bluuebunny/crossref_metadata_2025 huggingface dataset:
The feasibility and safety of left bundle branch pacing vs. right ventricular pacing after mid-long-term follow-up: a single-centre experience
Authors: Chen Xueying , Jin Qinchun , Bai Jin , Wang Wei , Qin Shengmei , Wang Jingfeng , Liang Yixiu , Su Yangang , Ge Junbo
Published: November 2020

Aims

The aim of this study is to prospectively assess the feasibility and safety of left bundle branch pacing (LBBP) when compared with right ventricular pacing (RVP) during mid-long-term follow-up in a large cohort.

Methods and results

Patients (n = 554) indicated for pacemaker implantation were prospectively and consecutively enrolled and were non-randomized divided into LBBP group and RVP group. The levels of cTnT and N-terminal pro-B type natriuretic peptide were measured and compared within 2 days post-procedure between two groups. Implant characteristics, procedure-related complications, and clinical outcomes were also compared. Pacing thresholds, sensing, and impedance were assessed during procedure and follow-up. Left bundle branch pacing was feasible with a success rate of 94.8% with high incidence of LBB potential (89.9%), selective LBBP (57.8%), and left deviation of paced QRS axis (79.7%) with mean Sti-LVAT of 65.07 ± 8.58 ms. Paced QRS duration was significantly narrower in LBBP when compared with RVP (132.02 ± 7.93 vs. 177.68 ± 15.58 ms, P < 0.0001) and the pacing parameters remained stable in two groups during 18 months follow-up. cTnT elevation was more significant in LBBP when compared with RVP within 2 days post-procedure (baseline: 0.03 ± 0.03 vs. 0.02 ± 0.03 ng/mL, P = 0.002; 1 day post-procedure: 0.13 ± 0.09 vs. 0.04 ± 0.03 ng/mL, P < 0.001; 2 days post-procedure: 0.10 ± 0.08 vs. 0.03 ± 0.08 ng/mL, P < 0.001). The complications and cardiac outcomes were not significantly different between two groups.

Conclusion

Left bundle branch pacing was feasible in bradycardia patients associated with stable pacing parameters during 18 months follow-up. Paced QRS duration was significantly narrower than that of RVP. Though cTnT elevation was more significant in LBBP within 2 days post-procedure, the complications, and cardiac outcomes were not significantly different between two groups.
Beyond Chronological Age: Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With Coronavirus Disease 2019
Authors: Marengoni Alessandra , Zucchelli Alberto , Vetrano Davide Liborio , Armellini Andrea , Botteri Emanuele , Nicosia Franco , Romanelli Giuseppe , Beindorf Eva Andrea , Giansiracusa Paola , Garrafa Emirena , Ferrucci Luigi , Fratiglioni Laura , Bernabei Roberto , Onder Graziano
Published: November 2020

Background

We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.

Method

A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated.

Results

Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05–1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04–1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years.

Conclusions

Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.
You Say Tomato, I Say Radish: Can Brief Cognitive Assessments in the U.S. Health Retirement Study Be Harmonized With Its International Partner Studies?
Authors: Kobayashi Lindsay C , Gross Alden L , Gibbons Laura E , Tommet Doug , Sanders R Elizabeth , Choi Seo-Eun , Mukherjee Shubhabrata , Glymour Maria , Manly Jennifer J , Berkman Lisa F , Crane Paul K , Mungas Dan M , Jones Richard N
Published: November 2020

Objectives

To characterize the extent to which brief cognitive assessments administered in the population-representative U.S. Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct.

Methods

Cognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N = 155,690), including the U.S. HRS and selected International Partner Studies. We used the time point of the first cognitive assessment for each study to minimize differential practice effects across studies and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single-factor general cognitive function models and bifactor models representing memory-specific and nonmemory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies.

Results

Despite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single-factor general cognitive function models. The data fit the models at reasonable thresholds for single-factor models in 6 of the 12 studies and for the bifactor models in all 12 of the 12 studies.

Discussion

The cognitive assessments in the U.S. HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data.
Political Alignment and Bureaucratic Pay
Authors: Fiva Jon H , Geys Benny , Heggedal Tom-Reiel , Sørensen Rune
Published: November 2020

Building on agency-theoretical perspectives of public bureaucracies, we argue that politician–bureaucrat preference alignment can have important implications for bureaucrats’ pay. We study such private gains to bureaucrats from their political alignment with elected politicians using detailed data on all 1,632 top administrators active in all Norwegian municipalities over a period of 25 years (1991–2015). Whereas existing studies generally rely on proxies for politician–bureaucrat political alignment, a rare feature of our data allows measuring it directly since 27% of top bureaucrats ran for political office. We focus explicitly on individuals at the very top of the administrative hierarchy and are able to separate the intensive margin (i.e., wage increases) from any additional effects at the extensive margin (i.e., new appointments). Using close elections for inference in a regression discontinuity analysis, we find that politician–bureaucrat alignment significantly increases top bureaucrats’ wage even in the Norwegian civil service system. This has important implications also from a theoretical perspective. Our results indeed go against predictions from models with policy-motivated bureaucrats, but are consistent with politically aligned principal–agent matches being more productive.
Brunner’s Gland Hamartomas: Two Cases of This (Sometimes) Distinctive Lesion
Authors: Bush Allison , Francis Jonathan , Laczek Jeffrey
Published: November 2020

Brunner’s gland hamartomas (BGHs) are rare, benign, primary duodenal tumors. The clinical presentations can vary, and confirming a diagnosis can be challenging because of the submucosal nature of the lesions. We report two cases of BGHs with different clinical presentations. The diagnoses were not determined initially, despite utilizing endoscopy, mucosal biopsies, endoscopic ultrasound, and, in one case, fine-needle aspiration. Confirmation of BGHs was subsequently made following endoscopic or surgical resection.
Cogenetic Dykes the Key to Identifying Diverse Magma Batches in the Assembly of Granitic Plutons
Authors: Guo Chun-Li , Wilde Simon A , Henderson Robert A , Li Qiu-Li , Yin Bing
Published: November 2020

This study demonstrates that dykes that are coeval and cogenetic with plutons can provide an important tool for recognizing discrete batches of magma with similar overall chemical compositions and physical attributes, but different isotopic characteristics, and which contributed to pluton formation. The Qianlishan granitic pluton, located in the Qin–Hang fault zone separating the Yangtze block from the Cathaysia block in South China, was emplaced at 155–152 Ma in the Late Jurassic. It consists of a central zone of strongly differentiated zinnwaldite-bearing equigranular granite surrounded by a less differentiated porphyritic granite. The pluton is spatially associated with an extensive granitic dyke swarm dated here at 153–152 Ma, demonstrating a coeval relationship. Amongst the dykes, two discrete end-member sources can be identified from the bimodal nature of their zircon hafnium and oxygen systematics, with one group showing a range in εHf(t) of -11·9 to -8·0 and in δ18O of 9·0–10·4‰, whereas in the other group the ranges are from -7·3 to -4·1 and 8·4–9·4‰, respectively. This contrasts with the two phases of the Qianlishan pluton, which record wide ranges in εHf(t) of -11·1 to -5·1 and in δ18O of 8·3–10.4‰, but without bimodality. Hence, the overlapping Hf–O isotopic profiling shows the dykes and pluton to be cogenetic. Small-volume magma batches, with their rapid transport through the crust and quick cooling, are all typical features of dyke generation, thus preserving the original heterogeneous Hf–O isotopic signatures that are characteristic of two distinct crustal sources. However, although the pluton was formed from similar sources to the dykes, the bimodal source identity was lost during its assembly through mixing of the magma batches. These findings also provide a potential explanation for the wide range of zircon hafnium isotopic systematics typical of granitic plutons, as shown by sampling at all scales.
The oral and gut microbiome in rheumatoid arthritis patients: a systematic review
Authors: Chu Xiu-Jie , Cao Nv-Wei , Zhou Hao-Yue , Meng Xiang , Guo Biao , Zhang Hai-Yan , Li Bao-Zhu
Published: November 2020

Background

Recently, researchers have proposed a possible relationship between RA and the microbiome of the oral cavity and gut. However, this relation has not been systematically established. Herein, we conducted a comprehensive review of the pertinent literature to describe this possible association.

Methods

We systematically performed searches in databases, namely EMBASE, the Cochrane Library, and PubMed, from inception to 7 June 2020 to identify case–control studies that compared the oral and gut microbiome in adult RA patients with those of controls. The primary outcome was specific bacterial changes between RA and controls. The secondary outcome was microbial diversity changes between RA and controls.

Results

In total, 26 articles were considered eligible for inclusion and reported some differences. Therein, ≥3 articles reported decreased Faecalibacterium in the gut of early-RA (ERA)/RA patients compared with healthy controls (HCs). Also, ≥3 articles reported decreased Streptococcus and Haemophilus and increased Prevotella in the oral cavity of ERA/RA patients compared with HCs. In addition, some Prevotella species, including P. histicola and P. oulorum, showed increased trends in RA patients’ oral cavity, compared with HCs. The α-diversity of the microbiome was either increased or not changed in the oral cavity of RA patients, but it was more commonly either decreased or not changed in the gut of RA patients.

Conclusions

In this systematic review, we identified the microbiome associated with RA patients in comparison with controls. More research is needed in the future to find the deep relationship between RA and the microbiome.
Coping with Psoriasis or Hidradenitis Suppurativa: A Qualitative Study
Authors: Fisher Shani , Ellen Moriah , Cohen Arnon D. , Kagan Ilya
Published: November 2020

OBJECTIVE

Psoriasis and hidradenitis suppurativa (HS) are both chronic inflammatory skin diseases with significant comorbidity. This study aimed to examine how patients with psoriasis or HS cope with their conditions on a personal and psychosocial level, especially in times of clinical exacerbation and symptom deterioration.

DESIGN

This qualitative initial study used the phenomenology model to examine patients’ lived experiences through the lens of their disease. Via semistructured interviews and content analysis, researchers aimed to describe the subjective reality of people with HS or psoriasis and identify any common issues.

PATIENTS AND INTERVENTION

Six open pilot interviews with three patients with HS and three patients with psoriasis uncovered five cardinal domains affecting patients’ lives. After completing all the interviews, transcripts were analyzed and classified numerically by frequency of identified terms and keywords. After classifications and data ranking, the main issues were identified and separated into the five domains.

MAIN RESULTS

Researchers interviewed 20 patients (10 with psoriasis and 10 with HS). The five domains were distressing symptoms, struggling to cope with the disease, avoiding acute or recurrent eruptions, dealing with eruption, and information sources regarding the disease. Pain and pruritus were the most disturbing symptoms, and the remaining issues concerned the emotional, functional, and financial burden of these chronic conditions.

CONCLUSIONS

Even though the symptoms of HS and psoriasis are different, this study reveals common denominators regarding the emotional side of living with chronic skin disease.
Understanding the most commonly billed diagnoses in primary care
Authors: Rogers Julia
Published: November 2020

This next article in the Most Commonly Billed Diagnoses series focuses on hypothyroidism and the significant role NPs play in identifying and managing patients with this condition and its associated comorbidities. Pathophysiology, systemic manifestations, screening, and treatment are discussed.
New NP job search experience
Authors: Horvath Emily , Higgins Karen
Published: November 2020

This descriptive study investigated new NPs' job search experience including the job search process, employment negotiation, and compensation. The majority of new graduates found a job through networking within 3 months in a specialty practice or family medicine. Lack of experience and few available positions were employment obstacles.
Nursing2020 survey report
Authors: Jones Michael
Published: November 2020

The ability to address sensitive health-related concerns tactfully is a crucial skill for nurses. This article provides an overview of participant responses to the Nursing2020 Empowering Language in Healthcare survey and breaks down the results.
Cost-Effectiveness of Leveraging Social Determinants of Health to Improve Breast, Cervical, and Colorectal Cancer Screening: A Systematic Review
Authors: Mohan Giridhar , Chattopadhyay Sajal
Published: November 2020

(Abstracted from JAMA Oncol 2020;6:1434–1444)

Persistent health disparities regarding screening for breast, cervical, and colorectal cancers exist in the United States. Health People 2020, the US Federal Government's health promotion and prevention agenda, describes 5 domains for social determinants: economic stability, education, social and community context, health and health care, and neighborhood and built environment.
Predictors of Severe Pain During Insertion of the Levonorgestrel 52 mg Intrauterine System Among Nulligravid Women
Authors: Ferreira Letícia Sanchez , de Nadai Mariane Nunes , Poli-Neto Omero B. , Franceschini Silvio A. , Juliato Cássia R. T. , Monteiro Ilza Maria U. , Bahamondes Luis , Vieira Carolina Sales
Published: November 2020

(Abstracted from Contraception 2020;102:267–269)

A barrier to uptake of intrauterine devices (IUDs) is fear of pain at the time of insertion. Although nulliparity is a common factor associated with pain at IUD insertion, it is often underestimated by health care professionals.
The Role of Sonographic Phenotyping in Delivering an Efficient Noninvasive Prenatal Diagnosis Service for FGFR3-Related Skeletal Dysplasias
Authors: Mellis Rhiannon , Chandler Natalie , Jenkins Lucy , Chitty Lyn S.
Published: November 2020

(Abstracted from Prenat Diagn 2020;40:785–791)

Skeletal dysplasia can be difficult to diagnose on prenatal sonogram because of phenotypic overlap between conditions. Two of the more common skeletal dysplasias, achondroplasia and thanatophoric dysplasia (TD), occur because of mutations in the FGFR3 gene.
Maternal and Perinatal Outcomes in Programmed Versus Natural Vitrified-Warmed Blastocyst Transfer Cycles
Authors: Makhijani Reeva , Bartels Chantal , Godiwala Prachi , Bartolucci Alison , Nulsen John , Grow Daniel , Benadiva Claudio , Engmann Lawrence
Published: November 2020

(Abstracted from RBMO 2020;41(2):300–308)

Hypertensive disorders of pregnancy (HDPs), ranging from gestational hypertension to eclampsia, have been shown to have a higher incidence in women using assisted reproductive technologies (ARTs). Women undergoing ART are more likely to be of advanced maternal age, have multigestation, and have other characteristics that may partly explain this association.
Surgical Technique Used in the UK for Native Tissue Anterior Pelvic Organ Prolapse Repair (VaST)
Authors: Fairclough Emily , Segar Julia , Myers Jenny , Smith Anthony , Reid Fiona
Published: November 2020

(Abstracted from Int Urogynecol J 2020;31:1519–1525)

Despite previous studies suggesting that surgery using polypropylene mesh provides a better anatomical cure of pelvic organ prolapse, the well-known complications of mesh-augmented repair have led to renewed interest in native tissue surgery. PROSPECT (PROlapse Surgery: Pragmatic Evaluation and randomized Controlled Trials) was a large United Kingdom–based surgical randomized controlled trial that compared outcomes of native tissue and mesh-augmented repairs.
SPRINTing to Innovation: Children’s Hospital of Philadelphia’s Strategic Approach to Discovering Its Untapped Innovation Potential
Authors: Hunter Ryan Brandon , Winston Flaura K. , Dehel Paul , Oh Kelsey , Nicklas Joshua , Hartung Helge
Published: November 2020

Problem

There is a clear and urgent need for health care innovation in the United States. Hospital employees routinely recognize pain points that affect care delivery and are in a unique position to propose innovative and practical solutions, yet leaders rarely solicit ideas for investment and development from frontline providers and staff, revealing an untapped resource with innovation potential.

Approach

To address these deficiencies, the Children’s Hospital of Philadelphia expanded its innovation infrastructure with the competition-based SPRINT program in 2015. All hospital employees are encouraged to apply with early-stage innovative ideas, and if selected, are provided with business, legal, technical, and scientific project management support to help accelerate their projects toward commercial viability. SPRINT was modeled around 4 core tenets: (1) small, dynamic, and attentive project manager-led teams; (2) low barriers to entry; (3) emphasis on outreach; and (4) fostering innovators.

Outcomes

Over its first 4 cycles from 2015 to 2018, 271 innovative teams applied to the SPRINT program, which led to support for 30 projects (11% acceptance rate). About a quarter of the projects each year were submitted by physician-led teams (mean 23%), a third by nonphysician clinical providers (mean 33%), and almost half were submitted by employees without direct patient contact (mean 44%). Nurses have emerged as the largest applicant group. Eleven of the SPRINT-supported projects (37%) resulted in commercial endpoints.

Next Steps

SPRINT has proven to be an effective model for supporting institution-wide, employee-driven health care innovation, especially among frontline clinical and nonclinical personnel. Critical next steps for the program include a formal cost–benefit analysis and the earlier participation of technology transfer and intellectual property experts to improve the commercialization roadmap for many SPRINT projects.
Auditory Development of Frequency Discrimination at Extended High Frequencies
Authors: Mishra Srikanta K. , Renken Lauren , Hernandez Michelle , Rodrigo Hansapani
Published: November 2020

Objectives:

Hearing in the extended high frequencies (EHFs; >8 kHz) is perceptually and clinically relevant. Recent work suggests the possible role of EHF audibility in natural listening environments (e.g., spatial hearing) and hidden hearing loss. In this article, we examine the development of frequency discrimination (FD) in the EHFs. Specifically, the objectives of the present study were to answer if the developmental timeline for FD is different for EHFs; and whether the discontinuity of FD thresholds across frequency—representing the hypothetical shift from a temporal to place code—for children occurs at about the same frequency as adults.

Design:

Thirty-one normal-hearing children (5 to 12 years) and 15 young adults participated in this study. FD thresholds were measured for standard frequencies (1, 2, 4, 6, and 8 kHz) and EHFs (10 and 12.5 kHz) using a three-alternative (odd-ball) forced-choice paradigm. Statistical analysis focused on examining the change of FD thresholds as a function of age and estimating the breakpoints in the discrimination threshold-frequency functions.

Results:

FD performance in younger children for EHFs was nearly six times poorer relative to older children and adults; however, there was no effect of test frequency on the child-adult difference. Change-point detection on group data revealed a higher knot frequency—representing the putative transition from temporal to place mechanisms—for adults (9.8 kHz) than children (~6 kHz). Individual spline functions suggest that the knot frequency varied from 2 to 10 kHz across participants.

Conclusions:

The present study provides evidence for a similar rate of maturation of FD for EHFs and standard frequencies. FD at EHFs matures by 10 to 12 years of age. Adult listeners may not all use temporal cues up to 10 kHz. Young children are relatively inefficient in using temporal fine-structure cues for FD at frequencies above 6 kHz.
Melanocytic Neoplasms With MAP2K1 in Frame Deletions and Spitz Morphology
Authors: Sunshine Joel C. , Kim Daniel , Zhang Bin , Compres Elsy V. , Khan Ayesha U. , Busam Klaus J. , Gerami Pedram
Published: November 2020

With the advent of better molecular characterization of Spitz melanocytic neoplasms, there has been increasing effort to better understand and describe the relationships between specific driver fusion and/or mutations with the clinical and histomorphological characteristics of the lesions. Structural rearrangements in mitogen activated protein kinase genes have recently been noted to be important in Spitz neoplasms. Only very few reports, however, have described in detail melanocytic tumors with in frame deletions in MAP2K1. Cases in the literature with this aberration have been described as having a diagnosis of Spitz, deep penetrating nevi, or pigmented epithelioid melanocytoma. In this study, we describe a cohort of 6 cases with MAP2K1 activating in frame deletions. The morphologic spectrum of the cases was broad. Common features of these cases include Spitzoid cytomorphology (5/6) cases, prominent melanin pigmentation (4/6) cases, and deep penetrating nevi–like plexiform architecture (3/6) cases. The diagnoses at the time of clinical care of these cases included nevus of Reed (1/6), desmoplastic Spitz tumor (1/6), BAPoma (1/6), deep penetrating melanocytic nevus (2/6), and melanoma (1/6). Clinical follow-up was available in 3 of the 6 cases. None of the patients had a tumor recurrence. This builds on the growing literature to help expand the spectrum of changes associated with Spitzoid melanocytic neoplasms.
Nutritional Support in the Intensive Care Unit
Authors: Boeykens Kurt
Published: November 2020

Several nursing practices are related to oral, enteral, or parenteral feeding on the intensive care unit. Nurses are the group of health care professionals who provide 24-hour care for patients. Therefore, they play a key role in not only identifying nutritional problems but also in ensuring the success of nutritional therapy by implementing evidence-based feeding protocols and ongoing care for (par)enteral access devices. Having an up-to-date evidence-based knowledge about nutritional support can increase safety and quality of care and can contribute to better outcomes. In this narrative review, the most recent European intensive care unit nutrition guidelines and related research are highlighted, and where appropriate, specific applications for nursing practice are described.
The Effect of an Educational Program on Nursing Knowledge and Empowerment in Antimicrobial Stewardship in a Surgical Intensive Care Unit
Authors: Fitzpatrick Eleanor R. , Pogorzelska-Maziarz Monika , Manning MaryLou , Gleason Vanessa M.
Published: November 2020

Background

Hospital antimicrobial stewardship (AS) interventions have been shown to reduce the overuse and misuse of antimicrobials and rates of resistant organisms. To date, nurses have had limited involvement in AS. Improving nursing AS knowledge and sense of empowerment may improve their engagement in AS.

Objective

The purpose of this study was to evaluate the impact of an educational intervention on AS knowledge and sense of empowerment among bedside registered nurses (RNs) in a surgical intensive care unit in an academic medical center.

Methods

This was a quasi-experimental pre-post study.

Results

Forty-four RNs (85%) participated. There was a statistically significant (P < .01) increase in both AS knowledge and empowerment level of staff RNs. Registered nurses identified participation in patient care rounds and use of antibiotic timeouts as strategies for increasing their AS engagement. Perceived barriers included lack of physician/other team member support and knowledge deficits.

Conclusions

The findings of this study indicate that educating nurses on their role in AS improves their knowledge and sense of empowerment for this emerging role. Future studies should examine how nurses apply this knowledge and sense of empowerment to engage in unit-based AS activities and the resultant patient outcomes.
Sleep and Activity Patterns Are Altered During Early Critical Illness in Mechanically Ventilated Adults
Authors: Munro Cindy L. , Liang Zhan , Elías Maya N. , Ji Ming , Chen Xusheng , Calero Karel
Published: November 2020

Background

Mechanically ventilated (MV) patients in the intensive care unit (ICU) often experience disturbed sleep and profound inactivity.

Objectives

The aim of this study was to report 5 consecutive days' descriptive analyses on sleep efficiency (SE), total sleep time (TST), daytime activity ratio (DAR), and hourly activity counts among critically ill MV adults from 9 ICUs across 2 hospitals.

Methods

A secondary analysis was undertaken from our parent National Institutes of Health–funded randomized controlled trial (NIH R01 NR016702). Subjects included 31 critically ill patients from multiple ICUs. Wrist actigraphy estimated SE and TST. Mean DAR, an indicator of altered sleep-wake cycles, was calculated. Continuous 24-hour activity counts over 5 consecutive days were summarized. Descriptive analyses were used.

Results

A total of 31 subjects with complete actigraphy data were included. Mean age was 59.6 (SD, 17.3) years; 41.9% were male; 83.9% were White, and 67.7% were Hispanic/Latino; and the mean APACHE III (Acute Physiology and Chronic Health Evaluation III) severity of illness score was 74.5 (SD, 25.5). The mean nighttime SE and TST over the 5-day ICU period were 83.1% (SD, 16.14%) and 6.6 (SD, 1.3) hours, respectively. The mean DAR over the 5-day ICU period was 66.5% (SD, 19.2%). The DAR surpassed 80% on only 17.5% of subject days. The majority of subjects' activity level was low, falling below 1000 activity counts per hour.

Conclusion

Our study revealed poor rest-activity cycle consolidation among critically ill MV patients during the early ICU period. Future interventional studies should promote quality sleep at nighttime and promote mobilization during the daytime.
How far would you travel to consult a rural Ugandan eye specialist? A cross-sectional study
Authors: Crossley Eleanor J. , Badhrinarayanan Shreya , Roberts Lesley M.
Published: November 2020

Aims:

Blindness and visual impairment are major public health concerns. However there is only 1 ophthalmologist per million individuals in Africa. Hence, individuals must travel long distances to see an eye specialist leading to reduced uptake of eye care services. The aims were to review patients’ demographics and geographical distribution, and conditions diagnosed at a rural eye clinic in Uganda.

Methods:

The ophthalmic clinical officer made handwritten records of attendees at the once-weekly morning clinic over a 14-week period. Data, including demographics, town of residence and diagnoses, were collated and analyzed.

Results:

During the study period, 273 participants attended the clinic (96 males, 177 females). On average, 19.5 patients were seen in the clinic per week. Patient ages’ ranged from 3 days to 89 years old (mean age=32.5 y). The commonest diagnoses were allergic conjunctivitis (9.9%), bacterial conjunctivitis (9.2%), pterygium (8.8%), presbyopia (8.8%), and blunt trauma (5.9%). Patients lived an average distance of 25.1 km from the clinic, with 23.0% living >30 km away.

Conclusion:

The wide geographical distribution of attendees at the Ugandan eye clinic supports earlier research that these clinics are sparsely distributed requiring individuals to travel long distances to seek eye care services.
Early Intervention and Newborn Screening
Authors: Bailey Donald B.
Published: November 2020

Both early intervention (EI) programs for infants and toddlers with disabilities and newborn screening (NBS) programs to identify specific disorders shortly after birth rest on the assumption that the best way to prevent or lessen the impact of a disorder is to provide treatment as early as possible. Despite this shared vision, the two programs differ in substantial ways, including historical beginnings and subsequent evolution; program entry and eligibility; service models; evidence, efficacy, and outcomes; roles and responsibilities vis-à-vis families; and financing. Each program is well established and highly successful. But 4 crosscutting issues need to be addressed: (1) documenting meaningful outcomes for children and families; (2) deciding whether and how to provide highly effective yet very expensive treatments; (3) implementing surveillance activities to monitor progress and determine optimal timing for intervention; and (4) identifying appropriate intersections between EI and NBS. Solving these challenges will require national and state leadership, stakeholder engagement, collaboration between EI and NBS, and a significant investment of resources if the promise of maximizing benefit for children and families is to be realized.
Stigma toward people with mental disorders in adolescents: comparison between Portugal and Moldova
Authors: Esanu Andrei , Morais Vitor , Araújo Joana , Ramos Elisabete
Published: November 2020

Background:

Mental disorders are one of the most significant public health challenges. Stigma toward people with mental disorders decreases help-seeking behaviors, and may be a cause of depression and anxiety. Research on the level of stigma and comparison between different countries in adolescence is scarce. We aim to study stigma toward people with mental disorders in adolescents, and to evaluate differences between Portugal and Moldova.

Methods:

In a cross-sectional analysis, we evaluated 657 high school students from Portugal and 612 from Moldova. Data were collected by a self-reported questionnaire that, beyond stigma, evaluated individual and family characteristics. Stigma was evaluated using the Attribution Questionnaire for Children (AQ-8-C) and the Depression Stigma Scale (DSS). Data were summarized using means and standard deviations, and comparison was performed using Student t test and analysis of variance.

Results:

The mean (standard deviation) level of mental disorder stigma measured by the AQ-8-C was 32.10 (8.77) in Moldova and 24.32 (9.20) in Portugal, P < .001. Adolescents from Moldova presented higher values for all items except for “Fear,” with higher mean value in Portugal and for “Help” with no significant differences between countries. Regarding the Depression Stigma Scale, adolescents from Moldova presented higher values, both for personal stigma [19.84 (4.78) vs 15.09 (5.08), P < .001] and for perceived stigma [26.43 (4.30) vs 22.62 (5.15), P < .001]. Stigma levels did not differ according to having or not someone with a mental disorder in the class or family.

Conclusion:

The level of stigma toward people with mental disorders is higher in Moldova than in Portugal.
Insights into hypersensitivity reactions in dentistry
Authors: Rama Tiago Azenha , Cernadas Josefina
Published: November 2020

Hypersensitivity reactions are an important hazard in healthcare. Modern dentistry depends on the use of drugs and materials widely known to elicit them. Such reactions are either immediate or nonimmediate – the former carries the risk of anaphylaxis, whereas the latter includes potentially fatal severe cutaneous adverse reactions.

Apart from well-established immunoglobulin E–mediated immediate hypersensitivity reactions (IHRs), recent advances have shed light on the pathophysiology of other IHRs, suggesting a role for MRGPRX2-induced mast cell activation.

Hypersensitivity to both drugs and metals may come as a challenge to dentists, often requiring changing to infrequently used compounds. Local anesthetics are cause for concern, but are a rare cause for IHRs. The opposite occurs with antimicrobials, as antibacterials frequently cause hypersensitivity reactions. Nonsteroidal anti-inflammatory drugs are another common cause, especially in patients suffering from asthma and/or chronic spontaneous urticaria. General anesthetics are a common cause for immediate hypersensitivity, whereas most drugs used for conscious sedation are rare elicitors. Chlorhexidine is a remarkable cause for anaphylaxis, nowadays, despite rare reports linked to rinsed formulations.

Preservatives, flavors, and other compounds present in dentifrices cause both irritative and allergic contact dermatitis/mucositis. Metals, notably nickel and cobalt, are a very common cause for hypersensitivity in dentistry. Acrylates may induce contact mucositis, due to lack of proper polymerization of residuals, being an important cause for contact stomatitis and a dentistry occupational hazard. Acute reactions require a prompt treatment, especially in the presence of anaphylaxis, which should be treated using intramuscular epinephrine. Delayed type reactions with fever should be referred to tertiary urgent care facilities. Suspicion of hypersensitivity in dentistry requires a thorough allergological study and referral is mandatory in all cases.
Erosive Vulvar Lichen Planus and Risk of Vulvar Neoplasia
Authors: Lyra Joana , Melo Catarina , Figueiredo Rita , Polonia-Valente Rita , Falcão Vera , Beires Jorge , Vieira-Baptista Pedro
Published: November 2020

Objective

The aim of the study was to assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients.

Materials and Methods

A retrospective cohort study, including all the women with the diagnosis of vulvar LP, followed in one institution during a period of 11 years, was performed. Demographic and clinical data, as well as treatment, follow-up, and histology results, were evaluated.

Results

A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.9 ± 0.5 years (range = 1–11 years). Ultrapotent topical corticosteroids were first-line treatment in 91.8% (n = 112), with 32 cases (25.2%) needing an alternative treatment. Overall, 30 biopsies were performed in 19 women (15%). Vulvar high-grade squamous intraepithelial lesion was diagnosed in 3 women (2.4%), 2 (1.6%) of whom were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed.

Conclusions

Premalignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up seems to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion seems during follow-up.
Movement Synchrony and Facial Synchrony as Diagnostic Features of Depression
Authors: Altmann Uwe , Brümmel Maria , Meier Julija , Strauss Bernhard
Published: November 2020

The pilot study investigated with a matched-subjects design whether nonverbal synchrony is a diagnostic feature for depression and whether it mediates between depression and postsession ratings of the interviewer behavior. The sample includes n = 15 patients with major depression and n = 15 healthy controls (aged 20–30 years, 40% female). We conducted structured diagnostic interviews for somatic complaints to standardize the recording setting, issue, and course of conversation. Body movements and facial expressions were coded automatically frame by frame using computer vision methods. Ratings of the interviewers' professional behavior and positive affect were assessed using questionnaires. Patients with depression showed less movement synchrony and less synchronous positive facial expressions. Only synchronous positive expressions mediated between depression and less perceived positive affect. We conclude that the applied methodology is well suited to examine nonverbal processes under naturalistic but widely standardized conditions and that depression affects the nonverbal communication in medical conversations.
The Impact of Preeclampsia on Women’s Health: Cardiovascular Long-term Implications
Authors: Orabona Rossana , Sciatti Edoardo , Sartori Enrico , Vizzardi Enrico , Prefumo Federico
Published: November 2020

Importance

Women with a history of preeclampsia have a 2- to 5-fold increased risk of cardiovascular diseases, which represent almost half of mortality in the female population worldwide.

Objective

To summarize the current evidence concerning women's future cardiovascular risk after pregnancies complicated by preeclampsia.

Evidence Acquisition

A PubMed and Web of Science search was conducted in English, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Relevant studies on cardiovascular risk after preeclampsia were included.

Results

Evidence suggests that the cardiovascular implications of preeclampsia do not cease with delivery, with a significant proportion of women demonstrating persistent asymptomatic myocardial impairment, aortic stiffening, and microcirculatory dysfunction. More severe and early-onset preeclampsia, as well as preeclampsia with concurrent neonatal morbidity, increases the risk of cardiovascular disease later in life.

Conclusions and Relevance

As former preeclamptics have been shown to be at increased cardiovascular risk, this identifies a subgroup of women who may benefit from early preventive measures.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this educational activity, the obstetrician/gynecologist should be better able to define what is meant by “cardiovascular long-term implications of preeclampsia”; identify women at higher risk of future cardiovascular disease; and evaluate intervention strategies proposed to manage this subgroup of the female population.
Where You Live Matters: A National Cancer Database Study of Medicaid Expansion and Endometrial Cancer Outcomes
Authors: Barrington David A. , Sinnott Jennifer A. , Calo Corinne , Cohn David E. , Cosgrove Casey M. , Felix Ashley S.
Published: November 2020

(Abstracted from Gynecol Oncol 2020;158(2):407–414)

Individuals diagnosed with endometrial cancer (EC) and presenting with early-stage disease have favorable outcomes and a high probability of cure compared with those presenting with advanced disease. Aggressive early interventions including surgery that contribute to good outcomes may be less available for those with various barriers to screening and health care access, including lacking insurance coverage.
Candy Cane Compared With Boot Stirrups in Vaginal Surgery: A Randomized Controlled Trial
Authors: Gupta Ankita , Meriwether Kate , Tuller Molly , Sekula Michael , Gaskins Jeremy , Stewart J. Ryan , Hobson Deslyn , Cardenas-Trowers Olivia , Francis Sean
Published: November 2020

(Abstracted from Obstet Gynecol 2020;136:333–341)

Incorrect patient positioning during surgery can lead to both transient and long-term injuries that affect patient recovery. Concerns about the role of patient positioning in neurologic injuries after gynecologic surgery have been raised in previous studies, especially the role of candy cane stirrups compared with boot stirrups.
What Determines the Quality of Rehabilitation Clinical Practice Guidelines?
Authors: Dijkers Marcel P. , Ward Irene , Annaswamy Thiru , Dedrick Devin , Hoffecker Lilian , Millis Scott R.
Published: November 2020

Objective

The aim of the study was to determine what factors determine the quality of rehabilitation clinical practice guidelines.

Design

Six databases were searched for articles that had applied the Appraisal of Guidelines for Research & Evaluation II quality assessment tool to rehabilitation clinical practice guidelines. The 573 deduplicated abstracts were independently screened by two authors, resulting in 81 articles, the full texts of which were independently screened by two authors for Appraisal of Guidelines for Research & Evaluation II application to rehabilitation clinical practice guidelines, resulting in a final selection of 40 reviews appraising 504 clinical practice guidelines. Data were extracted from these by one author and checked by a second. Data on each clinical practice guideline included the six Appraisal of Guidelines for Research & Evaluation II domain scores, as well as the two Appraisal of Guidelines for Research & Evaluation II global evaluations.

Results

All six Appraisal of Guidelines for Research & Evaluation II domain scores were statistically significant predictors of overall clinical practice guideline quality rating; D3 (rigor of development) was the strongest and D1 (scope and purpose) the weakest (overall model P < 0.001, R
2 = 0.53). Five of the six domain scores were significant predictors of the clinical practice guideline use recommendation, with D3 the strongest predictor and D5 (applicability) the weakest (overall model P < 0.001, pseudo R
2 = 0.53).

Conclusions

Quality of rehabilitation clinical practice guidelines may be improved by addressing key domains such as rigor of development.
Exploratory Analysis of Racial/Ethnic and Educational Differences in a Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention
Authors: Daubenmier Jennifer , Chao Maria T. , Hartogensis Wendy , Liu Rhianon , Moran Patricia J. , Acree Michael C. , Kristeller Jean , Epel Elissa S. , Hecht Frederick M.
Published: November 2020

Objective

People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions.

Methods

We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively.

Results

Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (−0.46 kg/mo; p = .039).

Conclusions

Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs.

Trial Registration: Clinicaltrials.gov registration: NCT00960414