bluuebunny/crossref_metadata_2025 huggingface dataset:
The Missing Profits of Nations
Authors: Tørsløv Thomas , Wier Ludvig , Zucman Gabriel
Published: July 2022

By exploiting new macroeconomic data known as foreign affiliates statistics, we show that affiliates of foreign multinational firms are an order of magnitude more profitable than local firms in a number of low-tax countries. Leveraging this differential profitability, we estimate that 36$\%$ of multinational profits are shifted to tax havens globally. US multinationals shift twice as much profit as other multinationals relative to the size of their foreign earnings. We analyse how the location of corporate profits would change if shifted profits were reallocated to their source countries. Domestic profits would increase by about 20$\%$ in high-tax European Union countries, 10$\%$ in the US, and 5$\%$ in developing countries, while they would fall by 55$\%$ in tax havens. We provide a new international database of GDP, trade balances, and factor shares corrected for profit shifting. In contrast to the picture painted by official statistics, our results suggest that the corporate capital share has increased not only in North America but also in high-tax European countries. Capital is making a comeback globally, but its rise is obscured by the tax avoidance strategies of multinational companies.
Comparison of rapid eye movement without atonia quantification methods to diagnose rapid eye movement sleep behavior disorder: a systematic review
Authors: Byun Jung-Ick , Yang Tae-Won , Sunwoo Jun-Sang , Shin Won Chul , Kwon Oh-Young , Jung Ki-Young
Published: July 2022

Study Objectives

Rapid eye movement (REM) sleep without atonia (RWA) is essential for diagnosing REM sleep behavior disorder (RBD). Manual and automatic quantifications of RWA that use different criteria have been validated. This study compared the RWA quantification methods for diagnosing RBD.

Methods

The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systemically searched for studies published from inception to December 2021. The inclusion criteria were cohort, cross-sectional, and case-control studies assessing the sensitivity and specificity of RWA quantification methods. Pooled estimates of the sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were determined. Risk of bias and certainty of evidence was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool and the Grading of Recommendations, Assessment, Development, and Evaluations framework, respectively.

Results

Fourteen articles including 402 patients with RBD met the inclusion criteria. Manual methods evaluating any chin and phasic flexor digitorum superficialis (FDS) activity had the highest DOR (138.8, 95% CI = 21.8% to 881.7%) and AUC (0.9686). The automatic REM atonia index (RAI) showed similar or higher sensitivity (89.1%, 95% CI = 84.6% to 92.7%) but a lower specificity (73.5%), DOR (43.1), and AUC (0.9369) than the manual techniques.

Conclusions

In this meta-analysis, manual RWA quantification that employed chin or phasic FDS activity had the best RBD diagnostic performance. The automatic RAI method may be useful for screening patients with RBD. The results should be interpreted carefully because of the high risk of bias in patient selection and significant heterogeneity among the studies.

PROSPERO Registration number

CRD42021276445.
Hindlimb Suspension As A Model For Intracranial And Intraocular Pressures, And Retinal Changes During Spaceflight
Authors: Fuller Charles A , Gompf Heinrich , Hoban‐Higgins Tana , Robinson Edward
Published: July 2022

A pronounced cephalic fluid shift is one of the responses to exposure to the microgravity spaceflight environment. This project uses the well‐documented rat hindlimb suspension (HLS) model to test the hypothesis that this fluid shift is a causative factor underlying the ocular changes seen in astronauts during and following long‐duration spaceflight. This hypothesis follows from the fact that similar ocular effects are seen in Idiopathic Intracranial Hypertension (IIH) and are associated with increased intraocular pressure (IOP).

In order to elucidate the roles played by age and sex in the relationship between a cephalic fluid shift and the regulation of intracranial pressure (ICP) and IOP, as well as visual system structure and function, three cohorts are under study: young adult females, young adult males, and older middle‐age males. Groups of animals are exposed to HLS durations of 0 (baseline), 7, 14, 28 and 90 days with 90 days of HLS being followed by equivalent intervals of recovery in a vivarium cage, i.e. either 0, 7, 14, 28 or 90 days. Each HLS subject has an age‐matched control maintained in the same room but in a vivarium cage. An LD 12:12 cycle is present and all subjects have ad lib access to food and water.

This presentation represents a status report of this ongoing program. We have measured ICP in one group of subjects. ICP recording is underway for the other 2 groups. To date, the data identify a very small increase in ICP, which is maintained during HLS. Our hypothesis is that this increase in ICP could lead to morphological changes in visual structures similar to those seen previously in some astronauts following long duration missions. To this end, MRI was used to image the eyes and brains in all 3 groups at baseline and at the midpoint and endpoint of HLS and recovery. Data analysis indicates increased optic nerve sheath diameters which are most pronounced in the middle‐aged males yet also observed in younger males, as well as globe flattening in HLS. IOP continues to be measured in all animals under study. In general, there is a trend for increased IOP during HLS. Moreover, refractive error increases over 90 days of suspension. These preliminary results continue to be supportive of our hypothesis that an increase in ICP may underlie such ocular changes.

Support or Funding Information

Supported by NASA Grant NNX13AD94G.
Concomitant neuroleptic malignant syndrome and diabetes insipidus
Authors: Zaki Carlee , Ugell Meredith , Vo Trang , Liu Steven
Published: July 2022

Each year, nearly one-fifth of adults in the United States are prescribed at least one psychotropic medication. An increased trend in psychiatric polypharmacy has heightened awareness of drug-drug interactions and the tracking of adverse drug reactions. This article describes a patient who developed concomitant neuroleptic malignant syndrome (NMS) and nephrogenic diabetes insipidus during cross-titration of his antipsychotics while on lithium. The patient's mild form of NMS in turn caused hypovolemia and acute kidney injury. This case study highlights the dangers of polypharmacy and how it can obscure the presentation of even classic adverse reactions.
American health workforce policy and PAs
Authors: Cawley James F.
Published: July 2022

Health workforce policy in the United States from the mid-1970s has been strongly influenced by perceptions of the adequacy of the physician supply and its relationship to physician assistants/associates (PAs) and NPs. During the 1980s, a series of inaccurate reports by the federal government mistakenly warned of an impending physician surplus and shaped policy decisions for decades. In spite of perceptions of a physician surplus, the PA profession expanded rapidly in the 1990s. Projections of the adequacy of the physician supply changed to a shortage in the first decade of this century and the PA component of the healthcare workforce continued to expand. During the past decade, the Association of American Medical Colleges has employed microsimulation modeling expertise to project the extent of physician shortages, an effort that initially failed to incorporate the contributions of PAs and NPs in the workforce. Although current projection models include the contributions of PAs and NPs, the substitution ratios used are notably low. Specifically, PA and NP productivity effort was set roughly at one-quarter to one-half that of the physician. PAs and NPs make up a substantial contingent within the US healthcare workforce and should be included fully in future workforce projection estimates. This article provides policy recommendations for the advancement of PA contributions to the delivery of medical care.
Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgeries
Authors: Villavicencio Alan T. , Nelson E. Lee , Rajpal Sharad , Beasley Kara , Burneikiene Sigita
Published: July 2022

Study Design.

Prospective, randomized, blinded clinical trial.

Objective.

To examine clinical and radiological outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF) surgeries randomized to receive either polyether-ether-ketone (PEEK) or structural bone allografts.

Summary of Background Data.

The biomechanical qualities as well as osteoconductive, osteogenic, and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however, as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF.

Methods.

Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. Radiographic and clinical outcomes were assessed at 3, 6, 12, and 24 months with an additional postoperative radiographic assessment.

Results.

A total of 120 patients were enrolled and randomized. Comparing clinical outcomes, no differences in arm or neck pain scores were noted; however, there was a statistically significant (≤0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency toward lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (P = 0.72) in the PEEK and allograft groups, respectively. At 24 months’ follow-up time, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24 months’ follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment.

Conclusion.

Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK versus allograft-assisted ACDF surgeries. Although MCID comparisons suggest that allograft and PEEK-treated patients have similar clinical outcomes, testing that incorporates the magnitude of the change suggests that there may be a statistically significant greater magnitude of improvement for the allograft group patients, but further studies with a larger sample size would be helpful to determine if a true effect exists.
Opioid Prescribing Patterns Before, During, and After Critical Illness: An Observational Study
Authors: Wampole Chelsea , McKenna Ariel , Riker Richard R. , May Teresa L. , Seder David B. , Abram Dawn , Fraser Gilles L. , Gagnon David J.
Published: July 2022

OBJECTIVES:

The association between opioid therapy during critical illness and persistent opioid use after discharge is understudied relative to ICU opioid exposure and modifiable risk factors. Our objectives were to compare persistent opioid use after discharge among patients with and without chronic opioid use prior to admission (OPTA) and identify risk factors associated with persistent use.

DESIGN:

Retrospective cohort study.

SETTING:

Medical, trauma/surgical, or neurologic ICU at an academic hospital.

PARTICIPANTS:

Adult patients surviving hospital admission.

INTERVENTIONS:

Opioid use during the ICU and post-ICU stays.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was persistent opioid use accounting for greater than 70% of days 4–6 months after discharge. Among 2,975 included patients, 257 (8.6%) were classified as OPTA, and 305 (10.2%) persistently filled opioid prescriptions, including 186/257 (72%) OPTA and 119/2,718 (4.4%) with no chronic opioid fills prior to admission. Among all patients, OPTA was strongly associated with persistent opioid use (odds ratio, 57.2 [95% CI, 41.4–80.0]). Multivariable logistic regression revealed that male sex, surgical procedure, and ICU opioid-free days were associated with reduced persistent opioid use for OPTA patients. Age and ICU opioid-free days were associated with reduced persistent opioid use for non-OPTA patients. Total ICU opioid dose and dose per day of ICU exposure were not associated with persistent use for either group.

CONCLUSIONS:

In this mixed cohort of ICU patients, 10.2% persistently filled opioid prescriptions 4–6 months after discharge. Although ICU opioid doses were not associated with persistent use, duration of ICU opioid administration is a modifiable risk factor that may reduce persistent opioid use after critical illness.
Surviving Sepsis Guideline–Directed Fluid Resuscitation: An Assessment of Practice Patterns and Impact on Patient Outcomes
Authors: Govero Austin B. , Yarrarapu Siva Naga S. , Harrison Michael F. , Baig Hassan Z. , Guru Pramod , Moreno Franco Pablo , Caples Sean M. , Grek Ami A. , Vizzini Michael R. , Ball Colleen T. , Khan Syed A. , Heise Katherine J. , Sekiguchi Hiroshi , Cantrell Warren L. , Sanghavi Devang K.
Published: July 2022

IMPORTANCE:

Aggressive fluid resuscitation remains a cornerstone of the Surviving Sepsis Campaign (SSC) guidelines, but there is growing controversy regarding the recommended 30 mL/kg IV fluid dosage. It is contended that, in selected patients, this volume confers an increased risk of volume overload without either concomitant benefit or strong evidence in support of the recommended IV fluid dosage.

OBJECTIVES:

Assessment of practice patterns and their impact on patient outcomes following the surviving sepsis guidelines for fluid resuscitation.

DESIGN:

Large, multisite retrospective cohort study.

SETTING AND PARTICIPANTS:

The retrospective study included all adult patients who presented to the emergency department at one of 19 different Mayo Clinic sites throughout the Midwest, Southeast, and Southwest from August 2018 to November 2020 with suspected sepsis.

MAIN OUTCOMES AND MEASURES:

Eight-thousand four-hundred fourteen patients suspected to have sepsis were assessed regarding fluid resuscitation and outcomes among patients receiving 30 mL/kg IV fluid dosing compared with patients who did not. Patient demographics and clinical information were collected via electronic health records. Patients were divided into two cohorts: those who received 0–29.9 mL/kg of IV fluid and those who received 30.0+ mL/kg of IV fluid. Statistical analyses were performed to evaluate the impact of fluid dose on in-hospital death, 30-day mortality, ICU admission after diagnosis, dialysis initiation after diagnosis, ventilator use, vasopressor use, as well as ICU and hospital length of stay.

RESULTS:

We observed lower in-hospital mortality and 30-day mortality risk in the 30+ mL/kg dosing group. Increased fluid dosage did, however, carry a much greater chance of ICU admission. Most patients (72% after propensity score weighting) in our population received less than 30 mL/kg fluid (based on ideal body weight).

CONCLUSIONS AND RELEVANCE:

IV fluid dosing for sepsis resuscitation greater than 30 mL/kg was associated with decreased risk of in-hospital mortality, 30-day mortality, and reduced risk of requiring mechanical ventilation. Our data does ultimately seem to support the SSC recommendation.
HTLV-1-related adult T-cell leukemia/lymphoma: insights in early detection and management
Authors: Wolf Sonia , Vercruyssen Marie , Cook Lucy
Published: July 2022

Purpose of review

Adult T-cell leukemia-lymphoma (ATL) is an aggressive mature T-cell malignancy that arises in approximately 5% of carriers of human T-lymphotropic virus type 1 (HTLV-1), but this risk is not random among carriers. We describe recent advance in pathogenesis, risk factors and for early detection of ATL.

Recent findings

Unraveling ATL molecular genetics has shed light on pathogenesis and provides insights into novel therapeutic targets. Moreover, an important step in improving outcomes is identifying asymptomatic carriers who are at high risk of progression to ATL, which has traditionally relied on quantifying the proviral load (PVL). This can be done by quantifying oligoclonality- and in particular the expanded clone- with molecular and flow cytometric techniques, that can be applied to a clinical setting. Studies using these methods have shown that carriers with oligoclonal populations are at an increased risk of transformation, beyond that that predicted by PVL alone.

There is an urgent unmet need for developing novel therapies in ATL in order to improve survival. Recent advances in the molecular and epigenetic landscape of ATL, and the early detection of disease offer the potential to intervene early, before disease becomes aggressive, and to offer tailored therapeutic strategies.
Bacterial infection-driven lymphomagenesis
Authors: Vannata Barbara , Pirosa Maria Cristina , Bertoni Francesco , Rossi Davide , Zucca Emanuele
Published: July 2022

Purpose of review

The first convincing evidence for a causal relationship between bacterial infection and lymphomagenesis came from the link between gastric lymphoma and chronic Helicobacter pylori gastritis. This review will summarize the current epidemiological, clinical, and biological evidence of a causative role of bacteria in the development of malignant lymphomas, particularly, the extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type.

Recent findings

Other microorganisms have been associated with specific extranodal lymphoma sites with variable and not always definitive, evidence, including Chlamydia psittaci, Borrelia burgdorferi, Campylobacter jejuni and, most recently, Coxiella Burnetii. According to most plausible models, lymphoma growth is a consequence of continuous antigenic stimulation induced by chronic infection. However, some evidence of a direct oncogenic role of H. pylori has been provided, too.

Lymphomas are not the result of a single cause but multifactorial diseases, influenced by a variety of genetic and environmental elements. Hence, ascertaining the specific contribution of bacterial infections is not always easy. Nevertheless, the eradication of the associated chronic infection may result in sustained lymphoma regression. Moreover, the association between infections and lymphoma may offer opportunities for reducing lymphoma incidence by preventing the predisposing infections or treating them early.
Diagnostic Process and Barriers Among Chinese-American and Korean-American Parents of Children with Autism
Authors: Kim Irang , Dababnah Sarah , Wang Yao , Reyes Charina
Published: July 2022

Objective:

We sought to understand the experiences of Chinese-American and Korean-American parents of children with autism, including their initial concerns regarding their child's development, reported health professionals' responses to these concerns, diagnostic barriers, and factors associated with early autism diagnosis.

Method:

We designed a survey with support from an expert advisory group and Asian-American parents of children with autism. We measured 3 time points of diagnostic history, areas of parents' concerns, professionals' responses to their concerns, 15 types of diagnostic barriers, and professionals' helpfulness. We used descriptive and independent t tests to analyze data from 28 parents of children with autism.

Results:

Most of the parents (86%) had early concerns about their children's developmental delays and expressed their concerns to health professionals. However, approximately 60% of the parents reported that the professionals did not conduct developmental screenings or make referrals to specialists. The most common diagnostic barrier was the stress of the diagnostic process, followed by navigating health care systems. Parents who required interpreters noted poor quality and unavailability. Early child developmental concerns were associated with early autism diagnoses.

Conclusion:

Although many Chinese-American and Korean-American parents had early concerns regarding their child's development and shared their concerns with health care professionals, parents encountered many barriers, including the stress of the diagnostic process. Chinese-American and Korean-American parents with limited English proficiency required additional support. Health care professionals' active listening and responses to parents' concerns can promote early diagnosis.
Ascending aortic intramural hematoma: current concepts
Authors: Nana Petroula , Kouvelos George , Spanos Konstantinos
Published: July 2022

Purpose of review

Type A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.

Recent findings

Recent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.

Despite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.
Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension
Authors: Jiménez-Balado Joan , Riba-Llena Iolanda , Nafría Cristina , Pizarro Jesús , Rodríguez-Luna David , Maisterra Olga , Ballvé Alejandro , Mundet Xavier , Violan Concepción , Ventura Oriol , Montaner Joan , Delgado Pilar
Published: July 2022

Background and aims:

We aimed to study the relationship between cerebral small vessel disease (cSVD) lesions, as markers of subclinical target organ damage (TOD) in the brain, and incident cardiovascular events (CVE).

Methods:

Data from the ISSYS (Investigating Silent Strokes in hYpertensives Study), which is a longitudinal and observational study conducted in patients with hypertension aged 50–70 years, and stroke-free at the inclusion. At the baseline visit, participants underwent a clinical interview, a brain MRI, urine and blood sampling collection and vascular testing studies. Therefore, we obtained markers of TOD from the brain [white matter hyperintensities, silent brain infarcts (SBI), cerebral microbleeds and enlarged perivascular spaces (EPVS)], from kidney (microalbuminuria, glomerular filtration) and regarding large vessels [ankle-to-brachial index (ABI), carotid–femoral pulse wave velocity]. Survival analyses were used to assess the relationship between these predictors and the incidence of cardiovascular events (CVE).

Results:

We followed-up 964 individuals within a median time of 5 years (4.7–5), representing 4377.1 persons-year. We found 73 patients presenting incident CVE, which corresponds to a rate of 8.2%. We found ABI less than 0.9 [hazard ratio, 2.2; 95% confidence interval (CI) 1.17–4.13, P value = 0.014] and SBI (hazard ratio, 2.9; 95% CI 1.47–5.58, P value = 0.002) independently associated with higher risk of incident CVE. The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CVE of 4.72%, according to the integrated discrimination index.

Conclusion:

Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension.
Arterial stiffness and nocturnal hypertension in preterm children and adolescents
Authors: Chainoglou Athanasia , Sarafidis Kosmas , Chrysaidou Katerina , Farmaki Evangelia , Kollios Konstantinos , Economou Marina , Kotsis Vasilios , Stabouli Stella
Published: July 2022

Background and objectives:

Preterm birth has been associated with increased risk for developing hypertension and other chronic diseases during childhood and adulthood. The aim of the current prospective case–control study was to investigate the associations of preterm birth with ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence.

Methods:

The study population included 52 children and adolescents born preterm and 26 healthy children born full term with similar age. The participants underwent ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV).

Results:

Preterm children presented higher night SBP z score values compared to controls, but did not differ in other ABPM parameters, office peripheral and central SBPs. Nocturnal hypertension was found in 78% (7/9) of ex-preterm children with ambulatory BP hypertension. Preterm birth was an independent predictor of PWV z score adjusted for heart rate. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95% confidence interval [CI] 0.431–0.975 versus −0.19, 95% CI −0.574–0.536, respectively, P = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score.

Conclusion:

Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Increased awareness for detection of hypertension and prevention of obesity in childhood could prevent future adverse cardiovascular outcomes in preterm individuals.
Differentiating Branch Retinal Artery Occlusion From Normal Tension Glaucoma With Optical Coherence Tomography Angiography
Authors: Ferreira Nathalie Sena , Oltramari Laura , Sousa Natanael de Abreu , Makarczyk Luciana de Sá Quirino , Abe Ricardo Yuji
Published: July 2022

Background:

To describe a patient with branch retinal artery occlusion that was misdiagnosed as normal tension glaucoma (NTG)

Case Presentation:

A female 76-year-old patient presenting inferior nasal visual field scotoma, neuroretinal thinning in the optic disk of the right eye with corresponding atrophy of superior retinal nerve fiber layer in optical coherence tomography (OCT). She was treated with latanoprost eye drops for NTG. However macular OCT angiography showed a localized thinning of the inner retina following the superior temporal branch retinal artery path, along with a superficial and medium capillary plexus reduction and superior macular ganglion cell layer atrophy. Further investigation with carotid arteries angio-tomography revealed an atheromatous lesion in the right and left carotid bulb with stenosis of 50–60%, in addition to aneurysms of the cavernous, pituitary and communicating segments of the left and right internal carotid artery, reinforcing the diagnosis of superior temporal branch retinal artery ischemic.

Conclusion:

This case highlights the importance of establishing differential diagnosis in cases of presumed NTG and reinforces the use of the OCT angiography in clinical practice.
Predicting Visual Field Progression by Optical Coherence Tomography Angiography and Pattern Electroretinography in Glaucoma
Authors: Lee Mee Yon , Park Hae-Young Lopilly , Kim Seong Ah , Jung Younhea , Park Chan Kee
Published: July 2022

Précis:

Reduced P50-N95 amplitude on pattern electroretinography (PERG) and the presence of microvasculature dropout (MvD) on optical coherence tomography angiography (OCT-A) at baseline were significant factors associated with visual field (VF) progression in predominantly normal tension glaucoma (NTG) patients.

Objective:

We investigated the baseline demographics and ocular characteristics that predict future progression in glaucoma patients, including PERG and OCT-A parameters.

Methods:

One Hundred forty eyes with open angle glaucoma that were prospectively enrolled and followed up for at least 3 years, and underwent at least 5 serial VF tests were included. Baseline PERG was performed, and N35, P50, and N95 latencies and amplitudes were obtained. Superficial vessel density at the macula and complete loss of microvasculature within the deep retinal layer of the parapapillary region (MvD) were evaluated from baseline OCT-A images. Eyes with a glaucomatous VF defect in either both hemifields within 24 points of a central 10 degrees of fixation, and with no VF abnormality in the nasal periphery outside 10 degrees of fixation, were considered to have isolated central scotoma. During follow-up, detected disc hemorrhage (DH) was recorded. Parameters associated with VF progression were determined using linear regression analysis of the mean deviation (MD) values, in combination with an event-based analysis using the Glaucoma Progression Analysis (GPA) software from the Humphrey Field Analyzer. “Likely progression” using GPA was considered to have glaucoma progression.

Results:

Of the 140 eyes, 107 (76.4%) were NTG and 57 (40.7%) exhibited glaucoma progression as defined by Humphrey VF GPA. The MD slopes were −0.43±1.11 dB/y in the progressors and 0.59±1.27 dB/y in the nonprogressors (P<0.001). Glaucoma patients with progression showed frequent MvD on OCT-A, isolated central scotoma, frequent DH, and reduced baseline P50-N95 amplitude compared with patients without progression. Age at diagnosis (P=0.038) and baseline P50-N95 amplitude (P=0.019) showed significant associations with the MD slope. The presence of MvD on OCT-A (P<0.001) and baseline P50-N95 amplitude (P=0.037) were significantly associated with VF progression on GPA.

Conclusions:

The presence of MvD and retinal ganglion cell dysfunction by PERG at baseline, DH or central scotoma were significant factors associated with VF progression in predominantly NTG patients. These patients should be monitored more closely.
Evaluating the Effect of Policy Prohibiting Body Checking on Physical Contacts in U15 and U18 Youth Ice Hockey Leagues
Authors: Kolstad Ash T. , Chin Mathieu , Martinez German , Janzen Leticia , Krolikowski Maciej , Goulet Claude , Nadeau Luc , Hagel Brent E. , Emery Carolyn A.
Published: July 2022

Objective:

To compare physical contacts (PCs) and head contacts (HCs) in nonelite U15 (ages 13-14) and U18 (ages 15-17) ice hockey players in body checking (BC) and non-BC leagues.

Design:

Cohort video analysis study.

Setting:

Ice hockey arenas in Calgary, Canada.

Participants:

Players from 13 BC and 13 non-BC games at the nonelite U15 and U18 levels (n = 52 total games).

Assessment of Risk Factors:

Games were videotaped and analyzed to compare PC variables between leagues allowing and prohibiting BC.

Main Outcome Measures:

Validated methodology for PC type (trunk PC and other types of PC with limb/stick/head), intensity (low and high intensity), and HC. Incidence rate ratios (IRRs) were estimated using Poisson regression (controlling for cluster by team game and offset by player minutes) to compare the incidence of PCs in BC and non-BC games.

Results:

The rate of trunk PCs was lower in the non-BC leagues for both U15 (IRR = 0.50, 99% confidence interval [CI]: 0.43-0.58) and U18 (IRR = 0.56, 99% CI: 0.46-0.67) players. This was most significant for BC contacts (U15: IRR = 0.18, 99% CI: 0.11-0.29; U18: IRR = 0.16, 99% CI: 0.08-0.34), although also significant for body contacts (U15: IRR = 0.54, 99% CI: 0.46-0.64; U18: IRR = 0.58, 99% CI: 0.48-0.70), other PCs, (U15: IRR = 0.60, 99% CI: 0.45-0.78; U18: IRR = 0.71, 99% CI: 0.58-0.88), and HCs (U15: IRR = 0.40, 99% CI: 0.22-0.71; U18: IRR = 0.37, 99% CI: 0.25-0.57).

Conclusions:

The incidence of BC was 82% lower in the U15 and 84% lower in U18 levels not allowing BC, with lower HC and other PC rates also in non-BC leagues. These findings demonstrate high adherence with BC policy change in youth ice hockey.
The Economic Burden of Disease in France From the National Health Insurance Perspective
Authors: Rachas Antoine , Gastaldi-Ménager Christelle , Denis Pierre , Barthélémy Pauline , Constantinou Panayotis , Drouin Jérôme , Lastier Dimitri , Lesuffleur Thomas , Mette Corinne , Nicolas Muriel , Pestel Laurence , Rivière Sébastien , Tajahmady Ayden , Gissot Claude , Fagot-Campagna Anne
Published: July 2022

Background:

Identifying the most frequently treated and the costliest health conditions is essential for prioritizing actions to improve the resilience of health systems.

Objectives:

Healthcare Expenditures and Conditions Mapping describes the annual economic burden of 58 health conditions to prepare the French Social Security Funding Act and the Public Health Act.

Design:

Annual cross-sectional study (2015–2019) based on the French national health database.

Subjects:

National health insurance beneficiaries (97% of the French residents).

Measures:

All individual health care expenditures reimbursed by the national health insurance were attributed to 58 health conditions (treated diseases, chronic treatments, and episodes of care) identified by using algorithms based on available medical information (diagnosis coded during hospital stays, long-term diseases, and specific drugs).

Results:

In 2019, €167.0 billion were reimbursed to 66.3 million people (52% women, median age: 42 y). The most prevalent treated diseases were diabetes (6.0%), chronic respiratory diseases (5.5%), and coronary diseases (3.2%). Coronary diseases accounted for 4.6% of expenditures, neurotic and mood disorders 3.7%, psychotic disorders 2.8%, and breast cancer 2.1%. Between 2015 and 2019, the expenditures increased primarily for diabetes (+€906 million) and neurotic and mood disorders (+€861 million) due to the growing number of patients. “Active lung cancer” (+€797 million) represented the highest relative increase (+54%) due to expenditures for the expensive drugs and medical devices delivered at hospital.

Conclusions:

These results have provided policy-makers, evaluators, and public health specialists with key insights into identifying health priorities and a better understanding of trends in health care expenditures in France.
Patient Sense of Belonging in the Veterans Health Administration
Authors: Lafferty Megan , Strange Wynn , Kaboli Peter , Tuepker Anaïs , Teo Alan R.
Published: July 2022

Background:

Health care systems have increasingly focused on patient engagement in efforts to improve patient-centered care. Appointment attendance is an integral component of patient engagement, and missed appointments are an ongoing problem for health care systems. Virtually no studies have examined how the sense of belonging is related to patient engagement within a health care system.

Objective:

To examine patient experiences in the Veterans Health Administration (VA) with outpatient appointment attendance to identify factors that affect sense of belonging and patient engagement.

Research Design and Participants:

This study draws from qualitative data collected as part of a study to reduce missed appointments through use of enhanced appointment reminder letters. We conducted semistructured interviews with 27 VA patients with primary care or mental health clinic visits, using deductive and inductive analysis to develop themes. More than half of the participants were Vietnam veterans, 24 were over 40 years old, 21 were White, and 18 were men.

Results:

We identified 3 factors that influence sense of belonging within the VA: (1) feelings of camaraderie and commitment toward other veterans were relevant to patient experience in the VA; (2) interactions with all staff influenced the engagement a patient felt with a particular clinic, care team, and the VA; (3) personalized communication and messaging could humanize the VA and demonstrate its interest in engaging with veterans. Lastly, we found (4) sense of belonging appeared to promote appointment attendance and patient engagement.

Conclusions:

There are multiple opportunities to strengthen patients’ sense of belonging within the health care system that serves them. For veterans, strategies that build their sense of belonging may be a novel approach to increase appointment attendance and patient engagement in their health care.
Current endoscopic approaches to biliary strictures
Authors: Sato Tatsuya , Nakai Yousuke , Fujishiro Mitsuhiro
Published: July 2022

Purpose of review

To summarize the current status and future perspectives of the endoscopic management of biliary strictures.

Recent findings

In addition to conventional diagnostic modalities, such as cross-sectional imaging and endoscopic ultrasonography (EUS), per-oral cholangioscopy is helpful for indeterminate biliary strictures. It allows direct visualization of the biliary tract and targeted biopsy. For distal malignant biliary obstruction (MBO), a self-expandable metal stent (SEMS) via endoscopic retrograde cholangiopancreatography (ERCP) is a standard of care. EUS-guided biliary drainage (EUS-BD) is an emerging alternative to percutaneous transhepatic biliary drainage in cases with failed ERCP. EUS-BD is also an effective salvage option for perihilar MBO, which can not be managed via ERCP or percutaneous transhepatic biliary drainage. Preoperative drainage is necessary for most jaundiced patients as neoadjuvant chemotherapy is widely administered for resectable and borderline resectable pancreatic cancer, and a SEMS is preferred in this setting, too. For benign biliary strictures, a covered SEMS can improve stricture resolution and reduce the number of endoscopic sessions as compared to plastic stents.

ERCP and EUS play a central role in the diagnosis and drainage for both malignant and benign biliary strictures.
Safe, efficient, and effective screening colonoscopy
Authors: Dornblaser David W. , Gross Seth A.
Published: July 2022

Purpose of review

Colorectal cancer continues to be one of the most common causes of cancer-related death. Widespread dissemination of screening colonoscopy in the United States has led to a significant reduction in the incidence and mortality. Here we review current literature with an aim to highlight recent improvements in the safety, efficiency, and effectiveness of screening colonoscopy.

Recent findings

Colon capsule endoscopy is an emerging noninvasive method to capture images of colonic mucosa for select patients with appreciable sensitivity for polyp detection. Recent literature supports the use of the novel oral anticoagulant apixaban over other anticoagulants to reduce the risk of gastrointestinal bleeding related to colonoscopy. Cold snare polypectomy for smaller lesions and prophylactic clipping following resection of large polyps in the proximal colon may reduce the rate of delayed bleeding. Novel methods and devices for improving bowel preparation continue to emerge. Mechanical attachment devices and artificial intelligence represent recent innovations to improve polyp detection.

Clinicians should be aware of relevant data and literature that continue to improve the quality and safety of screening colonoscopy and incorporate these findings into their clinical practice.
Medical malpractice and gastrointestinal endoscopy
Authors: Kantrowitz Michael G.
Published: July 2022

Purpose of review

Medical liability is a perennial issue that most physicians will face at some point in their careers. Gastroenterologists routinely perform endoscopic procedures to aid in the diagnosis and treatment of their patients. Advances in endoscopic techniques and technology have accelerated movement of the field into a more surgical realm. These developments warrant consideration of pitfalls that may expose gastroenterologists to liability. This review will explore trends in malpractice facing gastroenterologists and offer strategies to deliver high quality and safe patient care.

Recent findings

Despite being a procedure-oriented subspeciality, only a minority of malpractice claims against gastroenterologists are related to procedures. Diagnostic error is among the most prevalent reason for lawsuits. The consequences of malpractice are costly due litigation and indemnity as well as the increase in defensive medical practice. Improving diagnostic quality, optimizing informed consent, and enhancing patient–physician communication are important elements of risk mitigation.

Understanding the important role that diagnosis plays in medical liability allows physicians to better evaluate risk and apply deliberate decision-making in order to practice confidently.
Role of endoscopy on enteral feeding
Authors: Michael Florian A. , Friedrich-Rust Mireen , Blumenstein Irina
Published: July 2022

Purpose of review

The present review states current findings on the topic of enteral feeding and endoscopy. It is divided into two parts. First, important parts of the European Society of Gastrointestinal Endoscopy and European Society for Clinical Nutrition and Metabolism guidelines will be summarized and discussed. Second, important publications in the field of enteral nutrition published in the year 2021 will be discussed.

Recent findings

Currently published European guidelines on enteral nutrition provide well-structured guidance on preprocedural, periprocedural and postprocedural management. Relevant findings on endoscopy in enteral nutrition were currently rare. However, there were interesting meta-analysis and randomized controlled trials published on the topic of enteral feeding in surgery and intensive care medicine.
Neoadjuvant therapy in pancreatic cancer: a review and update on recent trials
Authors: Lo Winifred , Zureikat Amer
Published: July 2022

Purpose of review

Neoadjuvant therapy (NAT) has been enthusiastically embraced for patients with operable pancreatic cancer (PDAC) in hopes of improving survival. However, the rapid integration of clinical trial data has made it difficult to discern optimal treatment strategies. The goal of this review is to summarize notable recent trials and their contributions to the field.

Recent findings

The results of ESPAC-5F, NEOLAP-AIO-PAK-0113, SWOG1505, PREOPANC, HyperAcutePancreas, and ALLIANCE A021501 are reviewed in detail. These studies sequentially evaluate the different neoadjuvant treatment strategies, use of neoadjuvant chemoradiation, and immunotherapy in resectable, borderline-resectable, and locally advanced PDAC. Resection rate ranged from 24.4 to 95.7% (median 64.9%). These trials demonstrate median survival ranging from 14.9 to 41.0 months with progression-free survival ranging from 7.7 to 24.2 months. Survival results may be confounded by ability to reach resection, use of modern chemotherapy vs. gemcitabine monotherapy, and inclusion of locally advanced PDAC. Several upcoming trials will directly examine efficacy of NAT vs. adjuvant therapy, chemoradiation in the NAT setting, and molecular testing-driven chemotherapy selection.

NAT is associated with improved survival for patients with borderline resectable PDAC but broader efficacy for resectable PDAC and optimal treatment strategy have yet to be defined.
DSA in solid organ transplantation: is it a matter of specificity, amount, or functional characteristics?
Authors: Louis Kevin , Lefaucheur Carmen
Published: July 2022

Purpose of review

The present review describes the clinical relevance of human leukocyte antigen (HLA) donor-specific antibodies (HLA-DSAs) as biomarkers of alloimmunity and summarizes recent improvements in their characterization that provide insights into immune risk assessment, precision diagnosis, and prognostication in transplantation.

Recent findings

Recent studies have addressed the clinical utility of HLA-DSAs as biomarkers for immune risk assessment in pretransplant and peritransplant, diagnosis and treatment evaluation of antibody-mediated rejection, immune monitoring posttransplant, and risk stratification.

HLA-DSAs have proved to be the most advanced immune biomarkers in solid organ transplantation in terms of analytical validity, clinical validity and clinical utility. Recent studies are integrating multiple HLA-DSA characteristics including antibody specificity, HLA class, quantity, immunoglobulin G subclass, and complement-binding capacity to improve risk assessment peritransplant, diagnosis and treatment evaluation of antibody-mediated rejection, immune monitoring posttransplant, and transplant prognosis evaluation. In addition, integration of HLA-DSAs to clinical, functional and histological transplant parameters has further consolidated the utility of HLA-DSAs as robust biomarkers and allows to build new tools for monitoring, precision diagnosis, and risk stratification for individual patients. However, prospective and randomized-controlled studies addressing the clinical benefit and cost-effectiveness of HLA-DSA-based monitoring and patient management strategies are required to demonstrate that the use of HLA-DSAs as biomarkers can improve current clinical practice and transplant outcomes.
TouchPoint
Authors: Macera-DiClemente Linda , Ursuy Peggy Ann
Published: July 2022

Background:

TouchPoint is an innovative approach to traditional clinical postconferences for prelicensure BSN students in an immersion experience. The aim of TouchPoint was to build relationships between faculty and students in an unscripted method of deep, meaningful, reflective sharing.

Methods:

TouchPoint sessions were a synthesis of stories told by nursing students. These sessions addressed relationships among patient, nurse, and families, and the importance of inter- and intraprofessional relationships. Faculty facilitators guided discussions.

Results:

TouchPoint sessions promoted psychological safety, built resiliency, and enhanced student awareness. The safe space created and opened a structured discussion of sensitive topics such as death, dying, gossip, loss, unsupported nursing staff, joy, and happiness, and the supportive nature of nurse mentors throughout these positive and negative experiences.

Conclusions:

TouchPoint's success was in strengthening resilience practices for students by sharing lived experiences and adhering to an environment of trust, respect, and support.