bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of elemene combined with chemotherapy in advanced gastric cancer
Authors: Liu Ying , Chen Liuxi , Zhang Ruonan , Chen Bi , Xiang Yu , Zhang Mingming , Huang Xingxing , Zhang Wenzheng , Chen Xiaying , Pan Ting , Yan Lili , Jin Ting , Liu Shuiping , Feng Jiao , Duan Ting , Xie Tian , Lin Shuang , Sui Xinbing
Published: March 2020

Background:

Elemene is a natural compound extracted from Zingiberaceae plants, and is used in various cancer. However, the efficacy and safety elemene combined with chemotherapy in advanced gastric cancer (GC) are lack of systematic assessment.

Methods:

we searched the PubMed, EMBASE, Web of Science, Cochrane Library, China Academic Journals (CNKI), Chinese Science and Technology Journals (CQVIP) and Chinese Biomedical Literature databases. Randomized controlled trials (RCTs) comparing elemene plus chemotherapy with chemotherapy alone in participants with advanced GC and reporting at least one of the following outcomes were selected and assessed for inclusion. JADAD scale was used to assess the quality. Data was screened and extracted by two independent investigators. The primary clinical outcome was overall response rate (ORR); the secondary outcomes were quality of life (QOL) and adverse events (AEs). Analysis was performed using Review Manager 5.3.

Results:

Sixteen RCTs matched the selection criteria, which reported on 969 subjects. Risk ratios (RR) and corresponding 95% confidence intervals (CIs) were pooled for ORR, life quality based on KPS, and risk of AEs. Compared to chemotherapy alone, elemene combined with chemotherapy in the treatment of GC may increase the efficiency of ORR(RR: 1.41; 95% CI: 1.23–1.60; P < .0001), improve their life quality based on KPS (RR: 1.84; 95% CI: 1.45–2.34; P < .00001), and reduce the adverse reactions, including leukopenia(RR: 0.73; 95% CI: 0.62–0.85; P < .00001), neutropenia (RR: 0.75; 95% CI: 0.60–0.95; P = .02), anemia (RR: 0.76; 95% CI: 0.60–0.95; P = .02), thrombocytopenia (RR: 0.56; 95% CI: 0.43–0.73; P < .00001). Nausea and vomiting (RR: 0.84; 95% CI: 0.84–1.07; P = .39), diarrhea (RR: 0.69; 95% CI: 0.41–1.15; P = .15), neurotoxicity (RR: 0.77; 95% CI: 0.59–1.00; P = .05) and hepatic dysfunction (RR: 0.95; 95% CI: 0.58–1.54; P = .83) were similar between two groups.

Conclusions:

Elemene may have the potential to improve the efficacy and reduce the AEs of chemotherapy for gastric cancer. However, the long-term, high-quality researches with a large sample size in different populations are required.
Promoter hypermethylation of CD133/PROM1 is an independent poor prognosis factor for head and neck squamous cell carcinoma
Authors: Hu Zele , Liu Huigao , Zhang Xinrong , Hong Bin , Wu Zhenhua , Li Qun , Zhou Chongchang
Published: March 2020

PROM1 has played a pivotal role in the identification and isolation of tumor stem cells. This study aimed to assess the association between PROM1 promoter methylation and head and neck squamous cell carcinoma (HNSCC), and its diagnostic and prognostic value.

Bioinformatic analysis was performed using data from the Cancer Genome Atlas-HNSC and Gene Expression Omnibus datasets.

The results showed that PROM1 promoter was hypermethylated in HNSCCs compared with normal head and neck tissues (P = 4.58E-37). The area under the receiver-operating characteristic curve based on methylated PROM1 data was 0.799. In addition, PROM1 hypermethylation independently predicted poor overall survival (hazard ratio [HR]: 1.459, 95% confidence interval [CI]: 1.071–1.987, P = .016) and recurrence-free survival (HR: 1.729, 95% CI: 1.088–2.749, P = .021) in HNSCC patients. Moreover, PROM1 methylation was weakly negatively correlated with its mRNA expression (Pearson r = –0.148, P < .001).

In summary, our study reveals that methylated PROM1 might serve as a valuable diagnostic biomarker and predictor of poor survival for HNSCC patients. PROM1 hypermethylation might partially contribute to its downregulation in HNSCC.
Early recurrence detected by 18F-FDG PET/CT in patients with resected pancreatic ductal adenocarcinoma
Authors: Wang Li , Dong Ping , Wang Weiguo , Li Mao , Hu Weiming , Liu Xubao , Tian Bole
Published: March 2020

18F-fluoro-2-deoxy-D-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) has been proved to be practical in detecting occult malignant lesions. However, the evidence of its utility in detecting early recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) is lacking. Therefore, the primary aim of the present study is to evaluate the diagnostic value of 18F-FDG PET/CT in the early postoperative period after radical resection of PDAC.

This retrospective study included 32 patients who had 18F-FDG PET/CT scan within 6 months after radical resection of PDAC between January 2010 and December 2018.

In total, 10 positive PET results were found at surgical margins of remnant pancreas, 12 at locoregional lymph nodes, 5 at distant areas, with the corresponding mean maximum standard uptake value (SUVmax) of 5.8 ± 1.1, 5.9 ± 0.9, and 6.4 ± 0.7, respectively. The median follow-up time was 23.5 months (range: 8–75 months), and the median survival time was 39.5 months (95% confidence interval: 14.6–64.4 months) for the entire cohort. Patients with positive PET findings at either locoregional lymph nodes or distant areas obtained significantly poorer overall survival (OS) than those without increased FDG uptake at the corresponding areas (P = .003 and P < .001, respectively). Whereas comparisons of OS between patients with or without increased FDG uptake at the surgical margin of remnant pancreas presented no statistically difference (P = .742).

The early application of 18F-FDG PET/CT after radical resection of PDAC could stratify the prognosis of patients well by detecting occult early recurrence at locoregional lymph nodes and distant areas efficiently.
A CARE-compliant article: Unicentric Castleman disease presenting as a retroperitoneal mass of the upper edge of the pancreas
Authors: Zhou You-Xin , Ji Yong , Wu Sheng
Published: March 2020

Rationale:

Castleman disease (CD) is a rare lymphoproliferative disease with a poorly understood etiology. The occurrence of CD in the abdominal cavity is very rare, especially in the retroperitoneal peripancreatic region.

Patient concerns:

A 33-year-old woman was referred to our department on March 1, 2018 for a detailed physical examination due to retroperitoneal peripancreatic lymph node enlargement over 15 days.

Diagnosis:

Enhanced magnetic resonance imaging of the epigastrium showed the mass with abundant blood supply is located between the liver and the stomach in the upper margin of the pancreas. Postoperative pathological examination revealed CD, type of unicentric Castleman disease.

Interventions:

We performed an open surgery on this patient and completely removed the mass. There was no postoperative radiochemotherapy.

Outcomes:

The patient was followed-up for more than 12 months after the operation and showed good recovery.

Lessons:

CD is a rare disorder that is hard to diagnose early and complete resection of the tumor is still the most effective treatment.
Association between dietary patterns and disease recurrence in Thai colorectal cancer patients
Authors: Kunnavuttivanich Vorraaud , Pramyothin Pornpoj , Ithimakin Suthinee
Published: March 2020

Beside established anti-cancer treatment, dietary modification is one of the most promising approaches for reducing the probability of colorectal cancer (CRC) recurrence. Many Western studies showed a relationship between shortened survival and increased amounts of Western diet (meat and processed meat). Given that Thai food is dissimilar to Western diet, we aimed to explore the association between dietary patterns and disease recurrence among Thai CRC patients.

Early-stage CRC patients who were disease-free at the end of a 2-year period or patients with disease recurrence within 2 years were enrolled. Patients were administered a food frequency questionnaire to evaluate their dietary lifestyle. Quantitative comparison within individual food groups among patients who were disease-free and among those with recurrence was performed. Proportion of patients with recurrence and disease-free survival was compared between patients who had consumed the lowest and highest tertile of each dietary pattern.

A total of 225 CRC patients were enrolled (151 disease-free and 74 recurrence). There were no significant differences in demographic or tumor parameters between patients with or without disease recurrence. From the questionnaire, 45 food items were assigned to 1 of 12 food groups according to similarity in nutritional profile. Patients who consumed high amounts of pickled fish or chili-paste had significantly lower recurrence rates compared to patients who had never eaten those foods (P < .01). From the factor analysis, meat/wheat, vegetarian, and fast-food/processed fruit patterns were identified as the major dietary patterns. There was no significant association between intakes of individual dietary patterns and CRC recurrence.

Among CRC patients with Thai dietary lifestyles there was no association between meat/wheat, fast-food/processed fruit, or vegetarian dietary patterns and CRC recurrence. Greater consumption of some unique Thai foods, such as chili-paste or pickled fish, may relate to better outcomes for CRC patients.
Prophylactic cognitive enhancers for improvement of cognitive function in patients undergoing electroconvulsive therapy
Authors: Niu Yunlian , Ye Dan , You Yijie , Wu Jian
Published: March 2020

Objective:

Cognitive enhancers, including cholinesterase inhibitors and memantine, are used to treat dementia, but their effect for reducing post-electroconvulsive therapy (post-ECT) cognitive side effects is unclear. We conducted a systematic review and meta-analysis to assess the effectiveness of cognitive enhancers in the prevention of cognitive side effects due to ECT.

Methods:

We identified relevant studies by searching electronic databases (e.g., PubMed, EMBASE, Web of Science, Cochrane Library). Only studies published up to October 2019 comparing cognitive enhancer vs placebo for cognitive function after ECT were included. The primary outcome extracted from the studies was cognitive function score.

Results:

Five studies with 202 patients were included in this study. The cognitive enhancer group (CEG) had a significantly higher cognitive function score. Moreover, sensitivity analysis showed that no individual study had a significant impact on the overall results.

Conclusions:

This meta-analysis revealed that cognitive enhancers might improve cognitive function and reduce ECT-induced cognitive side effects. Nevertheless, more high-quality randomized controlled trials (RCTs) with long-term follow-up are still needed to make the final conclusion.
Benefits and effectiveness of using a wrist heart rate monitor as a telerehabilitation device in cardiac patients
Authors: Batalik Ladislav , Dosbaba Filip , Hartman Martin , Batalikova Katerina , Spinar Jindrich
Published: March 2020

Background:

Telerehabilitation in cardiology has the potential to become the alternative to regular outpatient cardiac rehabilitation. Our study focuses on the wrist heart rate monitor as a telerehabilitation device, defines detected limitations, and compares results between home-based and regular outpatient rehabilitation methods, related to physical fitness, quality of life, and training adherence. The study design was a randomized controlled trial.

Methods:

Eligible 56 cardiac rehabilitation patients were randomized into a 12-week regular outpatient training group (ROT) and interventional home-based telerehabilitation group (ITG). For both groups, the intensity of the training was prescribed to be performed at 70% to 80% of heart rate reserve for 60 minutes, 3 times a week. The ITG patients started their training with a wrist heart rate monitor in their home environment. These patients received feedback once a week, reflecting data uploaded on the internet application. The ROT patients performed their exercise under the direct supervision of a physical specialist in a regular outpatient clinic. Physical fitness and health-related quality of life were assessed at baseline and after 12 weeks. Training adherence in both groups was determined and compared.

Results:

Fifty-one patients comleted the intervention (91%); no serious adverse events were recorded. Physical fitness expressed as peak oxygen uptake showed significant improvement (P < .001) in ROT group from 23.4 ± 3.3 to 25.9 ± 4.1 mL/kg/min and (P < .01) in ITG group from 23.7 ± 4.1 to 26.5 ± 5.7 mL/kg/min without significant between-group differences after 12 weeks of intervention. The training adherence between groups was similar.

Conclusion:

Our study shows that telerehabilitation via wrist heart rate monitor could become an alternative kind of cardiac rehabilitation which deserves attention and further analyzing.
Comparison of the short-term effects of hyperbaric oxygen therapy and complex decongestive therapy on breast cancer-related lymphedema
Authors: Koo Jung Hoi , Song Sun Hong , Oh Ho Suk , Oh Se Hyun
Published: March 2020

Although there have been some reports that hyperbaric oxygen therapy (HBOT) is effective in treating breast cancer-related lymphedema (BCRL), controversy regarding its therapeutic effects remains.

We sought to evaluate the efficacy of HBOT in addition to conventional complex decongestive therapy (CDT) for BCRL.

A prospective observational study was conducted on 10 patients with BCRL. After screening, the subjects were stratified into a CDT-only group and a CDT and HBOT combination (CDT–HBOT) group. All patients received a total of 10 treatments over 2 weeks. Changes in the circumference of the upper limbs, quality-of-life questionnaire results, and bioelectrical impedance values were compared between the 2 groups.

Between both groups, there were no significant differences in demographic or clinical characteristics and in the quality-of-life outcomes for lymphedema of the limbs. The parameters measured by bioimpedance spectroscopy showed more significant improvements in the CDT–HBOT group than in the CDT-only group.

In patients with BCRL, HBOT may be recommended as an adjunct treatment to the existing therapies.
Amenorrhea, fertility preservation, and counseling among young women treated with anthracyclines and taxanes for early-stage breast cancer, a retrospective study
Authors: Abdel-Razeq Hikmat N. , Mansour Razan A. , Ammar Khawla S. , Abdel-Razeq Rashid H. , Zureigat Hadil Y. , Yousef Lina M. , Shahin Omar A.
Published: March 2020

Chemotherapy may cause ovarian toxicity and infertility. Cancer patients are usually overwhelmed, and focus exclusively on cancer diagnosis and may not pay attention to fertility-related issues. In this paper we look at the rate of amenorrhea and fertility counseling among such young patients.

Premenopausal women with early-stage breast cancer treated with adjuvant or neoadjuvant chemotherapy were recruited. Amenorrhea was defined as absence of menstruation for ≥12 months after the completion of chemotherapy.

A total of 94 patients met the eligibility criteria and were included in this analysis. Median age at diagnosis was 35.7 (range, 22–44) years. Seventy-nine (85.9%) respondents were counseled about amenorrhea and 37 (40.2%) were considering having children. Long-term amenorrhea was reported by 51 (54.3%) patients. The addition of taxanes to anthracyclines, in 2 different regimens, increased the risk of amenorrhea to 69.2% and 66.7% compared to 38.9% with anthracycline-alone, P < .0001. Longer duration of chemotherapy (≥24 weeks) might also be associated with higher rate of amenorrhea (67.7%) compared to 43.4% in those who had shorter duration (<24 weeks), P = .031.

The addition of taxanes to anthracycline-based chemotherapy increased the risk of amenorrhea. However, shorter duration of chemotherapy, even with taxanes, may lower such risk. Our study highlights the importance of fertility counseling to improve fertility preservation rates. Given the importance of taxanes, shorter regimens are associated with lower amenorrhea rates and should be preferred over longer ones.
Use of Personal Communication Devices in Clinical Settings
Authors: Conant Jessica , Elmore Rachael , Moore Aline , Blake Stacie , Peacock Ashley , Ward-Smith Peggy
Published: March 2020

OBJECTIVE

This survey study describes how nurses use personal communication devices while providing direct patient care and identifies generational differences.

BACKGROUND

Personal communication devices enhance and distract from patient care. Generational differences exist and these should be included in workplace policies.

METHODS

A study-specific survey was developed. Data were collected from 335 qualified participants and descriptively analyzed in total, then by generational specific study groups.

RESULTS

The perception of these participants is that personal communication devices do not pose a serious work distraction nor have a negative effect on patient care. Yet generational differences exist related to the presence of these devices in providing patient care.

CONCLUSIONS

Access to personal communication devices, while at work, is an expectation. The reasons for accessing these devices, and the perception that these devices have a negative impact on work performance, should be included when developing workplace policies.
The Role of a Certified Registered Nurse Anesthetist Led Acute Pain Service in Preventing Persistent Postoperative Opioid Use
Authors: Edwards John M. , Dollar Stace D. , Young Thomas , Brockopp Dorothy
Published: March 2020

Given the present opioid crisis, the use of opioids in the hospital setting is an increasing concern among hospital administrators and healthcare professionals. A serious problem related to surgical care is persistent postoperative opioid use among previously opioid-naïve patients. Certified registered nurse anesthetists (CRNAs) are strategically positioned within the hospital setting to address these concerns. These individuals are actively involved in managing the pain of their patients and can therefore lead change in relation to the opioid crisis. This article profiles a multidisciplinary acute pain service developed in a Magnet® redesignated hospital led by CRNAs that has demonstrated positive outcomes in decreasing the use of opioids postprocedure and postdischarge, education for healthcare providers, information for community members related to opioid abuse, and support of new protocols, including Enhanced Recovery After Surgery.
Preparing for an Influenza Pandemic: Hospital Acceptance Study of Filtering Facepiece Respirator Decontamination Using Ultraviolet Germicidal Irradiation
Authors: Nemeth Christopher , Laufersweiler Dawn , Polander Emily , Orvis Christianna , Harnish Del , Morgan Sherwin E. , O’Connor Michael , Hymes Saul , Nachman Sharon , Heimbuch Brian
Published: March 2020

Objectives

Predictions estimate supplies of filtering facepiece respirators (FFRs) would be limited in the event of a severe influenza pandemic. Ultraviolet decontamination and reuse (UVDR) is a potential approach to mitigate an FFR shortage. A field study sought to understand healthcare workers’ perspectives and potential logistics issues related to implementation of UVDR methods for FFRs in hospitals.

Methods

Data were collected at three hospitals using a structured guide to conduct 19 individual interviews, 103 focus group interviews, and 285 individual surveys. Data were then evaluated using thematic analysis to reveal key themes.

Results

Data revealed noteworthy variation in FFR use across the sample, along with preferences and requirements for the use of UVDR, unit design, and FFR reuse. Based on a scale of 1 (low) to 10 (high), the mean perception of safety in a high mortality pandemic wearing no FFR was 1.25 of 10, wearing an FFR for an extended period without decontamination was 4.20 of 10, and using UVDR was 7.72 of 10.

Conclusions

In addition to technical design and development, preparation and training will be essential to successful implementation of a UVDR program. Ultraviolet decontamination and reuse program design and implementation must account for actual clinical practice, compliance with regulations, and practical financial considerations to be successfully adopted so that it can mitigate potential FFR shortages in a pandemic.
A Call for the Application of Patient Safety Culture in Medical Humanitarian Action: A Literature Review
Authors: Biquet Jean-Marc , Schopper Doris , Sprumont Dominique , Michel Philippe
Published: March 2020

Objectives

The aims of the study were to assess lessons learned on patient safety in Organization for Economic Cooperation and Development (OECD) countries and to assess whether they are applied or can be applied to the humanitarian medicine.

Methods

This is (a) a 2013–2018 rapid literature review of reviews and systematic reviews articles (PubMed database) on “patient safety” and “medical error” to look for lessons learned regarding patient safety in OECD countries and (b) a rapid literature review (PubMed and Embase databases) on “humanitarian medicine” and “patient safety,” from their creation to 2018, to find any articles related to patient safety in humanitarian medicine. In both reviews were excluded articles specifically related to one device, disease, or medical act. These reviews were complemented by a Google search.

Results

Of the 245 references retrieved, 104 met the inclusion criteria. Of 308 references, 39 respected the inclusion criteria. In OECD countries, patient safety comprises correlated measures taken at three levels. The micro level focuses on individual staff involved in healthcare provision or management; the meso level focuses on medical institutions; the macro level focuses on national healthcare systems. Only one reference mentioned the implementation of a medical error reporting and analysis system in medical humanitarian organization.

Conclusions

The adoption of strategies and a culture of safety will need to be adapted to address the variety of intervention contexts and to respond first to the fears and expectations of humanitarian staff. Medical humanitarian organizations, in the absence of an overarching authority for the sector, have a major responsibility in the development of a general patient safety policy applicable in all their operations.
Continuous Drug Delivery is Significantly Affected by Relative Height Changes Between Patient and Syringe Driver
Authors: Zahid Aisha , Raffaj Dusan , Wignell Andrew , Davies Patrick
Published: March 2020

Objective

Syringe drivers are the principle method of giving small-volume continuous infusions of important drugs to patients. Many of these drugs are critical for the maintenance of normal physiology. Anecdotal evidence abounds of severe patient instability on movement of syringe drivers during infusion. We aimed to define the variation in drug delivery seen in three syringe drivers, with changes in relative height between the syringe driver and the end of the giving set.

Design

Three syringe drivers (Alaris CC [Becton Dickinson], Perfusor Space [B Braun], and Synamed μSP6000 [Arcomed]) were analyzed for reliability of flow at 0.5, 1, 2, and 5 mL/h.

Setting and subjects

This is an in vitro investigation.

Interventions

A small air bubble was introduced into the giving set, and the progression of this was documented before and after a vertical movement of the syringe driver by 25 or 50 cm upward or downward relative to the delivery port.

Measurements and Main Results

For all pumps, delivery was interrupted on movement of the pumps downward, and a bolus was given with movement of the pump upward. Delivery halted at lower pump speeds for longer than higher pump speeds. The maximum delivery interruption was 11.8 minutes. Boluses given on moving the pump up were calculated as the equivalent number of minutes needed to deliver the bolus volume at steady state. The maximum bolus given was equivalent to 15.8 minutes of delivery. We were unable to eliminate the effects seen by very slow, steady movement of the pumps up or down. Static height differences made no difference to delivery.

Conclusions

Syringe drivers should not be moved vertically in relation to the patient. Critical drug delivery is interrupted for up to 12 minutes with relative downward movements, and significant boluses of drugs are given with relative upward movements. As far as possible, elimination of relative height movements is advised, and extreme caution is necessary if any movements are unavoidable.
Preventing Operating Room Fires: Impact of Surgical Drapes on Oxygen Contamination of the Operative Field
Authors: Culp William C. , Muse Kenisha W.
Published: March 2020

Objective

The aim of the study was to measure underdrape oxygen pooling, surgical site oxygen contamination, and time to restoration of 21% oxygen concentration after cessation of oxygen delivery by measuring oxygen concentration under simulated clinical conditions with various drapes.

Methods

In a 2-part study, oxygen permeability of four differing surgical drapes was measured (Part A) and a mannequin was used to measure underdrape oxygen pooling and surgical site oxygen contamination (Part B). In Part A, a container of high concentration oxygen was sealed with a surgical drape. Oxygen concentrations on both sides of the drape were then measured over time to quantify drape oxygen permeability. Part B included a mannequin model draped for a hypothetical surgical site with oxygen administered by face mask. Oxygen concentration was measured at both the surgical site and under the drape nearest the surgical site.

Results

Oxygen permeability varied significantly between drapes tested. The surgical site oxygen concentration ranged from 20% to 58% (P = 0.0001). The commonly used woven 100% cotton operating room (OR) towel was highly permeable. The plastic occlusive drape created an impermeable barrier, which did not allow for any oxygen contamination but created the longest time to return to 21% oxygen concentration at the underdrape site after cessation of oxygen delivery.

Conclusions

Surgical drapes have varying oxygen permeability and can lead to high concentration underdrape oxygen pooling. Oxygen contamination of the surgical site varies widely based on drape material and may reach dangerously high levels, especially with the cotton OR towel. Surgical drape selection may impact OR fire risk.
Identifying Factors Leading to Harm in English General Practices: A Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis
Authors: Ricci-Cabello Ignacio , Gangannagaripalli Jaheeda , Mounce Luke T. A. , Valderas Jose María
Published: March 2020

Objective

The aim of the study was to identify the main factors leading to harm in primary care based on the experiences reported by patients.

Methods

We conducted a mixed-methods, cross-sectional study in 45 primary care centers in England. A random sample of 6736 patients was invited to complete the Patient-Reported Experiences and Outcomes of Safety in Primary Care questionnaire. We fitted structural equation modeling on the quantitative data (n = 1244 respondents) to identify contributory factors and primary incidents leading to harm. We conducted content analyses of responses to seven open-ended questions (n = 386) to obtain deeper insight into patient perceptions of the causes of harm experienced. Results from quantitative and qualitative analyses were triangulated.

Results

Patients reported harm related to physical health (13%), pain (11%), and mental health (19%) and harm that increased limitations in social activities (14%). Physical harm was associated with incidents affecting diagnosis (β = 0.43; delayed and wrong), and treatment (0.12; delayed, wrong treatment, or dose), which were in turn associated with incidents with patient-provider communication, coordination between providers, appointments, and laboratory tests. Pain was associated with laboratory tests (0.21; caused when collecting blood or tissue samples) and with problems booking an appointment when needed (0.13; delaying treatment for pain). Harm to mental health was associated with incidents related to the following: diagnosis (0.28), patient-provider communication (0.18), appointments (0.17), coordination between different providers (0.14), and laboratory tests (0.12). Harm increasing limitations in social activities was associated with incidents related to diagnosis (0.42) and diagnostic and monitoring procedures (0.20).

Conclusions

Our findings suggest the need for patient-centered strategies to reduce harm in primary care focusing on the improvement of the quality of diagnosis and patient-provider communication.
Patient Deterioration in Australian Regional and Rural Hospitals: Is the Queensland Adult Deterioration Detection System the Criterion Standard?
Authors: Le Lagadec Marie Danielle , Dwyer Trudy , Browne Matthew
Published: March 2020

Objective

This study compares the efficiency of six early warning systems (EWSs) to determine whether the EWS used in most public hospitals in Queensland, Australia, The Queensland Adult Deterioration Detection System (Q-ADDS), is best suited for use in small regional and rural hospitals.

Method

In this retrospective case-control study, patients who experienced an in-hospital severe adverse event (index patients) for a 3.5-year period were demographically and diagnostically matched with patients who had uneventful hospital stays (control patients). The EWS efficiency was based on the area under the receiver operator characteristic curve (AUROC) and the number of false and true alerts generated by each EWS.

Result

The incidence of severe adverse events was 1.2% of in-hospital patients, and 2500 sets of vital signs were collected from 159 index and 172 control patients. The EWSs were only able to identify approximately half of the index patients. The AUROC was 0.666 to 0.801 and the EWS generated 2.4 to 7.6 false alerts to every true alert per 1000 admissions. The National Early Warning Score had the best ratio of false to true alerts (2.4:1) but was only able to identify 40.8% of deteriorating patients. The Q-ADDS identified 46.5% of the deteriorating patients and had a false to true alert ratio of 3.2:1. When compared with the National Early Warning Score, systems with higher AUROCs (0.744 and 0.801) also had higher proportion of false alerts. None of the alternative EWSs seem to provide marked benefits over Q-ADDS.

Conclusions

At present, there is insufficient evidence to replace Q-ADDS with an alternative EWS. Because the EWSs were only able to identify half of the deteriorating patients, EWSs should be used in conjunction with good clinical judgment.
Proactive Evaluation of an Operating Room Prototype: A Simulation-Based Modeling Approach
Authors: Taaffe Kevin , Joseph Anjali , Khoshkenar Amin , Machry Herminia , Allison David , Reeves Scott T. ,   RIPCHD.OR Study Group
Published: March 2020

Objectives

There is a pressing need to improve safety and efficiency in the operating room (OR). Postsurgical adverse events, such as surgical site infections and surgical flow disruption, occur at a significant rate in industrial countries where a considerable portion of such complications result in death. The aim of the study was to identify an ideal room design that improves the flow of staff members using risk and safety performance measures.

Methods

Operating room designs were compared by using computer simulation modeling to analyze traffic flow inside an OR. The study was conducted in two phases. A historical data set was first created based on surgical flow data obtained from 23 video observations of actual surgical procedures. A detailed simulation-based model was then developed.

Results

As room size increases, staff members have more available space to maneuver in the room, resulting in more distance walked but far fewer undesirable contacts. An angled table orientation is preferred with the circulating nurse workstation at the foot of the OR table, as it provides more space for staff to move across the room without increasing the number of contacts. Furthermore, when the nurse workstation is near the wall, staff members experience fewer undesirable contacts.

Conclusions

Simulation modeling was used to assess the impact of OR layout alternatives on three performance metrics, and the medium-sized OR prototype performs well across the metrics. Future research will consider the relative influence of several factors on traffic-based safety and efficiency performance metrics, resulting in a more predictive simulation design model.
Role of Arthroscopic Eminoplasty in the Management of the Habitual Dislocation of Temporomandibular Joint
Authors: Garcia Martin Miguel , Garcia Medina Blas , Cariati Paolo , Galvez Pablo
Published: March 2020

Aim:

To evaluated the effectiveness of arthroscopic eminoplasty in the management of habitual dislocation of the temporomandibular joint (TMJ).

Patients and Methods:

The study is based on a retrospective evaluation of 11 patients (20 joints) with chronic habitual dislocations of TMJ treated with arthroscopic eminoplasty. Maximal postoperative mouth opening, complications related to surgery, duration of postoperative hospital stay, and recurrence rate (at 2 years follow up) were analyzed.

Results:

Six patients presented complete dislocation (non self-reducible), while 5 patients reported a history of repetitive subluxations that altered their quality of life. Arthroscopic eminoplasty showed great outcomes in terms of recurrence rate, complications related to surgery and hospital stay.

Discussion:

Arthroscopic eminoplasty represents a safe and effective technique to treat habitual dislocation of the TMJ. Moreover, the integrity of the TMJ capsule-ligament system is respected with this approach and this is extremely important in terms of joint stability.
Outcome of Different Treatment Modalities of Fracture Zygoma
Authors: Rahman Roselinda Ab , Ghazali Nurlidiah Md , Rahman Normastura Ab , Pohchi Abdullah , Razak Noor Hayati Abd
Published: March 2020

Objectives:

This study aimed to determine the pattern of fractured zygoma, different treatment modalities, and complications of the treatment in our center. It also aimed to determine the association between the treatment modalities and complication of treatment, and association between number of fixation and complication.

Methodology:

A retrospective review was conducted from January 2008 until December 2011. All patients diagnosed with zygomatic complex fractured that met the inclusion and exclusion criteria were included in the study. Zingg's Classification was used in the study.

Results:

The median age was 23.5. Type A was the most common fracture type made up 26.6%. About 90.8% of the injury was caused by road traffic accident. Forty-four patients were treated with open reduction and internal fixation and 4 patients were treated with close reduction only. Fifty patients were treated conservatively. Gillies approach in combination with fixation is the most common procedure accounted for 50%. Three-point fixation at infraorbital, maxillary buttress, frontozygomatic suture, and zygomatic arch was the most common site. However, there were no significant associations between the number of fixation and the occurrence of the complication (P = 0.307). About 29.2% in the treatment group and 66% in the conservative group had complications. About 35.7% of patients in treatment group had complications, while 66% had trismus in conservative group.

Conclusion:

There was a significant association between types of treatment and the occurrence of complication (P = 0.001). However, there were no significant association between number of fixation and the occurrence of complications (P = 0.307).
An Improved and Simplified Approach to Identify the Facial Nerve During Parotid Surgery
Authors: Al-Qahtani Khalid Hussain , AlQahtani Mubarak Shaie , Baqays Abdulsalam Ali , Islam Tahera
Published: March 2020

Precise identification and preservation of the facial nerve is mandatory to avoid dysfunction of the facial nerve during parotidectomy. In this article, the authors are introducing a new landmark to identify the facial nerve for parotidectomy that is more protective for the facial nerve. The authors use a simple approach to predict the position of facial nerve main trunk intraoperatively without geometric calculations and a lot of landmarks. An imaginary almost 2 cm line is drawn between mastoid tip inferiorly and bony-cartilaginous junction of the external auditory canal superiorly. The main trunk of the facial nerve can be visualized at the midpoint of this line. The authors have been using this landmark successfully for the last 10 years, without any functional deficit of the parotid nerve. Identifying the facial nerve at the trunk level by this landmark renders following the branches forward in the glandular parenchyma less complicated.
Gelatin Sponge Induced Maxillary Sinusitis After Transsphenoidal Pituitary Surgery
Authors: Lee Dong Hoon , Yoon Tae Mi , Lee Joon Kyoo , Lim Sang Chul
Published: March 2020

Transsphenoidal pituitary surgery is a safe, well-established treatment method, but it is associated with several postoperative nasal complications. However, gelatin sponge induced maxillary sinusitis after transsphenoidal pituitary surgery has not been reported. In this study, we present an unusual case of gelatin sponge induced maxillary sinusitis after transsphenoidal pituitary surgery. Therefore, it should be recognized that gelatin sponge induced maxillary sinusitis may occur as a complication after transsphenoidal pituitary surgery.
Searching for an Alternative Method to Evaluate Surgical Knowledge: Does a Drawing and Labeling Quiz Predict In-Service Exam Performance and Enhance Learning?
Authors: Mauch Jaclyn T. , Shubinets Valeriy , Chang Benjamin , Lin Ines C.
Published: March 2020

Background:

The best methods to assess surgical knowledge are still debated. The authors used a non-multiple-choice test as a pre- and post-conference assessment to measure residents’ knowledge gains with comparison to a standard summative assessment tool.

Methods:

At one didactic conference, plastic surgery residents at a single institution were given a pre-test of drawing and labeling structures in the extensor mechanism of the finger and within the carpal tunnel. The quiz was followed by a lecture on the same material and a subsequent post-test. Scores were correlated with in-service exam performance.

Results:

Pre-test scores (n = 13) were positively correlated with postgraduate year (PGY) until PGY-3. Performance on labeling structures was higher than performance on the respective drawing prompt. Residents’ ability to label structures increased more strongly with PGY than their ability to draw structures. The post-test (n = 8) demonstrated that teaching improves performance on labeling questions (pre-test score = 62%; post-test score = 87%). Improvement was observed across all PGYs. Pretest results were positively correlated with in-service exam performance.

Conclusions:

Our study suggests that a knowledge test focused on drawing and labeling structures given to surgical residents is a valid, nontraditional method for assessing resident knowledge. Such a quiz would offer programs an alternative method for regularly evaluating residents aside from in-service questions, in order to identify residents who may need targeted training for the in-service exam and to inform teaching plans.

Additionally, residents could use quiz feedback to guide study efforts and prime conference-related learning.
Risks and Associations of Third- and Fourth-Degree Lacerations: An Urban Single Center Experience
Authors: Chiu Kimberley , Mckay Elishia , Fazzari Melissa , Leegant Ava
Published: March 2020

Objective

Obstetric anal sphincter injuries (OASIs) are severe tears involving the external and internal anal sphincters. We aimed to document the incidence of OASIs within a racially and ethnically diverse institution to elucidate which maternal, fetal, and parturition factors may be associated with OASIs in minority subgroups.

Methods

This was a retrospective unmatched case-control study of reproductive aged women who delivered between January 1, 2014, and December 31, 2017, at our institution. Data for maternal, fetal, and parturition factors were gathered through chart review. We also investigated the expertise level of the surgeon performing repairs and complications that developed in the postpartum period. Logistic regression analysis was used to compare women with third- and fourth-degree lacerations against the control group of women with first-degree, second-degree, or no lacerations.

Results

Of the 23,362 deliveries between January 1, 2014, and December 31, 2017, the incidence of OASIs was 1%. Of our patients, 38% self-identified as Hispanic, 32% as Black, 13% as White, and 3.5% as Asian. Risk for OASIs was significantly increased in nulliparity, Pitocin use, operative deliveries, episiotomy, and prolonged second stage of labor. Black race and obesity were protective for OASIs. There was no significant difference in complication rates based on type of repair nor the provider level of training.

Conclusions

The incidence of OASIs at our institution is similar to current published literature. Our study population is unique in its overrepresentation of minority groups, offering insight into potentially distinctive risk and protective factors associated with OASIs.
Pelvic injury patterns in blast: Morbidity and mortality
Authors: Rankin Iain A. , Webster Claire E. , Gibb Iain , Clasper Jonathan C. , Masouros Spyros D.
Published: March 2020

BACKGROUND

Pelvic trauma has emerged as one of the most severe injuries to be sustained by the victim of a blast insult. The incidence and mortality due to blast-related pelvic trauma is not known, and no data exist to assess the relative risk of clinical or radiological indicators of mortality.

METHODS

The UK Joint Theater Trauma Registry was interrogated to identify those sustaining blast-mediated pelvic fractures during the conflicts in Iraq and Afghanistan, from 2003 to 2014, with subsequent computed tomography image analysis. Casualties that sustained more severe injuries remote to the pelvis were excluded.

RESULTS

One hundred fifty-nine casualties with a 36% overall mortality rate were identified. Pelvic vascular injury, unstable pelvic fracture patterns, traumatic amputation, and perineal injury were higher in the dismounted fatality group (p < 0.05). All fatalities sustained a pelvic vascular injury. Pelvic vascular injury had the highest relative risk of death for any individual injury and an associated mortality of 56%. Dismounted casualties that sustained unstable pelvic fracture patterns, traumatic amputation, and perineal injury were at three times greater risk (relative risk, 3.00; 95% confidence interval, 1.27–7.09) to have sustained a pelvic vascular injury than those that did not sustain these associated injuries. Opening of the pubic symphysis and at least one sacroiliac joint was significantly associated with pelvic vascular injury (p < 0.001), and the lateral displacement of the sacroiliac joints was identified as a fair predictor of pelvic vascular injury (area under the receiver operating characteristic curve, 0.73).

CONCLUSION

Dismounted blast casualties with pelvic fracture are at significant risk of a noncompressible pelvic vascular injury. Initial management of these patients should focus upon controlling noncompressible pelvic bleeding. Clinical and radiological predictors of vascular injury and mortality suggest that mitigation strategies aiming to attenuate lateral displacement of the pelvis following blast are likely to result in fewer fatalities and a reduced injury burden.

LEVEL OF EVIDENCE

Prognostic, level III.
New ischemic lesions on brain magnetic resonance imaging in patients with blunt traumatic cerebrovascular injury
Authors: Harrigan Mark R. , Griffin Russell L. , Deveikis John P. , Prattipati Veeranjaneyulu , Chimowitz Marc I. , Jansen Jan O.
Published: March 2020

BACKGROUND

Patients with blunt cerebrovascular injuries are at risk of thromboembolic stroke. Although primary prevention with antithrombotic therapy is widely used in this setting, its effectiveness is not well defined and requires further investigation. The aim of this study was to evaluate the utility of magnetic resonance imaging (MRI)–detected ischemic brain lesions as a possible future outcome for randomized clinical trials in this patient population.

METHODS

This prospective observational study included 20 adult blunt trauma patients admitted to a level I trauma center with a screening neck CTA showing extracranial carotid or vertebral artery injury. All subjects lacked initial evidence of an ischemic stroke and were managed with antithrombotic therapy and observation and then underwent brain MRI within 30 days of the injury to assess for ischemic lesions. The MRI scans included diffusion, susceptibility, and Fluid-attenuated Inversion Recovery (FLAIR) sequences, and were reviewed by two neuroradiologists blinded to the computed tomography angiography (CTA) findings.

RESULTS

Eleven CTAs were done in the emergency department upon admission. There were 12 carotid artery dissections and 11 unilateral or bilateral vertebral artery injuries. Median interval between injury and MRI scan was 4 days (range, 0.1–14; interquartile range, 3–7 days). Diffusion-weighted imaging evidence of new ischemic lesions was present in 10 (43%) of 23 of the injured artery territories. In those injuries with ischemic lesions, the median number was 8 (range, 2–25; interquartile range, 5–8). None of the lesions were symptomatic. Blunt cerebrovascular injury was associated with a higher mean ischemic lesion count (mean count of 3.17 vs. 0.14, p < 0.0001), with the association remaining after adjusting for injury severity score (p < 0.0001).

CONCLUSION

In asymptomatic blunt trauma patients with CTA evidence of extracranial cerebrovascular injury and treated with antithrombotic therapy, nearly half of arterial injuries are associated with ischemic lesions on MRI.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.