bluuebunny/crossref_metadata_2025 huggingface dataset:
How Social Psychological Factors May Modulate Auditory and Cognitive Functioning During Listening
Authors: Pichora-Fuller M. Kathleen
Published: July 2016

The framework for understanding effortful listening (FUEL) draws on psychological theories of cognition and motivation. In the present article, theories of social-cognitive psychology are related to the FUEL. Listening effort is defined in our consensus as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task that involves listening. Listening effort depends not only on hearing difficulties and task demands but also on the listener’s motivation to expend mental effort in challenging situations. Listeners’ cost/benefit evaluations involve appraisals of listening demands, their own capacity, and the importance of listening goals. Social psychological factors can affect a listener’s actual and self-perceived auditory and cognitive abilities, especially when those abilities may be insufficient to readily meet listening demands. Whether or not listeners experience stress depends not only on how demanding a situation is relative to their actual abilities but also on how they appraise their capacity to meet those demands. The self-perception or appraisal of one’s abilities can be lowered by poor self-efficacy or negative stereotypes. Stress may affect performance in a given situation and chronic stress can have deleterious effects on many aspects of health, including auditory and cognitive functioning. Social support can offset demands and mitigate stress; however, the burden of providing support may stress the significant other. Some listeners cope by avoiding challenging situations and withdrawing from social participation. Extending the FUEL using social-cognitive psychological theories may provide valuable insights into how effortful listening could be reduced by adopting health-promoting approaches to rehabilitation.
Results and complications in elderly patients with acetabular fractures
Authors: Scarcella Nicholas , Schnaser Erik , Vallier Heather A.
Published: July 2016

Background:

The frequency of acetabular fractures in elderly patients is rising over time. The group presents with underlying challenges including osteoporosis, medical comorbidities, and varying levels of baseline physical and cognitive function. The purposes of this study were to characterize such patients and to determine rates of complications and secondary operations. We propose to identify injury and treatment features associated with optimal recovery.

Methods:

One hundred and ninety-three patients over the age of 60 with acute acetabular fractures were retrospectively reviewed over 12 yr. Complications, mortality, and secondary operations were documented for 171 patients with complete records and mean 18.5 mo follow-up. Ninety-one were treated operatively.

Results:

Patients who underwent open reduction and internal fixation had a mean age of 73 yr (vs. 69 yr, P=0.0003) and mean Injury Severity Score of 28.4 (vs. 15.7, P=0.001), consistent with higher-energy injuries and unstable fracture patterns compared to patients treated nonoperatively. Twenty-two percent developed early complications, with a trend toward a higher rate in patients treated surgically (27% compared to 16%, P=0.057). After open reduction and internal fixation, posttraumatic arthrosis and conversion to total hip arthroplasty occurred in 18% and 14%, respectively, compared to 3.8% of patients who had nonoperative care (both P<0.02). Mortality at 1 yr was 9.9% and at 5 yr was 29.5%, increasing with greater age.

Conclusions:

Additional research into efforts to expedite open reduction and internal fixation in stable patients with unstable fracture patterns may minimize complications by promoting mobility from bed. Further study to define patients better suited for nonoperative management is needed, as is investigation into the role of acute total hip arthroplasty or minimally invasive methods of reduction and fixation.
Second Place Award Immediate versus delayed operative treatment of low-energy tibial plateau fractures
Authors: Ellsworth Harold Scott , Dubin Jonathan R. , Shaw Christopher M. , Alongi Sadie M. , Cil Akin
Published: July 2016

Background:

Current management of tibial plateau fractures requires careful soft-tissue management. Often a staged approach with temporary external fixation followed by delayed internal fixation is recommended. While proven in high-energy injuries, its relevance in treating low-energy fractures has not been investigated. The goal of the current study was to assess the short-term complication rates in low-energy tibial plateau fractures treated early (<48 hr). As a secondary aim, we investigated whether surgical approach would affect rates of wound complications.

Methods:

This is a retrospective analysis of patients treated operatively for low-energy tibial plateau fractures at a level-1 urban trauma center between January 1, 2000 and January 1, 2010. Schatzker type 1-3 fractures were considered “low-energy,” despite stated mechanism. Statistical analysis was performed using chi-square and Fischer’s exact tests.

Results:

We analyzed 49 patients. From these, 29 received early (<48 hr) definitive surgery, while 20 had surgery delayed (>48 hr). The early treatment group had an infection rate of 3.4% and total complication rate of 20.6%. The delayed treatment group had an infection rate of 5.0% and total complication rate of 25%. There was no significant difference with respect to superficial infection (P=1.0), deep infection (P=0.48), or total complications (P=0.74) Additionally, infection rates did not differ between surgical approaches (P=1.0, 1.0).

Conclusions:

Early surgical fixation (<48 hr) of low-energy tibial plateau fractures can be performed safely. Additionally, a midline approach did not increase soft-tissue complications and could be utilized in a patient with a prior midline incision, or one who will soon require a knee arthroplasty.
Clinical indications for CT angiography in lower extremity trauma
Authors: Patterson Joseph T. , Fishler Thomas , Bohl Daniel D. , Piper Greta L. , Leslie Michael P.
Published: July 2016

Background:

Missed vascular injuries in lower extremity trauma may lead to a preventable lower extremity amputation. CT angiography (CTA) is an accurate and expedient, but costly and potentially harmful, test for vascular injury in lower extremity trauma. Specific physical examination findings and injury patterns may be predictive of detection of a vascular injury by CTA and could guide CTA use in lower extremity trauma.

Methods:

This was a retrospective review of consecutive trauma patients at an academic level 1 trauma center who underwent CTA of a lower extremity from January 2006 through December 2012. The positive predictive values of injury pattern and physical examination signs for CTA detection of a vascular injury and vascular intervention, adherence to published guidelines for CTA use, and CTA-related adverse events were assessed.

Results:

Diagnostic CTA studies demonstrated a vascular injury in 55.6%. A vascular intervention followed in 13.9%, while 5.6% of studies led to a contrast-related adverse event. The positive predictive value of a CTA affecting treatment was significantly higher in the presence of high-risk injuries and hard examination findings than in the presence of low-risk injuries and soft examination findings (84.6%, 95% CI [54.6–98.1%] vs. 16.7%, 95% CI [3.6–41.1%]). Palpable pulses and ankle brachial index (ABI)>0.9 led to observational management without complications, regardless of CTA findings or other signs of vascular injury.

Conclusions:

The utility of CTA is improved by assessing the pretest positive predictive value of vascular injury from injury pattern and physical examination. The Eastern Association for the Surgery of Trauma guidelines may miss some vascular injuries in patients with high-risk injuries and normal ABI. CTA is not indicated in lower extremity trauma when physical examination and injury pattern do not suggest a vascular injury.
Analysis of needle type for musculoskeletal lesion biopsy: results of a novel steerable needle
Authors: Palisch Andrew , Patel Raj G. , Gutowski Christina , Zoga Adam C. , Colucci Phillip , O’Hara Brian J. , Roberts Catherine C. , Abraham John
Published: July 2016

Background:

Needle biopsy has proven to be a potentially adequate method for initial biopsy of many soft-tissue and bone lesions. To help optimize this procedure, this study sought to test the characteristics of several needles, including a steerable needle.

Materials and Methods:

Five needle types were tested, including a steerable needle. Animal muscle tissue was used for all testing. The following experiments were performed: (1) sample collection with different needle types, (2) histological analysis of needle track, (3) observation of steerable needle characteristics using CT-guidance.

Results:

Sample collection: The Menghini 21 g and Chiba 22 g needles were graded as excellent for ease of use and integrity of sample. Histologic evaluation showed good specimen preservation with all needle types. Histological analysis of needle track: tracks created by the Menghini 21 g and Spinal 20 g needles both showed no histologically detectable damage to surrounding tissue. Observation of steerable Menghini needle under CT-guidance: needle advanced easily through tissue, even when maximally curved. Small, large, and double curves were feasible to avoid obstacles and reach targets. There was no deflection or change in position of the needle tip when the stylet was removed. Needle withdrawal did not damage surrounding tissue.

Conclusions:

Compared to the other needles, the steerable needle was found to be durable and easy to use, allowing for precise navigation around vital structures yielding superior integrity of sample tissue.
PROMIS Computer Adaptive Tests Compared With Time to Brake in Patients With Complex Lower Extremity Trauma
Authors: Kim Chang-Yeon , Wiznia Daniel H. , Averbukh Leon , Torres Andrea , Kong Edward , Kim Seewan , Leslie Michael P.
Published: July 2016

Objectives:

To compare the PROMIS Physical Function and Pain Interference Computer Adaptive Tests (PROMIS PF CAT and PROMIS PI CAT) with time to brake (TTB) in patients with complex lower extremity traumas for evaluating whether patients can safely return to driving.

Design:

Prospective.

Setting:

Level-1 trauma center.

Patients:

Sixty-three patients with lower extremity injuries to the pelvis, acetabulum, hip, femur, knee, tibia/fibula, ankle, and foot within 15 weeks of treatment.

Intervention:

The TTB of patients with complex lower extremity trauma were tested at various time points postoperatively on a computerized driving simulator. Patients concurrently completed PROMIS PF CAT and PROMIS PI CAT.

Main Outcome Measure:

Correlations between TTB, PROMIS PF CAT, and PROMIS PI CAT.

Results:

The mean TTB for the healthy control group was 0.61 seconds. There was a statistically significant correlation between time since treatment and TTB (B = −0.008 s/d; P = 0.041) for right-sided lower extremity injuries below the knee (tibia/fibula, ankle, foot). TTB for right-sided injuries below the knee also significantly correlated with PROMIS PI CAT (B = 0.022; P = 0.029). The PROMIS PI CAT value was 43 when the healthy control group TTB was equal to 0.61 seconds.

Conclusions:

This study suggests that the PROMIS PI CAT can be used as an adjunct to the TTB in assessing whether a patient can safely return to driving.
The management of residual acetabular dysplasia: updates and controversies
Authors: Mansour Elie , Eid Roy , Romanos Elie , Ghanem Ismat
Published: July 2016

Residual acetabular dysplasia is a frequent cause of secondary osteoarthritis of the hip and its management is still controversial. The aim of this review is to describe residual acetabular dysplasia, to estimate the age limit above which surgical management is needed, and to emphasize the role of assistive imaging in evaluating predictive parameters for future acetabular development. A decision-making algorithm is presented.
Tissue Bioengineering in the Treatment of Osteochondritis Dissecans of the Talus in Children With Open Physis: Preliminary Results
Authors: Pagliazzi Gherardo , Baldassarri Matteo , Perazzo Luca , Vannini Francesca , Castagnini Francesco , Buda Roberto
Published: July 2016

Background:

Juvenile osteochondritis dissecans of the talus (JOCDT) is a focal idiopathic lesion primarily of the subchondral bone leading to subsequent cartilaginous damage. The majority of the papers dealing with JOCDT reported heterogeneous case studies of patients treated with different cartilage repair techniques. The purpose of this paper is to retrospectively review both clinical and radiologic results among 7 patients affected by JOCDT treated with arthroscopic bone marrow aspirate concentrate (BMAC) transplantation with the 1-step technique.

Methods:

Both standard anterior-posterior and lateral radiographs and a 1.5 T magnetic resonance imaging of the affected ankle were preoperatively performed in all the patients. The American Orthopaedic Foot and Ankle Society (AOFAS) score and the visual analogue scale were administered to the patients preoperatively and at the final follow-up.

Results:

Patients were followed up to an average of 48.1±18.4 months. According to the Berndt and Harty classification, 6 lesions were found to be in stage III and 1 lesion in stage IV. The average preoperative AOFAS score was 58.8±7.6 points. At the mean follow-up of 48.1 months the average AOFAS score improved to 95.7±5.4 points (P<0.05). Visual analogue scale improved from 6.3 preoperatively to 0.4 at final follow-up (P<0.05). Complete radiographic healing, in terms of complete bony filling, was observed in 3 of 7 cases. The magnetic resonance imaging analysis showed a complete filling of the osteochondral defect in 4 patients, whereas in 1 patient a hypotrofic tissue was observed.

Conclusions:

BMAC transplantation is able to provide good to excellent results in the treatment of JOCDT. The 43% of our patients showed a complete radiographic healing, but all the patients were satisfied with the procedure. Because of the rareness of the lesion, further studies involving more patients and with a longer follow-up are required, to establish the advantage of performing a regenerative procedure like the BMAC transplantation in a pediatric population.

Level of Evidence:

Level IV.
How Many Patients Who Have a Clubfoot Treated Using the Ponseti Method are Likely to Undergo a Tendon Transfer?
Authors: Zionts Lewis E. , Jew Michael H. , Bauer Kathryn L. , Ebramzadeh Edward , Sangiorgio Sophia N.
Published: July 2016

Background:

The Ponseti method has become the standard of care for the treatment of idiopathic clubfoot. A commonly reported problem encountered with this technique is a relapsed deformity that is sometimes treated in patients older than 2.5 years by an anterior tibial tendon transfer (ATTT) to the third cuneiform. Presently, there is insufficient information to properly counsel families whose infants are beginning Ponseti treatment on the probability of needing later tendon transfer surgery.

Methods:

All idiopathic clubfoot patients seen at the authors’ institution during the study period who met the inclusion criteria and who were followed for >2.5 years were included (N=137 patients). Kaplan-Meier Survival analysis was used to determine the probability of survival without the need for ATTT surgery. In addition, the influence of patient characteristics, socioeconomic variables, and treatment variables on need for surgery was calculated.

Results:

On the basis of the survivorship analysis, the probability of undergoing an ATTT remained below 5% for all patients at 3 years of age, but exceeded 15% by 4 years of age, increasing steadily afterwards such that by 6 years of age, the probability of undergoing an ATTT reached 29% of all patients. Overall, controlling for all other variables in the analysis, parent-reported adherence with bracing reduced the odds of undergoing surgery by 6.88 times, compared with parent-reported nonadherence (P<0.01).

Conclusions:

This is the first study to report the probability of undergoing ATTT surgery as a function of age using survivorship analysis following Ponseti clubfoot treatment. Although the overall probability reached 29% at 6 years, this was significantly reduced by compliance with bracing. This information may be useful to the clinician when counseling families at the start of treatment.

Level of Evidence:

Level III—theraputic.
Complications After Plate Fixation of Displaced Pediatric Midshaft Clavicle Fractures
Authors: Li Ying , Helvie Peter , Farley Frances A. , Abbott Matthew D. , Caird Michelle S.
Published: July 2016

Background:

Operative treatment of displaced pediatric midshaft clavicle fractures has become increasingly popular, despite lack of evidence that surgical management leads to superior outcomes. Complications, such as plate irritation necessitating removal and wound infection, have been reported in adults. The purpose of this study was to evaluate complications after plate fixation of midshaft clavicle fractures in the pediatric population.

Methods:

We retrospectively identified patients 10 to 18 years old who had undergone plate fixation of a displaced midshaft clavicle fracture between 2009 and 2014. Patients who had surgery for a malunion or nonunion, and patients with <6 months of follow-up were excluded. Demographic data, radiographic union, time to return to activity, and complications were recorded. Any complication that led to unplanned surgery was considered a major complication.

Results:

We analyzed 36 patients (25 males, 11 females) with 37 fractures. The average age at surgery was 14.5±1.7 years and mean follow-up was 1.3±1.0 years. All of the fractures healed and average time to return to activity was 58±28 days. The overall postoperative complication rate was 86% (32/37): 59% (22/37) implant prominence or irritation, 16% (6/37) anterior chest wall numbness, 5% (2/37) superficial wound dehiscence or infection, 3% (1/37) refracture adjacent to the plate, and 3% (1/37) refracture after implant removal. The major complication rate was 43% (16/37). Fifteen patients underwent a second surgery for implant removal secondary to prominence or pain. One patient underwent revision open reduction and internal fixation after he sustained a refracture at the distal aspect of the plate that resulted in a painful nonunion. Only 1 patient had a refracture after implant removal and this was treated nonoperatively.

Conclusions:

Implant prominence or irritation is common after plate fixation of displaced pediatric midshaft clavicle fractures. A second surgery for implant removal may be necessary. Patients should be appropriately counseled regarding complications before plate fixation of midshaft clavicle fractures.

Level of Evidence:

Level IV—therapeutic.
Management of Scoliosis in Patients With Loeys-Dietz Syndrome
Authors: Bressner Jarred A. , MacCarrick Gretchen L. , Dietz Harry C. , Sponseller Paul D.
Published: July 2016

Background:

Loeys-Dietz syndrome (LDS) is a genetic connective tissue disorder. We sought to determine the incidence of scoliosis in patients with LDS, characterize the spectrum of spinal deformity, determine the results of bracing and surgery, and define surgical complications.

Methods:

Patients were selected from our institution’s database of 183 patients with LDS. Imaging measurements were performed for 141 patients whose records permitted spinal evaluation. Deformity changes and complications after intervention were recorded for patients who underwent bracing or surgery, and associations were tested using Student t tests (significance, P<0.05).

Results:

Eighty-eight of 141 (62%) patients with LDS had scoliosis, with main thoracic and thoracolumbar curves being most common. Fifteen patients were braced (mean age, 9±3 y) for a mean of 2.3 years. They had a mean postbracing curve progression of 12±21 degrees (5±9 deg./y). There were no significant differences in age, sex, curve type, or prebracing curve magnitude between successfully braced (n=4) and unsuccessfully braced (n=11) patients (P>0.05). Nine patients, (mean age, 12±3 y), underwent 24 surgical procedures (16 growing rod procedures, 8 fusions). Mean curve corrections were 61% for growing rods and 73% for fusions. Associated blood loss for these procedures was 400 mL and 1293 mL, respectively, and normalized blood loss for fusion was 2.34 mL/kg/level. Fifteen of 24 surgical procedures involved complications (63%), including cerebrospinal fluid leaks (n=7) and blood loss >20% of estimated total blood volume (n=11).

Conclusions:

Scoliosis was present in 62% of our sample of LDS patients. Bracing did not halt curves in 11 of 15 patients, whose curves progressed >5 degrees or to >50 degrees by completion of bracing. At latest follow-up, 47% of the braced patients had undergone surgery after prior bracing attempts. The high blood loss associated with these operations is believed to be related to vascular fragility in patients with LDS.

Level of Evidence:

Level IV—retrospective cohort study.
Human papilloma virus infection in HIV-infected women in Belgium: implications for prophylactic vaccines within this subpopulation
Authors: Menon Sonia , Rossi Rodolfo , Benoy Ina , Bogers Jean P. , van den Broeck Davy
Published: July 2016

Although high-risk (HR) human papilloma virus (HPV) infection is the primary causative factor for cervical squamous intraepithelial lesions and invasive cervical cancer, the epidemiology of potentially HR (pHR) and low-risk HPV still remains to be elucidated in HIV-infected women. In addition, the synergistic potential of the multiplicity of HPV infections harboured renders it difficult to model the impact of vaccines. This cross-sectional analysis of HIV-infected women explores the epidemiology of abnormal cytology, thereby profiling and pairing pHR/HR HPV genotypes. This cross-sectional analysis reports the findings of 593 HIV-infected women, who underwent a cytological examination and HPV genotyping. A logistic regression model was fitted to adjust for age and coinfection with pHR/HR HPV genotypes. In the 143 women with abnormal cytology, a multiple pHR/HR HPV genotype prevalence of 64.1% [95% confidence interval (CI): 44.6–57.6%] was observed. A combined prevalence of HPV 16 and HPV 18 of 29.6% (95% CI: 22.2–37.8%) was found. HPV 6 and HPV 66 were found in two cases of low-grade squamous intraepithelial lesions as stand-alone genotypes and HPV 53 in a high-grade squamous intraepithelial lesion case. Pairing involving HPV 31 with HPV 16 and HPV 58 was found in high-grade squamous intraepithelial lesion cases. Significant associations were observed between abnormal cytology, multiple HPV, HPV 39 and HPV 53 [adjusted odds ratio (aOR): 2.02; P=0.01; 95% CI: 1.2–3.5; aOR: 3.8; P=0.01; 95% CI: 1.4–10.7; and aOR: 0.5; P=0.03; 95% CI: 0.2–0.9, respectively]. Coinfection with pHR/HR HPV genotypes HPV 39 and 53 was significantly associated with abnormal cytology. Research into the imputed role of HPV 31 in pairings, low-risk and pHR HPV genotypes in HIV-infected women is warranted.
Nursing Information Systems Requirements
Authors: Farzandipour Mehrdad , Meidani Zahra , Riazi Hossein , Sadeqi Jabali Monireh
Published: July 2016

Considering the integral role of understanding users’ requirements in information system success, this research aimed to determine functional requirements of nursing information systems through a national survey. Delphi technique method was applied to conduct this study through three phases: focus group method modified Delphi technique and classic Delphi technique. A cross-sectional study was conducted to evaluate the proposed requirements within 15 general hospitals in Iran. Forty-three of 76 approved requirements were clinical, and 33 were administrative ones. Nurses’ mean agreements for clinical requirements were higher than those of administrative requirements; minimum and maximum means of clinical requirements were 3.3 and 3.88, respectively. Minimum and maximum means of administrative requirements were 3.1 and 3.47, respectively. Research findings indicated that those information system requirements that support nurses in doing tasks including direct care, medicine prescription, patient treatment management, and patient safety have been the target of special attention. As nurses’ requirements deal directly with patient outcome and patient safety, nursing information systems requirements should not only address automation but also nurses’ tasks and work processes based on work analysis.
Supporting Caregivers of Children With Acute Lymphoblastic Leukemia via a Smartphone App
Authors: Wang Jingting , Yao Nengliang , Shen Min , Zhang Xiaoyan , Wang Yuanyuan , Liu Yanyan , Geng Zhaohui , Yuan Changrong
Published: July 2016

Smartphone applications are widely used for self-help interventions in adult cancer survivors. However, applications for parents of pediatric cancer patients are limited. We developed an applications to assist parents of children with acute lymphoblastic leukemia. The aim of this study is to evaluate the app's usability and effectiveness in a preliminary way. A stepwise approach and mixed methods were used. The application was initially tested by healthcare providers, and their comments and suggestions were used to develop an updated version. This version was tested by parents of children with acute lymphoblastic leukemia. Comments and nonverbal expressions of parents were recorded during a 2-week pilot test. The qualitative study was followed by a quantitative study using audit log data from the administration portal to understand how parents use the application. Six healthcare providers and 15 parents participated. Parents gained a greater knowledge of leukemia, confidence in caregiving, social support, and information on how to reduce stress. Over usability was rated as stable, useful, simple, and self-explanatory. No software failure occurred. Applications have the potential to support caregivers of pediatric cancer patients. We plan to address limitations and perform an empirical interventional study to examine its clinical effectiveness.
Social Media Use by Transplant Recipients for Support and Healing
Authors: Grumme Valarie S. , Gordon Shirley C.
Published: July 2016

Transplant recipients use a diverse support network that now includes transplant-related social media support groups. The purpose of this study is to explore the use of social media sites by transplant recipients as a potential source of support and healing and the usefulness of Internet postings as a source of rich qualitative data. A qualitative descriptive design was used for the study. A total of 126 retrospective postings from 58 participants were analyzed as they existed on this open publically available Web site over a 20-month period from the selected discussion threads. Two major themes emerged from the data: sharing overwhelming gratitude and finding sanctuary. Sharing overwhelming gratitude was expressed in emotional postings about feelings and letters to donor families. Finding sanctuary described the recipients’ perception of the online community as a safe and nonjudgmental environment to discuss sensitive issues and feelings. This study adds to what is known about the unique psychological and emotional needs of transplant recipients. Transplant-related support Web sites offer the opportunity to learn what matters most to transplant recipients and identify gaps in care related to calls for nursing.
Snapshots of Growing Up: Youth with Autism Explore Adulthood Through Photovoice
Authors: Cheak-Zamora Nancy C. , Teti Michelle , Maurer-Batjer Anna , Halloran Donna
Published: July 2016

Objective:

Youth with autism spectrum disorder (ASD) experience significant challenges transitioning to adulthood. We utilized Photovoice to better understand youth's desires for and perspectives on becoming adults.

Method:

Youth with ASD (N = 11) photographed their life experiences, attended group and individual photo-sharing and discussion sessions, and exhibited their work publicly. Thematic analysis was used to identify salient recurring patterns in the data.

Results:

Thematic analysis identified important topics in session transcripts and 184 photographs. Youth with ASD expressed many perspectives about their adult lives, which centered around 3 themes: the meaning of adulthood; desire for independent living; and employment goals.

Conclusion:

Findings identified what youth with ASD want and need to achieve adulthood. This study demonstrated the utility of a new methodology to provide opportunities for youth to share their experiences and define their priorities.
Review of gynecologic and reproductive care for women with developmental disabilities
Authors: Abells Dara , Kirkham Yolanda A. , Ornstein Melanie P.
Published: July 2016

Purpose of review

Care for women with developmental disabilities requires special consideration for unique needs related to their cognitive and physical abilities. These women and their caregivers require more support and guidance during reproductive health care. We review the literature and provide expert opinion surrounding gynecological issues for women with developmental disabilities to support healthcare providers better understand and care for this population.

Recent findings

Women with developmental disabilities are more vulnerable to abuse and experience poorer gynecological healthcare outcomes. Many women with developmental disabilities are fertile and participate in sexual activity without adequate knowledge. They are at higher risk of pregnancy and birth complications. They are less likely to receive appropriate preventive screening.

The review highlights important issues and practice suggestions related to the reproductive health care of women with developmental disabilities. Topics include clinic visits, menstruation, sexuality, sexual abuse, sexual health education, contraception, sexually transmitted infections, pregnancy, labor and delivery, and cancer screening/prevention. We emphasize the need for an individualized, comprehensive approach for these patients and review perceived and actual barriers to care. More education is needed on the aforementioned topics for women with developmental disabilities, their caregivers, and their providers.
L-positioned Perforator Propeller Flap for Partial Breast Reconstruction with Axillary Dead Space
Authors: Yamamoto Mao , Yano Tomoyuki , Shimizu Daisuke , Yokoyama Akiko , Ito Osamu
Published: July 2016

Partial breast reconstruction using perforator flaps harvested from the lateral chest wall has become a well-established surgical technique recently. In the case of a partial mastectomy with an axillary lymph node dissection, there are 2 main defects; one is a partial breast defect and the other is an axillary dead space. To reconstruct the 2 separate defects with local flaps, basically 2 different flaps are needed, and usually, it is rather difficult to harvest 2 different local flaps in the adjacent area. To resolve this problem, we introduce the L-positioned perforator propeller flap (PPF). We used an L-positioned PPF on 2 female patients, aged 46 and 47 years old, who were suffering from breast cancer in the upper outer quadrant. The concept of this flap design is as follows: the partial breast defect is reconstructed with the longer lobe of the L-positioned PPF and the axillary defect is filled with the smaller lobe of the L-positioned PPF at the same time. The reconstruction time was 2 hours and 0 minutes and 1 hour and 46 minutes in each case. The patients were successfully provided with aesthetically acceptable breast reconstruction without postoperative complications. Moreover, both patients had consecutive postoperative radiotherapy on the reconstructed area without complications. With this flap design, it is possible for patients to have safe and aesthetic reconstruction with only 1 local flap and fewer invasive procedures.
INCIDENCE OF ACUTE EXUDATIVE MACULOPATHY AFTER REDUCED-FLUENCE PHOTODYNAMIC THERAPY
Authors: Mammo Zaid , Forooghian Farzin
Published: July 2016

Purpose:

To describe the incidence and features of acute exudative maculopathy (AEM) after half-fluence photodynamic therapy (PDT) and/or very minimal fluence PDT.

Methods:

Retrospective chart review of all patients treated over a 7-year period.

Results:

A total of 52 patients (58 eyes, 140 treatments) were treated with half-fluence PDT and/or very minimal fluence PDT. Patients were diagnosed with either central serous chorioretinopathy (CSCR) or neovascular age-related macular degeneration (nAMD). Two patients (1 CSCR and 1 nAMD) returned to the clinic with acute vision loss after treatment and were identified as having developed AEM. In the CSCR case, resolution occurred after intravitreal bevacizumab treatment. The nAMD case resolved with topical difluprednate treatment. We were unable to identify any risk factors for the development of AEM.

Conclusion:

AEM seems to be a rare (incidence 1.4% per treatment) and unpredictable reaction related to the proinflammatory effects of half-fluence PDT and very minimal fluence PDT. Because of the inherent limitations of this study, the true incidence of AEM after reduced-fluence PDT may be higher.
Corneal Haze as Prognostic Indicator of Intraocular Pressure in Primary Congenital Glaucoma
Authors: Li Xintong , Mukkamala Lekha , Origlieri Catherine A. , Holland Bart K. , Fechtner Robert D. , Khouri Albert S.
Published: July 2016

Purpose:

To perform a longitudinal analysis on the association of corneal haze with intraocular pressure (IOP) in eyes with primary congenital glaucoma (PCG) over 3 years.

Patients and Methods:

Charts of all patients diagnosed with glaucoma of childhood from 2002 to 2012 at our institution were retrospectively reviewed. Inclusion criteria were age 18 years and below, plus elevated IOP or characteristic clinical signs. Exclusion criteria were eyes with secondary glaucoma or corneal haze not from PCG and patients with prior ocular surgery or incomplete follow-up.

Results:

Of 79 eyes with childhood glaucoma during this period, 36 eyes had PCG [25 patients; 15 male (60.0%), 14 bilateral (56.0%)]. Eighteen eyes (13 patients) presented with corneal haze, whereas 18 eyes (12 patients) did not. Eyes with haze were diagnosed at a younger age than eyes without haze (0.79 vs. 5.2 y, P<0.02). During year 1, eyes with haze underwent significantly more IOP-lowering procedures and used significantly fewer IOP-lowering medications. Multivariate analysis revealed that corneal haze increased IOP by 4.63 mm Hg when controlling for treatment over time (P<0.01). Eyes with haze had lower survival curves and a failure hazard of 1.3 times that of eyes without haze. These eyes had a lower proportion of qualified successes than eyes without haze at year 1 (P<0.05) but this was reversed at year 3 (P<0.02).

Conclusions:

Eyes with PCG-related corneal haze generally presented more severely than did those without haze, but postmanagement outcomes may be similar to those in eyes without haze.
Fiberoptic Microcatheter-assisted 360-Degree Trabeculotomy Ab Externo After Unsuccessful Trabeculotome Trabeculotomy in Primary Congenital Glaucoma: A Case Report
Authors: D’Amelio Savino , Gremmo Giulia , Gremmo Enrico , Demasi Christian L.
Published: July 2016

Fiberoptic microcatheter-assisted 360-degree trabeculotomy ab externo is a recent technique. Retrospective studies have proved the effectiveness as a first-angle surgery in eyes with primary congenital glaucoma. However, there are no reports in which it is performed after another unsuccessful surgical procedure. We present our case of a monolateral congenital glaucoma. We first performed an ab externo trabeculotomy with poor control of intraocular pressure (IOP). Then, a microcatheter-assisted 360-degree trabeculotomy was performed with IOP lowering. Microcatheter-assisted 360-degree trabeculotomy supplies successful IOP lowering after another angle surgery procedure.
Prior voluntary wheel running attenuates neuropathic pain
Authors: Grace Peter M. , Fabisiak Timothy J. , Green-Fulgham Suzanne M. , Anderson Nathan D. , Strand Keith A. , Kwilasz Andrew J. , Galer Erika L. , Walker Frederick Rohan , Greenwood Benjamin N. , Maier Steven F. , Fleshner Monika , Watkins Linda R.
Published: July 2016

Exercise is known to exert a systemic anti-inflammatory influence, but whether its effects are sufficient to protect against subsequent neuropathic pain is underinvestigated. We report that 6 weeks of voluntary wheel running terminating before chronic constriction injury (CCI) prevented the full development of allodynia for the ∼3-month duration of the injury. Neuroimmune signaling was assessed at 3 and 14 days after CCI. Prior exercise normalized ipsilateral dorsal spinal cord expression of neuroexcitatory interleukin (IL)-1β production and the attendant glutamate transporter GLT-1 decrease, as well as expression of the disinhibitory P2X4R-BDNF axis. The expression of the macrophage marker Iba1 and the chemokine CCL2 (MCP-1), and a neuronal injury marker (activating transcription factor 3), was attenuated by prior running in the ipsilateral lumbar dorsal root ganglia. Prior exercise suppressed macrophage infiltration and/or injury site proliferation, given decreased presence of macrophage markers Iba1, iNOS (M1), and Arg-1 (M2; expression was time dependent). Chronic constriction injury–driven increases in serum proinflammatory chemokines were suppressed by prior running, whereas IL-10 was increased. Peripheral blood mononuclear cells were also stimulated with lipopolysaccharide ex vivo, wherein CCI-induced increases in IL-1β, nitrite, and IL-10 were suppressed by prior exercise. Last, unrestricted voluntary wheel running, beginning either the day of, or 2 weeks after, CCI, progressively reversed neuropathic pain. This study is the first to investigate the behavioral and neuroimmune consequences of regular exercise terminating before nerve injury. This study suggests that chronic pain should be considered a component of “the diseasome of physical inactivity,” and that an active lifestyle may prevent neuropathic pain.
Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model
Authors: Stone Amanda L. , Wilson Anna C.
Published: July 2016

Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.
Perceived Changes in Sleep in Adults With Epilepsy
Authors: Miller Wendy R. , Otte Julie L. , Pleuger Madona
Published: July 2016

Background: Epilepsy is the most common chronic neurological disease in the United States, and 70% of diagnoses occur in late adolescence or adulthood. A disease of the brain, epilepsy can affect sleep. Lack of adequate or high-quality sleep can cause decrements in quality of life. Adults living with epilepsy are at especially high risk for sleep alterations, and these changes in sleep can worsen their epilepsy. The purpose of the study was to describe the perceived effect of epilepsy on sleep in adults who developed epilepsy in late adolescence or adulthood. Research questions included (a) “In adults with epilepsy, what is the perceived change in ability to sleep well because of having epilepsy?”; (b) “In adults with epilepsy, is there a significant relationship between perceived changes in ability to sleep well and perceived changes in overall life because of having epilepsy?”; and (c) “In adults with epilepsy, is there a significant relationship between perceived changes in ability to sleep well because of having epilepsy and total Life Changes in Epilepsy Scale (LCES) scores?”. Methods: One hundred seventy-four adults with epilepsy were recruited. Utilizing data collected via the LCES, a quantitative descriptive/correlational design was utilized. Analyses were carried out to answer each research question. Results: The mean score for the sleep item of the LCES was 2.76 (SD = 1.31), indicating an overall negative change in ability to sleep well. There was a statistically significant, strong positive relationship between the sleep and overall life changes items of the LCES (Pearson r = .476, p < .0000) and also between the sleep item and total LCES scores (Pearson r = .620, p < .0000). Implications: Findings from this study contribute to the extant literature by revealing epilepsy-related changes in sleep as perceived by adults living with epilepsy specifically because of having epilepsy. On the basis of findings rendered from this sample, having epilepsy can lead to perceived negative changes in a person’s ability to sleep well, and these negative changes are significantly correlated with negative overall life changes. Recommendations for clinical practice and research can be made based on current results.
Linear-Endobronchial Ultrasound-Guided Insertion of a Fiducial Marker
Authors: Casutt Alessio , Koutsokera Angela , Peguret Nicolas , Lovis Alban
Published: July 2016

Stereotactic body radiotherapy (SBRT) is an effective method for the treatment of localized primary lung tumors. Cyberknife, a highly accurate SBRT technique, follows the target during respiratory cycles using a metallic fiducial marker (FM) previously inserted into the lesion. Various methods have been described for the placement of an FM in peripheral pulmonary lesions; however, none of these is appropriate for mediastinal or hilar tumors. The placement of FMs in central lesions to achieve accurate SBRT is particularly relevant due to their higher mobility during respiratory and cardiac cycles. Here, we describe the use of linear-endobronchial ultrasound for the insertion of an FM marker in a centrally located metastatic melanoma, thereby allowing subsequent treatment with Cyberknife.
Older Patients With Hepatocellular Carcinoma Have More Advanced Disease, Lower Rates of Treatment, and Lower Survival
Authors: Yan Melissa , Ha John , Aguilar Maria , Liu Benny , Frenette Catherine T. , Bhuket Taft , Wong Robert J.
Published: July 2016

Goals:

To evaluate age-specific disparities in cancer stage at diagnosis, receipt of treatment, and survival among adults with hepatocellular carcinoma (HCC).

Background:

HCC has become the fastest rising cause of cancer-related deaths in the United States. The aging population coupled with the rising incidence of HCC will result in an emerging cohort of older patients with HCC placing significant burden health care systems.

Study:

Using 2003 to 2011 Surveillance, Epidemiology, and End Results data, a US population-based cancer registry, we retrospectively evaluated age-specific disparities in cancer stage at diagnosis, receipt of treatment, and survival among adults with HCC. Multivariate logistic regression models evaluated HCC stage at diagnosis and HCC treatment received. Multivariate Cox proportional hazard models evaluated long-term survival.

Results:

Compared with HCC patients below 50 years old, patients aged 70 years or older were less likely to have HCC within Milan criteria [odds ratio, 0.58; confidence interval (CI), 0.54-0.63; P<0.001]. Older age was also associated with significantly lower rates of receiving HCC treatment. Even after adjusting for stage of disease, patients aged 70 years or older had the lowest odds of receiving any HCC treatment compared with patients below 50 years old (odds ratio, 0.52; CI, 0.46-0.60; P<0.001). On multivariate Cox regression, HCC patients aged 70 years or older had significantly lower survival compared with patients below 50 years old (hazards ratio, 1.22; CI, 1.15-1.30; P<0.001).

Conclusions:

Among US adults with HCC, patients aged 70 years or older were less likely to have HCC within Milan criteria at diagnosis, less likely to receive any HCC treatment, and had significantly lower long-term survival.
Clinical characteristics and outcome of cirrhotic patients with high protein concentrations in ascites: a prospective study
Authors: Guillaume Maeva , Robic Marie-Angèle , Péron Jean-Marie , Selves Janick , Otal Philippe , Sirach Estelle , Vinel Jean-Pierre , Bureau Christophe
Published: July 2016

Background

The protein concentration in ascites is usually low in cirrhosis because capillarization and defenestration of the sinusoids limit diffusion of large proteins from plasma to the space of Disse. However, some cirrhotic patients have high-protein ascites (HPA).

Aim

The aim of this study was to describe and compare the characteristics and prognosis between cirrhotic patients with HPA (>20 g/l) and patients with low-protein ascites (LPA).

Patients and methods

In this longitudinal observational prospective cohort study, all consecutive cirrhotic patients with ascites hospitalized in our tertiary liver center were included and followed for up to 2 years, provided that they had no other cause of HPA. HPA was defined as protein concentrations of more than 20 g/l.

Results

Among 107 patients included, 19 (17.8%) had HPA. HPA patients had more refractory ascites (63 vs. 34%), better liver functions, and a higher 1-year transplant-free survival rate compared with LPA patients (P<0.05). Portal hypertension parameters were not different. During follow-up, 47% of HPA patients were treated by transjugular intrahepatic portosystemic shunts versus 18% of LPA patients, whereas 15 LPA patients required liver transplantation for end-stage liver disease versus only one HPA patient. We observed higher protein filtration and less pericellular, centrilobular, and sinusoidal fibrosis in cirrhotic HPA livers compared with LPA livers.

Conclusion

Almost 20% of cirrhotic patients with ascites have HPA (>20 g/l). These patients have better liver functions and a higher 1-year survival than those with LPA, even though ascites are more often refractory.