bluuebunny/crossref_metadata_2025 huggingface dataset:
Sun Yat-sen and the 1911 Revolution
Authors: Murdock Michael G.
Published: August 2016

Sun Yat-sen (generally known as Sun Zhongshan孫中山or Sun Wen孫文 in Chinese) plays a central role in the national narratives of both the Republic of China on Taiwan and the People’s Republic of China, which lionize him as a “national hero” of gigantic proportions and the determined revolutionary who brought low the Qing dynasty. Sun’s formative and early revolutionary years were spent overseas studying or in exile to avoid arrest by Qing authorities, exposing him to foreign contacts, ideals, and funding. Although a stalwart patriot, Sun spent little time in China itself, viewed the world through Christian lenses, and routinely sought foreign aid. In 1911, Sun’s Tongmenghui, or Revolutionary Alliance, overthrew the Qing dynasty, ending two millennia of imperial rule and propelling China into a new stage of sociopolitical development under the Republic of China. The earliest literature on the 1911 Revolution narrated revolutionary events and explained the Qing’s fall as the result of Sun’s foreign connections. Subsequent explanations turned inward, examining factors, figures, events, changes, and participants within China itself. By 1971, studies on local and provincial connections to the 1911 Revolution became popular, spiking every decade. In 2011, the centenary of the 1911 Revolution, interest exploded, producing waves of symposia, document collections, exhibitions, monographs, and articles. Unfortunately for Sun, his 1911 Revolution failed to produce the society of his dreams. He served as the Republic of China’s provisional president in 1912, but soon found himself exiled again, banished by the usurper Yuan Shikai and his military dictatorship. Sun spent years planning a comeback, first against Yuan and then against the disastrous warlord regimes that followed. Sun’s semi-exiled life in the French quarter in Shanghai and mounting failures vis-à-vis warlord regimes, however, dimmed his international reputation. Newspapers and foreign ministry documents alike portrayed Sun as a fallen figure. Nevertheless, these years in the wilderness drove Sun to carefully rethink China’s state-building challenges. He wrote extensively, meticulously planning China’s future political and economic development. Moving to Guangzhou at the invitation of reformist warlord Chen Jiongming, Sun tried to build a movement that could unify China. Chen, however, preferred provincial development over national unification and drove Sun from Guangzhou, Desperate, Sun opened negotiations with Soviet agents in 1923. Mercenary troops helped Sun regain a foothold in Guangzhou, whereupon Soviet advisors and Chinese communists alike helped him launch another revolution. Accounts from the period painted Sun as a leftist radical or “Bolshevik.” Criticisms haunted Sun until his death from liver cancer in 1925.
Trends and Correlates of Cannabis-involved Emergency Department Visits: 2004 to 2011
Authors: Zhu He , Wu Li-Tzy
Published: August 2016

Objectives:

To examine trends and correlates of cannabis-involved emergency department (ED) visits in the United States from 2004 to 2011.

Methods:

Data were obtained from the 2004 to 2011 Drug Abuse Warning Network. We analyzed trend in cannabis-involved ED visits for persons aged ≥12 years and stratified by type of cannabis involvement (cannabis-only, cannabis-polydrug). We used logistic regressions to determine correlates of cannabis-involved hospitalization versus cannabis-involved ED visits only.

Results:

Between 2004 and 2011, the ED visit rate increased from 51 to 73 visits per 100,000 population aged ≥12 years for cannabis-only use (P value for trend = 0.004) and from 63 to 100 for cannabis-polydrug use (P value for trend < 0.001). Adolescents aged 12–17 years showed the largest increase in the cannabis-only-involved ED visit rate (rate difference = 80 per 100,000 adolescents). Across racial/ethnic groups, the most prevalent ED visits were noted among non-Hispanic blacks. Among cannabis-involved visits, the odds of hospitalization (vs ED visits only) increased with age strata compared with age 12 to 17 years.

Conclusions:

These findings suggest a notable increase in the ED visit numbers and rates for both the use of cannabis-only and cannabis-polydrug during the studied period, particularly among young people and non-Hispanic blacks.
Clinically Meaningful Improvements After Hip Arthroscopy for Femoroacetabular Impingement in Adolescent and Young Adult Patients Regardless of Gender
Authors: Cvetanovich Gregory L. , Weber Alexander E. , Kuhns Benjamin D. , Hannon Charles P. , D’Souza Dwayne , Harris Joshua , Mather Richard C. , Nho Shane J.
Published: August 2016

Background:

The objective of this study was to determine if adolescent and young adult patients undergoing hip arthroscopy for symptomatic femoroacetabular impingement (FAI) experience clinically meaningful improvements in functional outcome scores.

Methods:

A consecutive series of patients under age 18 who underwent primary hip arthroscopy for symptomatic FAI was identified using our institution’s hip registry. Demographics, preoperative radiographic measurements, and preoperative and postoperative patient-reported outcome scores [Hip Outcome Score (HOS), Activity of Daily Living (ADL), and Sports-Specific Subscale (SS), and modified Harris Hip Score (MHHS)] were collected. Percentage of patients achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) were determined using published cutoffs for HOS and MHHS in FAI patients.

Results:

Forty-three patients met study inclusion criteria, and 37 patients (86%) were available at a minimum follow-up of 2 years. Mean age was 17.0±1.4 years, 70% were female, and 8.1% had an open proximal femoral physis. All competitive high school and college athletes were able to return to sport. Patients experienced significant improvements following hip arthroscopy in HOS-ADL, HOS-SS, and MHHS scores (all P<0.0001). MCID was achieved in 81% of patients (27/34) for HOS-ADL, 97% (33/34) for HOS-SS, and 84% (27/32) for MHHS. PASS was achieved for 76% of patients (26/34) for HOS-ADL, 79% (27/34) for HOS-SS, and 81% (26/32) for MHHS. Lower body mass index but not age or sex was correlated with a greater improvement in MHHS scores (r=0.39; P=0.03). There were 2 minor complications and no revision surgery.

Conclusions:

Adolescent and young adult patients experienced statistically significant improved functional outcomes 2 years after hip arthroscopy for FAI. In addition, these outcomes can be achieved with a low complication rate and a high return to preoperative activity. Approximately 80% of patients achieved clinically significant outcomes based on MCID and PASS criteria. Patient improvements in MHHS were equal regardless of age or sex; however, lower preoperative body mass index led to greater postoperative MHHS improvements.

Level of Evidence:

Level IV—therapeutic case series.
Knowledge of clinical trials regarding hormone therapy and likelihood of prescribing hormone therapy
Authors: Taylor Hugh S. , Kagan Risa , Altomare Corrado J. , Cort Susannah , Bushmakin Andrew G. , Abraham Lucy
Published: August 2016

Objective:

The aim of the study was to examine whether physicians who are better informed about large, published hormone therapy (HT) trials (eg, the Women's Health Initiative) are more likely to prescribe HT for menopausal symptoms.

Methods:

US obstetricians/gynecologists and primary care physicians completed a 15- to 20-minute Internet-based survey. Knowledge was assessed via nine true-false statements about HT trials (range: 0-9). Prescribing practices were assessed via six case studies with a seven-point response scale of “extremely unlikely” to “extremely likely” in relation to treatment options (range: 6-42). The primary analysis examined the correlation between HT trial knowledge and likelihood of prescribing HT. Secondary analyses gauged knowledge and prescribing practices based on practice type, sex, and years in practice.

Results:

Among 501 physicians who completed the survey (representing 10.7% of those invited; median age: 51.0 y; female: 26.9%; obstetricians/gynecologists: 49.9%; median 19.0 y in practice), HT knowledge (mean [SD] 3.8 [2.3]), and prescribing (mean [SD] 24.5 [5.6]) exhibited a statistically significant, moderate positive correlation (0.30; 95% CI, 0.21-0.37; P < 0.0001). Obstetricians/gynecologists were significantly (P < 0.0001) more knowledgeable and more likely to prescribe HT than primary care physicians. Male physicians were more likely (P < 0.05) to prescribe HT but not more knowledgeable about it than female physicians. Knowledge (but not likelihood of prescribing) significantly increased as a function of years in practice.

Conclusions:

Physicians who are more knowledgeable about large, published HT trials are more likely to prescribe HT for menopausal symptoms.
Bone health assessment by quantitative ultrasound and dual-energy x-ray absorptiometry in postmenopausal women with breast cancer receiving aromatase inhibitors
Authors: Catalano Antonino , Morabito Nunziata , Agostino Rita Maria , Basile Giorgio , Gaudio Agostino , Atteritano Marco , Natale Giuseppe , Xourafa Anastasia , Morini Elisabetta , Adamo Vincenzo , Lasco Antonino
Published: August 2016

Objective:

Phalangeal quantitative ultrasound (QUS) measurements provide surrogate information on bone quality. The aim of the present study was to assess bone status by phalangeal QUS and by dual-energy x-ray absorptiometry (DXA), and to evaluate bone turnover in breast cancer (BC) women receiving aromatase inhibitors (AIs).

Methods:

Sixty postmenopausal BC women and 42 matched controls were recruited (mean age 61.64 ± 8.33 y). Amplitude-dependent speed of sound (AD-SoS), bone transmission time (BTT), Ultrasound Bone Profile Index, as QUS parameters, L1-L4 and femoral neck BMD by DXA were assessed at baseline and after 18 months; serum bone-specific alkaline phosphatase (BSAP) and C-telopeptide of type 1 collagen were measured at baseline, 9 and 18 months.

Results:

FRAX (without BMD) derived 10-years probability of major fractures and hip fractures were significantly associated with AD-SoS (r = −0.381, P = < 0.001 and r = −0.370, P < 0.001, respectively), Ultrasound Bone Profile Index (r = −0.434, P ≤ 0.001 and r = −0.409, P = < 0.001, respectively), BTT (r = −0.309, P = 0.002 and r = −0.340, P = 0.001, respectively). The median percent changes of AD-SoS (−3.71 [−5.38 to 0.11] vs −0.7 [−4.15 to 0.83], P = 0.02 respectively), BTT (−8.4 [−14.91 to −3.53] vs −1 [−5.72 to 3.75], P < 0.001 respectively) were significantly different between AIs users and controls. The same trend was observed for DXA measurements. BSAP and C-telopeptide of type 1 collagen significantly changed in AIs users. AD-SoS was associated with change of BMD at lumbar spine (β, 0.16; SE, 0.08; P = 0.04) and change of BSAP (β, −0.04; SE, 0.02; P = 0.04).

Conclusions:

Phalangeal QUS appeared a useful tool to evaluate bone quality in BC women on AIs.
Clinical investigation of RAD1901, a novel estrogen receptor ligand, for the treatment of postmenopausal vasomotor symptoms: a phase 2 randomized, placebo-controlled, double-blind, dose-ranging, proof-of-concept trial
Authors: Hattersley Gary , Harris Alan G. , Simon James A. , Constantine Ginger D.
Published: August 2016

Objective:

The aim of the study was to assess the efficacy and safety of RAD1901, an oral estrogen receptor ligand, for the treatment of moderate-to-severe vasomotor symptoms of menopause.

Methods:

This was a randomized, placebo-controlled, double-blind, dose-ranging, proof-of-concept trial. Postmenopausal women with a minimum of 7 moderate-to-severe, diary-reported hot flashes per day, or 50 per week, were randomized to one of five blinded dose groups (0 [placebo], 10, 25, 50, or 100 mg RAD1901 daily for 28 d). Efficacy endpoints included frequency and severity of hot flashes over 4 weeks of treatment.

Results:

One hundred participants were randomized across the five treatment regimens. The frequency of moderate-to-severe hot flashes decreased in all groups over the treatment period (mean percent change from baseline at 4 wk, −54.1%, −77.2%, −51.8%, −53.8%, and −67.0% for placebo, 10, 25, 50, and 100 mg groups). The response in the 10 mg group was significantly different from placebo at 4 weeks (P = 0.024). No other dose group was significantly different from placebo. There were no statistically significant differences in severity of hot flashes between placebo and any dose group. Treatment was well tolerated; most treatment-emergent adverse events were mild to moderate in severity.

Conclusions:

Daily treatment with 10 mg RAD1901 over 4 weeks resulted in a statistically significant reduction in the frequency of moderate-to-severe hot flashes compared with placebo, with an acceptable safety profile. Further clinical trials are warranted to investigate RAD1901's utility as a potential treatment for vasomotor symptoms.
Anatomy of the Gynecomastia Tissue and Its Clinical Significance
Authors: Blau Mordecai , Hazani Ron , Hekmat Daniel
Published: August 2016

Background:

Gynecomastia is a very common entity in men, and several authors estimate that approximately 50% to 70% of the male population has palpable breast tissue. Much has been published with regard to the etiology, diagnosis, and treatment of gynecomastia. However, the anatomy of the gynecomastia tissue remains elusive to most surgeons.

Purpose:

The purpose of this article was to define the shape and consistency of the glandular tissue based on the vast experience of the senior author (MB).

Patients and Methods:

Between the years 1980 and 2014, a total of 5124 patients have been treated for gynecomastia with surgical excision, liposuction, or a combination of both. A total of 3130 specimens were collected with 5% of the cases being unilateral.

Results:

The specimens appear to have a unifying shape of a head, body, and tail. The head is semicircular in shape and is located more medially toward the sternum. The majority of the glandular tissue consists of a body located immediately deep to the nipple areolar complex. The tail appears to taper off of the body more laterally and toward the insertion of the pectoralis major muscle onto the humerus.

Conclusions:

This large series of gynecomastia specimens demonstrates a unique and unifying finding of a head, body, and tail. Understanding the anatomy of the gynecomastia gland can serve as a guide to gynecomastia surgeons to facilitate a more thorough exploration and subsequently sufficient gland excision.
Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique
Authors: Harel Marcos , Leibou Lior
Published: August 2016

Background:

The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen.

Objective:

The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach.

Methods:

In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors’ interdomal suturing technique between the years 2011 and 2013. The average age of the patients was 25.3 years. Intercrural sutures (PDS 4.0 straight needle, Cincinnati, Ohio) were placed as mattress-like suture in the tip region, with the knot buried between both alar cartilages. The suture is tightened progressively according to the tip definition and narrowing sought.

Results:

The patients were followed for 12 months. All of the patients demonstrated a significant reduction in lobule and tip widths. This series had only 1 complication of tip asymmetry that was revised 1 year after the initial operation. There were no cases of infection, allergic reaction, or extrusion of the suture.

Conclusions:

Despite the lack of a large volume of patients, our study confirms that this technique is indeed an attractive and highly predictable option for achieving adequate tip refinement and definition when using a nondelivery endonasal rhinoplasty.
Cellular Neurothekeoma: A Rare Tumor with a Common Clinical Presentation
Authors: Boukovalas Stefanos , Rogers Hayley , Boroumand Nahal , Cole Eric Lowry
Published: August 2016

Neurothekeomas are rare benign tumors commonly found on the head, neck, and upper extremities of women and younger individuals. They are thought to be of nerve sheath origin and usually present as painless, slow growing masses. We present a case of cellular neurothekeoma on the nasal ala of an 8-year-old girl with no previous history of trauma or piercings. Differential diagnosis, treatment options, and special considerations regarding potentially atypical characteristics are discussed.
Lymphovenous Anastomosis and Secondary Resection for Noonan Syndrome with Vulvar Lymphangiectasia
Authors: Winters Harm , Tielemans Hanneke J.P. , Ulrich Dietmar J.O.
Published: August 2016

In this case report we describe the use of a 2-stage approach to treat severe recurrent vulvar lymphangiectasia in a patient with Noonan syndrome. First, 3 functional lymphatic vessels were identified and anastomosed to venules in an end-to-end fashion. Then, in a second surgical procedure, the vulvar lesions were resected as much as possible and the vulva was reconstructed. By the 12-month follow-up the patient had recovered well. Although there were still some small vesicles on the left labia there was no more ooze, itch, and pain. Lymphatic mapping using indocyanine green showed improvement of the edema of her vulva region and patent LVA. In addition to the demonstration of this 2-stage approach, this case report also demonstrates the benefits of preemptive LVA before performing surgery that may be at high risk for postoperative lymph edema.
Shaeer’s Technique: A Minimally Invasive Procedure for Monsplasty and Revealing the Concealed Penis
Authors: Shaeer Osama Kamal Zaki
Published: August 2016

Background:

A concealed penis is a condition where part of the penis is invisible below the surface of the prepubic skin. Dermolipectomy can correct this condition, although it involves a long abdominal crease incision, or infrapubic incision around the base of the penis, and a possibility for genital lymphedema. This study describes Shaeer’s technique, a minimally invasive method for revealing the concealed penis.

Methods:

A 1- to 2-cm-long incision was cut over the anterior superior iliac spine (ASIS) on either side. A long curved blunt forceps was inserted from one incision, down to the base of the penis and then up to the contralateral ASIS. A 5-mm wide nonabsorbable tape was picked up by the forceps from 1 incision and pulled through to emerge from the other. Pulling on the tape cephalad pulled the mons pubis and revealed the penis. The tape was sutured to the periosteum overlying the ASIS on either side. Patients were followed up for 18 months for penile length, complications, and overall satisfaction.

Results:

Twenty patients were operated upon. Preoperatively, flaccid visible length was 3 ± 0.9 cm, and erect visible length was 8 ± 4.6 cm. Postoperatively, the flaccid visible length was 7.1 ± 2.1 cm, with a 57.9% improvement in length (P < 0.0001). Erect visible length was 11.8 ± 2.1 cm, with a 32% improvement in length (P < 0.0001). Length gain was maintained for 18 months.

Conclusion:

Shaeer’s technique is a minimally invasive, short, and simple procedure for monsplasty and revealing the concealed penis.
Early Intervention Special Instructors and Service Coordinators in One State
Authors: Edwards Nicole Megan , Gallagher Peggy A.
Published: August 2016

The success of Early Intervention (EI) programs (Part C, IDEA [Individuals with Disabilities Education Improvement Act of 2004]) for infants and toddlers with special needs (birth to 36 months) is largely influenced by the quality of direct service providers. Little is known, however, about characteristics of providers or involvement in training initiatives to inform practice. As a rare glimpse into a state's EI personnel system, the authors examined cross-sectional information from a Professional Development database in one state's home-based Part C program. Trainees (N = 425) included primarily those who were in a sole or combined position as special instructor and/or service coordinator. Key insights and needed lines of inquiry to inform national Part C professional development initiatives are discussed.
Engaging Preschool Children With Severe and Multiple Disabilities Using Books and iPad Apps
Authors: Kemp Coral , Stephenson Jennifer , Cooper Megan , Hodge Kerry
Published: August 2016

A single subject multiple treatment design was used to compare the engagement of 3 preschool children with severe and multiple disabilities, using 2 different stimuli: picture books and iPad apps matched for theme and content. Two of the 3 children had diagnoses of autism spectrum disorder in addition to their other disabilities. Sessions for each child were guided by trained facilitators who were staff working in the inclusive childcare settings attended by the children. Sessions were video recorded and later coded using a 5-second interval recording system. Visual inspection of the data indicated that 1 child was equally engaged with both media, while the 2 with diagnosed autism spectrum disorders were better engaged with the iPad apps. These results are discussed in relation to the potential of technology to engage children with high support needs and autism spectrum disorder with a view to enhancing their engagement in inclusive early childhood settings.
The Adaptation Process of Families With Children With Intellectual Disabilities in Catalonia
Authors: Mas Joana Maria , Giné Climent , McWilliam Robin A.
Published: August 2016

The most important adaptation task that all families must undertake is the construction of a sustainable, meaningful, and congruent daily routine of family life (R. Gallimore, T. Weisner, L. Bernheimer, D. Guthrie, & K. Nihira, 1993). The aim of this mixed-method study was to understand, from the perspective of parents, how families adapt their family routines to rearing a 3- to 5-year-old child with intellectual or developmental disabilities to guarantee a sustainable family routine. Accordingly, this study focused on accommodations—changes that parents make or do not make because of the child's disabilities; ecological and cultural elements explaining why parents make or do not make a specific accommodation; and the sustainability of the family routine. Eighteen families with a preschooler who attended an early intervention center in Catalonia, Spain, participated in interviews and completed a series of questionnaires. The main instrument used was the Ecocultural Family Interview adapted for the Catalonian context. Results show the importance of different cultural and ecological elements in the family's accommodation processes, such as parents' jobs, services for the child, perceived support, information, and—especially—the need for professionals (and researchers) to understand family adaptation in terms of the importance of building a sustainable family routine.
Spillover of Ratings of Patient- and Family-Centered Care
Authors: Christensen Anna L. , Brown Jonathan D. , Wissow Lawrence S. , Cook Benjamin
Published: August 2016

As primary care models increasingly include nonphysician team members, more attention should be paid to patient- and family-centered care (PFCC) among medical assistants (MAs). The aims of this article are to describe parent perceptions of PFCC by MAs and assess associations between MA PFCC and other perceptions of their care experience. To assess PFCC, we administered the CARE (Consultation and Relational Empathy) measure to the parent/guardian of 360 children following a primary care visit. Perceptions of PFCC by MAs were significantly associated with 6 of 7 other measures of patient experience, including PFCC by the physician, treatment by the receptionist, and satisfaction with wait time. Each team member can potentially shape perceptions of care in ways that could “spill over” into other parts of the visit.
Early Experiences Engaging Patients Through Patient and Family Advisory Councils
Authors: Peikes Deborah , O'Malley Ann S. , Wilson Claire , Crosson Jesse , Gaddes Rachel , Natzke Brenda , Day Timothy J. , Cromp DeAnn , Keith Rosalind , Little Jasmine , Ralston James
Published: August 2016

Primary care practices are increasingly asked to engage patients in improving care delivery. We report early experiences with Patient and Family Advisory Councils (PFACs) from interviews of patients and practice staff in the Comprehensive Primary Care initiative, and identify ways to improve PFACs. Patients and practice staff report PFACs help practices elicit patient feedback and, in response, improve care delivery. Nonetheless, there are areas for refinement, including recruiting more diverse patients, providing an orientation to members, overcoming reticence of some patients to raise issues, and increasing transparency by sharing progress with PFAC members and patients in the practice more generally.
Assessing the Proximity Relationship of Walk-in Clinics and Primary Care Physicians
Authors: Chen Alissa , Revere Lee , Ramphul Ryan
Published: August 2016

This article evaluates the spatial relationship between primary care provider clinics and walk-in clinics. Using ZIP code level data from Harris County, Texas, the results suggest that primary care physicians and walk-in clinics are similarly located at lower rates in geographic areas with populations of lower socioeconomic status. Although current clinic location choices effectively broaden the gap in primary care access for the lower income population, the growing number of newly insured individuals may make it increasingly attractive for walk-in clinics to locate in geographic areas with populations of lower socioeconomic status and less competition from primary care physicians.
Sick of Health Care Politics? Comparing Views of Quality of Care Between Democrats and Republicans
Authors: Scott Kirstin W. , Blendon Robert J. , Benson John M.
Published: August 2016

Objective:

Improving the quality of care delivered by the U.S. health care system is a topic of important policy and political debate. Although public opinion surveys have shown concerns regarding the state of quality of care nationally, the majority of Americans are satisfied with the quality of care they personally receive. Studies have shown that Republicans and Democrats may differ in these views.

Methods:

We used a 2012 national survey of 1,508 American adults that captured perceptions of quality, political party, medical experiences, and self-reported interactions with the health care system due to an illness to examine these differences.

Results:

Regardless of having a recent illness or hospitalization, Democrats generally expressed greater concerns about the country's state of health care quality relative to Republicans. Partisan differences also emerged when identifying the most important problems contributing to quality-of-care deficiencies in the nation. However, partisan differences were nonexistent on measures related to self-reported experiences with quality of care.

Conclusion:

Although their individual experiences with quality of care do not differ, Republicans and Democrats differ in their views on national quality-of-care issues. This may have implications for efforts to improve quality of care in the current polarized healthcare environment.
Impaired Work Productivity After Aneurysmal Subarachnoid Hemorrhage
Authors: Crago Elizabeth A. , Price Thomas J. , Bender Catherine M. , Ren Dianxu , Poloyac Samuel M. , Sherwood Paula R.
Published: August 2016

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a sudden debilitating condition affecting individuals during the most productive times of their lives. Treatment advances have reduced mortality rates but increased the number of survivors facing deficits in physical and neuropsychological function. Objective: This study examined associations between neuropsychological function and work productivity after aSAH. Methods: Fifty-two patients with aSAH, employed before hemorrhage, were recruited from an ongoing National Institutes of Health study. Work Limitations Questionnaire (WLQ), neuropsychological tests (executive function, psychomotor speed, attention and mental flexibility, memory), and Patient Assessment of Own Function were completed at 3 and 12 months after aSAH. Results: Subjects in this analysis reported some level of difficulty in work productivity at 3 and 12 months (35% and 30%, respectively) after hemorrhage. Lower WLQ scores in time management and mental/interpersonal subscales were associated with poorer performance in psychomotor function (r = .5, p = .04 and r = .42, p = .09). Poorer mental flexibility and working memory correlated with time management difficulty at 3 months (r = −.4, p = .09 and r = .54, p = .02). Patients performing poorly on story recall tests were more likely to report difficulty with job physical performance (r = −.42, p = .09) and completing work effectively (r = .61, p = .009). Poorer working memory performance was associated with lower scores on mental/interpersonal WLQ subscales (r = .45, p = .05) and overall health-related work productivity loss (r = .47, p = .04). WLQ areas also correlated with participants’ perception of their neuropsychological function after aSAH. Conclusions: These results suggest that neuropsychological deficits impact work quality after hemorrhage and provide strong impetus for future studies so that domain-specific interventions can be implemented to improve outcomes that affect quality of life including work productivity.
Developing Guidelines for the Reversal of Anticoagulant and Antithrombotic Agents in the Setting of Intracranial Hemorrhage
Authors: Christensen Michael A. , Cooper Caleb M.
Published: August 2016

Background: The use of anticoagulants and antithrombotic agents in the population is increasing as the population ages with a concomitant rise in chronic diseases such as atrial fibrillation. The incidence of intracranial hemorrhage (ICH) with these agents is small but clinically significant. The purpose of this article is to illustrate how a single institution developed anticoagulation-associated ICH treatment guidelines. Methodology: A literature review of the topic was performed using the PubMed and Cochrane Evidence-Based Medicine review databases using keywords including antithrombotic agents, antiplatelet agents, traumatic brain injury, and intracranial hemorrhage. The results of the search were reviewed, and relevant English-language manuscripts were retained. The pharmacology of each agent was reviewed. Results: Anticoagulants increase the risk and severity of ICH; the association is not as clear with the use of antithrombotic agents. Each agent’s pharmacology and development is discussed, and reversal strategies are reviewed. Whereas some agents may be reversed medically, others are dialyzable, and a few agents have no effective reversal mechanism currently available. Conclusion: ICH, either primary or traumatic, that is complicated by these agents must be rapidly recognized and appropriately treated. Use of a common, simple clinical practice guideline will assist clinicians in intervening rapidly for this patient group.
Patient and Caregiver Perspectives of Preoperative Teaching for Deep Brain Stimulation Surgery
Authors: Lanier-Bohan Elaine M. , Heath Susan L.
Published: August 2016

Deep brain stimulation (DBS) has developed into an important therapy for Parkinson disease, essential tremor, and dystonia with more nurses in varied settings often preparing patients and families for this type of surgery. This exploratory study sought to obtain patient and caregiver perspectives of the current DBS teaching for Parkinson disease, essential tremor, and dystonia; to improve the teaching; and to standardize the education. Using survey methodology, 41 patients with movement disorder and 32 caregivers completed surveys about the preoperative instructions they received. Data analysis calculated frequencies for response rate, demographic information, multiple-choice questions, and Likert scale responses. Fill-in questions were summarized. Results overall showed that, because of the teaching, two thirds of patients and nearly two thirds of caregivers felt fully prepared for the DBS surgery. Patients’ and caregivers’ suggested recommendations for nurses and surgeons included requests for specific information such as attention to delivery of the education, more individualized care during the education, attention to pain during and after procedure, and postdischarge follow-up. The study identified unmet patient and caregiver needs, resulted in changes in practice, and serves as a guide toward standardization of educational approach and/or content.
Collaborative Care on the Stroke Unit: A Cross-Sectional Outcomes Study
Authors: Wood Janet G.
Published: August 2016

Objective: The aim of this study was to evaluate the economic and quality outcomes associated with a collaborative advanced practice nurse and hospitalist physician model of care on the inpatient stroke unit as compared with usual hospitalist physician-led care. Background: High functioning collaborative teams are anticipated to be essential under value-based reimbursement. Methods: Hospitalist nurse practitioners were assigned to the stroke unit in collaboration with hospitalist physicians to implement daily hospital management for patients with stroke and transient ischemic attack. To evaluate outcomes associated with the care model, a retrospective cross-sectional design was used with 100 patients in the collaborative advanced practice nurse and hospitalist physician care group and 100 patients in the usual hospitalist physician-led care group. Primary outcome measures were length of stay, 30-day readmissions, stroke core measure documentation, and patient experiences of care. Analysis of demographic characteristics assured that the samples were similar. Results: The collaborative care group performed better on one of five stroke core quality measures and on two of three patient experiences of care measures. Mean length of stay and hospital readmissions were similar between groups. Five patients left the stroke unit against medical advice in the usual hospitalist physician-led care group, whereas there were no discharges against medical advice in the collaborative care group. Conclusion: Advanced practice nurse and hospitalist physician collaboration is a promising model for healthcare quality improvement during inpatient stroke care; results are likely generalizable to other adult medicine populations.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Study
Authors: Halbert Roger Kelsey
Published: August 2016

Anti-N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome that presents with personality changes, autonomic dysfunction, and neurologic deterioration. Most patients with this syndrome progress from psychosis to seizure to catatonia, often associated with abnormal movements, autonomic instability, and hypoventilation. First-line treatment constitutes resection of the associated neoplasm, corticosteroids, intravenous immunoglobulin, and plasma exchange. Second-line treatment includes rituximab and cyclophosphamide. A case of confirmed anti-N-methyl-D-aspartate receptor encephalitis is presented that illustrates the diagnostic and treatment challenges associated with this syndrome and underscores the nursing implications of medical management during immunosuppression. This case study recommends surface cooling and a pharmaceutical regimen for management of autonomic storming, which is a hallmark of this disorder.
Intraoperative nerve monitoring during thyroid surgery
Authors: Gardner Ivy H. , Doherty Gerard M. , McAneny David
Published: August 2016

Purpose of review

Laryngeal nerve injury, resulting in speech and swallowing dysfunction, is a feared complication of thyroid operations. Routine visualization of the recurrent laryngeal nerve (RLN) has decreased the likelihood of nerve injury, and intraoperative nerve monitoring has been applied in the hope of further enhancing safety.

Recent findings

There is conflicting evidence about the value of nerve monitoring during thyroid operations, despite ample research. The data favor nerve monitoring in certain situations, such as neck re-explorations, contralateral RLN injury, extensive or challenging dissections, invasive tumors or large goiters, and nonrecurrent or branching recurrent laryngeal nerves. Continuous intraoperative nerve monitoring may reduce the chances of excessive traction, which is the most common mechanism of injury. Nerve monitoring may also identify and protect the external branches of the superior laryngeal nerve.

Surgeons should routinely identify recurrent laryngeal nerves during thyroid operations, and intraoperative nerve monitoring might be a useful adjunct to prevent injury. As a result of the relatively low probability of permanent recurrent laryngeal nerve injury, it is difficult to establish the absolute value of nerve monitoring. Further research may focus on continuous nerve monitoring and intraoperative monitoring of the external branches of the superior laryngeal nerves.
The gastrin receptor antagonist netazepide (YF476) in patients with type 1 gastric enterochromaffin-like cell neuroendocrine tumours: review of long-term treatment
Authors: Sagatun Liv , Mjønes Patricia , Jianu Constantin S. , Boyce Malcolm , Waldum Hege L. , Fossmark Reidar
Published: August 2016

Objective

Netazepide (YF476) is a recently developed, orally active gastrin receptor antagonist that, in short trials in patients with type 1 gastric enterochromaffin-like cell neuroendocrine tumours, has been shown to induce a significant reduction in the number and size of tumours as well as serum chromogranin A (CgA). The aim of this review is to evaluate the long-term effect and safety of netazepide.

Patients and methods

Five patients previously treated with netazepide in an open-label trial were offered continuous treatment with netazepide 25 mg once daily. Upper endoscopy was performed every 6 months. The tumours were counted and measured, and tissue samples were obtained from the flat corpus mucosa. Enterochromaffin-like cell hyperplasia was classified according to Solcia and colleagues and volume density of CgA immunoreactive (IR) cells was calculated. Fasting serum CgA and fasting serum gastrin were measured every 3 months.

Results

All tumours regressed completely in three of five patients; time until total disappearance was 3, 9 and 12 months. In the other two patients, the number of tumours was reduced from 13 to 5 and from 14 to 3. Serum CgA showed a rapid and sustained decrease (P<0.001). The mean reduction in serum CgA was 4.1±0.5 nmol/l. Similarly, volume density of CgA IR cells in the flat corpus mucosa decreased (P<0.001), with the mean change being 2.0±0.4%. Serum gastrin and volume density of gastrin IR cells in the antral part of the stomach remained unchanged (P=0.2 and 0.7, respectively).

Conclusion

Long-term administration of netazepide is effective and safe.
The role of dietary supplements in inflammatory bowel disease: a systematic review
Authors: Rossi Roberta E. , Whyand Tara , Murray Charles D. , Hamilton Mark I. , Conte Dario , Caplin Martyn E.
Published: August 2016

Inflammatory bowel diseases (IBD) are chronic immune disorders of unclear aetiology. Dietary deficiencies may be a potential pathogenic factor in their development. Patients often take food supplements without knowledge of any evidence base. We have therefore assessed the evidence for food supplementation in the management of IBD. A PubMed search was performed for the terms Inflammatory bowel disease; nutritional deficiencies; dietary supplements; curcumin; green tea; vitamin D/other vitamins; folic acid; iron; zinc; probiotics; andrographis paniculata; and boswellia serrate. PubMed was used to search for all relevant articles published between January 1975 and September 2015. Curcumin supplementation has been reported to be effective in reducing the symptoms and the inflammatory indices in IBD patients. Similar results have been observed for green tea; however, pertinent studies are limited. Vitamin D supplementation may help to increase bone mineral density in IBD patients and to reduce disease activity. IBD patients with ileal resections higher than 20 cm may develop vitamin B12 deficiency that requires parenteral supplementation. There is no current evidence to support fat-soluble vitamin supplementation in IBD patients. Zinc and iron should be supplemented in selected cases. Probiotics (VSL#3) may reduce disease activity in IBD patients with pouchitis. Complementary and alternative medicines are used by IBD patients and some studies have shown promising results. In summary, attention to dietary factors such as curcumin, green tea and vitamins, including vitamins D and B12, appears to be beneficial and, if necessary, supplementation may be appropriate.
Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats
Authors: Dong Zhe-Qing , Zhu Ji , Lu De-zhao , Chen Qin , Xu Ying-ling
Published: August 2016

Background:

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. Previous study suggested that toll-like receptor (TLR) signaling pathway contributes to the development and progression of RA. In recent years, acupuncture has become one of the most vital treatments of arthralgia. But little is known about the mechanisms of improving RA by acupuncture.

Study Question:

The study studied the effect of electroacupuncture in “Zusanli” and “Kunlun” acupoints on the expression of TLR4, myeloid differentiation factor 88 (MYD88), and NF-κB in adjuvant arthritis rats to clarify the molecular mechanism of acupuncture of RA.

Study Design:

A rat model of adjuvant arthritis was established with injection of 0.1 mL Freund complete adjuvant in the right hindlimb footpad. We next punctured the Zusanli and Kunlun acupoints with 0.25 × 40-mm acupuncture needles to 5-mm depth. Then, we performed electroacupuncture treatment for 28 days with frequency of 2 Hz and intensity of 2 mA, once a day and 30 minutes each time.

Measures and Outcomes:

Arthritis index and paw swelling were measured every week. FQ-PCR and western blot were used to detect the expression of TLR4, MYD88, and NF-κB.

Results:

Paw swelling of rats injected with Freund complete adjuvant was more serious than that of the normal rats, which illustrated the successful establishment of adjuvant arthritis rat model. After treatment for 14 days, the paw swelling and joint symptoms score decreased, paw tissue inflammation eased in the rats of treatment group compared with the model group during the same period. After treatment for 28 days, the expression of TLR4, MYD88, and NF-κB in the ankle bone tissues decreased at both mRNA and protein levels.

Conclusions:

Stimulation with electric needle in Zusanli and Kunlun acupoints can reduce the expression of TLR4, MYD88, and NF-κB, which play an important role in treatment of adjuvant arthritis.
Prediction of Clearance and Dose of Midazolam in Preterm and Term Neonates: A Comparative Study Between Allometric Scaling and Physiologically Based Pharmacokinetic Modeling
Authors: Mansoor Najia , Ahmad Tasneem , Alam Khan Rafeeq , Sharib Syed Mohammad , Mahmood Iftekhar
Published: August 2016

Children are not small adults because besides size there are subtle physiological and biochemical differences between children and adults. Like adults, children also require medicine for the management or cure for the underlying diseases. To select a right dose in children, pharmacokinetic (PK) information is warranted. However, in many instances, a PK study in neonates and infants may not be possible. Therefore, various methods are used to predict PK parameters in this group of population, and these predicted parameters may help to calculate a safe dose for the very young children. Allometry is widely used for the prediction of PK parameters in children and subsequently one can predict dose from these predicted PK parameters. Physiologically based pharmacokinetic modeling (PBPK) has also become a useful tool to achieve these goals. Therefore, the objective of this study was to compare the predictive performance of allometry and PBPK for a test compound, midazolam in preterm, and term neonates. In this study, there were 5 preterm neonates (gestational age ranging from 34 to 37 weeks) and 5 term neonates (gestational age ranging from 38 to 41 weeks). PBPK modeling was performed using PK-Sim 6.0 and clearance, as well as midazolam dose in neonates was predicted. Clearance and midazolam dose in neonates was also predicted by allometric scaling. In this study, the allometric exponents for the prediction of midazolam clearance in preterm neonates and term neonates were 1.2 and 1.1, respectively. Similarly, for the prediction of midazolam neonatal dose, the exponent of allometry was either 0.9 or 1.0. The predicted midazolam clearance and dose by both methods were then compared with observed midazolam clearance and dose in neonates. The results of the study showed a slightly better prediction of midazolam clearance in neonates by PBPK than allometric scaling. However, the projected dose of midazolam in neonates was comparable between the 2 methods. Overall, it was noted that both PBPK and allometric model can be used to predict clearance and dose of midazolam in neonates.
Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures
Authors: Yeung Kai , Basu Anirban , Hansen Ryan N. , Watkins John B. , Sullivan Sean D.
Published: August 2016

Background:

Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments.

Objective of the Study:

The objective of the study was to determine the impact of the VBF.

Design:

Interrupted time series of employer-sponsored plans from 2006 to 2013.

Subjects:

Intervention group: 5235 beneficiaries exposed to the VBF. Control group: 11,171 beneficiaries in plans without any changes in pharmacy benefits.

Intervention:

The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers.

Measures:

Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures.

Results:

In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1–$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18–$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15–$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days’ supply (CI, 1.29–2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change.

Conclusions:

Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.