bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-Conscious Colposcopy: A Single-Institution Review of Biopsy Submission Practices and Outcomes
Authors: Cook Ian C. , Fuhr Laura I. , Flores Sarah E. , Novicoff Wendy M. , Cantrell Leigh A.
Published: April 2023

Objective

Distribution of cervical dysplasia may influence approach for excisional procedures. Separating colposcopy biopsies into multiple specimen cups for pathologic evaluation incurs additional costs. The authors aimed to determine whether the practice of separating biopsy specimens impacts patient outcomes.

Methods

A retrospective review of all colposcopy cases from a single institution was performed. A total of 1,331 cases were reviewed from January 1, 2017, to December 31, 2019. Multibiopsy cohorts were separated by number of specimen cups received by pathology (single or multiple). Cohorts were compared for histology, need for excisional procedure, and final excisional pathology results. Specimen processing fees were acquired from the Department of Pathology ($70/specimen). Statistical analysis performed on MINITAB using Pearson chi-square and Fisher exact tests.

Results

Excisional procedures were required by 30.4% (86/283) of multiple specimen submissions compared with 28.2% (154/547) of single specimen cup submissions (p = .50). There was a higher, although not statistically significant, rate of additional procedures in the multiple specimen cup cohort (8.8 vs 2.9% [p = .08]). Malignancy diagnosis was equivalent in each cohort. Cost analysis revealed adopting a single specimen cup model would reduce costs up to approximately $30,000/year.

Conclusions

Patient outcomes were not improved by the practice of submitting multiple specimen cups. Given the additional cost associated with separating specimens, the authors recommend during routine colposcopy that all cervical biopsies be sent for evaluation as a single pathology specimen unless a lesion of concern is identified in an area not normally excised during traditional excisional procedures.
Utility of Extended HPV Genotyping as Primary Cervical Screen in an Unscreened Population With High HIV Co-Infection
Authors: Botha Matthys H. , Van der Merwe Frederick H. , Snyman Leon C. , Dreyer Gerrit J. , Visser Cathy , Dreyer Greta
Published: April 2023

Objective

Screening with primary human papillomavirus (HPV) testing has been evaluated in highly prescreened populations with lower HPV and HIV prevalence than what is the case in South Africa. High prevalence of HPV and underlying precancer in women living with HIV (WLWH) affect the clinical performance of screening tests significantly. This study investigates the utility and performance of an extended genotyping HPV test in detection of precancer in a population with a high coinfection rate with HIV.

Methods

A total of 1,001 women aged 25 to 65 years with no cervical cancer screening in the preceding 5 years were tested with cytology and primary extended genotyping HPV testing. The cohort of 1,001 women included 430 WLWH (43.0%) and 564 HIV-negative (56.3%) women.

Results

Abnormal cytology (atypical squamous cells of undetermined significance or higher) was significantly higher in WLWH (37.2% vs 15.9%) and high-grade squamous intraepithelial lesion or above (23.5% vs 5.2%). The WLWH also tested positive more often for any HPV type (44.3% vs 19.6%; p < .0001) The specificity for cervical intraepithelial neoplasia 2+ at 91.2% of a combination of HPV types, 16/18/45 (very high risk) and 31/33/58/52 (moderate risk), performed better than cytology or any HPV-positive result to predict cervical intraepithelial neoplasia 3+ on histology. The additional genotype information supports direct referral to treatment or colposcopy in a larger proportion of the screen-positive population.

Conclusions

The potential contribution of extended genotyping is demonstrated. The ideal choice of sensitivity and specificity ultimately depends on the health budget. More information will allow a screening algorithm, guiding management according to risk.
Stories of Coping with Sickness: Illness Narratives in Early Medieval Chinese Anecdotal Literature
Authors: Richter Antje
Published: April 2023

As basic facts of life, illness and healing occur frequently and in a variety of patterns in Chinese non-medical literature, starting from the earliest sources inscribed on oracle bones and continuing throughout literary history up to the present day. This article looks at illness narratives in early medieval anecdotal literature (third to sixth century CE) to understand how the experience of being sick or of attending to the sick was reflected in these socio-literary environments and what rhetorical and ideological roles these narratives played in their larger narrative contexts. By focusing on the experiences of the sick and those around them, this article aims at “Honoring the Stories of Illness,” in Rita Charon’s words, that are hiding in plain sight in much of Chinese non-medical literature.
AfterWards: A Narrative Medicine Program at Johns Hopkins Medicine and in China
Authors: Small Lauren
Published: April 2023

Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories. Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians, medical students, and other health-care providers. Narrative medicine can promote empathy and trust between patients and physicians and foster self-care. In 2014, the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children's Center of the Johns Hopkins Hospital called AfterWards. The program, which meets monthly, is open to all on a volunteer basis. Through literature, art, and writing, AfterWards nurtures empathy, encourages reflective practice, and builds community among a diverse group of health care providers. Through a series of lectures and workshops at Johns Hopkins Medicine, Peking Union Medical College, and Fudan Hospital in Shanghai, the author has introduced AfterWards to Chinese medical educators and clinicians. Working with Dr. Marta Hanson, she created an AfterWards Facilitator’s Guide for the use of Chinese practitioners. A recent White Paper on Chinese health care indicates that an infusion of humanities-based education, of which narrative medicine forms a part, can help rebuild patient-physician trust. Recently there has been an increase in interest in narrative medicine in the United States and China. However, more research is needed to demonstrate the impact of programs like AfterWards. Challenges to the implementation of narrative medicine programs remain, most significantly in terms of expertise, resources, and time.
Chinese Sources for AfterWards: From Premodern Poetry, Paintings, and Medical Texts to Modern Novels, Film, and Documentaries
Authors: Hanson Marta
Published: April 2023

This paper focuses on Chinese sources suggested for a narrative medicine (NM) program, called AfterWards. Dr Lauren Small established AfterWards in 2014 and has been coordinating it since out of the Pediatrics Department at Johns Hopkins Medicine. In early 2019, she started giving a series of lectures and workshops about AfterWards to Chinese medical educators and clinicians in Beijing and Shanghai. She created an AfterWardsFacilitator’s Guidebased on Western-language sources for workshop participants. She also started to organize with Jiang Yuhong (Peking Union Medical College) a workshop for Chinese colleagues to be held at Johns Hopkins Medicine in October 2019. They invited the author to participate. The idea was hatched then to develop Chinese source materials following the AfterWards structure for an updatedFacilitator’s Guidethat Dr Small had initially written. A typical one-hour AfterWards session consists of a specific five-part structure: a literary text or artwork, an associated theme, discussion topics, a writing exercise, and shared reflection. While the content of the program always changes from session to session, the basic structure remains the same. This paper summarizes the types of Chinese sources and their related narrative-medicine themes that were originally selected for inclusion in the updated AfterWardsFacilitator’s Guideintended for Chinese colleagues. These sources about coping with sick family members, aging, and illness ranged from the textual (classical Chinese poems on aging and diagnostic forms for training students) and visual (premodern Chinese paintings and murals of medical encounters) to the fictive (novels) and performative (contemporary Asian-American film in English and Chinese-language film and documentaries).
Doctors’ Dilemma in Auspicious Pulse Diagnosis Represented in the Ming-Qing Fiction
Authors: Li Yuanda , Xu Mao
Published: April 2023

Pregnancy diagnosis in traditional Chinese medicine involves such issues as medical skills, narrative skills, family decency, and ethics. It is an excellent case for the exploration of ethical dilemmas in traditional Chinese medical practice. The early classical medical texts such as Su Wen (Basic Questions) and Ling Shu Jing (Spiritual Pivot Canon) provide a principle-based ethical guide for doctor-patient communication, while popular fiction such as Hong Lou Meng (A Dream of Red Mansions), Yu Mu Xing Xin Bian (Stories: Entertain to Enlighten) and Feng Yue Meng (Courtesans and Opium) in the Ming and Qing dynasties present literary examples for solving ethical dilemmas. This article will analyze these texts from three perspectives. First, the doctors in the text were subject to gender order and other delicate etiquette and customs, therefore were unable to make the diagnosis without embarrassing the patients and jeopardizing family decency. Second, the narrator tends to attribute pregnancy misdiagnosis to three reasons: incomplete patient information, doctors’ poor narrative competence, and doctors’ corrupted medical ethics. Finally, the Ming-Qing fiction proposes three methods to solve this moral dilemma: clear pulse reading, tactful speech, and taboo challenging. This discussion of moral dilemmas in pregnancy diagnosis in traditional Chinese medical practice can be used as a reference for the localization of narrative medicine.
An Overview of Narrative Medicine in China
Authors: Guo Liping
Published: April 2023

This paper sketches the history and the author’s involvement in the development of narrative medicine in China. It also describes “narrative medicine with Chinese characteristics,” explaining why narrative medicine is regarded as a tool to materialize the medical humanities in clinical practice, and detailing the features of narrative medicine in China. The features include the wide acceptance of the “22334 model” of narrative medicine, and borrowing theories and practice from Traditional Chinese Medicine. Finally, the author argues that the medical humanities should be given a “Class-A discipline” status, and narrative medicine should be a class-B discipline under the medical humanities.
Narrative Medicine Under the Guidance of Traditional Chinese Medicine Theory
Authors: WANG Chunyong
Published: April 2023

This paper is an exploration into the practice of narrative medicine in the clinical setting guided by the theory and approaches of traditional Chinese medicine (TCM). By adopting the theory of TCM, the author attempted to provide the patients with systematic treatment from the perspective of society-psychology-biology under the guidance of both the unity of Heaven and Man, and the unity of Xing (Body) and Shen (Mind/Spirit) through his clinical practice. Guided by yin-yang and Wu Xing (Five Elements) theory and focusing on the social relations of the patients for any possible relationships between patients’ social, psychological and biological state, the author took the patients’ emotion management as a point of departure and helped the patients recover both physically and psychologically by promoting positive transformation in patients’ social, psychological, and biological state. A clinical case was provided at the end of this paper to demonstrate how the above theory was put into practice. Narrative medicine under the guidance of TCM theory can supplement modern medical humanity practices as well as extend the scope of modern medical treatment from the perspective of the unity of Heaven and Man, by enriching the content of narrative medicine, and promoting the medical model from biological medical model toward social-psychological-biological model.
Outcome of COVID-19 mRNA Vaccination in Patients Treated With Clozapine WHO Previously Went Through SARS-COV-2 Infection
Authors: Moga Silvia , Petric Paula Simina , Miron Ana Aliana , Ifteni Petru , Teodorescu Andreea
Published: April 2023

Background:

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had multiple consequences for the health care system, especially for patients with mental illnesses. Schizophrenia patients particularly appear to have a higher risk of complications due to coronavirus-19 (COVID-19). Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS). However, the COVID-19 pandemic had an important negative impact on clozapine treatment, mainly because of its administration protocol, which was very difficult to follow during the restrictions imposed in the pandemic, and its side effects in patients with COVID-19 infection. Vaccination is an effective method of avoiding SARS-CoV-2 infection or its severe complications, especially in susceptible populations. Data on adverse events after vaccination against COVID-19 are limited, both in the general population and in schizophrenia patients.

Study Question:

The study aimed to investigate the safety of COVID-19 vaccination in patients treated with clozapine for hematological parameters.

Study Design:

We conducted an analytical cross-sectional study between July 1, 2021, and June 30, 2022. We compared 2 groups of COVID-19 vaccinated patients who had previously experienced SARS-CoV-2 infection: The first group was treated with clozapine, whereas the second group was treated with other antipsychotics.

Measures and outcomes:

The primary objective was to identify granulocytopenia, leukocytopenia, and lymphocytopenia. The results were measured after the second dose of the Pfizer-BioNTech vaccine.

Results:

This study included 100 patients. White blood cell count changes were limited to a few cases of mild granulocytopenia (8.16% in the clozapine group and 3.92% in the nonclozapine group, P = 0.37) with no cases of severe granulocytopenia or agranulocytosis.

Conclusions:

As far as leukocyte counts are concerned, mRNA COVID-19 vaccination seems to be safe in patients treated with clozapine who previously had SARS-CoV-2 infection. Leukocyte changes had no clinical implications.
Lichen planus esophagitis
Authors: Blonski Wojciech , Slone Samuel , Jacobs John W.
Published: April 2023

Purpose of review

Dysphagia is one of the most common reasons for patients’ visits to a gastroenterologist. Esophageal lichen planus (ELP) has historically been felt to be a rare disease, when in fact it is often misdiagnosed and unrecognized. Often first diagnosed as an unusual esophagitis, all gastroenterologists will see ELP in their practice, and need to be able to recognize this condition.

Recent findings

Although there is still a relative paucity of data on this condition, this article will update the typical presenting symptoms, endoscopic findings, and ways to differentiate ELP from other inflammatory mucosal diseases. There is still no standardized treatment algorithm, but we will also present the most recent treatment approaches.

It is critical that physicians maintain an increased awareness of ELP and have a high clinical suspicion in the appropriate patients. While management remains challenging, it is important to treat both the inflammatory and stricturing components of the disease. A multidisciplinary approach is also often required, utilizing dermatologists, gynecologists, and dentists who are familiar with managing patients with LP.
Radiofrequency ablation for the management of pancreatic mass lesions
Authors: Merchant Ambreen A. , Goebel Anna M. , Willingham Field F.
Published: April 2023

Purpose of review

Patients with pancreatic tumors may have limited treatment options. Pancreatic tumor ablation is a novel and emerging treatment modality which can now be performed using endoscopic ultrasound (EUS) guidance. This modality is well suited to guide energy delivery for radiofrequency ablation (RFA) and microwave ablation. These approaches provide minimally invasive, nonsurgical methods for delivering energy to ablate pancreatic tumors in situ. This review summarizes the current data and safety profile for ablation in managing pancreatic cancer and pancreatic neuroendocrine tumors.

Recent findings

RFA uses thermal energy to induce cell death by coagulative necrosis and protein denaturation. Studies have reported increased overall survival in patients with pancreatic tumors treated with EUS-guided RFA in a multimodality systemic approach and when used in palliative surgeries. Radiofrequency ablation may have corollary benefits in inducing an immune-modulatory effect. Tumor marker carbohydrate antigen 19–9 has been reported to decrease in response to RFA. Microwave ablation is an emerging modality.

RFA utilizes focal thermal energy to induce cell death. RFA has been applied through open, laparoscopic, and radiographic modalities. EUS-guided approaches are now allowing RFA and microwave ablation to be performed for pancreatic tumors in situ.
Practical considerations for diagnosis and treatment of polycystic ovary syndrome in adolescence – distilling guidelines into clinical practice
Authors: DiVall Sara A.
Published: April 2023

Purpose of review

The diagnostic criteria for polycystic ovary syndrome (PCOS) in adults may overdiagnose PCOS in adolescents. Since 2015, three guidelines have developed adolescent-specific diagnostic criteria and treatment recommendations. In this review, we compare and contrast the recommendations to assist in the practical application to clinical practice.

Recent findings

The guidelines agree that hyperandrogenism with menstrual irregularity be diagnostic criteria for PCOS in adolescents yet have slight differences in how to diagnose hyperandrogenism and in the definition of menstrual irregularity. The diagnostic option of ‘at risk for PCOS’ is recommended for those girls presenting with criteria within 3 years of menarche or with hyperandrogenism without menstrual irregularity, with re-assessment later in adolescence. Lifestyle changes is first line treatment. Treatment with combined oral contraceptives or metformin is suggested, using patient characteristics and preferences to guide decision-making.

PCOS is associated with long term reproductive and metabolic complications and will present during adolescence. Yet, diagnostic features may overlap with normal adolescent physiology. The recent guidelines strove to develop criteria to accurately identify girls with PCOS allowing early surveillance and treatment yet avoid overdiagnosis of normal adolescents.
The Prevalence of Bowel and Bladder Function During Early Childhood: A Population-Based Study
Authors: Verkuijl Sanne J. , Trzpis Monika , Broens Paul M.A.
Published: April 2023

Objectives:

Our primary aim was to determine bowel and bladder function in children aged 1 month to 7 years in the general Dutch population. Second, we aimed to identify demographic factors associated with the presence of bowel and bladder dysfunction, and their coexistence.

Methods:

For this cross-sectional, population-based study, parents/caregivers of children aged from 1 month to 7 years were asked to complete the Early Pediatric Groningen Defecation and Fecal Continence questionnaire. Different parameters of bowel and bladder function were assessed using validated scoring systems such as the Rome IV criteria.

Results:

The mean age of the study population (N = 791) was 3.9 ± 2.2 years. The mean age at which parents/caregivers considered their child fully toilet-trained was 5.1 ± 1.5 years. Prevalence of fecal incontinence among toilet-trained children was 12%. Overall prevalence of constipation was 14%, with a constant probability and severity at all ages. We found significant associations between fecal incontinence and constipation [odds ratio (OR) = 3.88, 95% CI: 2.06–7.30], fecal incontinence and urinary incontinence (OR = 5.26, 95% CI: 2.78–9.98), and constipation and urinary incontinence (OR = 2.06, 95% CI: 1.24–3.42).

Conclusions:

Even though most children are fully toilet-trained at 5 years, fecal incontinence is common. Constipation appears to be common in infants, toddlers, and older children. Fecal incontinence and constipation frequently coexist and are often accompanied by urinary incontinence. Increased awareness of bowel and bladder dysfunction in infants, toddlers, and young children is required to prevent these problems from continuing at older ages.
Hypohydration, Functional Constipation, and Physical Activity in Elementary School Students
Authors: Dias Francine Canovas , Melli Lígia Cristina Fonseca Lahoz , Boilesen Sabine Nunes , Tahan Soraia , Morais Mauro Batista de
Published: April 2023

This school-based, cross-sectional study aimed to evaluate whether hypohydration is related to functional constipation and physical activity in school-aged children. The study included 452 students aged 6–12 years. Hypohydration, defined as urinary osmolality >800 mOsm/kg, was more prevalent (P = 0.002) in boys (72.1%) than in girls (57.5%). The difference in the prevalence of functional constipation according to sex (20.1% in boys and 23.8% in girls) was not statistically significant (P = 0.81). In bivariate analysis, functional constipation was associated with hypohydration in girls (odds ratio = 1.93, 95% confidence interval: 1.07–3.49), and multiple logistic regression did not reach statistical significance (P = 0.082). Low proportions of active commuting to school in both sexes were associated with hypohydration. However, there were no associations between functional constipation, active commuting to school, and physical activity scores. In conclusion, multiple logistic regression did not demonstrate an association between hypohydration and functional constipation in school-aged children.
Clinical Characteristics of Children with Eosinophilic Esophagitis and Bulbar Duodenitis
Authors: Lulgjuraj Tony , Thomas Ronald , Sawyers Cindy , Gupta Sandeep K.
Published: April 2023

We describe a cohort of 33 patients with eosinophilic esophagitis (EoE) and incidental duodenal bulb inflammation, termed bulbar duodenitis (BD). We conducted a single-center retrospective cohort study and recorded demographics, clinical presentation, endoscopic, and histological findings. BD was observed at the initial endoscopy in 12 cases (36%) and at a subsequent endoscopy in the remainder. Bulbar histology was usually a mix of chronic and eosinophilic inflammation. Patients were more likely to have active EoE (n = 31, 96.9%) at time of BD diagnosis. Our data indicate that the duodenal bulb of children with EoE should be carefully examined at each endoscopy and mucosal biopsies considered. Larger studies are needed to explore this association.
Trends in implementation of evidence-based hip fracture management in a major Canadian city
Authors: Vergouwen Martina , James Michael G. , You Daniel Z. , White Neil J.
Published: April 2023

Aims:

The importance of hip fracture care has resulted in an abundance of hip fracture management literature. The degree this evidence is incorporated into clinical practice is unknown. We examined 5 trends in hip fracture management: arthroplasty versus fixation, total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented femoral stem fixation, short versus long cephalomedullary nail (CMN) fixation, and time from admission to surgery. Our primary aim was to understand and assess hip fracture management trends in relation to pertinent literature.

Methods:

Data were collected from acute hip fractures in patients aged 50 years or older who presented from 2008 to 2018. ICD-10 diagnostic codes were assigned using preoperative radiographs. Surgical management was confirmed using intraoperative and postoperative radiographs and split into 6 categories: (1) short CMN, (2) long CMN, (3) cannulated screws, (4) dynamic hip screw, (5) HA, and (6) THA. Appropriate statistical tests were used to analyze trends.

Results:

In 4 assessed trends, hip fracture management aligned with high-level evidence. This was the case for a trend toward arthroplasty for displaced femoral neck fractures, increased use of THA relative to HA, increased use of short relative to long CMNs, and consistent decrease in surgical wait times. Despite the literature highlighting the disadvantages of uncemented femoral stems, our data demonstrated increased use of uncemented femoral stems.

Conclusion:

Evidence to guide orthopaedic practice is constantly emerging but may not be effectively used by clinicians. Our findings demonstrate the successes and failures of integrating evidence into hip fracture management and highlight that orthopaedic surgeons have an ongoing responsibility to strive for evidence-based practice.
Comparison of Three Different Devices for the Evaluation of Axial Length, Refractive Error, and Keratometry
Authors: Hessler Philipp , Künzel Peter , Degle Stephan
Published: April 2023

SIGNIFICANCE

Myopia prevalence is increasing worldwide. Axial length, refractive error, and keratometry are important outcome measures in myopia management. Precise measurement methods are required for myopia management. Various devices are used to measure these three parameters, and it is not known whether their results can be used interchangeably.

PURPOSE

The aim of this study was to compare three different devices to evaluate axial length, refractive error, and keratometry.

METHODS

A total of 120 subjects (37.7 ± 15.5 years) were enrolled in this prospective study. All subjects were measured with DNEye Scanner 2 (Rodenstock GmbH, Munich, Germany), Myopia Master (Oculus Optikgeräte GmbH, Wetzlar, Germany), and IOLMaster 700 (Carl Zeiss Meditec AG, Jena, Germany). Myopia Master and IOLMaster 700 use interferometry to measure axial length. Rodenstock Consulting software (Rodenstock GmbH, Munich, Germany) was used to calculate axial length from DNEye Scanner 2 measurement. Differences were analyzed using Bland-Altman 95% limits of agreement.

RESULTS

Differences for axial length were as follows: DNEye Scanner 2 versus Myopia Master, 0.67 ± 0.46 mm; DNEye Scanner 2 versus IOLMaster 700, 0.64 ± 0.46 mm; and Myopia Master versus IOLMaster 700, −0.02 ± 0.02 mm. Differences for mean corneal curvature were as follows: DNEye Scanner 2 versus Myopia Master, −0.20 ± 0.36 mm; DNEye Scanner 2 versus IOLMaster 700, −0.40 ± 0.35 mm; and Myopia Master versus IOLMaster 700, −0.20 ± 0.13 mm. The difference in noncycloplegic spherical equivalent between DNEye Scanner 2 and Myopia Master was 0.05 ± 0.25 D.

CONCLUSIONS

The results for axial length and keratometry from Myopia Master and IOLMaster were comparable. The axial length calculated by DNEye Scanner 2 was significantly different from interferometry devices and is not appropriate for myopia management. The differences in keratometry readings were clinically not significant. All refractive outcomes were comparable.
An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India
Authors: Adarsha Naik , Samprathi Madhusudan , Sankhyan Naveen , Singh Mini P. , Bansal Arun , Jayashree Muralidharan , Angurana Suresh Kumar , Nallasamy Karthi
Published: April 2023

Objectives:

To identify the prevalence of herpes simplex encephalitis (HSE), factors influencing the duration of empirical acyclovir and frequency of acute kidney injury (AKI) in children with acute encephalitis syndrome (AES).

Design:

Prospective observational study.

Setting:

Pediatric Emergency Department and PICU of a tertiary hospital in Northern India.

Patients:

All consecutive, eligible children between 1 month and 12 years old presenting with AES, defined as altered consciousness for greater than 24 hours (including lethargy, irritability, or a change in personality) and two or more of the following signs: 1) fever (temperature ≥ 38°C) during the current illness, 2) seizures or focal neurological signs, 3) cerebrospinal fluid (CSF) pleocytosis, 4) electroencephalogram, and/or 5) neuroimaging suggesting encephalitis, who received at least one dose of acyclovir.

Interventions:

None.

Measurements and Main Results:

Of the 101 children screened, 83 were enrolled. The median (interquartile range [IQR]) age was 3 years (1–6 yr). Thirty-one children (37.3%) were diagnosed with AES, of which four were labeled as probable HSE (three based on MRI brain, one based on serology). Scrub typhus, dengue, Japanese encephalitis, and mumps were the other infective causes. The median (IQR) duration of acyclovir therapy was 72 hours (24–264 hr); 21 children (25.3%) received acyclovir for less than 24 hours and 11 (13.3%) for greater than or equal to 14 days. New-onset AKI was seen in 18 children (21.7%) but was mostly transient. Death (n = 8, 9.6%) and discontinuation of care due to futility or other reasons (n = 15, 18%) were noted in 23 children (28%). Factors associated with duration of acyclovir greater than 7 days, on univariable analysis, were lower modified Glasgow Coma Score at admission, requirement of invasive ventilation, invasive intracranial pressure monitoring, and CSF pleocytosis (5–500 cells). On multivariable analysis, only CSF pleocytosis of 5–500 cells was associated with duration of acyclovir greater than 7 days.

Conclusions:

Given the low prevalence of HSE, and the risk of AKI, this study sensitizes the need to review our practice on initiation and stopping of empirical acyclovir in children with acute encephalitis.
Protecting First Responders While Maintaining Personal Privacy During the COVID-19 Pandemic: One County's Approach
Authors: Fifolt Matthew , McMahon Sean , Hoff Christopher , Smith Lisa , Ayala Karen
Published: April 2023

In this case study, the authors discuss a special situation infectious disease alert process for first responders. Issues explored include the development of this infectious disease alert process and legal issues that the DuPage County Health Department addressed to share protected health information between public health and public safety. The authors illustrate the important relationship between a local health department and its legal counsel as they balanced the needs of different stakeholder groups and identified a solution that satisfied both without infringing on individual privacy. The case study closes with a discussion regarding the value of multisector collaborations and opportunities to improve information sharing between sectors.
Impact of COVID-19 Pandemic on the Influenza Vaccination and Predictors of Influenza Vaccination in Japan: A Cross-sectional Study
Authors: Shojima Kensaku , Kobayashi Taiichiro , Tabuchi Takahiro
Published: April 2023

Objective:

With the current global pandemic of COVID-19, there is concern that an influenza outbreak could exacerbate the health care burden. Improving the influenza vaccination rate is becoming more critical because controlling the spread of influenza is essential for reducing excess mortality. Therefore, we investigated whether the influenza vaccination rate changed during the COVID-19 pandemic in Japan and identified the factors associated with influenza vaccination uptake.

Design:

This cross-sectional study used data from an Internet survey with adjustments to approximate a nationally representative estimate using inverse probability weighting.

Setting:

A total of 23 142 respondents, aged 15 to 80 years, were evaluated to estimate weighted percentages and prevalence ratios with 95% confidence intervals of influenza vaccination in the period 2020-2021.

Results:

Overall, in the period 2020-2021, the influenza vaccination rate rose from 38.1% before the COVID-19 pandemic to 44.6%. “Using traditional media” was a positive predictor of influenza vaccination uptake. “Using social media,” “COVID-19 vaccine hesitancy,” and “living in a prefecture with a high proportion of COVID-19 cases” were negative predictors.

Conclusions:

It is crucial to use predictors of influenza vaccination, such as how to use the media, for promoting a more widespread influenza vaccination uptake. The results of this study may be helpful in improving influenza vaccination rates, which could reduce the burden on health care services during outbreaks of influenza and COVID-19.
Effectiveness of music therapy within community hospitals: an EMMPIRE retrospective study
Authors: Rodgers-Melnick Samuel N. , Rivard Rachael L. , Block Seneca , Dusek Jeffery A.
Published: April 2023

Introduction:

Given the challenges health systems face in providing effective nonpharmacologic treatment for pain and psychological distress, clinical effectiveness studies of evidence-based strategies such as music therapy (MT) are needed.

Objectives:

This study examined changes in patient-reported outcomes (PROs) after MT and explored variables associated with pain reduction of ≥2 units on a 0 to 10 numeric rating scale (NRS).

Methods:

A retrospective review was conducted on initial MT interventions provided to adults receiving community hospital care between January 2017 and July 2020. Sessions were included if participants reported pre-session pain, anxiety, and/or stress scores of ≥4 on the NRS. Data analysis included a bootstrap analysis of single-session changes in PROs and a logistic regression exploring variables associated with pain reduction (ie, ≥2 units vs <2 units).

Results:

Patients (n = 1056; mean age: 63.83 years; 76.1% female; 57.1% White; 41.1% Black/African American) reported clinically significant mean reductions in pain (2.04 units), anxiety (2.80 units), and stress (3.48 units). After adjusting for demographic, clinical, and operational characteristics in the model (c-statistic = 0.668), patients receiving an MT session in which pain management was a goal were 4.32 times more likely (95% confidence interval 2.26, 8.66) to report pain reduction of ≥2 units than patients receiving an MT session in which pain management was not a session goal.

Conclusion:

This retrospective study supports the clinical effectiveness of MT for symptom management in community hospitals. However, additional research is needed to determine which characteristics of MT interventions and patients influence pain change.
Challenges and Solutions for Monitoring Alcohol Use in Patients with Alcohol Related Liver Disease: Pilot Study of a Wearable Alcohol Biosensor
Authors: DiMartini Andrea , Behari Jaideep , Dunn Michael , Bataller Ramon A. , Jakicic John M. , McNulty Mary , Young Ryan C. , Dew Mary Amanda
Published: April 2023

Objectives

Early alcohol use identification can prevent morbidly/mortality for alcohol-associated liver disease (ALD). Innovative wearable alcohol biosensors (biosensors) that identify alcohol use through perspiration are an emerging technology with potential application for Patients with ALD. Our primary aim was to determine biosensor acceptability and feasibility for Patients with ALD. We describe participant acceptance and challenges using biosensor technology in a pilot study of biosensors with Patients with ALD.

Design

Participants had a recent diagnosis or hospitalization for decompensated ALD, had to be drinking within the past three months and be followed at our center. Participants wore the biosensor daily for 3 months. Quantitative data using the Technology Acceptance Model 2 (TAM2) measure were collected at intake and study conclusion. The TAM2’s 13 items cover 4 scales; perceived usefulness, ease of use, attitude towards technology and intention to use on a 7-point Likert scale. Lower scores indicate higher acceptance. Participants were asked open-ended questions about issues wearing the biosensor.

Results

Among 27 participants, 60% were women, average age 45 + 10, and 89% were white. TAM2 subscales indicated initially high acceptance (mean scores 1.2-2.2) and remained high (mean scores 1.3-2.3) without statistically significant decline at study conclusion. From open-ended questions, several themes regarding problems with device wear emerged: a) uncomfortable or cumbersome to wear, b) problems with biosensor appearance, and c) issues with useability. Challenges to biosensor usage included data being lost when devices were damaged and devices being lost during the study.

Conclusions

Alcohol biosensors appear to be acceptable to ALD participants. However, improving the appearance, comfort, durability and functionality of biosensor devices is critical to clinical deployment.

Clinicaltrials.gov
identifier NCT03533660: Alcohol biosensor monitoring for alcohol liver disease
Childhood Trauma and Adult Somatic Symptoms
Authors: Eilers Hanna , aan het Rot Marije , Jeronimus Bertus F.
Published: April 2023

Objective

Childhood trauma is a key public health risk factor for developing physical illness. This study examined how childhood abuse and neglect predict adult somatic symptoms assessed retrospectively and in real time.

Methods

Participants in the HowNutsAreTheDutch project completed the Childhood Trauma Questionnaire—Short Form and, to assess somatic symptoms, the cross-sectional Patient Health Questionnaire (n = 406) or a longitudinal ecological momentary assessment protocol that included responding to an item on physical discomfort 3 times a day for 30 days (n = 290).

Results

As hypothesized, childhood trauma was positively associated with adult somatic symptoms assessed using the Patient Health Questionnaire (d = 0.30) and assessed using the ecological momentary assessment item (d = 0.31), also after adjustment for age, sex, educational level, and relationship status. Longitudinally, we also explored whether interpersonal context moderated abuse outcomes, and observed that social company dampened momentary physical discomfort among people with a history of more physical neglect (d = 0.04).

Conclusions

Childhood trauma, especially emotional and sexual abuse, predicts specific adult somatic symptoms. Future work may examine how symptom expression is influenced by the social lives of traumatized individuals.
Trait Hostility Moderates the Relationships between Work Environments and Ambulatory Blood Pressure and Momentary Affect
Authors: Small Amanda K. , Zawadzki Matthew J.
Published: April 2023

Objective

Hostility is a risk factor for cardiovascular disease and mortality, but less is known about when hostility poses greatest risk. Work environments can be characterized by features that are reactive for high hostile individuals. Using a person by environment approach, this paper tested whether hostility interacted with work location to predict the cardiovascular disease risk factors of ambulatory blood pressure (ABP) and momentary affect.

Method

Community participants (n = 108; aged 20-68, M = 36.52, SD = 11.96; 66.06% men; primarily 35.62% non-Hispanic Black, 31.51% non-Hispanic White, and 15.07% Latino/Hispanic) completed a measure of trait hostility followed by two 24-hour ABP monitoring sessions. After each ABP reading, ecological momentary assessment was used to capture participants’ current location and ratings of anger, sadness, happiness, and anxiety.

Results

4,321 observations were recorded. Multilevel models tested the relationship between work location, trait hostility, and their interaction on ABP and momentary affect. Participants higher on hostility had higher systolic ABP, diastolic ABP, anger, and sadness (but not happiness nor anxiety) when at work compared to when not at work; no differences were observed for those lower on hostility. A more consistent pattern of results was found for the William hostility subscale than a traditional measure.

Conclusions

Results suggest mechanisms for how trait hostility can lead to cardiovascular disease and mortality and highlight the importance of studying traits like hostility within context. Future research should consider the role of social determinates of health like socioeconomic status and features of the work environment to better understand this relationship.
Microsurgical Reconstruction of Extensive Lower Lip Defects
Authors: Ribeiro Luis Mata , Peng Chi , Cheong David Chon-Fok , Hung Shao-Yu , Tsao Chung-Kan
Published: April 2023

Background

Large defects of the lower lip pose a difficult challenge for any reconstructive surgeon. When there is limited local tissue available to resurface the defects, free flaps are the preferred option.

Aim and Objectives

We reported our experience in the reconstruction of extensive lower lip defects. The authors propose a new algorithm for microsurgical technique selection and assessment of the functional outcomes obtained.

Materials and Methods

A retrospective review of all microsurgical reconstructions of extensive lower lip defects by the senior author for 10 years was performed. The functional outcomes assessed included speech, feeding, and oral continence. Patients were stratified according to their status of simultaneous mandible resection (none, marginal, segmental).

Results

Fifty-one patients were included in this study. Almost all patients (96.1%) achieved intelligible speech. Only 1 patient experienced severe drooling. Most patients could eat a solid or soft diet (72.5%). Mandible resection was associated with the worst feeding outcomes.

Conclusions

Microsurgical reconstruction of extensive lip defects is safe and provides good results. Free flap selection should take into account the location of the defect, the resected structures, and the body mass index of the patient. Feeding status seems to be inversely correlated with the amount of mandibular resection.
The Comparison of Functional Outcomes in Patients With Unilateral or Bilateral Intracapsular Mandibular Condylar Fractures After Closed or Open Treatment
Authors: Lai Bo-Ru , Liao Han-Tsung
Published: April 2023

Background

The treatment strategies for mandibular condylar head fractures, also known as intracapsular condylar fractures (ICFs), have not been concluded. We humbly present our treatment outcomes and share our experience in our department.

Aims and Objectives

The aim of this study was to compare the functional outcomes between closed reduction (CR) and open reduction and internal fixation (ORIF) for management of unilateral or bilateral ICFs.

Materials and Methods

This 10-year retrospective cohort study included 71 patients with 102 ICFs who were treated in our department from May 2007 to August 2017. Nine patients mixed with extracapsular fractures were excluded; thus, 62 patients with 93 ICFs were included. All patients received treatment by the senior surgeon in Chang Gung Memorial Hospital, Linkou Branch, Taiwan. The patient's basic data, fracture morphologies, associated injuries, managements, complications, and maximal mouth opening (MMO) measurement at 1, 3, 6, and 12 months postoperative were reviewed for analysis.

Results

Among the 93 fractures, 31 (50%) were bilateral and 31 were unilateral (50%). Based on He′s classification, 45 (48%) had type A fracture, 13 (14%) had type B, 5 (5%) had type C, 20 (22%) had type M, and 10 (11%) had no displacement. Maximal mouth opening of 37 mm in unilateral cases after 6 months was significantly higher than the 33-mm MMO in bilateral cases. In addition, the MMO in the ORIF group was significantly higher than that of the CR group in 3 months postoperative. Univariate (odds ratio, 4.92;P= 0.01) and multivariate (odds ratio, 4.76;P= 0.027) analyses revealed CR as an independent risk factor for trismus development compared with ORIF. Malocclusion was observed in 5 patients in both CR and ORIF groups. In addition, 1 patient developed temporomandibular joint osteoarthritis in the CR group. No surgical-related temporary or permanent facial nerve palsy was observed.

Conclusions

Open reduction and internal fixation for condylar head fracture provided better recovery in MMO than CR, and the MMO recovery was less in bilateral condylar head fracture than unilateral condylar head fracture. Open reduction and internal fixation in ICFs have a lower risk for trismus development and should be the treatment of choice in selected cases.
Pediatric Mandibular Reconstruction With Free Serratus Anterior-Rib Composite Flap
Authors: Wu Yao-Cheng , Tai Hao-Chih
Published: April 2023

Reconstruction of children's mandibles after mandibular resection for benign or malignant tumors is challenging. Microvascular flap reconstruction is a common treatment option for restoring mandibular continuity after the resection of oral cavity neoplasms.

We presented 2 cases of childhood mandibular reconstruction after tumor wide excision and segmental mandibulectomy, one for malignant cancer and one for benign ossifying fibroma, with serratus-rib composite free flap. All 2 patients had a favorable facial profile, functional outcome, and dental occlusion at the last follow-up. The development of children's mandible and donor site needs to be considered compared with adult's mandibular reconstruction. Given its reliability and utility, this flap can be an alternative for pediatric mandibular reconstruction compared with the free fibular flap and other candidates.
A One-Size-Fits-All Approach to Pressure Ulcers
Authors: Chen Jill , Chen Jian-An , Chen Chien-Chung , Yang Yi-Hsuan , Teklu Yonas Eshetu , Chang Li-Ren , Feng Kuan-Ming
Published: April 2023

Background

Buttock pressure injuries can be difficult to treat. There are many choices of flaps to reconstruct these wounds, but few are large, technically simple, and easily recycled.

Aim and Objective

We are presenting our experience on surgical reconstruction of buttock pressure injuries using large whole-buttock fasciocutaneous flaps that are easily designed for ulcers regardless of location and size and are easily recycled for treatment of recurrences.

Material and Methods

We conducted a retrospective review of all patients who received reconstruction with fasciocutaneous rotational flaps for buttock region pressure injuries from January 2013 to December 2018. The key steps of this one-size-fits-all flap include elevation of a large, oversized flap to achieve tension-free closure, avoiding fascial incisions over bony prominences, placing the V-Y type closure wound in the posteromedial thigh, and the use of closed incisional negative wound therapy postoperatively.

Results

Fifty patients underwent 54 flaps reconstruction for coverage of stage 4 gluteal pressure injuries between January 2013 and December 2018. Seventy-four percent healed without the need for further operation. The average size of the defect was 90 cm2 (maximum = 300 cm2). The average follow-up period was 31 months. Four of the 54 flaps were “recycled” flaps, 3 were performed for the coverage of recurrent ulcers and 1 flap was performed for treatment of a postoperative wound dehiscence.

Conclusions

We recommend this simple, one-size-fits-all approach, whole-buttock fasciocutaneous flap when surgically treating gluteal pressure injuries for selected patients.