bluuebunny/crossref_metadata_2025 huggingface dataset:
FLUORESCENCE LIFETIME PATTERNS IN MACULAR TELANGIECTASIA TYPE 2
Authors: Solberg Yasmin , Dysli Chantal , Wolf Sebastian , Zinkernagel Martin S.
Published: January 2019

Purpose:

Type 2 idiopathic macular telangiectasia (MacTel) is a rare bilateral neurodegenerative disease characterized by alterations in the macular capillary network leading to central vision loss. The purpose of this study was to quantify disease-specific retinal fluorescence lifetime patterns in patients with MacTel using fluorescence lifetime imaging ophthalmoscopy.

Participants:

Both eyes of 14 patients (mean age ± SEM, 67.8 ± 6.4 years) with a clinical diagnosis of MacTel Type 2 and 14 healthy age-matched controls (age 69.8 ± 6.4 years) were included in this study.

Methods:

All participants were imaged with a fluorescence lifetime imaging ophthalmoscope (Heidelberg Engineering, Germany). Mean retinal fluorescence lifetimes (Tm) were obtained in the short spectral channels (498–560 nm) and long spectral channels (560–720 nm). Clinical features, fundus images, fundus autofluorescence intensity images, spectral domain optical coherence tomography, and corresponding macular pigment optical density measurements using a modified confocal scanning laser ophthalmoscope (mpHRA) were further analyzed. Patients were classified into five phenotypic subgroups using the Gass and Blodi classification.

Results:

Mean fluorescence lifetimes were significantly prolonged temporal to the fovea in patients with MacTel compared with healthy controls (mean ± SEM: short spectral channels 543 ± 61 ps vs. 304 ± 9 ps; P < 0.0001; long spectral channels: 447 ± 26 ps vs. 348 ± 11 ps; P < 0.0001), and appeared as a crescent or ring-shaped pattern. Prolonged lifetime patterns correlated with decreased macular pigment density on macular pigment optical density measurements. Follow-up examinations were performed in four MacTel patients, which revealed an increase of short spectral channel Tm of 22% over 2.1 years in the temporal fovea.

Conclusion:

This study confirms that fundus autofluorescence lifetimes display characteristic patterns in patients with MacTel Type 2 disease and provide information about macular pigment and possibly photoreceptor loss. Fluorescence lifetime prolongation correlates with disease severity and may therefore be a useful addition to other imaging modalities for assessing disease progression in MacTel Type 2.
CHOROIDAL THICKNESS AND VASCULARITY VARY WITH DISEASE SEVERITY AND SUBRETINAL DRUSENOID DEPOSIT PRESENCE IN NONADVANCED AGE-RELATED MACULAR DEGENERATION
Authors: Keenan Tiarnan D. , Klein Brandon , Agrón Elvira , Chew Emily Y. , Cukras Catherine A. , Wong Wai T.
Published: January 2019

Purpose:

To investigate how choroidal features vary with age-related macular degeneration (AMD) severity in early-intermediate disease.

Methods:

One hundred fifty-one eyes of 151 participants >50 years with no to intermediate AMD were analyzed with enhanced depth imaging optical coherence tomography. Mean macular choroidal thickness (CT), choroidal vascular thickness (CV), and choroidal vascularity index (CVI) were determined, and statistical associations were calculated.

Results:

Decreased CT and CV were associated with increased axial length (+30 and +14 µm/mm, respectively; P < 0.0001 each), whereas decreased CVI was associated with increased age (+0.1%/year; P = 0.004). Compared with eyes with no/early AMD (Group 0), eyes with large drusen without late AMD in the fellow eye (Group 1) showed increased CV and CVI (+22 µm, P = 0.03 and +2.2%, P = 0.02, respectively). However, eyes with large drusen and late AMD in the fellow eye (Group 2) resembled Group 0. Eyes with subretinal drusenoid deposits demonstrated lower mean CT/CV/CVI than Group 0 (−57 µm, P = 0.02; −31 µm, P = 0.02; −3.6%, P = 0.007).

Conclusion:

Early AMD progression seems associated with biphasic alterations in choroidal dimensions, increasing during early drusen formation but decreasing thereafter. Subretinal drusenoid deposits are independently associated with marked reductions in all choroidal parameters. Changes in choroidal vascular anatomy may drive or reflect the pathobiology of AMD progression.
DEVELOPMENT OF IDIOPATHIC MACULAR HOLE IN FELLOW EYES
Authors: Choi Jae Hwan , Kim Kyung Tae , Kang Se Woong , Bae Kunho , Lee Sang Eon , Kim Ah Young
Published: January 2019

Purpose:

To investigate the long-term incidence and risk factors of macular hole (MH) development in the fellow eyes of patients with unilateral idiopathic MH.

Methods:

The retrospective case–control study involved the fellow eyes of 215 consecutive patients with idiopathic MH. The patients were classified into two groups according to the presence or development of MH in the fellow eye. The spectral domain optical coherence tomography features and clinical characteristics of each group were compared.

Results:

Twelve (5.6%) patients presented with bilateral MH at the initial visit, whereas 20 (9.3%) initially unilateral patients developed MH in the fellow eye over a median interval of 44 months. Vitreomacular traction and inner foveal cyst were noted more frequently in the baseline spectral domain optical coherence tomography scans of fellow eyes of the bilateral group (P < 0.01). An outer foveal defect was found in five patients (35.7%) of the bilateral MH group (P < 0.01).

Conclusion:

The incidence of MH in fellow eyes was approximately 10%. The presence of outer foveal defect, inner foveal cyst, and vitreomacular adhesion or traction on spectral domain optical coherence tomography in the fellow eye was the risk factor for MH.
ATYPICAL MACULAR HOLES
Authors: Kumawat Devesh , Venkatesh Pradeep , Brar Anand S. , Sahay Pranita , Kumar Vinod , Chandra Parijat , Chawla Rohan
Published: January 2019

Purpose:

To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs).

Methods:

A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related, myopic, and traumatic MHs were excluded.

Results:

Atypical or secondary MHs arise out of concurrent ocular pathologies (dystrophy, degeneration, or infections) and laser/surgery. The contributing factors may be similar to those responsible for idiopathic or typical MHs, i.e., tangential or anteroposterior vitreofoveal traction or cystoid degeneration. The management is either observation or treatment of the underlying cause. The prognosis depends on the background pathology, duration of disease, and baseline visual acuity governed by the size of MH and morphologic health of underlying RPE and photoreceptors. The closer the morphology of atypical MH is to that of an idiopathic MH, the better the surgical outcome is.

Conclusion:

With the advancements in retinal imaging, atypical MHs are now more frequently recognized. With increasing understanding of the underlying disease processes, and improvement in investigations and surgical treatment, management of atypical MHs may improve in the future.
NOVEL OPTICAL COHERENCE TOMOGRAPHY FINDINGS OF A CASE OF SYMPATHETIC OPHTHALMIA AFTER 23-GAUGE VITRECTOMY
Authors: Abdelmaksoud Ahmed , Terk-Howe Khoo Nigel , Sears Katharine , Winder Stephen
Published: January 2019

Purpose:

Sympathetic ophthalmia (SO) is a rare panuveitis after trauma to one eye. We present a case of SO after 23-gauge transconjunctival vitrectomy, including optical coherence tomography evidence of response to treatment. To our knowledge, this is the first SO case report to include spectral domain optical coherence tomography images of Dalen-Fuchs nodules.

Methods:

Observational case report of a case of SO after two pars plana vitrectomies in the fellow eye.

Results:

A 67-year-old woman who had an operation for her pseudophakic left eye for a macula-off retinal detachment. She had two surgeries and later on had a total retinal detachment with vision of no perception of light. Eighteen months later, she presented back with a panuveitis with vitritis in her other eye and a visual acuity of 6/18. Dalen-Fuchs denoting SO was found. Treatment was commenced, and multimodal imaging was performed.

Conclusion:

Sympathetic ophthalmia is a known complication after vitrectomy. Optical coherence tomography can be invaluable in monitoring diagnosis and progression of Dalen-Fuchs nodules.
CHOROIDAL MELANOMA DURING PREGNANCY: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Kheir Wajiha Jurdi , Materin Miguel Angel
Published: January 2019

Purpose:

To report a case of a woman diagnosed with choroidal melanoma during pregnancy, as well as review similar cases published in the literature. The prevalence, risk factors, treatment, prognosis, and outcomes of choroidal melanoma in pregnancy are addressed.

Methods:

An extensive search of the literature was conducted by accessing PubMed, MEDLINE, and Scopus databases in January 2018 to identify cases of choroidal or uveal melanoma diagnosed during pregnancy.

Patient:

A 37-year-old white woman pregnant with twins and diagnosed with choroidal melanoma.

Results:

Choroidal melanoma in pregnancy has a prevalence ranging from 4.3% to 7.5% among women of childbearing age with the disease. Pregnancy has been linked to increased incidence of choroidal melanoma, but female hormones have not been shown to play a role in the pathogenesis of the disease. Other factors such as melanocyte-stimulation hormone and fetal-induced angiogenesis may be implicated. Choroidal melanoma in pregnancy has not resulted in a worse maternal or fetal outcome.

Conclusion:

Although rare, choroidal melanoma in pregnancy is a clinical challenge. Management of these patients should be tailored to maternal and fetal needs.
ALTITUDE-ASSOCIATED INTRAOCULAR PRESSURE CHANGES IN A GAS-FILLED EYE
Authors: Foulsham William , Chen Xiaohong N. , Vavvas Demetrios G.
Published: January 2019

Purpose:

Intraocular gases are commonly used in vitreoretinal surgery. Patients are routinely advised against air travel before the complete absorption of intraocular gas. Consequently, reports on air travel in patients with large intraocular gas bubbles are highly unusual. Here, we report the intraocular pressure changes of a patient ascending to an altitude of 2,600 feet in a helicopter with a 50% fill perfluoropropane (C3F8) gas bubble in his left eye.

Methods:

Case report and literature review.

Results:

A 61-year-old male patient underwent pars plana vitrectomy for a rhegmatogenous retinal detachment, with fluid–gas exchange using 16% C3F8. With a 50% fill bubble in the left eye, the patient took a short helicopter trip ascending to a maximum altitude of 2,600 feet. Before take-off, intraocular pressure in the operated eye was 14 mmHg. The average increase in intraocular pressure was 10.8 mmHg per 1,000 feet of ascent, with a maximum recorded intraocular pressure of 42 mmHg. The patient denied both ocular pain and loss of vision but did report changes in the appearance of the gas bubble meniscus at 2,100 feet.

Conclusion:

Short-term low-altitude air travel may be tolerated by some patients with intraocular gas in situ. Further studies are required to define the conditions by which patients with gas bubbles may fly safely.
Orbital Roof Reconstruction Using Nylon Foil Implants
Authors: Grob Seanna R. , Chen Katherine G. , Tao Jeremiah P.
Published: January 2019

Purpose:

To describe a surgical technique of orbital roof reconstruction with a thin nylon foil implant.

Methods:

This study is a description of a surgical technique with a retrospective chart review of 3 consecutive patients treated with a nylon foil implant for a complete superior orbital defect after meningioma resection via craniotomy approach.

Results:

The nylon foil reconstruction achieved an anatomically stable orbit without globe dystopia, pulsatile proptosis, cerebrospinal fluid leak, or other serious cranio-orbital problems, in all cases. Postoperative visual acuity, pain, extraocular motility, proptosis, and globe position remained stable or improved in each case. There were no complications related to the orbital roof reconstruction.

Conclusions:

Nylon foil implantation was an effective and inexpensive surgical technique for orbital roof reconstruction after tumor resection in this small series.
Functional and neurochemical disruptions of brain hub topology in chronic pain
Authors: Kaplan Chelsea M. , Schrepf Andrew , Vatansever Deniz , Larkin Tony E. , Mawla Ishtiaq , Ichesco Eric , Kochlefl Laura , Harte Steven E. , Clauw Daniel J. , Mashour George A. , Harris Richard E.
Published: January 2019

A critical component of brain network architecture is a robust hub structure, wherein hub regions facilitate efficient information integration by occupying highly connected and functionally central roles in the network. Across a wide range of neurological disorders, hub brain regions seem to be disrupted, and the character of this disruption can yield insights into the pathophysiology of these disorders. We applied a brain network–based approach to examine hub topology in fibromyalgia, a chronic pain condition with prominent central nervous system involvement. Resting state functional magnetic resonance imaging data from 40 fibromyalgia patients and 46 healthy volunteers, and a small validation cohort of 11 fibromyalgia patients, were analyzed using graph theoretical techniques to model connections between 264 brain regions. In fibromyalgia, the anterior insulae functioned as hubs and were members of the rich club, a highly interconnected nexus of hubs. In fibromyalgia, rich-club membership varied with the intensity of clinical pain: the posterior insula, primary somatosensory, and motor cortices belonged to the rich club only in patients with the highest pain intensity. Furthermore, the eigenvector centrality (a measure of how connected a region is to other highly connected regions) of the posterior insula positively correlated with clinical pain and mediated the relationship between glutamate + glutamine (assessed by proton magnetic resonance spectroscopy) within this structure and the patient's clinical pain report. Together, these findings reveal altered hub topology in fibromyalgia and demonstrate, for the first time to our knowledge, a neurochemical basis for altered hub strength and its relationship to the perception of pain.
Chronic pain is associated with a brain aging biomarker in community-dwelling older adults
Authors: Cruz-Almeida Yenisel , Fillingim Roger B. , Riley Joseph L. , Woods Adam J. , Porges Eric , Cohen Ronald , Cole James
Published: January 2019

Chronic pain is associated with brain atrophy with limited evidence on its impact in the older adult's brain. We aimed to determine the associations between chronic pain and a brain aging biomarker in persons aged 60 to 83 years old. Participants of the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (N = 47) completed demographic, psychological, and pain assessments followed by a quantitative sensory testing battery and a T1-weighted magnetic resonance imaging. We estimated a brain-predicted age difference (brain-PAD) that has been previously reported to predict overall mortality risk (brain-PAD, calculated as brain-predicted age minus chronological age), using an established machine-learning model. Analyses of covariances and Pearson/Spearman correlations were used to determine associations of brain-PAD with pain, somatosensory function, and psychological function. Individuals with chronic pain (n = 33) had “older” brains for their age compared with those without (n = 14; F[1,41] = 4.9; P = 0.033). Greater average worst pain intensity was associated with an “older” brain (r = 0.464; P = 0.011). Among participants with chronic pain, those who reported having pain treatments during the past 3 months had “younger” brains compared with those who did not (F[1,27] = 12.3; P = 0.002). An “older” brain was significantly associated with decreased vibratory (r = 0.323; P = 0.033) and thermal (r = 0.345; P = 0.023) detection, deficient endogenous pain inhibition (F[1,25] = 4.6; P = 0.044), lower positive affect (r = −0.474; P = 0.005), a less agreeable (r = −0.439; P = 0.020), and less emotionally stable personality (r = −0.387; P = 0.042). Our findings suggest that chronic pain is associated with added “age-like” brain atrophy in relatively healthy, community-dwelling older individuals, and future studies are needed to determine the directionality of our findings. A brain aging biomarker may help identify people with chronic pain at a greater risk of functional decline and poorer health outcomes.
Assessing Knowledge, Attitudes, and Behaviors Regarding Sun Safety in Female Collegiate Athletes
Authors: Shue McGuffin Katherine , Jordan Kathleen , Langford David , Honeycutt Jennifer
Published: January 2019

Across the United States, there is a rising incidence of melanoma in the adolescent and young adult population. Collegiate athletes are at an increased risk of skin cancer because of prolonged, frequent exposure to ultraviolet radiation. The aim of this quantitative study was to evaluate an improvement in knowledge, attitudes, and sun safety behaviors after an educational intervention for female collegiate athletes (N = 81). Data collection occurred in three phases: a pretest was issued before the face-to-face educational intervention and a posttest was issued immediately after the intervention. A final posttest was distributed 3 months after the intervention. After an educational intervention, the collegiate athletes showed an increase in knowledge and an improvement in attitudes and behaviors. The difference in knowledge between the pretest and the posttest was statistically significant (p < .000). The increase in knowledge at the final posttest was also statistically significant (p < .000). After an educational intervention, female collegiate athletes experienced an improvement in knowledge, attitudes, and sun safety behaviors. Establishing routine sun safety education may potentially reduce the risk of melanoma in this vulnerable population.
Development of the Fundamental Training and Evaluation Tool for the Prosthetic Body-Powered Split Hook: A Preliminary Correlational Study
Authors: Nakagawa Masaki , Sasao Kumiko , Ishioka Toshiyuki , Suzuki Makoto , Hamaguchi Toyohiro
Published: January 2019

Introduction

Body-powered split hook training that makes the user focus on somatic sensations may help to improve prosthetic hook operation capacity of individuals with amputation. We have devised the fundamental training for the body-powered split hook (FTBSH) tool, which uses somatic sensations and comprises activities across the domains of time (five items), accuracy (two items), and dexterity (two items), in training for tasks such as opening/closing of body-powered split hook and manipulating objects. We have also devised a tool for assessing the outcomes of this training (FTBSH test).

Materials and Methods

The subjects were 5 men who had undergone below-the-elbow amputations. These subjects underwent skills training for 6 weeks using FTBSH, and subsequently another round of training for 6 weeks using time- and dexterity-related training items.

Results

Verification of the reproducibility of the FTBSH test revealed significantly high consistency and low error for time- and dexterity-related items. However, accuracy-related items did not demonstrate significant consistency. We administered FTBSH for 6 weeks using time- and dexterity-related items. An examination of the sensitivity to clinical change revealed significant changes in time-related items.

Conclusions

These results suggest that time-related items in the FTBSH test are highly reproducible and sensitive to clinical change. Although further studies on the FTBSH are required, the FTBSH shows promise as an effective tool for clinical practice to bring about improvements in operational capacity for individuals with amputation with a prosthetic body-powered split hook.
An Interprofessional Team Experience—Value and Timing in a Doctor of Physical Therapy Curriculum
Authors: Schiller Martha , Gilkey Stephanie , Mendez Jennifer , Dunleavy Kim
Published: January 2019

Introduction.

Intentional interprofessional experiences (IPE) in physical therapy education are needed to address Commission on Accreditation in Physical Therapy Education criteria and ensure student readiness for practice. The purpose of this study was to compare Doctor of Physical Therapy (DPT) student perceptions of participation in an older adult interprofessional team visit (IPTV) between 3 cohorts at different points in the professional entry level curriculum.

Methods.

A retrospective comparison of different cohorts was possible at different time points due to curricular changes. Ninety one DPT students in 3 cohorts from 2013 to 2015 participated in the same IPTV experience format in their first, second or third year of the professional program. Doctor of Physical Therapy students were matched with students from 2 disciplines. All participated in a team and discipline-specific orientation and debriefing and completed an assessment with an older adult living in the community and a prequestionnaire/postquestionnaire. Results from postvisit surveys were examined using nonparametric statistics, and open-ended questions were coded and analyzed for themes. Responses were compared for differences across the 3 years.

Results.

There were significant differences across cohorts. Student reflections were positive with themes emerging across all cohorts for communication, teamwork, and learning. First-year students reported the greatest overall agreement for all learning outcome statements in comparison to the second or third cohort of students.

Discussion and Conclusions.

The IPTV experience provided a unique opportunity for students to work in an interprofessional team while learning about issues experienced by community dwelling older adults. The activity was ideal to provide early active community participant exposure and meet curricular objectives for communication strategies but could be used for the team-based interprofessional objectives at any stage. While student perceptions of the activity were very positive for all cohorts, this activity was valued by the first-year group more than second or third years. Timing and design of community-based IPE activities should be intentionally sequenced to meet learning objectives suitable for the stage of professional development and take into account exposure to patient care as well as other logistical and curricular sequencing to maximize learning and motivation.
Data-Driven Decision-making in DPT Curricula Part II: Course-Level Analysis
Authors: Leard John , Wininger Michael , Roller Dawn , Crane Barbara
Published: January 2019

Background and Purpose.

In a physical therapist entry-level education program, there is need for continuous monitoring of student progress toward degree completion and forecasts of potential roadblocks. We propose a method by which a course instructor can provide reasonable estimates of final course performance in real time, so that the student and instructor together can make data-driven decisions regarding next steps. Our primary goal was to apply this method to a course that had a high correlation of successful performance to first time pass rate on the National Physical Therapy Examination exam. Our secondary goal was to replicate this methodology in additional classes to further determine utility of this method.

Method/Model.

We have developed a methodology, using a simple algebraic framework, based on individual assessment grades (quizzes or tests) in any particular course, which can provide a student with a final grade prediction within two or four points to encourage conversation with the student and guide the student early in the semester.

Description and Evaluation.

To validate this approach, a retrospective analysis of course grades in one course across five Doctor of Physical Therapy (DPT) cohorts was performed and the technique was replicated using additional courses at the graduate and undergraduate levels.

Outcomes.

By Quiz 2, the final grade is predictable for 82 ± 13% of the students to within a 2-point margin and for 90 ± 9% of students to within a 4-point margin. Thus, with only 9.5% of the total grade determined and 83% of the time remaining in the semester, average prediction utility was greater than 80%. Prediction utility varied over time, and by margin, but is generally near 80% throughout the semester in the narrow margin (2 points; coefficient of variation = 0.13 ± 0.04) and greater than 90% in the wide margin (4 points; coefficient of variation = 0.05 ± 0.03).

Discussion and Conclusion.

We show that course performance can be predicted with high utility and with maximal time for intervention. We provide an evidence-based approach to guide the tandem investment in success, as shared between student and school. We believe that regular monitoring of course performance as described here may provide increased opportunity to intervene with remediation activities and foster better student success within a course, enhancing the probability of successful and timely program completion.
The transformation of health care for patients: Information and communication technology, digiceuticals, and digitally enabled care
Authors: Downes Elizabeth , Horigan Ann , Teixeira Patrick
Published: January 2019

The way patients access care and interact with health care systems is rapidly changing through the use of information and communication technology (ICT). Health care is being transformed through digital innovations, such as wearable technology, remote monitoring, patient portals, mobile applications (apps), and new service models such as telemedicine and virtual visits. Through a review of the current literature, this article presents the use of digitally enabled tools and ICT, including electronic health records, telehealth, remote patient monitoring, and mobile health apps. These effective and innovative digitally enabled tools have expanded options for patients interested in actively engaging in their own health. Information and communication technology can improve health outcomes, enhance the patient experience, and curtail costs. Providers must stay fluent with ICT options to best collaborate with patients. Although providers recognize that patient-centered care can improve effectiveness and efficiency, many have been slow to incorporate digital therapeutics, or “digiceuticals,” into practice.
Implementation of an obstructive sleep apnea screening tool with hypertensive patients in the primary care clinic
Authors: Showalter Laura , O'Keefe Catherine
Published: January 2019

Background and Purpose:

Patients with severe obstructive sleep apnea (OSA) have an almost 4-fold higher odds of resistant hypertension than those with less severe OSA. Obstructive sleep apnea screening practices in primary care are deficient. Additional study is needed regarding the value of OSA screening in hypertensive adults who present to the primary care clinic.

Methods:

This was a convenience sample of adults with hypertension from a rural primary care clinic in Iowa. Staff identified patients who met the inclusion criteria for the project. The STOP-Bang Questionnaire was used to screen the patients for OSA. Providers subsequently used discretion as to ordering polysomnography (PSG).

Conclusions:

Thirty-two patients were screened over a 3-month time period. All of the men included in the study scored either high or intermediate risk for OSA. Forty percent of the study participants scored high risk for OSA, with 33% of those participants referred for PSG. At project conclusion, three participants had undergone PSG testing, and all were diagnosed with sleep apnea.

Implications for Practice:

To ensure timely diagnosis and treatment of OSA, primary care providers should consider screening all hypertensive adults for OSA. With compulsory screening and subsequent identification and treatment of patients with OSA, nurse practitioner providers can pave the way in reducing mortality and morbidity associated with OSA, as well as resistant hypertension.
Implementation of pulmonary ultrasound training for critical care advanced practice providers
Authors: Leibenguth Emily , Magdic Kathy , Loeslie Vicki , Yadav Hemang , Guttendorf Jane
Published: January 2019

Background and purpose:

The use of pulmonary ultrasound (US) in the critical care setting has been increasing over the past 2 decades. The use of advanced practice providers (APPs) in the critical care setting is also increasing. Limited data exist regarding the clinical and educational impact of a formal pulmonary US training course for APPs working in critical care settings.

Methods:

A preimplementation and postimplementation comparative design focused on the development and implementation of a formal pulmonary US course for novice critical care APPs.

Conclusions:

Eleven APPs underwent formal pulmonary US training. There was a significant increase in pulmonary US knowledge after the course, with pretest median of 13 and posttest median of 22 (p < .001; maximum score = 23). Presurvey and postsurvey comparison showed overall increase in skill and clinical use of pulmonary US. After the course, participating APPs reported a greater frequency of clinical decision-making based on US examination as measured by presurvey and postsurvey results.

Implications for practice:

Implementation of a formal pulmonary US course for critical care APPs improved pulmonary US knowledge, skill, and utilization, and impacted clinical decision-making and should be a highly recommended addition to the practice setting.
Predictors of gastrointestinal bleeding in older persons taking nonsteroidal anti-inflammatory drugs: Results from the FDA adverse events reporting system
Authors: McDonald Deborah Dillon
Published: January 2019

Background and purpose:

Older adults continue to take nonsteroidal anti-inflammatory drugs (NSAIDs) to manage chronic pain. The study's purpose was to identify predictors of gastrointestinal (GI) bleeding in older adults taking NSAIDs.

Methods:

A secondary analysis of the 2016 Food and Drug Administration's Adverse Events Reporting System data was conducted with 1,347 cases aged 65 years and older with an NSAID as the primary suspect for an adverse drug event (ADE). Data included age, sex, NSAID, multiple NSAID use, rivaroxaban, warfarin, clopidogrel, cardiovascular drug (proxy for cardiovascular disease), diabetes drug (proxy for diabetes mellitus), and primary adverse drug response.

Conclusions:

Aspirin was the primary suspect NSAID in 72.5% of cases. Rivaroxaban was taken in 67.9% of cases. Logistic regression was conducted to predict GI bleed versus other NSAID-related ADEs with age, sex, cardiovascular medication, diabetes medication, warfarin, clopidogrel, concurrent NSAID use, aspirin, and rivaroxaban as predictors. Aspirin, rivaroxaban, and concurrent NSAID were significant predictors of GI bleed. Gastrointestinal bleed risk versus other ADE risk increased by 39.77 times when taking aspirin, rivaroxaban, and another NSAIDs concurrently.

Implications for practice:

Results support reduced NSAID use by older adults, especially aspirin, and avoidance of rivaroxaban in older persons taking NSAIDs.
Implementation of alcohol and drug screening, brief intervention, and referral to treatment: Nurse practitioner learner perspectives on a mobile app
Authors: Curtis Alexa C. , Satre Derek D. , Ly Khanh , Wamsley Maria , Satterfield Jason
Published: January 2019

Background and purpose:

Screening, brief Intervention, and referral to treatment (SBIRT) is a widely trained evidence-based strategy to identify and address alcohol and drug use problems. The purpose of this qualitative study was to explore the experience of family nurse practitioner (FNP) learners in the implementation of SBIRT and the perceived clinical utility of an SBIRT mobile app.

Methods:

Twenty-two FNP learners completed didactic SBIRT training and orientation to an SBIRT mobile app. At the conclusion of the study, participant focus groups explored overall SBIRT delivery (N = 19) and SBIRT mobile app utilization (N = 14). Focus group data were analyzed within a Theory of Planned Behavior framework.

Results:

Participants indicated that the mobile app was useful in the ongoing development of SBIRT knowledge, skill confidence, and motivation. Learners identified the clinical context as a major factor in facilitating the delivery of SBIRT overall. Participants who did not deliver SBIRT indicated that the most significant barriers to SBIRT implementation were lack of support from clinical preceptors and health systems.

Conclusions:

Findings suggest that a mobile app is an acceptable and feasible tool to improve the delivery of SBIRT. However, collaboration with preceptors and clinical training organizations is essential to optimize clinical translation.
Clinical Validity of Quantified Visually Enhanced Vestibulo-ocular Reflex Test to Detect Horizontal Semicircular Canal Hypofunction
Authors: Rey-Martinez Jorge , Ninchritz Elisabeth , Palicio Idoia , Goiburu Miren , Casado Carmen Maria , Altuna Xabier
Published: January 2019

Objective:

To investigate the clinical validity of the mathematical measured VVOR test results to detect horizontal semicircular canal hypofunction.

Study Design:

Prospective, nonrandomized, observational study.

Setting:

Tertiary referral center, hospital.

Patients:

Consecutive patients on first time visit to otoneurology unit.

Intervention(s):

Diagnostic.

Main Outcome Measure(s):

Values of statistical indicators of clinical validity for VVOR test to detect horizontal canal hypofunction were used considering vHIT horizontal aVOR gain values as gold standard.

Results:

Area under curve of ROC curve for quantified VVOR testing was 0.92. Head movement frequency on VVOR test and contralateral VVOR gain were identified as significant influence factors of (unilateral) VVOR gain (p < 0.0001) on statistical linear model.

Conclusions:

According to the obtained results, the quantified VVOR test has excellent clinical validity for detecting angular horizontal VOR hypofunction.
A Histopathologic Comparison of Eustachian Tube Anatomy in Pediatric and Adult Temporal Bones
Authors: Noonan Kathryn Y. , Linthicum Fred H. , Lopez Ivan A. , Ishiyama Akira , Miller Mia E.
Published: January 2019

Hypothesis:

In children, the distance between the carotid canal (CC) and Eustachian tube (ET) is not significantly narrower than the adult population.

Background:

ET dysfunction treated with ET dilation is FDA approved for adults. Several studies describe the close relationship between the CC and the ET in adults, but the anatomy of the ET has not been well defined in children. This study seeks to investigate these relationships in the pediatric population.

Methods:

Histologic sections from 23 temporal bones of pediatric patients ages 0 to 18 were reviewed by two independent observers. The distance between the CC and the cartilaginous Eustachian tube (CET), bony-cartilaginous junction (BCJ), and bony Eustachian tube (BET) were measured. Fifteen adult temporal bones were used as a control group.

Results:

The distance to the CC was narrowest at the BET, and was actually higher in the pediatric population when compared to adults (0.5 mm and 0.2 mm, respectively, p = 0.06). The CC-CET distance was smaller in the pediatric group (2.3 mm vs 3.3 mm, p < 0.01). The bony-cartilaginous junction is often the region of most concern during dilation. There was no significant difference between the CC-BET distance in pediatric and adult groups (1.9 vs 2.3 mm, p = 0.20).

Conclusions:

CET-CC is smaller in the pediatric population, as expected due to smaller anatomic structures. However, the variable incline of the ET results in a CC-BCJ distance that is similar to the adult population. Although imaging studies are necessary.
Lupus and Left Ventricular Assist Devices: High-Risk for Bleeding?
Authors: Gage Ann , Blumer Vanessa , Joyce Emer
Published: January 2019

Continuous-flow left ventricular assist devices (LVAD) have become an increasingly utilized treatment strategy for patients with end-stage heart failure. Despite the improved outcomes evident with current generation pumps, proper patient selection remains crucial to minimize the risk of potential adverse events. The evolving use of these devices as destination therapy (DT) has led to growing numbers of patients with higher risk comorbid conditions being evaluated as potential LVAD candidates. Understanding which patient and disease-specific characteristics increase postoperative morbidity and mortality is paramount as this technology continues to expand and the experience with select populations remains limited. Presented here is a case of a patient with systemic lupus erythematosus receiving a HeartWare LVAD as DT complicated by recurrent, diffuse spontaneous bleeding. The case presented here highlights a potential unique bleeding complication in a high-risk patient cohort and underscores the need to enhance our understanding of factors influencing outcomes in high-risk populations after LVAD therapy.
A giant aggressive angiomyxoma of vulva in a young woman
Authors: Xie Yao , Qian Yanping , Zou Bingyu
Published: January 2019

Rationale:

Aggressive angiomyxoma (AAM) is a rare and benign invasive mesenchymal stromal tumor predominantly in women at reproductive age. AAM tends to relapse locally and should be differentially diagnosed from other mesenchymal tumors.

Patient concerns:

We report here a rare case of massive vulvar AAM in a 22-year-old Chinese woman with left labia majora mass with ulcer.

Diagnoses:

The diagnosis “aggressive angiomyxoma of vulva” was based on clinicopathologic and immunohistochemical features.

Interventions:

A surgery with local excision of the mass was performed.

Outcomes:

The patient was discharged 12 days after the surgery. There was no AAM recurrence or metastasis in a period of 12-month follow-up.

Lessons:

The vulvar AAM is a benign and aggressive mesenchymal tumor. In this case, we present the diagnosis, treatment, and prognosis for vulvar AAM. The tumor was removed completely by the surgery, but a long-term follow-up is requisite for surveilling on recurrence.
Neuroacanthocytosis with unusual clinical features
Authors: Zhu Hui , Feng Xue-min , Zhao Teng , Liu Jing-yao
Published: January 2019

Rationale:

Neuroacanthocytosis (NA) is a heterogeneous group of inherited neurodegenerative disorders characterized by misshapen spiculated erythorcytes and symptoms that resemble Huntington's disease.

Patient concerns:

A 59-year-old female who developed hyperkinetic involuntary movements that became progressively more obvious during the course of a year.

Diagnoses:

Acanthocytes were observed in a peripheral blood smear. The patient had elevated levels of serum creatine kinase (CK). Gene sequencing did not reveal a genetic mutation.

Interventions:

The patient was administered oral tiapride, alprazolam, B1 and B12 Vitamins.

Outcomes:

After 2 months of treatment the patient's symptoms were obviously alleviated. At the 6 month follow-up, the patient could feed herself and walk without assistance.

Lessons:

The NA syndrome is extremely rare. It may be identified in the clinic based on abnormal orofacial movement, chorea, cognitive decline, elevated CK levels, and acanthocytosis. If available, protein- or genetic-based testing may provide a confirmatory diagnosis.
A randomized controlled trial of neuromuscular electrical stimulation for chronic urinary retention following traumatic brain injury
Authors: Zhang Yong-bing , Cheng Yan-na
Published: January 2019

Background:

This study aimed to evaluate the effectiveness of neuromuscular electrical stimulation (NMES) therapy for chronic urinary retention (CUR) following traumatic brain injury (TBI).

Methods:

This 2-arm randomized controlled trial (RCT) enrolled 86 eligible patients with CUR following TBI. All included patients were randomly allocated to a treatment group (n = 43) or a sham group (n = 43). The administration of NMES or sham NMES, as intervention, was performed for an 8-week period treatment, and 4-week period follow-up. In addition, all subjects were required to undergo indwelling urinary catheter throughout the study period. The primary outcome was assessed by the post-voiding residual urine volume (PV-VRU). The secondary outcomes were evaluated by the voided volume, maximum urinary flow rate (Qmax), and quality of life, as assessed by Barthel Index (BI) scale. In addition, adverse events were also recorded during the study period. All primary and secondary outcomes were measured at baseline, at the end of 8-week treatment, and 4-week follow-up.

Results:

At the end of 8-week treatment, the patients in the treatment group did not achieve better outcomes in PV-VRU (P = .66), voided volume (P = .59), Qmax(P = .53), and BI scores (P = .67), than patients in the control group. At the end of 4-week follow-up, there were also no significant differences regarding the PV-VRU (P = .42), voided volume (P = .71), Qmax(P = .24), and BI scores (P = .75) between 2 groups. No adverse events occurred in either group.

Conclusions:

In summary, the findings of this study showed that NMES therapy may not benefit patients with CUR following TBI.
D-hole breakage of 2 angular stable locking plates for medial opening-wedge high tibial osteotomy
Authors: Nha Kyung-Wook , Jung Woon-Hwa , Koh Young-Gon , Shin Young-Soo
Published: January 2019

An adequate stable fixation implant should be used for medial opening-wedge high tibial osteotomy (MOWHTO) to promote rapid bone healing without complications. To date, the highest fixation stability has been observed for angular stable locking plates. However, there is still little medical literature regarding breakage of these plates. The purpose of the present study was to report the results of plate breakage around D-hole with the use of both types of locking plate fixation for MOWHTO.

Medical records of 12 patients who experienced plate breakage after MOWHTO with either a TomoFix or OhtoFix plate between August 2013 and August 2016 were retrospectively reviewed.

A total of 12 patients (7 males and 5 females) who experienced plate breakage at the screw hole just above the osteotomy were evaluated (age, 63 ± 8 years; body mass index (BMI), 28 ± 2 kg/m2; opening gap height, 12 ± 2 mm). There were 9 patients (75%) with plate breakage and loss of correction necessitating revision surgery, and 11 patients (92%) had lateral cortical hinge fractures postoperatively. Of the 9 patients with loss of correction necessitating revision surgery, 4 had a TomoFix plate and 5 had an OhtoFix plate. The only statistically significant association with broken plates lost reduction was the presence of lateral cortical hinge fractures (P = .003), but there was no significant association with age, gender, BMI, diabetes, smoking, plate type, opening gap height, and material used to fill the wedge. In addition, mean knee society score in the 12 patients was significantly higher postoperatively than preoperatively (P < .001).

Since the amount of plate breakage was just over 1% and with only 12 in total, no true conclusion can be made with certainty. However, in the face of no lateral hinge or cortical disruption, there is a 99% success rate with the plate described. If the lateral hinge is disrupted, a restriction of activity or weight bearing may be needed.
Liver stiffness measurement changes following hepatocellular carcinoma treatment with percutaneous microwave ablation or transarterial chemoembolization: a cohort study
Authors: Abdelaziz Ashraf O. , Abdelhalim Hanan , Elsharkawy Aisha , Shousha Hend I. , Abdelmaksoud Ahmed H. , Soliman Zeinab A. , Seif Mohamed I. , Sayed Dina B. , Farouk Mohamed H. , Elbaz Tamer M. , Nabeel Mohamed M.
Published: January 2019

Background

Liver stiffness increases after the development of hepatocellular carcinoma (HCC). Transient elastography for liver stiffness measurement (LSM) using fibroscan is a simple noninvasive method of proven efficacy. This study aims to assess the changes in LSM following HCC treatment.

Patients and methods

This study included 150 patients with hepatitis C virus related HCC attending the multidisciplinary HCC clinic, Kasr Al-Ainy Hospital between March 2014 and October 2015 who underwent either transarterial chemoembolization (TACE) or microwave ablation (MWA). Baseline LSM was carried out 3 and 6 months after treatment. The response rate was calculated according to the modified Response Evaluation Criteria in Solid Tumors criteria; overall survival and LSM changes were then compared between the two procedures.

Results

MWA showed higher rates of complete ablation (77.4%) than did TACE (31.7%) (P=0.004). Increase in LSM 3 and 6 months after treatment was statistically significant in the TACE group (P<0.001) but not in the MWA group (P=0.4). Patients who showed complete ablation had statistically significant lower baseline LSM than those with incomplete ablation, and their 6 months increase in LSM was also significantly lower. Logistic regression revealed that with each unit increase in baseline stiffness, 3% reduction in the odds of complete ablation is expected, and this did not change after controlling for the type of treatment. Child–Pugh class, number, and size of HCCs were our independent prognostic factors by Cox proportional analysis.

Conclusion

The increase in LSM is significant after TACE than after MWA. Moreover, lower pre-ablation LSM is a predictor of complete ablation.
Prophylactic efficacy of a novel method against postendoscopic papillary balloon dilation pancreatitis
Authors: Natsui Masaaki , Aoki Yohei , Oka Hiromitsu , Tsuboi Kiyotaka , Tsubata Shunsuke , Yoko Kazumi , Sato Toshifumi
Published: January 2019

Objective

This study aimed to investigate whether a novel method including prophylactic pancreatic stent (PS) placement prevents postendoscopic papillary balloon dilation pancreatitis.

Patients and methods

This study enrolled 200 consecutive patients with bile duct stones measuring up to 8 mm in diameter and retrospectively recruited 113 patients undergoing ordinary endoscopic papillary balloon dilation (EPBD) without PS placement from our previous study. In the novel method, EPBD and PS placement was attempted with a guidewire left in the main pancreatic duct for patients in whom stable guidewire placement in the main pancreatic duct was possible. EST was performed for patients in whom stable guidewire placement was impossible. The incidence rate of pancreatitis was compared between the novel method and ordinary EPBD, and risk factors for pancreatitis were analyzed.

Results

Of 194 patients undergoing the novel method, EPBD and EST were performed in 180 and 14 patients, respectively. Following EPBD, PS placement was successful in 177/180 (98.3%) of patients. Pancreatitis occurred in 7/194 (3.6%) of patients after the novel method and 9/113 (8.0%) of patients after ordinary EPBD. There was a trend toward lower incidence rate of pancreatitis in the novel method. Stent dislodgement by the first postoperative morning and no previous endoscopic nasobiliary drainage (ENBD) were identified as risk factors for pancreatitis after EPBD with PS placement. No previous ENBD was also identified as a risk factor for pancreatitis after ordinary EPBD.

Conclusion

Our novel method is likely to be superior to ordinary EPBD in preventing pancreatitis. Previous ENBD may prevent post-EPBD pancreatitis regardless of PS placement.