bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent evidence of nurse practitioner outcomes in a variety of care settings
Authors: Geller Daniel E. , Swan Beth Ann
Published: September 2020

When nurse practitioners (NPs) work to expand their scope of practice through state legislatures, the opposing lobbying groups are often physician-led organizations. The main argument against NP independence and limited scope of practice is that NP care is inherently inferior to that of physicians. However, more than three decades of research demonstrates quality and cost outcomes to be equal to or better than that of physicians. This article reviews a wide range of evidence documenting NP competency, satisfaction, and safety, as well as the challenges and consequences when limiting NP scope of practice. The evidence is clear and has not changed in over 30 years, NPs provide access to effective primary care in a variety of settings, equal in quality outcomes, safety, and cost-effectiveness compared with physicians.
Developing the advanced practice nursing role in Slovakia: Perception, education, and practice
Authors: Grešš Halász Beáta , Majerníková L'udmila , Obročníková Andrea , Hudáková Anna , Vojteková Marta
Published: September 2020

Background:

Advanced practice nursing (APN) is a modern and effective nursing role that has a positive impact on health care systems around the world. Guiding principles are advanced education, expanded scope of practice, and policies supportive of the role.

Purpose:

The aim of this study was to find out the perception of APNs of their own practice in the context of the current legislative conditions in Slovakia and to identify related factors.

Methods:

A quantitative exploratory design was selected. From 5,067 APN, 584 were conveniently selected. The adapted and modified SCAPE study questionnaire was used for data collection. Data were processed using SPSS 25.

Results:

There were differences between newly introduced competencies for the APN role in Slovakia and the general concept of the role that could influence practice. The level of APNs' perception of their own practice is low. Years of practice was significantly and positively related to the perception. The results in each region were significantly different. Community nurses/outpatient nurses assessed their practice at a significantly higher level. The educational curriculum lacks the subject of APN. Competencies, remuneration, and satisfaction with the status are insufficient.

Implications for practice:

To understand, implement, and practice the concept of APN, it is essential to change policies related to competencies, education, remuneration, and status. Creation of an educational model that includes the subject area of advanced practice nursing in the postgraduate curriculum is essential. Education and practice conditions for advanced practice nurses should be uniform in all regions of the country.
Improving the rate of colorectal cancer screening with the “80% in every community” campaign
Authors: Morrow Linda , Greenwald Beverly
Published: September 2020

Colorectal cancer (CRC) ranks third in both cancer diagnoses and cancer-related deaths in men and women in the United States. Fortunately, both incidence and deaths have declined due to the increased use of CRC screening to find and remove precancerous polyps and to diagnose CRC at earlier, more treatable stages. Deaths from CRC have shifted to a new demographic, with a recent increase in incidence of 2% per year in people younger than 55 years. The American Cancer Society has issued a qualified recommendation that screening start at the age of 45 years because of this increase in early-onset CRC. There are multiple CRC screening test options. Professional organizations vary in their screening guidelines, but regardless of these differences, screening has been shown to save lives. Currently, one out of every three adults aged 50–75 years are not screened as recommended. The National Colorectal Cancer Roundtable (NCRCRT) has placed a high priority on screening people who remain unscreened. Nurse practitioners can improve the screening rates in outpatient clinics and health systems by adopting the campaign, “80% in Every Community,” which has a goal to reduce disparities and improve screening rates in underserved and rural populations. The NCRCRT resources will help clinics and health systems reach the screening goal of 80% in every community.
Menstrual suppression in girls with disabilities
Authors: Hopkins Casey S. , Fasolino Tracy
Published: September 2020

Background:

Girls with disabilities and their caregivers are challenged during pubertal transitions, particularly with menses onset. More than 50% of caregivers report concern and anxiety related to menarche, and they have sought health care providers to discuss options. Menstrual suppression planning and education from nurse practitioners (NP) is key to ensure quality of life for these girls and their caregivers.

Objective:

The purpose of this systematic review is to examine and evaluate the state of the science surrounding the use of medical modalities for menstrual suppression in adolescent girls with disabilities.

Data sources:

Articles were identified through systematic electronic search of the following databases: CINAHL, Medline, Health Sources: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, PsycINFO, Cochrane Register of Controlled Trials, and Academic Search Complete.

Conclusions:

Results indicate that the most common medical modality used for menstrual suppression in girls with disabilities is the combined oral contraceptive pill, but depot medroxyprogesterone acetate and levonorgestrel-releasing intrauterine system have been recommended. Concerns related to menstrual suppression include expressed wishes of the girl and her caregivers, existing comorbid conditions, and risks associated with medical modalities used for suppression.

Implications for practice:

Meaningful conversations about concerns and expectations related to pubertal transitions are essential to ensure smooth transitions. NPs should provide counseling and discuss the variety of interventions available for menstrual suppression, being mindful of the need for comprehensive gynecological care. Additional studies using robust methods, including longitudinal and prospective strategies, are needed to better inform NPs of the goals and desirable outcomes for these girls and their caregivers.
Prescriptive practice differences between nurse practitioners and physicians in the treatment of uncomplicated urinary tract infections in the emergency department setting
Authors: O'Neill Daniel , Branham Steve , Reimer Andrew , Fitzpatrick Joyce
Published: September 2020

Background:

Nurse practitioners (NPs) have increasingly broad prescribing authority, yet there is insufficient information available on the prescribing practices of NPs working in the emergency department setting.

Purpose:

The purpose of this study was to describe prescriptive practices between two provider groups, NPs and physicians, in an emergency department setting in the United Arab Emirates. This comparison focused on treatment of a common emergency department diagnosis of uncomplicated urinary tract infection (UTI).

Methods:

The investigators reviewed a sample of 690 UTI patients during the period of August 30, 2016 to June 30, 2018. Physician and NP provider groups were then assessed for treatment selection and associated patient outcomes. A Chi-square test was used to compare empiric antibiotic selection using variables of population type, gender, age, and provider type.

Results:

There were similar prescriptive practices for beta-lactam, nitrofurantoin, and trimethoprim prescriptions. The investigators noted a statistical difference for fluoroquinolone use, with the physician group selecting fluoroquinolones more often than the NP group. Also, fluoroquinolone use within the physician group varied significantly; however, the investigators did not see this within the NP group.

Implications for practice:

The findings support that there is comparable care quality in the treatment of uncomplicated UTIs between physician providers and NPs in this setting. Comparing outcome similarities and differences on a commonly occurring medical problem in the emergency department provides an early look at the value-added services that NPs provide.
Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project
Authors: Thompson Summer , Johnson Deborah , Lindgren Teri , Compton Laura , Chen Jyu-Lin
Published: September 2020

Background:

Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence.

Local problem:

Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider's overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management.

Methods:

This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine.

Interventions:

Phase 2 of the project consisted of a pretest–posttest design pilot of the guideline via a “Lunch and Learn” educational session at a Federally Qualified Health Care Center located in the Northern California.

Results:

The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice.

Conclusions:

Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.
How nurse practitioners can advocate for local, state, and federal policy to promote colorectal cancer prevention and screening
Authors: Morrow Linda , Greenwald Beverly
Published: September 2020

Colorectal cancer (CRC) is the second most common cause of cancer deaths for men and women, combined, even though it is the most preventable, treatable, and beatable cancer. Polyp removal during colonoscopy is one major way to help prevent CRC, but it can also be prevented by modifiable risk factor reduction. The National Colorectal Cancer Roundtable's campaign “80% in Every Community” is an effort to address disparities in the less-screened populations and communities. The nurse practitioner (NP) can assist health care organizations to develop policies for high-quality screening programs and create system changes to promote CRC prevention and screening. Professional organizations provide an easy way to become involved in policy change at the health system, local, state, and federal levels. State and federal policies affect patient access to care and adherence to the CRC prevention and screening recommendations. Fourteen states have not yet elected to expand Medicaid. Every NP has the knowledge, skills, and ability to advocate for the expansion of Medicaid in these remaining states to reduce this access to care barrier for underserved patients and communities.
Nurse practitioners' experiences of polypharmacy in community-dwelling older adults
Authors: Pariseault Christine A. , Sharts-Hopko Nancy , Blunt Elizabeth
Published: September 2020

Background:

Numerous studies have defined polypharmacy and its impact on health. The literature is also rich in studies documenting the benefits of care provided by nurse practitioners (NPs). A gap in research exists at the intersection of the value of NPs in caring for older adults and their management of polypharmacy.

Purpose:

Coinciding with growth in America's older adult population and the need for adequate care, the purpose of this study was to explore the experiences of NPs caring for community-dwelling older adults experiencing polypharmacy.

Methodological orientation:

A qualitative descriptive study was conducted. Interviews were conducted, and data were analyzed for themes.

Sample:

This study was conducted using a purposive sampling of NPs who care for older adults (n = 15).

Conclusions:

Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of NPs in relation to polypharmacy, and medication issues of older adults. The themes depict the complexity of medication management in older adults and the important role of NPs in providing care to older adults.

Implications for practice:

The significance of the study findings to future practice includes improving communication and collaboration between prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires that NPs consider the unique needs of each older adult while using technology to support collaboration and decision making.
Initiation of HIV pre-exposure prophylaxis in adolescents and young adults: Barriers and opportunities
Authors: Mocorro Igor , Sandhu Prabjot Jodie , Rowniak Stefan , Leonard Adam
Published: September 2020

Background:

Adolescents and young adults (AYA) ages 13 to 24 years comprise a quarter of the new HIV diagnoses in the United States. Lack of access to HIV-preventive biomedical tools such as pre-exposure prophylaxis (PrEP) reduces opportunities to prevent HIV infection in this population. Initiating PrEP in AYA significantly reduces the negative health outcomes of HIV, but many providers are still reluctant to initiate PrEP in their AYA patients based on perceived threats and barriers.

Objectives:

This review aims to highlight the barriers and opportunities for initiating PrEP services in AYA and provides recommendations for PrEP services in this population.

Data sources:

Ten scholarly articles rated levels IIA through IIIB were identified using the Johns Hopkins Evidence-Based Practice ratings. These included quasi-experimental and nonexperimental publications. Both quantitative and qualitative data contributed to identifying perceived barriers, opportunities, and recommendations for increased PrEP access and prescription in AYA.

Conclusions:

Pre-exposure prophylaxis is a vital component of a robust HIV prevention program. Themes that emerged hindering optimal PrEP utilization in AYA included provider-related barriers (e.g., knowledge deficit, lack of familiarity with PrEP guidelines, and protocols), patient-related barriers (e.g., lack of awareness, confidentiality issue, and HIV stigma), and structure-related barriers (e.g., lack of AYA-friendly clinics and insurance coverage).

Implications for practice:

Providers in any setting should be able identify at-risk AYA and prescribe PrEP accordingly. Nurse practitioners should make PrEP accessible to AYA by addressing the barriers to PrEP utilization, prescribing, and continuity of care. Nurse practitioner curriculum, training, and continuing education should include PrEP for AYA.
Conflict resolution between physicians and nurse practitioners
Authors: Blackwell Christopher W. , Faraci Nicholas
Published: September 2020

Background:

In the United States health care system, nurse practitioners (NPs) and physicians work very closely in the delivery of high-quality patient care across lifespans and acuities. In fact, advanced practice nurses work closer with physicians in their day-to-day care delivery than with any other group of professionals. This remains true even in states with independent practice for NPs. Because of the significant relationships between physicians and NPs, assessment of how these professionals resolve conflict is essential.

Purpose:

The purpose of this study was to determine the style of conflict resolution employed by NPs and physicians.

Methods:

Nurse practitioners (n = 57) and physicians (n = 58) were randomly sampled from the Florida Department of Health—Health Care Practitioner Data Portal (N = 115). Participants completed a demographic questionnaire assessing experience in conflict resolution training and the Rahim Organizational Conflict Inventory—II, Form C, which defined the style of conflict resolution they most used and preferred.

Results:

Results showed that 29.8% of physicians and 40.4% of NPs received formal conflict resolution/management education/training (p = .24). The dominant style of conflict resolution used for 78% of physicians and 74% of NPs was the integrating style, with no statistical difference between the two professions (p = .87).

Implications for practice:

Physicians and NPs lack formal education on conflict resolution in their graduate studies. In addition, both professionals tend to use similar styles of conflict resolution among one another in clinical practice, which affects their collaboration and ultimately how optimal care is delivered to patients.
Evaluation of an electronic clinical algorithm to improve screening and evaluation of college students for depressive symptoms
Authors: Webb Chris , Owens Heather , Hager Kathy , Lindsay Ta'Neka , Steinbock Stacie
Published: September 2020

Background:

Depression is higher among college students compared with the general population, and lesbian, gay, bisexual, transgender and questioning/queer (LGBTQ+) persons have higher rates than heterosexuals. Evidence supports the implementation of automated depressive symptoms screenings to improve provider compliance.

Local problem:

A student health clinic at a private, catholic university did not consistently collect Patient Health Questionnaire 2 (PHQ-2) and Patient Health Questionnaire 9 (PHQ-9) depressive screening scores or sexual orientation and gender identity (SOGI) data.

Methods:

The Plan-Do-Study-Act method of quality improvement was used to improve depressive symptom screenings and SOGI data collection. Baseline assessment included a review of patient medical records during a 10-week period before the intervention.

Interventions:

Patient Health Questionnaire 2 data were collected electronically and PHQ-9 data were collected automatically when indicated. Sexual orientation and gender identity data were added to the electronic intake form. The project was evaluated by: (1) comparing preimplementation and postimplementation compliance of PHQ-2 and PHQ-9 screenings; (2) assessing SOGI data collection; and (3) comparing LGBTQ+ and heterosexual student's PHQ-2 scores.

Results:

Preimplementation data revealed a PHQ-2 compliance rate of 44.3%, with 0% PHQ-9 compliance, and no self-reported SOGI data collection. Postimplementation, PHQ-2 and PHQ-9 compliance increased to 93.2% and 100%, respectively. Patient Health Questionnaire 2 scores did not differ between LGBTQ+ and heterosexual students.

Conclusions:

The electronic clinical algorithm increased PHQ-2 and PHQ-9 data collection, supporting automated screenings for depressive symptoms. Collection of SOGI data also improved, thus potentially improving health outcomes. No differences between LGBTQ+ and heterosexual student's depressive symptoms were identified.
Use of an educational intervention to increase screening for antenatal depression in an obstetrics and gynecology practice
Authors: VanderWall Rachel , Haefner Judy , Wehbe-Alamah Hiba
Published: September 2020

Background:

Depression affects approximately 12% of pregnant women and increases maternal and fetal risk during pregnancy and the postpartum period. The United States Preventative Services Task Force and the American College of Obstetricians and Gynecologists recommend that all prenatal care include depression screening. This study assessed the effectiveness of an educational intervention to increase screening for depression during prenatal care.

Local problem:

The clinical site serves a socioeconomically and culturally high-risk population. Prior to the intervention, prenatal depression screening was not incorporated into prenatal care.

Methods:

Health records of patients presenting for prenatal care to an obstetrics and gynecology clinic were analyzed before an educational intervention on prenatal depression was delivered to providers at the practice site. Data for prenatal depression screening rates, treatment plans, and patient demographic information were extracted and compared to determine compliance with antenatal depression screening guidelines.

Interventions:

The primary intervention of this initiative is the provision of education on the importance of and techniques for prenatal depression screening, diagnosis, and treatment.

Results:

Prenatal depression screening increased from 0% to 27% of patients following the intervention. No significant correlation was found between factors of age, gestational age, gravidity, parity, or marital status. A total of 2.8% of screened patients scored positive for severe depression, 5.7% indicated moderate depression, and 51% indicated mild depression.

Conclusions:

Education and training improves provision of prenatal depression screening, but further work is needed to improve the accurate and timely identification of depression, as well as its appropriate treatment, referral, and follow-up.
Communication, leadership and organizational support facilitate successful transition into practice for nurse practitioners in the emergency department
Authors: Soco Cheryl , Simonovich Shannon D. , Dillon Deborah , Bishop-Royse Jessica , Lattner Christina
Published: September 2020

Background:

Postgraduate programs, specialized academic programs, and national health organizations such as the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills, and factors for successful transition into practice.

Purpose:

The purpose of this study is to examine the relationships and differences among the personal and community resources that promote successful transition for nurse practitioners (NP) who practice in the emergency department (ED) and the skills or procedures they find difficult to perform independently.

Methods:

A descriptive, correlational, comparative study design was conducted using an online survey administered to a convenience sample of NPs with 6 months to 5 years of experience as an NP.

Results:

Findings from this study identified factors associated with successful and unsuccessful transition into practice and help support positive outcomes for health care institutions, ED patients, and NPs practicing in this specialty area.

Implications for practice:

Support in transition recognizes recommendations set by health care organizations in promoting professional development, safe clinical practice, job satisfaction, and retention. Further study will provide clarity in financial gains and improved patient health outcomes during a time in which complex disease processes and provider shortages continue to weigh heavily on society.
Preparing nurse practitioners to combat the opioid epidemic: A survey of nurse practitioner academic programs in the United States
Authors: Kameg Brayden N. , Fradkin Dina , Mitchell Ann M.
Published: September 2020

Between 1999 and 2017, nearly 400,000 individuals died from opioid-related overdoses in the United States. Nurse practitioners (NPs) can be instrumental in providing care for those with opioid use disorders (OUDs) but must be adequately prepared to do so. Currently, there is limited evidence regarding how NP programs are preparing their graduates to address opioid use. The purpose of this study was to evaluate how NP programs have addressed the opioid epidemic within their curricula, and to evaluate barriers to and facilitators of curricular modifications. Electronic surveys were distributed to all 444 NP program directors in the United States. The survey consisted of 10 questions and inquired about curricular modifications made in regard to OUDs, barriers and facilitators of such modifications, and perceived importance of addressing the opioid epidemic within NP programs. A total of 130 (29.3%) of program directors responded to the survey. Of the program directors who responded, 89 (76.1%) reported that curricular modifications were made to address OUDs. Barriers to curricular modification included limited time, lack of faculty expertise or confidence, and stigma in regard to opioid use. Facilitators included faculty champions, availability of external educational resources, student interest, and financial incentives. Nurse practitioners can treat patients with OUDs, mitigating significant barriers to care reported in light of the opioid epidemic. Graduate NP programs should assure that curricula adequately cover opioid use and related management.
Mastoid Obliteration Using Autologous Bone Dust Following Canal Wall Down Mastoidectomy
Authors: Sioshansi Pedrom C. , Alyono Jennifer C. , Blevins Nikolas H.
Published: September 2020

Objective:

To describe a technique for mastoid obliteration following canal wall down (CWD) mastoidectomy for chronic otitis media with cholesteatoma, and review its early results in producing a dry, safe ear, and a small mastoid cavity.

Study Design:

Retrospective review.

Setting:

Tertiary referral center.

Patients:

Forty-three consecutive CWD procedures using bone dust obliteration for chronic otitis media.

Intervention:

All patients underwent CWD mastoidectomy and, if indicated, concurrent tympanoplasty and ossicular chain reconstruction. Bone dust harvested from healthy mastoid cortex was used to obliterate selected portions of the tympanomastoid defect. Temporalis fascia and/or an inferiorly-based periosteal flap were used for coverage of the bone dust.

Main Outcome Measures:

Postoperative infection, need for mastoid bowl cleaning, incidence of recurrent cholesteatoma, need for revision surgical intervention.

Results:

At mean follow-up of 29 months, 95% of ears have remained dry and safe since mastoid obliteration, with a lack of symptoms and no evidence of recurrent disease. Cholesteatoma recurrence rate was 5%. Postoperative otorrhea, while rare, was managed successfully with topical medication in all affected patients. Clinical, radiographic, and surgical appearance of grafted bone dust suggests good take with long-term viability.

Conclusions:

The described technique used for mastoid obliteration using autologous bone dust and cartilage is simple, effective, and safe to reduce the size of the mastoid cavity in patients undergoing CWD mastoidectomy. It might help to reduce morbidity by improving the surgeon's control over mastoid bowl size and shape.
Perioperative safety of simultaneous off-pump coronary artery bypass grafting with non-cardiac surgery of moderate-to-severe severity
Authors: Dong Shiyong , Wang Jin , Xiao Feng
Published: September 2020

Background

To evaluate the perioperative safety of simultaneous off-pump coronary artery bypass grafting (OPCABG) with non-cardiac surgery.

Methods

From September 2013 to January 2019, patients who underwent OPCABG surgery in the Department of Cardiology, Peking University First Hospital were included in this retrospective study. A total of 54 patients who underwent simultaneous surgery were defined as simultaneous surgery group. A total of 108 patients who had recently undergone isolated OPCABG surgery, and had similar vascular reconstruction methods were selected for matching, and these patients were defined as the OPCABG group. The general data and laboratory indicators were detected and were used as baseline data, and the EuroSCORE II scoring system was used to evaluate the surgical risk of patients based on these data. During surgery, intraoperative indicators were assessed and evaluated during surgery. In addition, evaluation of postoperative indicators was performed, including mechanical ventilation time, residence time in ICU, and proportion of perioperative myocardial infarction, perioperative stroke, postoperative renal failure, and surgical wound infection.

Results

All the combined non-cardiac surgeries were assessed to be of moderate-to-severe grade by operative severity scoring system. The analysis of intraoperative indicators showed that there were no significant differences in proportion of emergency or urgent surgery, cases of arterial and venous anastomosis, and proportion of intraoperative blood transfusion between two groups (P > 0.05). Meanwhile, the values of operation time and intraoperative blood loss of patients in simultaneous surgery group were significantly higher than that in OPCABG group (P < 0.05). No perioperative death events occurred in this study. In terms of postoperative indicators, the values of operation duration and intraoperative blood loss of patients in simultaneous surgery group were significantly higher than that in OPCABG group (P < 0.05).

Conclusions

Simultaneous OPCABG surgery with non-cardiac surgeries of moderate-to-severe severity may not be associated with increased postoperative risks when compared with isolated OPCABG.
Albumin administration in patients with decompensated liver cirrhosis: a meta-analytic update
Authors: Ashour Anas A. , Atta Mohamed A. , Sadek Khaled W. , Obaid Koutaibah R. , Ashour Mohammed Awad , Ashour Amr , Danjuma Mohammed I. , Doi Suhail A. , ElZouki Abdel-Naser
Published: September 2020

End-stage liver disease and its related complications exert a huge disease burden and reduce the survival rates of many patients. Albumin administration for patients with decompensated liver cirrhosis has been a controversial topic of discussion. The aim of this study is to investigate whether albumin reduces the mortality and complications of liver cirrhosis compared to standard medical therapy (SMT) alone. Clinical trials in which albumin administration was compared to SMT in patients with liver cirrhosis were included in this meta-analysis. The primary outcome of this study was to evaluate the effect on reducing all-cause mortality. Ascites control, renal failure and hepatic encephalopathy were evaluated as secondary outcomes. Nine clinical trials with 1231 patients were recruited and analyzed using the quality effect model. Mortality rate was significantly reduced in the albumin group [relative risk (RR) 0.73, 95% confidence interval (CI) 0.56–0.96]. Heterogeneity was mild across all studies (I2 23.3%). Studies reporting long-term albumin (LTA) administration were found to have a significant decrease in mortality (RR 0.57, 95% CI 0.44–0.73). However, studies reporting short-term albumin administration were found to have no effect on mortality (RR 0.90, 95% CI 0.56–1.45). Furthermore, there was a significant decrease in the incidence of all secondary outcomes. This meta-analysis provides evidence that LTA administration is significantly effective in reducing the mortality of liver cirrhosis compared to SMT. Albumin administration was also shown to reduce the occurrence of ascites, renal failure and hepatic encephalopathy as complications of liver cirrhosis.
Characterization of mucosal cytokine profile in ulcerative colitis patients under conventional and anti-TNF-a treatment
Authors: Lopetuso Loris Riccardo , Corbi Maddalena , Scaldaferri Franco , Petito Valentina , Graziani Cristina , Castri Federica , Neri Matteo , Gasbarrini Antonio , Sgambato Alessandro , Papa Alfredo
Published: September 2020

Objectives

Cytokines play a pivotal role in inflammatory bowel disease (IBD). We investigated the expression of inflammatory and regulatory cytokines in inflamed and uninflamed mucosal samples of ulcerative colitis patients.

Methods

Twenty-five ulcerative colitis patients were enrolled. Bioptic samples from inflamed and not inflamed intestinal areas were obtained. Multiplex analysis for inflammatory and regulatory cytokines was performed. Serum C-reactive protein (CRP) was assessed. Endoscopic Mayo score and histological simplified Geboes score were calculated.

Results

Interleukin (IL)-1Ra, IL-6, IL-8, IL-17, induced Protein (IP)-10, monocyte chemoattractant protein (MCP)-1, macrophage inflammatory protein (MIP)-1a, MIP-1b resulted increased in ulcerative colitis inflamed vs ulcerative colitis not inflamed areas. No differences were registered between conventional and anti-tumor necrosis factor-a regimens. No difference with CRP levels was found. IL-7 resulted reduced in patients with endoscopic Mayo score ≥2. All the not inflamed samples had a Geboes score <2A, while all the inflamed specimens had a Geboes score ≥2B. IL-1Ra resulted increased in the group with a Geboes score ≥4.

Conclusions

Inflamed and adjacent not inflamed mucosal areas in ulcerative colitis patients share detailed inflammatory molecular pathways, but can be differentiated endoscopically and histologically on the basis of specific cytokines levels. This underlines the complexity of the mucosal cytokine network in ulcerative colitis and highlights the major limitations of a single proinflammatory target therapeutic strategy in IBD.
The impact of acute kidney injury on mortality and clinical outcomes in patients with alcoholic cirrhosis in the USA
Authors: Makar Michael , Reja Debashis , Chouthai Abhishek , Kabaria Savan , Patel Anish Vinit
Published: September 2020

Introduction

Acute kidney injury (AKI) is associated with increased morbidity and mortality in patients with chronic liver disease. Although the impact of AKI on patients with liver disease has been established, its impact on alcoholic cirrhosis has not been studied.

Methods

Our study utilized data from the National Inpatient Sample for the year 2016 for all patients with a diagnosis of alcoholic cirrhosis and AKI. Primary outcomes were mortality, length of stay (LOS) and hospitalization cost were compared. Secondary outcomes were complications of cirrhosis and its impact on mortality. Multivariate logistic regression analysis and propensity-score matching were used to compare the two groups.

Results

A total of 29 906 patients were included and 6733 (22.5%) had AKI. Propensity-matched multivariate analysis demonstrates that AKI was associated with a significant increase risk of mortality [odds ratio (OR): 8.09; 95% confidence interval (CI), 6.68–9.79; P < 0.0001]. AKI prolonged the hospital stay by 3.68 days (95% CI, 3.42–3.93; P < 0.0001) and increased total hospital charges by $50 284 (95% CI, 45 829–54 739; P < 0.0001). AKI increased the risk of complications of cirrhosis, including hepatorenal syndrome (OR: 19.15; 95% CI, 16.1–22.76), ascites (OR: 2.27; 95% CI, 2.11–2.44), hepatic encephalopathy (OR: 2.54; 95% CI, 1.87–3.47) and portal hypertension (OR: 1.08; 95% CI, 1.01–1.16).

Conclusion

AKI in alcoholic cirrhosis significantly increases the risk of mortality, hospitalizations costs and LOS. Further studies are needed on addressing renal failure and treatment options for patients with alcoholic cirrhosis.
An Exploratory Study of the Influence of Perceived Organizational Support, Coworker Social Support, the Nursing Practice Environment, and Nurse Demographics on Burnout in Palliative Care Nurses
Authors: Lowe Marcia A. , Prapanjaroensin Aoyjai , Bakitas Marie A. , Hites Lisle , Loan Lori A. , Raju Dheeraj , Patrician Patricia A.
Published: September 2020

Burnout, a condition characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment, has been studied in many disciplines in health care, including nursing, medicine, and social work. The purpose of this study was to examine the relationship between perceived organizational support, coworker social support, the nursing practice environment, and nurse demographics (age, years of nursing experience, education level, marital status, and sex) on burnout in a national sample of palliative care nurses. The study aims were (1) to examine the relationship between perceived organizational support, coworker social support, and nursing practice environment on burnout in palliative care nurses; (2) to examine the relationship between age, years of nursing experience, education level, marital status, and sex on burnout in palliative care nurses; and (3) to examine potential moderators (perceived organizational support and coworker social support) on the relationship between demographic characteristics and palliative care nurse burnout. A convenience sample of 73 Hospice and Palliative Nurses Association registered nurses who were bedside caregivers was recruited from Hospice and Palliative Nurses Association's membership. Data were analyzed using Pearson correlation and regression modeling. Findings indicated palliative care nurses had moderate to high levels of burnout. There was a negative correlation between burnout and perceived organizational support, and between burnout and coworker social support. The nursing practice environment of palliative care nurses was favorable; perceived organizational support and coworker social support were not moderators for demographics of age and years of experience and their relationship to burnout.
Increased Burden of Concordant and Sequential Anogenital Human Papillomavirus Infections Among Asian Young Adult Women With Perinatally Acquired HIV Compared With HIV-Negative Peers
Authors: Sohn Annette H. , Chalermchockcharoenkit Amphan , Teeraananchai Sirinya , Hansudewechakul Rawiwan , Gatechompol Sivaporn , Chokephaibulkit Kulkanya , Dang Hanh Le Dung , Tran Dan Ngoc Hanh , Achalapong Jullapong , Teeratakulpisarn Nipat , Thamkhantho Manopchai , Phanuphak Nittaya , Ananworanich Jintanat , Reiss Peter , Kerr Stephen J.
Published: September 2020

Background

Youth with perinatally acquired HIV (YPHIV) are at higher risk for anogenital human papillomavirus (HPV) infection.

Methods

We enrolled a cohort of YPHIV and HIV-negative youth in Thailand and Vietnam, matched by age and lifetime sex partners, and followed them up for 144 weeks (to 2017). Participants had annual pelvic examinations with samples taken for HPV genotyping. Concordant infection was simultaneous HPV detection in multiple anogenital compartments (cervical, vaginal, anal); sequential infection was when the same type was found in successive compartments (cervicovaginal to/from anal). Generalized estimating equations were used to assess factors associated with concordant infection, and Cox regression was used to assess factors associated with sequential infection.

Results

A total of 93 YPHIV and 99 HIV-negative women were enrolled, with a median age of 19 years (interquartile range, 18–20 years). High-risk anogenital HPV infection was ever detected in 76 (82%) YPHIV and 66 (67%) HIV-negative youth during follow-up. Concordant anogenital high-risk HPV infection was found in 62 (66%) YPHIV versus 44 (34%) HIV-negative youth. Sequential cervicovaginal to anal high-risk HPV infection occurred in 20 YPHIV versus 5 HIV-negative youth, with an incidence rate of 9.76 (6.30–15.13) versus 2.24 (0.93–5.38) per 100 person-years. Anal to cervicovaginal infection occurred in 4 YPHIV versus 0 HIV-negative women, with an incidence rate of 1.78 (0.67–4.75) per 100 person-years. Perinatally acquired HIV was the one factor independently associated with both concordant and sequential high-risk HPV infection.

Conclusions

Children and adolescents with perinatally acquired HIV should be prioritized for HPV vaccination, and cervical cancer screening should be part of routine HIV care for sexually active YPHIV.
Brief Enhanced Partner Notification and Risk Reduction Counseling to Prevent Sexually Transmitted Infections, Cape Town, South Africa
Authors: Kalichman Seth , Banas Ellen , Kalichman Moira , Dewing Sarah , Jennings Karen , Daniels Johann , Berteler Marcel , Mathews Catherine
Published: September 2020

Background

Evidence-based interventions are needed to stem sexually transmitted infections (STIs). Clinic-delivered counseling remains an important avenue for effective STI prevention.

Methods

A 3-arm randomized clinical trial compared (a) STI health education control condition, (b) risk reduction counseling, and (c) enhanced partner notification counseling. Men and women (n = 1050) were recruited from an STI clinic in Cape Town, South Africa. After baseline assessments, participants were randomly allocated to receive 1 of the 3 single-session counseling interventions and were followed up for 9 months of behavioral assessments and 12 months of electronic medical records abstraction for STI clinic services.

Results

Sexual risk reduction counseling reported greater condom use than did the other 2 conditions during the 3 and 6 months follow-ups. In addition, women receiving risk reduction counseling were significantly less likely to have returned for STI clinic services but did not differ in the number of STI clinic visits over the year.

Conclusions

Brief single-session STI prevention counseling demonstrates significant targeted outcomes. The findings suggest that counseling approaches to both increase condom use and enhance partner notification may offer more robust and sustained outcomes and should be tested in future research.
Barriers, Facilitators, and Cost of Integrating HIV-Related Activities Into Sexually Transmitted Disease Partner Services in Jackson, Mississippi
Authors: Digre Peder , Avoundjian Tigran , Johnson Kendra , Peyton David , Lewis Christie , Barnabas Ruanne V. , Golden Matthew R. , Khosropour Christine M.
Published: September 2020

Background

Many US health departments now integrate HIV-related outcomes (e.g., relinkage to HIV care and preexposure prophylaxis [PrEP]) into sexually transmitted disease (STD) partner services (PS) programs. We sought to determine the barriers, facilitators, and cost of integrating these activities into PS.

Methods

From 2016 to 2018, the Mississippi State Department of Health integrated 3 new activities into STD PS: HIV testing for partners of HIV-negative men who have sex with men with gonorrhea/chlamydia, relinkage to HIV care for STD PS recipients previously diagnosed with HIV, and PrEP referrals. We conducted direct observations and interviews with disease intervention specialists (DIS) in Jackson to assess barriers and facilitators to implementing these activities. We completed time and motion studies with 8 DIS and case tracking forms for 90 unique cases to estimate the incremental staff time and associated personnel cost of added services compared with a standard PS case.

Results

Disease intervention specialists were optimistic about integrating HIV-related activities but noted disparate data systems, nonsystematic documentation, and lack of training as barriers. The mean time for a standard STD PS case without HIV-related activities was 195 minutes (cost, $77.69/case). The cost to conduct PS for HIV-negative men who have sex with men with gonorrhea/chlamydia was 36% higher than a standard case. Integrating relinkage to care and PrEP referrals resulted in a 44% and 20% increase in cost, respectively.

Conclusions

Integrating HIV care relinkage and PrEP referrals into STD partner services was generally acceptable by DIS and added marginal cost per case. Coupling these cost metrics with an assessment of the effectiveness of these activities can inform prioritization of partner services activities.
Extranodal Follicular Dendritic Cell Sarcoma—A Review: “What the Mind Does Not Know the Eye Does Not See”
Authors: Kaur Ramandeep , Mehta Jay , Borges Anita
Published: September 2020

Follicular dendritic cell sarcoma (FDCS) is an intermediate-grade malignancy of follicular dendritic cells, which are derived from mesenchymal stem cells. Nodal FDCS is well-recognized. However, when it occurs at an extranodal site, it may not be recognized and is often misdiagnosed. These tumors exhibit a variable spindle to epithelioid cell morphology with a lymphocytic infiltrate and a distinct immunophenotype. The World Health Organization has classified this entity under tumors of hematopoietic and lymphoid tissue, that is, histiocytic and dendritic cell neoplasms. However, its occurrence at extranodal sites and its behavior and management more closely resemble that of a soft tissue tumor. Increased awareness about the existence of FDCS at extranodal sites may aid in the reduction of diagnostic errors. We wish to draw attention to this entity by reporting our experience of 54 cases of extranodal FDCS encountered over a period of 14 years and present a review of the literature of this underrecognized entity. We also describe the ontogeny and molecular pathogenesis of this uncommon lesion.
Recurrent YAP1 and MAML2 Gene Rearrangements in Retiform and Composite Hemangioendothelioma
Authors: Antonescu Cristina R. , Dickson Brendan C. , Sung Yun-Shao , Zhang Lei , Suurmeijer Albert J.H. , Stenzinger Albrecht , Mechtersheimer Gunhild , Fletcher Christopher D.M.
Published: September 2020

Retiform and composite hemangioendotheliomas (CHEs) are both locally aggressive, rarely metastasizing vascular neoplasms characterized by arborizing vascular channels lined by endothelial cells with a hobnail morphology. CHE displays additional cytologic and architectural components, including often vacuolated epithelioid cells, solid areas, or features reminiscent of well-differentiated angiosarcoma. Triggered by an index case of a soft tissue retiform hemangioendothelioma (RHE) which revealed aYAP1-MAML2gene fusion by targeted RNA sequencing, we sought to investigate additional cases in this morphologic spectrum for this genetic abnormality. A total of 24 cases, 13 RHE and 11 CHE involving skin and soft tissue were tested by fluorescence in situ hybridization using custom BAC probes for rearrangements involving these genes. An additional visceral CHE with neuroendocrine differentiation was tested by targeted RNA sequencing. Among the soft tissue cohort, 5/13 (38%) RHE and 3/11 (27%) CHE showedYAP1gene rearrangements, with 5 cases showing aYAP1-MAML2fusion, including all 3 CHE. The single neuroendocrine CHE showed the presence of aPTBP1-MAML2fusion. AllYAP1-positive CHE lesions occurred in female children at acral sites, compared with fusion-negative cases which occurred in adults, with a wide anatomic distribution.YAP1-positive RHE occurred preferentially in males and lower limb, compared with negative cases. These results suggest that RHE and CHE represent a morphologic continuum, sharing abnormalities inYAP1andMAML2genes. In contrast, the neuroendocrine CHE occurring in a 37-year-old male harbored a distinctPTBP1-MAML2fusion and showed aggressive clinical behavior (pancreatic mass with multiple liver and lung metastases). These preliminary findings raise the possibility that neuroendocrine CHE may be genetically distinct from the conventional RHE/CHE spectrum. Further studies are needed to investigate the pathogenetic relationship of fusion-negative cases with this subset and, less likely, with other members of the HE family of tumors.