bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Government-Driven Smartphone Text Messages on Public Compliance With COVID-19 Preventative Measures
Authors: Kim Suhyun , Lee Seonah
Published: July 2021

The new pandemic situation caused by a highly infectious virus has prompted the government of many countries to strengthen epidemic prevention measures. An unprecedented action was taken by the Korean government by sending text messages on COVID-19 preventative measures and the movement routes of confirmed-positive persons to the entire nation's smartphones. This study aimed to examine how effective the government-driven smartphone text messages were for public compliance with the measures. A total of 489 participants completed an online questionnaire or a pencil-and-paper questionnaire between September and October 2020. A self-reported questionnaire was used to measure the degree of compliance with the measures, the perceptions of the role of smartphone text messages in compliance with the measures, and the overall feelings toward smartphone text messages. The data were analyzed using descriptive statistics and two-way analysis of variance. The written responses were grouped by meaning. The participants presented a high degree of compliance with the measures and perceived the importance of the role of continuous smartphone text messages in complying with the measures. Positive feelings toward smartphone text messages predominated over negative feelings. Using smartphone text messages in nursing practice is recommended for patients requiring the continuous management of their disease.
Development of fetal growth charts in twins stratified by chorionicity and mode of conception: a retrospective cohort study in China
Authors: Xia Yuan-Qing , Lyu Shu-Ping , Zhang Jun , Chen Yi-Ting , Gao Li , Zhao An-Da , Wang Yan-Lin , Li Sheng-Hui
Published: July 2021

Background:

Twin pregnancies continue to increase worldwide; however, the current clinical prenatal evaluation for the intrauterine growth of twins still relies on the growth standards of singletons. We attempted to establish a set of fetal biometric references for Chinese twin pregnancies, stratified by chorionicity and conception mode as spontaneously conceived monochorionic diamniotic (SC-MCDA), spontaneously conceived dichorionic diamniotic (SC-DCDA), and assisted reproductive technology dichorionic diamniotic (ART-DCDA) twins.

Methods:

From 2016 to 2019, the ultrasonographic fetal biometric measurements were longitudinally collected in pregnant women, including fetal weight, biparietal diameter, head circumference, abdominal circumference, femur length, and humerus length. The linear mixed models were used to test the difference of growth patterns between groups, and the growth curve of each biometric parameter was modeled by a generalized additive model for location scale and shape.

Results:

A total of 929 twin pregnant women and 2019 singleton pregnant women, met the inclusion criteria. Among twin pregnancies, 148 were SC-MCDA, 215 were SC-DCDA, and 566 were ART-DCDA twins. Overall, SC-DCDA twins grew faster than SC-MCDA twins, while slower than ART-DCDA twins (all P < 0.05), and all of the three groups showed significant differences comparing with singletons, especially during the third trimester. Hence, the customized fetal growth charts of each fetal biometric parameter were, respectively, constructed for SC-MCDA, SC-DCDA, and ART-DCDA twins.

Conclusions:

The fetal biometric trajectories demonstrated characteristic patterns according to chorionicity and conception mode. To fill the gap, we modeled fetal biometric parameters for Chinese SC-MCDA, SC-DCDA, and ART-DCDA twin pregnancies, hoping to provide a reference for the further establishment of fetal growth reference values for Chinese twin fetuses.
Practice Variation in Utilization of Flap or Graft Reconstruction Among Veterans Affairs Surgeons After Extirpation of Keratinocyte Carcinoma on the Nose
Authors: Massey Paul R. , Rothstein Brooke E. , Gupta Sameer , Sigel Keith , Schmults Chrysalyne D. , Waldman Abigail
Published: July 2021

BACKGROUND

Practice variation has been well documented across the US health care system but has not been explored in reconstructive surgical choice after keratinocyte carcinoma (KC) extirpation.

OBJECTIVE

Assess practice variation in utilization of complex (flap or graft) reconstruction after excision of KC on the nose among a multidisciplinary group of reconstructive surgeons (Mohs micrographic and plastic surgery).

MATERIALS AND METHODS

A randomly selected subset of surgically treated, routine, primary, invasive KCs on the nose between 2000 to 2012 at the Veterans Affairs (VA)-Boston Healthcare System were assessed. Patient factors, tumor factors, and individual surgeons with sufficient case volume were fit to a multivariate logistic regression model to assess between-surgeon differences in the odds of performing a complex reconstruction.

RESULTS

Ten surgeons met the case volume threshold for analysis, encompassing 338 KC on the nose excised and reconstructed from 2000 to 2012. After adjusting for patient age, tumor diameter, and location, 6 surgeons performed significantly more complex reconstructions than the reference surgeon, and the case-adjusted predicted probability of complex reconstruction ranged from 7% to 99% (p ≤ .0001).

CONCLUSION

Marked practice variation in reconstruction choice exists among surgeons after extirpation of KC on the nose at one VA health care system. High-quality comparative studies regarding optimal nasal reconstruction after extirpation of KC are needed.
Orbital Vascular Anomalies: A Nomenclatorial, Etiological, and Nosologic Conundrum
Authors: Tawfik Hatem A. , Dutton Jonathan J.
Published: July 2021

Purpose:

Vascular anomalies are a heterogeneous group of disorders that frequently present in the periorbital region. They encompass 2 broad entities: vascular tumors, which possess a proliferative endothelium, and vascular malformations, which are basically localized defects of vascular morphogenesis. The primary goal of this review was to address inaccurate or controversial terminology in the oculoplastic literature concerning orbital and periorbital vascular anomalies and to categorize these lesions in an abridged and simplified hierarchical list that adheres as much as possible to the most recent (2018) iteration for the classification of vascular lesions proposed by the International Society for the Study of Vascular Anomalies (ISSVA). The secondary goal of this review was to review and update information regarding the genetic underpinnings of vascular anomalies and the downstream signaling pathways that are subsequently affected as a result of these genetic errors.

Methods:

A literature review was conducted in PubMed, MEDLINE, PubMed Central, National Center for Biotechnology Information Bookshelf, and Embase for several related keywords including “vascular anomalies, vascular malformations, vascular tumors, and cavernous venous malformation,” both with and without adding the keywords “eyelid,” “orbital,” and “periorbital.” In addition, a detailed search was conducted for controversial or obsolete keywords like “cavernous hemangioma,” “lymphangioma,” and “varices,” again in their systemic and orbital/periorbital context.

Results:

Crucial issues in the 2018 ISSVA classification regarding the proper categorization of orbital vascular anomalies, particularly venous lesions, were critically evaluated and revised, and a regional, simplified, and abridged modification of the ISSVA 2018 classification was proposed.

Conclusions:

Interdisciplinary and intradisciplinary dialogue concerning orbital vascular anomalies is seriously compromised due to the lack of a unanimous agreement on terminology and the absence of a unified classification concept system. The authors recommend that oculoplastic surgeons adopt ISSVA terminology whenever technically possible and scientifically sound. However, they also propose modifying the ISSVA 2018 classification specifically to adapt to the peculiarities of vascular anomalies in the periorbital region. At present, the simplified classification proposed here is a preliminary first step towards managing patients with orbital vascular anomalies with greater diagnostic and therapeutic precision, until such time in the future when the entire genetic makeup of orbital vascular anomalies is more completely elucidated. Optimistically, this could pave the way for a more robust classification and the ultimate therapeutic cure.
Patterns of Adherence to Secondary Prevention Measures Among Chinese Patients With Coronary Artery Disease
Authors: Lu Minmin , Hravnak Marilyn , Chang Yuefang , Lin Ying , Zhang Xian , Ma Jianying , Shen Yunzhi , Xia Haiou
Published: July 2021

Background

Adherence to secondary prevention measures among patients with coronary artery disease (CAD) affects patient prognosis, whereas patients' adherence behaviors change over time.

Objectives

The aims of this study were to identify adherence trajectories to secondary prevention measures including medication-taking and a heart-healthy lifestyle and to estimate predictors of adherence trajectories among patients with CAD.

Methods

This longitudinal study enrolled 698 patients with CAD who received a percutaneous coronary intervention in China. Demographics, clinical characteristics, adherence to secondary prevention measures, and patient-related factors including disease knowledge, self-efficacy, and health literacy were measured during hospitalization. Adherence behaviors were followed at 1, 3, and 6 months, and 1 year after discharge. Group-based trajectory models estimated adherence trajectories, and multinomial logistic regression identified trajectory group predictors.

Results

Four trajectory groups were identified for medication-taking adherence: sustained adherence (39.9%), increasing and then decreasing adherence (23.1%), increasing adherence (23.4%), and nonadherence (13.6%). The 3 adherence trajectory groups for a heart-healthy lifestyle were sustained adherence (59.7%), increasing adherence (28.3%), and nonadherence (12.0%). Married patients were more likely (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.56–7.52) to have sustained adherence to medication-taking. However, patients with higher disease knowledge were less likely (OR, 0.93; 95% CI, 0.87–0.99) to be adherent. Patients who were not working (OR, 2.25; 95% CI, 1.03–4.92) had higher self-efficacy (OR, 1.21; 95% CI, 1.08–1.37). Those with higher health literacy (OR, 1.18; 95% CI, 1.01–1.38) were more likely to have sustained adherence to a heart-healthy lifestyle. However, patients having no coronary stents (OR, 0.36; 95% CI, 0.19–0.70) were less likely to have done so.

Conclusions

Trajectories of adherence to secondary prevention measures among mainland Chinese patients with CAD are multipatterned. Healthcare providers should formulate targeted adherence support, which considers the influence of disease knowledge, self-efficacy, and health literacy.
Sex Differences in the Association Between Inflammation and Event-Free Survival in Patients With Heart Failure
Authors: Saleh Zyad T. , Alraoush Ahmad T. , Aqel Ahmad A. , Shawashi Tagreed O. , Chung Misook , Lennie Terry A.
Published: July 2021

Background

Heart failure (HF) is associated with chronic inflammation, which is adversely associated with survival. Although sex-related differences in inflammation have been described in patients with HF, whether sex-related differences in inflammation are associated with event-free survival has not been examined.

Aim

The aim of this study was to determine whether the association between inflammation as indicated by tumor necrosis factor-α and event-free survival differs between men and women with HF after controlling for demographic and clinical variables.

Method

This was a secondary analysis of data from 301 male (age, 61.0 ± 11.4 years) and 137 female (age, 60.3 ± 12.1 years) patients with HF. Serum levels of soluble tumor necrosis factor receptor 1 were used to indicate inflammatory status. Patients were grouped according to median split of soluble tumor necrosis factor receptor 1 level and sex into male with low inflammation (≤1820 pg/mL) (n = 158) or high inflammation (>1820 pg/mL) (n = 143), and female with low inflammation (n = 63) or high inflammation (n = 74). Cox regression models were run separately for men and women to determine whether inflammation contributed to differences in event-free survival between sexes with HF.

Results

There were 84 male (27.9%) and 27 female (19.7%) patients who had an event. Event-free survival in women did not differ by the severity of inflammation in the Cox regression analysis. In contrast, men with high inflammation had 1.85 times higher risk for an event compared with men with low inflammation.

Conclusion

These data provide evidence that inflammation contributed to differences in event-free survival in men but not women with HF. Clinicians should be aware that men who have higher inflammation may be at a greater risk of HF or cardiac-related events than others with HF.
Adolescents With Congenital Heart Disease
Authors: Burström Åsa , Acuña Mora Mariela , Sparud-Lundin Carina , Moons Philip , Bratt Ewa-Lena
Published: July 2021

Background

Studies show that adolescents with congenital heart disease (CHD) lack knowledge about reproductive health in relation to their CHD.

Objective

The aims were to investigate (i) the proportion of adolescents with CHD receiving information about reproductive health, (ii) the level of reproductive health knowledge in adolescents with CHD, and (iii) potential correlates for receiving information about reproductive health.

Methods

A total of 202 adolescents aged 14 to 18 years (mean age 15.7 ± 1.1 years) with CHD completed the Knowledge Scale for Adults with Congenitally Malformed Hearts and were asked if they had received information about contraception and pregnancies or if this would be of interest.

Results

Few adolescents could recall receiving information about contraceptives (5%) and pregnancies (15%). Furthermore, only 24% adolescents wanted information about contraceptives, and 42% of the female adolescents wanted information about pregnancies. There was a higher probability of male adolescents wanting information about contraceptives. Knowledge about reproductive health varied regarding knowledge about why they had been born with CHD (68%), knowledge about the hereditary nature of the CHD (48%), and if sexual activity could worsen their CHD (70%). However, few (11%) had knowledge about the elevated risk of having a child with CHD. Age was associated with a higher probability of having knowledge about the risks of having a child with CHD.

Conclusions

The low number of adolescents receiving information about contraceptives and pregnancies may have implications for future health and family planning. Future research is needed to identify and evaluate successful communication strategies that help to identify adolescents' preferences on how to approach this sensitive topic.
Study of the Comorbidity Between Cases of Acute Peripheral Vestibulopathies and COVID-19
Authors: Charpiot Anne , Hautefort Charlotte , Jourdaine Clément , Lavieille Jean-Pierre , Levy Daniel , Poillon Guillaume , Tighilet Brahim , Weckel Alexandra , Chabbert Christian
Published: July 2021

Importance:

An infective etiology of acute peripheral vestibulopathy (APV) has long been hypothesized. In the context of coronavirus disease 2019 (COVID-19), we examined the possible comorbidity between these two entities.

Objectives:

APV is the second most common cause of vestibular disorders and results from a sudden and unilateral loss of vestibular inputs. The characteristic signs and symptoms include sudden and prolonged vertigo, absence of auditory symptoms, and absence of other neurological symptoms. An infective etiology of APV has long been hypothesized on the basis of its association with respiratory tract infections and its frequent occurrence in epidemics. Possible comorbidity with herpes simplex virus type 1 reactivation or influenza virus infection has also been proposed. This study was designed to assess the possible comorbidity between APV and COVID-19.

Design/setting/participants:

Quantification of the number of hospital admissions for APV over the period from February to May 2020 was carried out in 5 French hospitals. A comparison with 2018 and 2019 entries over the same period was made. Comorbidity between APV and COVID-19 infection was investigated.

Results:

No significant increase in admission for APV was noticed over the examination period. No significant difference was noticed among hospitals located in COVID-19 high- and low-risk zones for SARS-CoV-2. No significant increase in the severity of the APV cases was noticed. No case of comorbidity between APV and SARS-CoV-2 infection was reported. Based on our observations, no correlation was made between APV and COVID-19.

Conclusion:

Based on our observations, COVID-19 is not statistically correlated with APV.
A Novel Instrument for Endoscopic Ear Surgery With a Steerable Flexible Tip: A Pediatric Anatomical Validation Study
Authors: Chayaopas Nichtima , Swarup Arushri , Eastwood Kyle W. , Francis Peter , Kahrs Lueder A. , Maguire Bryan , Drake James , James Adrian
Published: July 2021

Hypothesis:

This study compares the reaching ability of two classes of transcanal endoscopic ear surgery (TEES) instruments when operating on difficult to access anatomical targets; two novel instruments with steerable flexible tips (SFT-A and SFT-B) and suction capability are compared with standard commercially available tools.

Background:

TEES surgeons identified the need for a new surgical instrument that can enable accessibility of all areas visualized by the endoscope. This motivated the development of the two instrument prototypes.

Methods:

Six temporal bone models were 3D printed based on CT data from five cholesteatoma patients. Four anatomical targets were marked on each model. Using these targets, the reaching ability while using four standard TEES instruments were compared with the SFT-A and SFT-B prototypes by five surgeon participants. Results were analysed to compare success rates of contacting each target using each tool by fitting four Firth's logistic regression models. This calculated the statistically significant differences (p < 0.05) in tool success rate.

Results:

Using SFT-A to contact the sinus tympani (100%) was significantly more successful than the Panetti suction dissector for atticus (PAT) (77%) and to contact the sinodural angle (0%) was less successful than the PAT (10%) and SFT-B (93%). Using SFT-B to contact the lateral semicircular canal (90%) was significantly more successful than all current tools and to contact the sinodural angle (93%) was significantly more successful than all tools.

Conclusion:

Using SFT-B enables enhanced accessibility of anatomical structures during TEES which may lead to less extensive bone removal to facilitate minimally invasive TEES.
Tinnitus and Subjective Hearing Loss are More Common in Migraine: A Cross-Sectional NHANES Analysis
Authors: Goshtasbi Khodayar , Abouzari Mehdi , Risbud Adwight , Mostaghni Navid , Muhonen Ethan G. , Martin Elaine , Djalilian Hamid R.
Published: July 2021

Objectives:

To investigate whether migraine is independently associated with tinnitus and subjective hearing loss (HL) in a large national database.

Methods:

The de-identified 1999 to 2004 National Health and Nutrition Examination Survey database was retrospectively queried for subjects aged 18 to 65. HL and tinnitus were subjectively reported by subjects.

Results:

A total of 12,962 subjects (52.9% female) with a mean age of 38.1 ± 14.6 years were included. This consisted of 2,657 (20.5%), 2,344 (18.1%), and 2,582 (19.9%) subjects who had migraine, subjective-HL, and tinnitus, respectively. In patients with tinnitus or subjective-HL, migraine was reported in 35.6% and 24.5%, respectively. Migraineurs were more likely to have subjective-HL (25.0% vs. 16.6%, p < 0.001) and tinnitus (34.6% vs. 16.9%, p < 0.001) compared to the nonmigraineurs. This corresponded to migraine having an odds ratio of 1.5 (95% confidence interval [CI] 1.3–1.7, p < 0.001) and 2.2 (95% CI 2.0–2.4, p < 0.001) for subjective-HL and tinnitus, respectively. After adjusting for confounders, subjective-HL (odds ratio [OR] = 1.2, 95% CI 1.1–1.4, p = 0.003), tinnitus (OR = 2.1, 95% CI 1.9–2.3, p < 0.001), and neck pain (OR = 4.0, 95% CI 3.6–4.5, p < 0.001) were more common in migraineurs. Among migraineurs, a higher proportion of those with tinnitus also had subjective-HL compared to those without tinnitus (40.0% vs. 15.3%, p < 0.001), and a higher proportion of those with subjective-HL also had tinnitus compared to those without HL (58.1% vs. 27.3%, p < 0.001).

Conclusions:

This study suggests an independent association between migraine with subjective-HL and tinnitus. Otologic migraine, which is the effects of migraine on the ear, may be partly responsible for the link between HL, tinnitus, neck pain, and migraine.
The Influence of Extent of Resection and Tumor Morphology on Facial Nerve Outcomes Following Vestibular Schwannoma Surgery
Authors: Perkins Elizabeth L. , Manzoor Nauman F. , Totten Douglas J. , Sherry Alexander D. , Cass Nathan , Thompson Reid , Tawfik Kareem , O’Malley Matthew , Bennett Marc , Haynes David S.
Published: July 2021

Objective:

To determine the influence extent of resection and tumor characteristics on facial nerve (FN) outcomes following microsurgical resection of vestibular schwannoma (VS).

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Three hundred eighty-five patients who underwent VS microsurgical resection.

Interventions:

Microsurgical VS resection.

Main Outcome Measures:

House-Brackmann (HB) scores postoperatively. Good FN function was defined as HB grade I and II and poor FN function was defined as HB grade III and VI. Gross total resection (GTR) versus subtotal resection (STR). Propensity-score matching was used in subset analysis to balance tumor volume between the surgical cohorts, followed by multivariable analysis.

Results:

Seventy-one patients (18%) underwent STR and 314 patients (82%) underwent GTR. Two hundred fourteen patients (63%) had good FN function at 2 to 3 weeks postoperatively, and 80% had good FN function at 1 year. In single predictor analysis, STR did not influence FN function at 2 to 3 weeks (p = 0.65). In propensity-score matched subset analysis (N = 178), patients with STR were less likely to have poor FN function at 2 to 3 weeks (p = 0.02) independent of tumor volume (p = 0.004), but there was no correlation between STR and FN function at 1 year (p = 0.09). Ventral extension of tumor relative to the internal auditory canal plane was associated with poor FN outcomes at 2 to 3 weeks (p = 0.0001) and 1-year postop (p = 0.002).

Conclusions:

When accounting for tumor volume, STR is protective in immediate postoperative FN function compared to GTR. Ventral extension of the tumor is a clinical predictor of long-term FN outcomes.
Opioids Are Infrequently Required following Ambulatory Otologic Surgery
Authors: Mavrommatis Maria A. , Fan Caleb J. , Villavisanis Dillan F. , Kaul Vivian F. , Schwam Zachary G. , Wong Kevin , Perez Enrique , Wanna George B. , Cosetti Maura K.
Published: July 2021

Objective:

To determine the frequency with which postoperative opioid prescriptions are required after ambulatory otologic surgery.

Study Design:

Retrospective chart review.

Setting:

Tertiary otology–neurotology practice.

Patients:

Patients (n = 447) given over-the-counter acetaminophen and ibuprofen following ambulatory otologic surgery between July 1, 2018 and June 30, 2020.

Intervention:

Opioid prescription upon request.

Main Outcome Measures:

Patient, disease, and surgical variables such as age, sex, past medical history, chronic pain condition, surgical procedure, primary versus (vs.) revision surgery, and endoscopic vs. microscopic approach were examined for relationship to ad hoc opioid prescription rate.

Results:

Of 370 adult patients (mean age 49.0 yrs, range 18.0–88.5 yrs), 75 (20.3%) were prescribed opioids for postoperative pain, most commonly oxycodone-acetaminophen 5/325 mg. Of 77 pediatric patients (mean age 8.8 yrs, range 0.7–17.9 yrs), 5 (6.5%) were prescribed postoperative opioid analgesia. In the adult population, chronic pain condition, pain medication use at baseline, canal wall up mastoidectomy, tympanoplasty, tympanomeatal flap, bone removal of the mastoid, postauricular incision, and intraoperative microscopy were independent predictors of opioid pain prescription. When controlling for all significant variables, only chronic pain condition remained significant (odds ratio = 3.94; p = 0.0007). In the pediatric population, atresiaplasty, meatoplasty, and conchal cartilage removal were independently associated with opioid prescription, but none remained significant when analyzed in a multivariate linear model.

Conclusions:

Pain following ambulatory otologic surgery may be adequately managed with over-the-counter pain medications in the majority of cases. Opioids may be necessary in adults with preexisting pain conditions.
An AI Approach for Identifying Patients With Cirrhosis
Authors: Obeid Jihad S. , Khalifa Ali , Xavier Brandon , Bou-Daher Halim , Rockey Don C.
Published: July 2021

Goal:

The goal of this study was to evaluate an artificial intelligence approach, namely deep learning, on clinical text in electronic health records (EHRs) to identify patients with cirrhosis.

Background and Aims:

Accurate identification of cirrhosis in EHR is important for epidemiological, health services, and outcomes research. Currently, such efforts depend on International Classification of Diseases (ICD) codes, with limited success.

Materials and Methods:

We trained several machine learning models using discharge summaries from patients with known cirrhosis from a patient registry and random controls without cirrhosis or its complications based on ICD codes. Models were validated on patients for whom discharge summaries were manually reviewed and used as the gold standard test set. We tested Naive Bayes and Random Forest as baseline models and a deep learning model using word embedding and a convolutional neural network (CNN).

Results:

The training set included 446 cirrhosis patients and 689 controls, while the gold standard test set included 139 cirrhosis patients and 152 controls. Among the machine learning models, the CNN achieved the highest area under the receiver operating characteristic curve (0.993), with a precision of 0.965 and recall of 0.978, compared with 0.879 and 0.981 for the Naive Bayes and Random Forest, respectively (precision 0.787 and 0.958, and recalls 0.878 and 0.827). The precision by ICD codes for cirrhosis was 0.883 and recall was 0.978.

Conclusions:

A CNN model trained on discharge summaries identified cirrhosis patients with high precision and recall. This approach for phenotyping cirrhosis in the EHR may provide a more accurate assessment of disease burden in a variety of studies.
Mental Health, Social Support, and Death Anxiety in Patients With Chronic Kidney Failure
Authors: Khodarahimi Siamak , Veiskarami Hassan Ali , Mazraeh Nasrollah , Sheikhi Sonay , Rahimian Bougar Mojtaba
Published: July 2021

Purpose: This study aimed to investigate the relationship between mental health, perceived social support, and death anxiety, and the predictive roles of mental health and perceived social support in the explanation of death anxiety in a sample of adults with chronic kidney disease. Methods: A demographic questionnaire, the Symptom Check List−25, the Social Support Survey Scale, and the Death Anxiety Scale (DAS) were used in the present study. The sample consisted of 58 adult patients with chronic kidney failure. Results: Findings showed that mental health had significantly positive relationships to the total score of the death anxiety and the fear of death, the fear of pain and disease, and the death thoughts subscales of the DAS. Social support had a significant negative relationship to the total score of the death anxiety and the fear of pain and disease, the death thoughts, and the transient time and the short life subscales of the DAS. Mental health and combined mental health and social support explained 14% and 21% of death anxiety variation in patients with chronic kidney failure, respectively. Conclusion: Mental health and social support constructs can relatively predict the variations of death anxiety in patients with chronic kidney failure.
Telehealth Educational Resources for Graduate Nurse Faculty
Authors: Chike-Harris Katherine E. , Garber Kelli , Derouin Anne
Published: July 2021

Background

The rapid acceleration of virtual health care delivery, telehealth, has underlined the pressing need for graduate nursing students to gain skills and competencies that will ensure effective and efficient delivery of telehealth care in future generations.

Problem

There is a need for graduate nursing students to be prepared to use telehealth, but few nursing programs offer this training. Barriers to this implementation may be due to lack of faculty knowledge, telehealth resources, or telehealth opportunities.

Solution

Graduate nursing faculty should use resources and the wisdom of early adopters of telehealth to ensure adequate telehealth preparation is integrated into all graduate nursing programs.

Conclusion

This article describes emerging core competencies for telehealth education and offers guidance, resources, and activities for nurse educators who seek to prepare emerging advanced practice RNs to plan, deliver, and implement effective telehealth practices.
Familial Adenomatous Polyposis–associated Traditional Serrated Adenoma of the Small Intestine
Authors: Alruwaii Zainab I. , Chianchiano Peter , Larman Tatianna , Wilentz Alexander , Wood Laura D. , Montgomery Elizabeth A.
Published: July 2021

Familial adenomatous polyposis (FAP) is an inherited cancer predisposition syndrome associated with numerous gastrointestinal tract adenomatous polyps, as well as gastric fundic gland polyps and pyloric gland adenomas in the upper gastrointestinal tract. While colonic FAP-associated traditional serrated adenomas (TSAs) have been reported in a few studies, small bowel FAP-associated adenomas with TSA morphology have not been characterized. This study describes the clinicopathologic and molecular findings of this type of adenoma in the small bowel of patients with FAP. We reviewed small bowel adenomas in 45 consecutive FAP patients to identify adenomas with zones showing slit-like serrations, cells with eosinophilic cytoplasm, ectopic crypt formation, and vesicular nuclei. Sporadic small bowel adenomas from 51 consecutive patients were also reviewed for adenomas with the same features. Of the 177 polyps from 45 FAP patients and 60 polyps from 51 nonsyndromic patients, 18 TSAs from 9 FAP patients (20%) and 10 TSAs from the sporadic group (19.6%) were identified. FAP patients presented at a younger age than nonsyndromic patients (median: 43 vs. 66; P=0.0048). FAP-associated TSAs were asymptomatic and smaller than sporadic TSAs (median size: 0.6 vs. 2.5 cm; P=0.00006). Immunostaining for β-catenin and testing for BRAF and KRAS mutations were performed in a subset of the cohort. Nuclear β-catenin was seen in 1 FAP-associated TSA and 3 nonsyndromic TSAs. All TSAs (FAP-associated and nonsyndromic) showed wild-type BRAF, while KRAS mutations were identified only in the nonsyndromic setting. In summary, small bowel FAP-associated and sporadic TSAs share a similar morphology, and the BRAF-serrated pathway does not contribute to their pathogenesis.
Misleading Germ Cell Phenotype in Pulmonary NUT Carcinoma Harboring the ZNF532-NUTM1 Fusion
Authors: Agaimy Abbas , Haller Florian , Renner André , Niedermeyer Jost , Hartmann Arndt , French Christopher A.
Published: July 2021

NUT carcinoma (aka NUT midline carcinoma) is a rare, still significantly underrecognized aggressive malignancy. Although historically considered a midline malignancy of children and young adults, NUT carcinoma can originate in almost any body site and in any age group. Beside the classic BRD4-NUTM1 fusion, less common fusion partners include BRD3, NSD3, ZNF532, and ZNF592. Other fusions, including CIC, MGA, MXD4, MXD1, and BCORL1 are associated with sarcomas or cancers of unknown histogenesis. Involvement of the Z4 zinc finger protein (ZNF) family members ZNF532 and ZNF592 is exceedingly rare with only 3 recently reported cases. We herein describe a ZNF532-NUTM1–rearranged NUT carcinoma presenting as a 7.5 cm mass in the left lower lung lobe of a 65-year-old woman. Histology revealed undifferentiated monotonous small round cells with focal epithelioid and rhabdoid elements within a variably myxoid stroma. Immunohistochemistry revealed paucity of keratins and variable p63 combined with extensive CD30 and PLAP expression, leading to initial diagnoses of combined small cell carcinoma, CD30-positive unclassified hematolymphoid malignancy and malignant germ cell neoplasm. Negativity for other more specific germ cell markers justified seeking a fourth opinion, which revealed diffuse expression of the NUT antibody. The diagnosis was then confirmed by fluorescence in situ hybridization. Targeted RNA sequencing revealed the ZNF532-NUTM1 fusion. Screening of 7 NUT carcinomas (5 with BRD4-NUTM1 and 2 with NSD3-NUTM1 fusions) for germ cell markers revealed focal SALL4 reactivity in 3 cases (combined with variable AFP expression in 2), but none expressed CD30 or PLAP. An aberrant germ cell immunophenotype should be considered in NUT carcinoma to avoid misinterpretation as genuine germ cell malignancy as both diseases predominantly affect the young population, frequently involve the mediastinum and can be associated with elevated serum AFP.
Sigmoid Colon Carcinoma Presenting in Inguinoscrotal Hernia With FDG PET/CT
Authors: Erol Özge , Beyhan Ediz , Şahin Rahime , Baloğlu Mehmet Can , Çermik Tevfik Fikret
Published: July 2021

Primary carcinoma of the sigmoid colon in an inguinal hernia is a rare condition. We present a 79-year-old man diagnosed with sigmoid colon carcinoma referred to 18F-FDG PET/CT for staging. PET/CT showed the primary lesion in the inguinal hernia into scrotum.
Osteoblastoma of the Lumbar Spine
Authors: Laverde Mächler Alfredo , Suárez Fernández Juan Pablo , Domínguez Grande María Luz , Vigil Díaz Carmen , González García Francisco Manuel
Published: July 2021

Osteoblastoma is an uncommon benign osteoid tissue-forming bone tumor. We present the case of a 16-year-old adolescent boy with lower back pain that radiated down the right thigh. Lumbar MRI and CT findings were consistent with a long-standing osteoid osteoma located in the right laminae and pedicle of L3. SPECT/CT with 99mTc-DPD showed a highly increased osteogenic activity within the lesion, especially in the core region, also suggesting an osteoid osteoma. Surgical en bloc resection was performed with a final histological diagnosis of osteoblastoma.
Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control
Authors: DuBose Joseph J. , Burlew Clay Cothren , Joseph Bellal , Keville Meghan , Harfouche Melike , Morrison Jonathan , Fox Charles J. , Mooney Jennifer , O’Toole Robert , Slobogean Gerard , Marchand Lucas S. , Demetriades Demetrios , Werner Nicole L. , Benjamin Elizabeth , Costantini Todd
Published: July 2021

Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. In addition, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined.

LEVEL OF EVIDENCE

Review, level IV.
Femoral vascular access for endovascular resuscitation
Authors: Manning James E. , Moore Ernest E. , Morrison Jonathan J. , Lyon Regan F. , DuBose Joseph J. , Ross James D.
Published: July 2021

Endovascular resuscitation is an emerging area in the resuscitation of both severe traumatic hemorrhage and nontraumatic cardiac arrest. Vascular access is the critical first procedural step that must be accomplished to initiate endovascular resuscitation. The endovascular interventions presently available and emerging are routinely or potentially performed via the femoral vessels. This may require either femoral arterial access alone or access to both the femoral artery and vein. The time-critical nature of resuscitation necessitates that medical specialists performing endovascular resuscitation be well-trained in vascular access techniques. Keen knowledge of femoral vascular anatomy and skill with vascular access techniques are required to meet the needs of critically ill patients for whom endovascular resuscitation can prove lifesaving. This review article addresses the critical importance of femoral vascular access in endovascular resuscitation, focusing on the pertinent femoral vascular anatomy and technical aspects of ultrasound-guided percutaneous vascular access and femoral vessel cutdown that may prove helpful for successful endovascular resuscitation.
Can RH+ whole blood be safely used as an alternative to RH− product? An analysis of efforts to improve the sustainability of a hospital’s low titer group O whole blood program
Authors: McCoy C. Cameron , Montgomery Kelsey , Cotton Madeline E. , Meyer David E. , Wade Charles E. , Cotton Bryan A.
Published: July 2021

BACKGROUND

Low-titer group O whole blood (LTO-WB) has recently gained popularity in trauma centers for the acute resuscitation of hemorrhagic shock. However, limited supplies of Rh− product prevent implementation and strain sustainability at many trauma centers. We set out to identify whether Rh+ LTO-WB could be safely substituted for RH− product, regardless of patient’s Rh status.

METHODS

Following Institutional Review Board approval, information on all trauma patients receiving prehospital or emergency department transfusion of uncrossed, emergency release LTO-WB (11/17–10/19) were evaluated. Patients were first divided into those who received Rh− versus Rh+ product, the assessed by Rh of the recipient. Serial hemolysis panels, transfusion reactions, and outcomes were compared.

RESULTS

Six hundred thirty-seven consecutive trauma patients received emergency release LTO-WB. Of these, 448 received Rh+ product, while 189 received Rh− LTO-WB. Patients receiving Rh+ product were more likely to be men (81 vs. 70%) and have lower field blood pressure (median 99 vs. 109) and GCS (median 7 vs. 12); all p < 0.05. There were no differences in blood product volume, hemolysis laboratories, transfusion reactions, complications, or survival. We then separated patients by Rh status (577 were Rh+, 70 were Rh−). Rh− patients were older (median age 54 vs. 39), more likely to be women (57 vs. 26%), and more likely to have sustained blunt trauma than their Rh+ counterparts (92 vs. 70%); all p < 0.05. There were no differences in hemolysis laboratories, transfusion reactions, complications, or survival between Rh+ and Rh− patients, regardless of Rh product received.

CONCLUSION

When Rh− whole blood is unavailable or in short supply, Rh+ LTO-WB appears to be a safe alternative for the resuscitation of hemorrhagic shock in both Rh+ and Rh− patients. Use of Rh+ product may help trauma centers incorporate LTO-WB into their hospital and improve sustainability of such programs.

LEVEL OF EVIDENCE

Therapeutic, Level III
In-house intensivist presence does not affect mortality in select emergency general surgery patients
Authors: Rushing Amy P. , Strassels Scott A. , Ricci Kevin B. , Daniel Vijaya T. , Ingraham Angela M. , Paredes Anghela Z. , Diaz Adrian , Oslock Wendelyn M. , Baselice Holly E. , Heh Victor K. , Santry Heena P.
Published: July 2021

BACKGROUND

This study aimed to assess the relationship between availability of round-the-clock (RTC) in-house intensivists and patient outcomes in people who underwent surgery for a life-threatening emergency general surgery (LT-EGS) disease such as necrotizing soft-tissue infection, ischemic enteritis, perforated viscus, and toxic colitis.

METHODS

Data on hospital-level critical care structures and processes from a 2015 survey of 2,811 US hospitals were linked to patient-level data from 17 State Inpatient Databases. Patients who were admitted with a primary diagnosis code for an LT-EGS disease of interest and underwent surgery on date of admission were included in analyses.

RESULTS

We identified 3,620 unique LT-EGS admissions at 368 hospitals. At 66% (n = 243) of hospitals, 83.5% (n = 3,021) of patients were treated at hospitals with RTC intensivist-led care. These facilities were more likely to have in-house respiratory therapists and protocols to ensure availability of blood products or adherence to Surviving Sepsis Guidelines. When accounting for other key factors including overnight surgeon availability, perioperative staffing, and annual emergency general surgery case volume, not having a protocol to ensure adherence to Surviving Sepsis Guidelines (adjusted odds ratio, 2.10; 95% confidence interval, 1.12–3.94) was associated with increased odds of mortality.

CONCLUSION

Our results suggest that focused treatment of sepsis along with surgical source control, rather than RTC intensivist presence, is key feature of optimizing EGS patient outcomes.

LEVEL OF EVIDENCE

Therapeutic, level III.
ABO Mismatch in Allogeneic Hematopoietic Stem Cell Transplant: Effect on Short- and Long-term Outcomes
Authors: Valentini Caterina Giovanna , Metafuni Elisabetta , Gallo Lorenzo , Giammarco Sabrina , Orlando Nicoletta , Bianchi Maria , Sica Simona , Bacigalupo Andrea , Chiusolo Patrizia , Teofili Luciana
Published: July 2021

Background.

The impact of ABO incompatibility (ABO-I) on hematopoietic stem cell transplant outcomes is still debated.

Methods.

We retrospectively investigated 432 consecutive transplants performed at our center (2012–2020). All patients but 6 were affected by hematologic malignancies. The effect of different ABO match combinations on engraftment rate, transfusion support, acute and chronic graft-versus-host disease incidences, nonrelapse mortality (NRM), disease-free survival, and overall survival was assessed in univariate and multivariate analysis. Significance was set at P < 0.05.

Results.

ABO match distribution among transplants was as follows: 223 ABO-compatible, 94 major ABO-I, 82 minor ABO-I, and 33 bidirectional ABO-I. At univariate analysis, major ABO-I delayed the engraftment of neutrophils, platelets, and erythroid cells. At multivariate analysis, major ABO-I transplants displayed delayed erythroid engraftment (odds ratio [OR], 0.51; 95% confidence intervals [CIs], 0.38-0.70; P < 0.0001) and hindered transfusion independence for both red blood cells (OR, 0.52; 95% CI, 0.37-0.72; P = 0.0001) and platelets (0.60; 95% CI, 0.45-0.86; P = 0.0048). Moreover, major ABO-I transplants received greater amounts of blood products (P < 0.0001 for red blood cells and P = 0.0447 for platelets). In comparison with other ABO matches, major ABO-I was associated with an increased NRM (OR, 1.67; 95% CI, 1.01-2.75; P = 0.0427). No effects of ABO-mismatch were found on graft-versus-host disease, disease-free survival, and overall survival.

Conclusions.

Major ABO mismatch delays multilineage engraftment hinders transfusion independence and increases NRM. The prognostic impact of transfusion burden in hematopoietic stem cell transplantation deserves to be explored.
Successful Use of Minocycline for the Treatment of Methamphetamine-Induced Psychosis and Cognitive Impairments: An Open-Label Case Series
Authors: Alavi Sasan , Darharaj Mohammad , Bilehsavar Shirin Haghshenas , Amini Mahdi , Zafarghandi Mohammad Bagher Saberi , Berenji Vahid , Arezoomandan Reza
Published: July 2021

Aim

Methamphetamine-induced psychosis and neuropsychological impairments are common among patients with methamphetamine use disorder. Given some preclinical and clinical studies reporting potential effects of minocycline, a second-generation tetracycline, on correcting manifestations of drug addiction, this study aimed to examine the effectiveness of minocycline in attenuating psychotic symptoms and neuropsychological impairments in chronic methamphetamine users.

Method

Five men with treatment-resistant methamphetamine use disorder and psychotic symptoms were selected using a convenience sampling method, and they were administered a daily dose of 200-mg minocycline for 8 weeks; within this period, psychiatric and neuropsychological assessments (including memory and executive functions) were carried out at the baseline, week 2, week 4, week 8, and 2-month follow-up.

Results

The findings showed that minocycline attenuated both positive (Cohen d = 0.63) and negative (Cohen d = 0.53) methamphetamine-induced psychotic symptoms and also improved patients' neuropsychological functions, particularly their auditory working memory (Cohen d = 0.45).

Conclusions

These results provide promising evidence regarding the positive effects of minocycline as adjunctive pharmacotherapy for patients with methamphetamine use disorder. However, given that this was an open-label study, further research is warranted to draw a firm conclusion about the effectiveness of minocycline for methamphetamine-induced psychosis and neuropsychological deficits.
Real World Pharmacological First Treatment Patterns of Patients With Parkinson Disease and Disease Duration: A Large-Scale Cohort Study Using an Health Maintenance Organization Database
Authors: Faust-Socher Achinoam , Gurevich Tanya , Rozani Violetta , Giladi Nir , Hemo Beatriz , Peretz Chava
Published: July 2021

Objectives

Real-world data were used to describe first antiparkinsonian drug (FAPD) prescription patterns among Parkinson disease (PD) patients and to evaluate disease duration until levodopa (l-DOPA) treatment and until death, as related to FAPD, by age group.

Methods

The community-based cohort (2000–2012) included 6243 patients, members of an Israeli Health Maintenance Organizations. Time from FAPD purchase to 2 end points (l-DOPA purchase and death) was calculated. Cox regressions were used to estimate adjusted heart rate (HR) to either end point as related to FAPD type, by age group.

Results

During a mean follow-up of 4.8 ± 3.2 years, one third of the cohort died. The percent of l-DOPA use as a start drug increased with age, whereas the percent of dopamine agonists (DAs) and monoamine oxidase inhibitor B inhibitor (MAO-BI) decreased with age. Younger women were treated more often with DA as a start drug compared with younger men. In ages of younger than 50 years, time to l-DOPA start in the initial DA-group was 4 times longer than in the initial MAO-BI group (HR, 0.23; 95% confidence interval, 0.08–0.43; 1/0.23, 4.35). All age groups exhibited a similar survival time trend associated with initial drug type. An age-pooled HR with initial l-DOPA-group as a reference group yielded that survival time was 2.4 times longer for the initial DA group (HR, 0.41; 95% confidence interval, 0.31–0.55; 1/0.41, 2.44), 1.9 times and 1.4 times for initial MAO-BI or amantadine, respectively.

Conclusions

First antiparkinsonian drug choice might be associated with time until l-DOPA initiation but may represent disease severity at the time of prescription, thus also affecting survival time as well. Real-world data illustrated that this choice is also age and sex dependent.