy. Average duration of follow up was 13 months (N = 30, standard deviation = 14.97, range = 0.2–45.7).

Conclusions:

Medial tarsorrhaphy is a safe and effective primary or salvage technique to address complex causes of eyelid retraction, lagophthalmos, ectropion, and exposure keratopathy.
Sensory-Processing Patterns of Preterm Children at 6 Years of Age
Authors: Pekçetin Serkan , Sarıdaş Bağdagül , Üstünyurt Zeynep , Kayıhan Hülya
Published: November 2018

The purpose of this study was to compare the sensory-processing patterns of preterm and term children at 6 years of age. The sensory profile (SP; W. Dunn, 1999) was used to evaluate sensory-processing patterns. We compared the section and factor SP scores of 118 preterm children with those of 158 term children at 6 years of age. Preterm children were significantly different from their term peers in all section and factor scores except the sedentary factor. Birth weight, gestational age, and days spent in the neonatal intensive care unit were correlated with sensory-processing issues. The sensory-processing abilities of preterm children should be evaluated at the age of 6 years and occupational therapy interventions should be implemented when necessary.
Exploring Continuities Between Family Engagement and Well-Being in Aboriginal Head Start Programs in Canada
Authors: Gerlach Alison J. , Gignac Joan
Published: November 2018

Children and families receive maximum benefits from early childhood programs when families are actively engaged. “Parental involvement” is an established feature of Aboriginal Head Start in Urban and Northern Communities (AHSUNC) in Canada, and there is interest in increasing the knowledge on how AHSUNC sites engage with parents and families. This qualitative study generated knowledge and insights into the nature of family engagement in AHSUNC programs. From May to November 2016, semistructured interviews were undertaken with 26 participants in AHSUNC programs across British Columbia. Participants included parents (n = 10); Elders (n = 6), and AHSUNC program coordinators and family workers (n = 10). Findings illustrate a nuanced, relational, and strengths-based approach to family engagement that included AHSUNC program staff being responsive to the influence of broader social and structural factors on families' everyday lives and program engagement. Findings highlight how family engagement practices in AHSUNC are interdependent and continuous with practices aimed at supporting family well-being. The implications of reframing family engagement from a relational perspective are discussed. These findings have relevancy beyond Indigenous contexts to all early childhood and child health programs that are questioning how to engage with families who experience multifaceted forms of social disadvantage and marginalization.
eConsult Mental Health
Authors: Leung Lucinda B. , Benitez Christopher T. , Yee Hal F.
Published: November 2018

We describe the implementation of a novel electronic platform for specialty referral and consultation, eConsult Mental Health. This innovation aims to address mental health care access and coordination challenges in the nation's second largest public health system in Los Angeles. eConsult Mental Health is one of the largest documented electronic platforms to facilitate the integration of behavioral health services in primary care. Although implementation has been met with barriers unique to mental health care, eConsult Mental Health appears to be a promising tool to expand the spectrum of care for Los Angeles County safety net primary care providers in patient-centered medical homes.
Ropinirole Augmentation for Depression
Authors: Gershon Ari A. , Amiaz Revital , Shem-David Haim , Grunhaus Leon
Published: November 2018

Objective

Evidence both from animal and human studies suggests a role for dopaminergic pathways in the treatment of depression. Ropinirole, a selective agonist of dopamine D2/D3, is in use for the treatment of parkinsonism. Preliminary evidence suggests that such agonists might be useful as antidepressants. We tested whether an add-on ropinirole is an effective in depressed patients.

Methods

We conducted a double-blind, randomized, placebo-controlled trial of add-on ropinirole in depressed patients unresponsive to at least one antidepressant. We recruited 32 unipolar and bipolar patients who remained depressed (modified 21-item Hamilton Depression Rating Scale) despite at least 4 weeks of treatment with an adequate dose of antidepressant medication. Patients received either 2 mg of oral ropinirole or placebo twice daily added on to their current medication and were evaluated weekly for 7 weeks using the Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale.

Results

No difference in primary or secondary outcome measures was detected between the treatment and control groups.

Discussion

These results differ from previous studies and are unexpected in light of theoretical considerations. This may indicate that there are differences in pharmacological activity between ropinirole and other dopaminergic agents such as pramipexole.
The Relationship Among Multiple Sclerosis–Related Symptoms, Sleep Quality, and Sleep Hygiene Behaviors
Authors: Newland Pamela , Lorenz Rebecca A. , Smith Judith M. , Dean Emily , Newland John , Cavazos Patricia
Published: November 2018

Aims and Objectives: The aim of this study was to examine the relationships among multiple sclerosis (MS)–related symptoms, sleep hygiene behaviors, and sleep quality in adults with MS who self-report fatigue. Background: Fatigue is a frequent, prevalent symptom among adults with MS. Few studies have examined the relationship among fatigue and other symptoms with sleep quality and sleep behaviors. Design: This is a descriptive correlational study. Methods: A convenience sample of 39 adults with MS were recruited for the study. Instruments used included the revised MS Related Symptom Scale and the Pittsburgh Sleep Quality Index. Correlations examined the relationships among fatigue and other MS symptoms with sleep quality and sleep hygiene behaviors. Results: The frequency of several symptoms correlated with poor sleep quality, and fatigue frequency was higher in those who used electronic devices and practiced poor sleep hygiene behaviors. Nursing Implications: Nurses should incorporate interventions for symptoms that impact sleep quality. These findings suggest that sleep hygiene education should be a part of routine clinical care. Conclusion: Adults with MS experience the burden of many symptoms that impact sleep quality. Interventions that include education to improve symptoms, sleep hygiene behaviors, and sleep quality are needed.
Why Do Women Get Cervical Cancer in an Organized Screening Program in Canada?
Authors: Jackson Rebecca , Wang Li , Jembere Nathaniel , Murphy Joan , Kupets Rachel
Published: November 2018

Objective

The aim of the study was to determine factors associated with the development of cervical malignancy among women participating in an organized cervical screening program.

Materials and Methods

A population-based retrospective cohort study was performed examining the screening histories 2 to 10 years before diagnosis of invasive cancer in Ontario women between 2011 and 2014.

Results

A total of 2,002 cases of cervical cancer were identified; 1,358 (68%) were squamous cell carcinomas and 644 (32%) were adenocarcinomas. The mean age at the time of diagnosis was 50.3 years. More than 60% of the cohort had at least 1 cytology test within 2 to 10 years of their diagnosis. Of the women having a cytology result 24 to 36 months before diagnosis, 69% had a normal cytology whereas only 7% had a high-grade cytology result. Stage of cancer was most advanced in women who did not have cytology in the 2 to 10 years before their diagnosis. On multivariate regression, those with cervical cancer who were less likely to have undergone screening include older age, advanced stage, lower income, not having a family physician, and those diagnosed with adenocarcinoma.

Conclusions

Although nonparticipation in screening is the greatest factor associated with cervical cancer diagnosis, failure of cervical cytology to detect cytologic abnormalities in women 2 to 3 and 3 to 5 years before diagnosis is of concern. Efforts must be directed to recruitment of women for screening as well as improving the sensitivity of screening tests to detect existing abnormalities.
Left Ventricular Assist Device Decommissioning Compared with Explantation for Ventricular Recovery: A Systematic Review
Authors: Choi Jae Hwan , Weber Matthew P. , Horan Dylan P. , Luc Jessica G. Y. , Phan Kevin , Patel Sinal , Rizvi Syed-Saif Abbas , Maynes Elizabeth J. , Reeves Gordon R. , Entwistle John W. , Morris Rohinton J. , Massey H. Todd , Tchantchaleishvili Vakhtang
Published: November 2018

Left ventricular assist device (LVAD) withdrawal with ventricular recovery represents the optimal outcome for patients previously implanted with an LVAD. The aim of this systematic review was to examine the patient outcomes of device withdrawal via minimally invasive pump decommissioning as compared with reoperation for pump explantation. An electronic search was performed to identify all studies in the English literature assessing LVAD withdrawal. All identified articles were systematically assessed for inclusion and exclusion criteria. Overall, 44 studies (85 patients) were included in the analysis, of whom 20% underwent decommissioning and 80% underwent explantation. The most commonly used LVAD types included the HeartMate II (decommissioning 23.5% vs. explantation 60.3%; p = 0.01) and HeartWare HVAD (decommissioning 76.5% vs. explantation 17.6%; p < 0.001). At median follow-up of 389 days, there were no significant differences in the incidence of cerebrovascular accidents (p = 0.88), infection (p = 0.75), and survival (p = 0.20). However, there was a trend toward a higher recurrence of heart failure in patients who underwent decommissioning as compared with explantation (decommissioning 15.4% vs. explantation 8.2%, cumulative hazard; p = 0.06). Decommissioning appears to be a feasible alternative to LVAD explantation in terms of overall patient outcomes.