bluuebunny/crossref_metadata_2025 huggingface dataset:
Conceptualization of Competency-Based Medical Education Terminology in Family Medicine Postgraduate Medical Education and Continuing Professional Development: A Scoping Review
Authors: Lochnan Heather , Kitto Simon , Danilovich Natalia , Viner Gary , Walsh Allyn , Oandasan Ivy F. , Hendry Paul
Published: January 2020

Purpose

To examine the extent, range, and nature of how competency-based medical education (CBME) implementation terminology is used (i.e., the conceptualization of CBME-related terms) within the family medicine postgraduate medical education (PGME) and continuing professional development (CPD) literature.

Method

This scoping review’s methodology was based on Arksey and O’Malley’s framework and subsequent recommendations by Tricco and colleagues. The authors searched 5 databases and the gray literature for U.S. and Canadian publications between January 2000 and April 2017. Full-text English-language articles on CBME implementation that focused exclusively on family medicine PGME and/or CPD programs were eligible for inclusion. A standardized data extraction form was used to collect article demographic data and coding concepts data. Data analysis used mixed methods, including quantitative frequency analysis and qualitative thematic analysis.

Results

Of 470 unique articles identified, 80 (17%) met the inclusion criteria and were selected for inclusion in the review. Only 12 (15%) of the 80 articles provided a referenced definition of the coding concepts (i.e., referred to an article/organization as the definition’s source), resulting in 19 highly variable—and 12 unique— referenced definitions of key terms used in CBME implementation (competence, competency, competency-based medical education). Thematic analysis of the referenced definitions identified 15 dominant themes, among which the most common were (1) a multidimensional and dynamic concept that encompasses a variety of skill components and (2) being able to use communication, knowledge, technical skills, clinical reasoning, judgment, emotions, attitudes, personal values, and reflection in practice.

Conclusions

The construction and dissemination of shared definitions is essential to CBME’s successful implementation. The low number of referenced definitions and lack of consensus on such definitions suggest more attention needs to be paid to conceptual rigor. The authors recommend those involved in family medicine education work with colleagues across medical specialties to develop a common taxonomy.
Speech Understanding With Bimodal Stimulation Is Determined by Monaural Signal to Noise Ratios: No Binaural Cue Processing Involved
Authors: Dieudonné Benjamin , Francart Tom
Published: January 2020

Objectives:

To investigate the mechanisms behind binaural and spatial effects in speech understanding for bimodal cochlear implant listeners. In particular, to test our hypothesis that their speech understanding can be characterized by means of monaural signal to noise ratios, rather than complex binaural cue processing such as binaural unmasking.

Design:

We applied a semantic framework to characterize binaural and spatial effects in speech understanding on an extensive selection of the literature on bimodal listeners. In addition, we performed two experiments in which we measured speech understanding in different masker types (1) using head-related transfer functions, and (2) while adapting the broadband signal to noise ratios in both ears independently. We simulated bimodal hearing with a vocoder in one ear (the cochlear implant side) and a low-pass filter in the other ear (the hearing aid side). By design, the cochlear implant side was the main contributor to speech understanding in our simulation.

Results:

We found that spatial release from masking can be explained as a simple trade-off between a monaural change in signal to noise at the cochlear implant side (quantified as the head shadow effect) and an opposite change in signal to noise at the hearing aid side (quantified as a change in bimodal benefit). In simulated bimodal listeners, we found that for every 1 dB increase in signal to noise ratio at the hearing aid side, the bimodal benefit improved by approximately 0.4 dB in signal to noise ratio.

Conclusions:

Although complex binaural cue processing is often implicated when discussing speech intelligibility in adverse listening conditions, performance can simply be explained based on monaural signal to noise ratios for bimodal listeners.
Birth Weight and Adult-Onset Hearing Loss
Authors: Gupta Shruti , Wang Molin , Hong Biling , Curhan Sharon G. , Curhan Gary C.
Published: January 2020

Objectives:

Among low-birth-weight infants, exposure to stress or undernutrition in utero may adversely affect cochlear development. As cochlear reserve declines, the risk of hearing loss may increase with age. While low birth weight is associated with a higher risk of neonatal hearing loss, our objective was to examine whether birth weight was associated with adult-onset, self-reported hearing loss in the Nurses’ Health Studies (NHS) I and II (n = 113,130).

Design:

We used Cox proportional hazards regression to prospectively examine whether birth weight, as well as gestational age at birth, is associated with adult-onset hearing loss. Participants reported their birth weight in 1992 in NHS I and 1991 in NHS II. Mothers of NHS II participants reported gestational age at birth in a substudy (n = 28,590). The primary outcome was adult-onset, self-reported moderate or greater hearing loss, based on questionnaires administered in 2012/2016 in NHS I and 2009/2013 in NHS II.

Results:

Our results suggested a higher risk of hearing loss among those with birth weight <5.5 lbs compared with birth weight 7 to <8.5 lbs (pooled multivariable-adjusted hazard ratio 1.14, 95% confidence interval = 1.04–1.23;ptrend = 0.01). Additionally, participants with gestational age at birth ≥42 weeks had a higher risk of hearing loss, compared with gestational age 38 to <42 weeks (multivariable-adjusted hazard ratio 1.33, 95% confidence interval = 1.06–1.65).

Conclusions:

Birth weight <5.5 lbs was independently associated with higher risk of self-reported, adult-onset hearing loss. In addition, gestational age at birth ≥42 weeks was also associated with higher risk.
Twenty-five-Year Follow-up of a Prospective Randomized Trial Comparing Preoperative Versus Postoperative FLAC/Granulocyte Colony–Stimulating Factor Chemotherapy for Stage II Breast Cancer
Authors: Malekzadeh Parisa , Cowan Kenneth , Steinberg Seth M. , Camphausen Kevin A. , Shriver Craig , Merino Maria J. , Good Meghan L. , Berman Arlene , Danforth David N.
Published: January 2020

Background:

Preoperative chemotherapy is important in the management of women with breast cancer, with the ability to downstage the breast primary tumor and axillary lymph nodes. Long-term studies are needed to identify late toxicities, recurrence patterns, and equivalency with postoperative chemotherapy for recurrence-free survival (RFS) and overall survival (OS).

Patients and Methods:

We conducted a single-institution prospective randomized control trial comparing preoperative or postoperative fluorouracil, leucovorin calcium, doxorubicin, and cyclophosphamides/granulocyte colony–stimulating factor chemotherapy for women with untreated clinical stage II (T1N1, T2N0, and T2N1) breast cancer. Long-term follow-up was conducted to define toxicities, recurrence patterns and RFS and OS.

Results:

Fifty-three women with clinical stage II breast cancer were randomized, 26 patients to receive preoperative chemotherapy and 27 to receive postoperative chemotherapy. Long-term follow-up, with a median of 25.3 years, was obtained. Local or systemic recurrence occurred in 8 women in the preoperative group and in 10 women in the postoperative group, and recurrences were predominantly within 10 years of treatment. Late toxicities included local upper extremity paresthesia’s, upper extremity edema and congestive heart failure in 1 patient each. Analysis revealed no difference in RFS (20-year RFS probabilities; preoperative: 61.3%, postoperative: 54.7%, P=0.42), or in OS between the 2 treatment groups (20-year probabilities, preoperative: 64.6%, postoperative: 62.2%, P=0.44). Twenty-five of 53 patients (47%) were alive and without disease at this follow-up.

Conclusion:

Twenty-five-year follow-up for this prospective randomized trial confirms the equivalency of preoperative versus postoperative chemotherapy with fluorouracil, leucovorin calcium, doxorubicin, and cyclophosphamides/granulocyte colony–stimulating factor for stage II breast cancer for both RFS and OS.
Retrospective Cohort: Genomic Differences Between Pigmented Spindle Cell Nevi of Reed and Reed-Like Melanomas
Authors: Mohan Lauren S. , Khan Ayesha U. , Zhang Bin , Quan Victor L. , Shi Katherine , Panah Elnaz , Isales Maria Cristina , Yazdan Pedram , Zhang Yongzhan , Beaubier Nike , Taxter Timothy J. , Compres Elsy V. , Kim Daniel , White Kevin P. , Gerami Pedram
Published: January 2020

Background:

Some melanomas closely resemble pigmented spindle cell nevi (PSCN) of Reed histologically. The distinction of these entities is important for clinical management. A recent study showed most PSCN (78%) are fusion-driven, commonly involving NTRK3 (57%). Conversely, BRAF V600E mutations are not characteristic of PSCN but are frequent in melanoma.

Objective:

In this study, we assessed clinical, histologic and genomic differences between PSCN of Reed and Reed-like melanomas (RLMs).

Methods:

We performed BRAF V600E immunohistochemistry (IHC) for 18 PSCN and 20 RLM cases. All 23 benign PSCN cases previously underwent whole transcriptome and targeted DNA sequencing with a 1711 gene panel.

Results:

We previously demonstrated the majority of PSCN (18 of 23) has chimeric fusions. Among PSCN without a chimeric fusion, BRAF mutations were common. Noncanonical BRAF mutations were identified in 2 of 5 nonfusion cases, and 1 case had a canonical BRAF mutation. Alternatively, 70% of RLM demonstrated a BRAF V600E mutation. RLM also occurred more frequently in older patients.

Limitations:

The overall sample size was small.

Conclusions:

In diagnostically challenging cases, ancillary IHC studies can assist in distinguishing PSCN from RLM. Our study suggests positive staining by IHC for BRAF V600E and older age strongly favors a diagnosis of RLM.
Critical Care Registered Nurses' Preparedness in the Provision of End-of-Life Care
Authors: Hall Meg Ambrose
Published: January 2020

Background

The number of deaths in critical care units continues to rise as patients are living longer with chronic illnesses; however, critical care registered nurses report feelings of unpreparedness in the provision of end-of-life (EOL) care.

Objectives

To understand and find meaning of critical care registered nurses' preparedness in the provision of EOL care.

Methods

A qualitative interpretive description study was conducted to allow for rich, descriptive detail through the participants' eyes. Semistructured one-on-one interviews were conducted with 12 participants. Constant comparative method was used to analyze the data.

Results

According to the participants, to be prepared to provide EOL care, the nurses need to understand their personal beliefs about death and dying; be able to provide care to both patient and family; combine knowledge based on education, personal and professional experience, and support resources; balance the ongoing dialogue between their professional and personal role as a registered nurse; and find ways to make sense of the dying experience, specifically through closure.

Discussion

Ultimately, the provision of EOL is contextual and will vary, requiring the critical care registered nurse to adapt to each situation utilizing the tools learned and experienced to promote patient, family, and nurse comfort. Improvements to nursing education and nursing practice are warranted to expose students and nurses to more EOL care experiences while also providing the tools and support resources during the provision of EOL care.
A Graphical Description of Partial Exchangeability
Authors: Sarvet Aaron L. , Wanis Kerollos Nashat , Stensrud Mats J. , Hernán Miguel A.
Published: January 2020

Partial exchangeability is sufficient for the identification of some causal effects of interest. Here we review the use of common graphical tools and the sufficient component cause model in the context of partial exchangeability. We illustrate the utility of single world intervention graphs (SWIGs) in depicting partial exchangeability and provide an illustrative example of when partial exchangeability might hold in the absence of complete exchangeability.
Essential Role of the ELABELA-APJ Signaling Pathway in Cardiovascular System Development and Diseases
Authors: Chen Sun , Chen Fengyuan , Sun Kun , Zhou Shuang , Wang Jian , Wang Qingjie , Meng Zhuo , Peng Jiayu , Song Wenting , Zhou Yue
Published: January 2020

ELABELA (ELA), previously classified as a “noncoding” RNA, is a new endogenous peptidic ligand of apelin receptor (APJ/APLNR), a class A (rhodopsin-like) G protein–coupled receptor. It has been identified to play a crucial role in diverse biological processes, especially in the normal and pathological cardiovascular system. In comparison with APJ's first ligand apelin, ELA may play a key role at different time points or heart regions. In this review, we summarized the roles of the ELA-APJ signaling pathway in cardiovascular system development and diseases.
Plastic Surgery on YouTube
Authors: Almarghoub Mohammed A. , Alghareeb Muath A. , Alhammad AlAnoud K. , Alotaibi Haya F. , Kattan Abdullah E.
Published: January 2020

Background:

YouTube is the most accessed video website in the world. It hosts a variety of medical content. Plastic surgery-related content on YouTube has not been investigated before. In this study, we analyzed the most prevalent plastic surgery-related content available on YouTube.

Methods:

Search terms were selected to cover the broad topics of plastic surgery. The top 20 most-viewed videos returned for each search term were analyzed. The videos were classified by the type of content, authorship, number of views, and number of likes. Data were collected and analyzed using Microsoft Excel (2016) program.

Results:

Out of the 280 videos analyzed, “patient experience” was the most prevalent content type. Thirty percent of the analyzed videos were uploaded by medical centers, and 29% were uploaded from personal accounts. Educational video content constituted 6% of the total videos analyzed. Entertainment was the most prevalent (60%) content type returned when “plastic surgery” was used as the search term.

Conclusions:

YouTube is an underutilized social media platform by plastic surgeons. The entertainment industry is taking advantage of the social media platform to attract and gain millions of views. Educational videos are low in number and quality.
Controversies in the Treatment of Follicular Lymphoma
Authors: Hübel Kai , Ghielmini Michele , Ladetto Marco , Gopal Ajay K.
Published: January 2020

The overall prognosis of patients with follicular lymphoma has substantially improved over the last decades with a 10‐year overall survival of around 80% for the majority of patients. However, for most patients follicular lymphoma it is still a relapsing and remitting disease. Furthermore, certain subsets of patients still have much shorter survival. Currently, there is no established standard how to treat high‐risk follicular lymphoma. With advances in the understanding of the biology and pathogenesis of B cell malignancies, a plethora of new compounds have been investigated in FL. These compounds have the potential to increase efficacy if added to current regimens or even replace them. The implementation of these compounds in treatment algorithms is another unsolved issue. This overview highlights major controversies in the treatment of follicular lymphoma and discusses the most recent and relevant clinical trials.
Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group
Authors: Daw Stephen , Hasenclever Dirk , Mascarin Maurizio , Fernández‐Teijeiro Ana , Balwierz Walentyna , Beishuizen Auke , Burnelli Roberta , Cepelova Michaela , Claviez Alexander , Dieckmann Karin , Landman‐Parker Judith , Kluge Regine , Körholz Dieter , Mauz‐Körholz Christine , Wallace William Hamish , Leblanc Thierry ,   EuroNet Paediatric Hodgkin Lymphoma Group
Published: January 2020

The objective of this guideline is to aid clinicians in making individual salvage treatment plans for pediatric and adolescent patients with first relapse or refractory (R/R) classical Hodgkin lymphoma (cHL). While salvage with standard dose chemotherapy followed by high dose chemotherapy and autologous stem cell transplant is often considered the standard of care in adult practice, pediatric practice adopts a more individualized risk stratified and response adapted approach to salvage treatment with greater use of non‐transplant salvage. Here, we present on behalf of the EuroNet Pediatric Hodgkin Lymphoma group, evidence and consensus‐based guidelines for standardized diagnostic, prognostic and response procedures to allocate children and adolescents with R/R cHL to stratified salvage treatments.
Factor VIII Fc Fusion Protein but not FVIII Drives Human Monocyte‐Derived Dendritic Cell Activation via FcγRIIa
Authors: Kannicht Christoph , Danßmann Ilona , Weilandt Constanze , Derkow Katja , Kohla Guido , Geyer Henriette
Published: January 2020

Supplemental Digital Content is available in the text
Abnormal Dendritic Cell‐poiesis in Patients With Lower‐risk Myelodysplastic Syndromes
Authors: Sánchez Ángela , Anguita Eduardo , Chaparro Alberto , Roldán‐Etcheverry Juan José , López‐García Alberto , Ramos‐Acosta Carlos , Oancea Raluca , Rodriguez‐Muñoz Diego , Alemany Susana
Published: January 2020

Supplemental Digital Content is available in the text
Association Between Traumatic Brain Injury and Dementia in Veterans: A Rapid Systematic Review
Authors: Peterson Kimberly , Veazie Stephanie , Bourne Donald , Anderson Johanna
Published: January 2020

Objective:

To systematically review the prevalence of dementia in Veterans versus civilians and the association between previous traumatic brain injuries (TBIs) and the risk and timing of dementia onset in Veterans.

Design:

We systematically searched MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials from database inception to October 2018. One reviewer assessed articles for inclusion, evaluated study quality, graded strength of evidence, and extracted data, with second reviewer checking.

Results:

Forty articles were included, among which 10 presented the best evidence. Evidence suggests that dementia rates are likely similar between Veterans and civilians (10.7% vs 8.8%-11.6%, respectively). Dementia prevalence is likely higher in those with TBI (6%-16%) than in those without (3%-10%), with a possible dose-response relationship between the two. There may also be an association between TBI and early-onset dementia, although this evidence has important limitations. No studies evaluated whether dementia prevalence varied on the basis of combat deployment history or era of conflict.

Conclusion:

Dementia prevalence is likely similar in Veteran and civilian populations, and the risk of dementia is likely increased by TBI. To inform development of screening, prevention, and rehabilitation efforts, research is still needed addressing the mechanism of association and timing of dementia onset.

Protocol:

PROSPERO; CRD42018107926.
Physical and Functional Impairment Among Older Adults With a History of Traumatic Brain Injury
Authors: Kornblith Erica S. , Langa Kenneth M. , Yaffe Kristine , Gardner Raquel C.
Published: January 2020

Objectives:

To examine the association of lifetime history of traumatic brain injury (TBI) with later-life physical impairment (PI) and functional impairment (FI) and to evaluate the impact of neurobehavioral symptoms that frequently co-occur with TBI on these relations.

Participants:

A total of 1148 respondents to the 2014 Wave of the Health and Retirement Study, a nationally representative survey of older community-dwelling adults, randomly selected to participate in a TBI exposure survey. They reported no prior TBI (n = 737) or prior TBI (n = 411).

Design:

Cross-sectional survey study.

Main Measures:

Physical impairment (self-reported difficulty with ≥1 of 8 physical activities); FI (self-reported difficulty with ≥1 of 11 activities of daily living); self-reported current neurobehavioral symptoms (pain, sleep problems, depression, subjective memory impairment); The Ohio State University TBI Identification Method (OSU-TBI-ID)—short form.

Analyses:

Stepwise logistic regression models ([1] unadjusted; [2] adjusted for demographics and medical comorbidities; [3] additionally adjusted for neurobehavioral symptoms) compared PI and FI between TBI groups.

Results:

Traumatic brain injury—exposed (mean: 33.6 years postinjury) respondents were younger, less likely to be female, and reported more comorbidities and neurobehavioral symptoms. Although TBI was significantly associated with increased odds of PI and FI in unadjusted models and models adjusted for demographics/comorbidities (adjusted odds ratio, 95% confidence interval: PI 1.62, 1.21-2.17; FI 1.60, 1.20-2.14), this association was no longer statistically significant after further adjustment for neurobehavioral symptoms.

Conclusion:

History of TBI is associated with substantial PI and FI among community-dwelling older adults. Further research is warranted to determine whether aggressive management of neurobehavioral symptoms in this population may mitigate long-term PI and FI in this population.
ENDOGENOUS ASPERGILLUS ENDOPHTHALMITIS IN AN IMMUNOCOMPETENT PATIENT WITH A REMOTE HISTORY OF PULMONARY TUBERCULOSIS
Authors: Sastry Ananth , Kwon Julie Y. , Tan Jeffrey J. , Rodger Damien C. , Rao Narsing A.
Published: January 2020

Purpose:

To report a case of Aspergillus fumigatus endogenous endophthalmitis in an immunocompetent patient initially diagnosed as acute retinal necrosis.

Methods:

Case report.

Patient:

A 67-year-old woman with a remote history of treated pulmonary tuberculosis and no ocular history presented to an outside retina specialist with a sudden onset of floaters and blurred vision in one eye. Examination and fluorescein angiography at the time revealed findings suspicious for acute retinal necrosis, and the patient was started on oral valganciclovir and an intravitreal injection of ganciclovir. Despite treatment, the patient's vision and pain worsened. After evaluation at the University of Southern California Roski Eye Institute, she was diagnosed with a likely fungal endogenous endophthalmitis based on ultrasound findings and underwent emergent vitrectomy. A chest x-ray demonstrated partial collapse of the right upper lobe with hilar enlargement.

Results:

Aspergillus fumigatus was cultured from vitreous, blood, and bronchoalveolar lavage samples, suggesting that the patient's infection had a pulmonary origin, most likely from the right upper lobe that had healed from previous tuberculosis infection.

Discussion:

To the best of our knowledge, this is the first reported case of Aspergillus endogenous endophthalmitis in an immunocompetent patient secondary to pulmonary changes that occurred from previously treated tuberculosis.
Longitudinal prevalence and determinants of pain in multiple sclerosis: results from the German National Multiple Sclerosis Cohort study
Authors: Heitmann Henrik , Haller Bernhard , Tiemann Laura , Mühlau Mark , Berthele Achim , Tölle Thomas R. , Salmen Anke , Ambrosius Björn , Bayas Antonios , Asseyer Susanna , Hartung Hans-Peter , Heesen Christoph , Stangel Martin , Wildemann Brigitte , Haars Sarah , Groppa Sergiu , Luessi Felix , Kümpfel Tania , Nischwitz Sandra , Meuth Sven G. , Klotz Luisa , Linker Ralf A. , Zettl Uwe K. , Ziemann Ulf , Tumani Hayrettin , Tackenberg Björn , Zipp Frauke , Wiendl Heinz , Gold Ralf , Hemmer Bernhard , Ploner Markus ,   on behalf of the German Competence Network Multiple Sclerosis (KKNMS)
Published: January 2020

Pain is frequent in multiple sclerosis (MS) and includes different types, with neuropathic pain (NP) being most closely related to MS pathology. However, prevalence estimates vary largely, and causal relationships between pain and biopsychosocial factors in MS are largely unknown. Longitudinal studies might help to clarify the prevalence and determinants of pain in MS. To this end, we analyzed data from 410 patients with newly diagnosed clinically isolated syndrome or relapsing-remitting MS participating in the prospective multicenter German National MS Cohort Study (NationMS) at baseline and after 4 years. Pain was assessed by self-report using the PainDETECT Questionnaire. Neuropsychiatric assessment included tests for fatigue, depression, and cognition. In addition, sociodemographic and clinical data were obtained. Prevalence of pain of any type was 40% and 36% at baseline and after 4 years, respectively, whereas prevalence of NP was 2% and 5%. Pain of any type and NP were both strongly linked to fatigue, depression, and disability. This link was even stronger after 4 years than at baseline. Moreover, changes in pain, depression, and fatigue were highly correlated without any of these symptoms preceding the others. Taken together, pain of any type seems to be much more frequent than NP in early nonprogressive MS. Moreover, the close relationship between pain, fatigue, and depression in MS should be considered for treatment decisions and future research on a possible common pathophysiology.
Management of the Pregnant Patient With a Spinal Cord Injury
Authors: Hollenbach Pamela Marie , Ruth-Sahd Lisa A. , Hole James
Published: January 2020

INTRODUCTION: Spinal cord injuries (SCIs) and pregnancy can present a challenging scenario for healthcare professionals. Information regarding the management of patients who become pregnant and have SCIs is limited in the nursing literature, and therefore, more case studies must be presented and research must be conducted to build evidence-based care. Physiologic changes in pregnancy can increase a patient's risk for serious complications during pregnancy and, consequently, may put the fetus at a greater risk. Neuroscience healthcare providers must take into consideration the level of the SCI and how this may impact a pregnancy. CASE STUDY: This article highlights an interdisciplinary approach by presenting a case study and provides neuroscience nurses with a foundation on which to base their practice when managing a pregnant woman with an SCI through the antepartum, intrapartum, and postpartum phases of pregnancy. CONCLUSION: By understanding the physiologic changes after an SCI, patients and their healthcare teams can work together to have a healthy pregnancy and a healthy baby.
Improving the Experience of Care
Authors: Stapleton Susan , Wright Jennifer , Jolles Diana R.
Published: January 2020

In 2018, the Center for Medicare and Medicaid Innovation in the United States (US) released report demonstrating birth centers as the appropriate level of care for most Medicaid beneficiaries. A pilot project conducted at 34 American Association of Birth Centers (AABC) Strong Start sites included 553 beneficiaries between 2015 and 2016 to explore client perceptions of high impact components of care. Participants used the AABC client experience of care registry to report knowledge, values, and experiences of care. Data were linked to more than 300 process and outcome measures within the AABC Perinatal Data Registry™. Descriptive statistics, t tests, χ2 analysis, and analysis of variance were conducted. Participants demonstrated high engagement with care and trust in pregnancy, birth, and parenting. Beneficiaries achieved their preference for vaginal birth (89.9%) and breastfeeding at discharge through 6 weeks postpartum (91.7% and 87.6%). Beneficiaries reported having time for questions, felt listened to, spoken to in a way they understood, being involved in decision making, and treated with respect. There were no variations in experience of care, cesarean birth, or breastfeeding by race. Medicaid beneficiaries receiving prenatal care at AABC Strong Start sites demonstrated high levels of desired engagement and reported receiving respectful, accessible care and high-quality outcomes. More investment and research using client-reported data registries are warranted as the US works to improve the experience of perinatal care nationwide.
Mothers' Adaptation to a Late Preterm Infant When Breastfeeding
Authors: Gerhardsson Emma , Rosenblad Andreas , Mattsson Elisabet , Funkquist Eva-Lotta
Published: January 2020

The aim of this study was to psychometrically test the Adaptation to the Late Preterm Infant when Breastfeeding Scale (ALPIBS) and also to test how a mother's self-efficacy predicts adaptation to a late preterm infant when breastfeeding. This study had a longitudinal and prospective design, and data collection was consecutive. Mothers (n = 105) with infants born between 34 0/7 and 36 6/7 weeks were recruited from a neonatal intensive care unit or a maternity unit. The ALPIBS was developed using exploratory factor analysis, and the association between breastfeeding self-efficacy and ALPIBS score was examined using linear regression analysis. The Breastfeeding Self-Efficacy Scale–Short Form instrument was used to measure self-efficacy in breastfeeding. A higher degree of self-efficacy was significantly associated with a higher degree of adaptation to the late preterm infant's breastfeeding behavior (P < .001). We identified 4 separate underlying factors measured by 11 items in the ALPIBS: (A) breastfeeding is a stressful event; (B) the infant should breastfeed as often as he or she wants; (C) a mother has to breastfeed to be a good mother; and (D) it is important to ensure control over the infant's feeding behavior. There is a link between self-efficacy and ALPIBS score, and self-efficacy is a modifiable factor that influences breastfeeding.
Associations between heart failure and risk of dementia
Authors: Li Juan , Wu Yujing , Zhang Dongyang , Nie Jing
Published: January 2020

Background:

There are differences among the outcomes regarding cognitive impairment in heart failure (HF) because the evidence is fragmented and sample size is small. Therefore we aimed to systematically review and analyze the available evidence about the association between HF and dementia.

Methods:

In the present study, we searched for articles published until August 2019 in the following databases: PubMed, Web of Science, EMBASE, Medline and Google Scholar. The pooled multivariate odds ratio (OR) or relative risk (RR) and 95% confidence intervals (CI) were obtained by the use of STATA 12.0 software.

Results:

The meta-analysis showed a positive association between HF and risk of all-cause dementia (OR/RR = 1.28, 95% CI 1.15 to 1.43, I2 = 70.0%, P < 0.001). Additionally, the study showed no significant association between HF and risk of Alzheimer's disease (AD) (OR/RR = 1.38, 95% CI 0.90 to 2.13, I2 = 74.8%, P = 0.008).

Conclusion:

In conclusion, HF was associated with an increased risk of developing dementia. In addition, large scale prospective studies are essential to explore the associations between HF and risk of AD.
Optimal cut-off value of high-sensitivity troponin I in diagnosing myocardial infarction in patients with end-stage renal disease
Authors: Lim Eunsoo , Lee Min-Jeong
Published: January 2020

End-stage renal disease (ESRD) is a major risk factor for cardiovascular disease and the prognosis after myocardial infarction (MI) is dismal. Although cardiac troponin is a key diagnostic test, troponin levels are often elevated in ESRD patients without evidence of MI. Thus, this study attempted to determine the optimal diagnostic value of high-sensitivity troponin I (hsTnI) by dialysis modality in ESRD patients.

Medical records of adult dialysis patients who visited tertiary emergency department (ED) were collected retrospectively. Diagnosis of MI was made according to the fourth universal definition of MI. The cut-off values were calculated using a receiver operating characteristic (ROC) curve.

Medical records of 1144 patients were analyzed and MI was diagnosed in 82 patients (75 on hemodialysis and 7 on peritoneal dialysis). The optimal cut-off value of hsTnI in hemodialysis patients was 75 ng/L, with 93.33% sensitivity and 60.76% specificity. Area under the curve (AUC) was .870 (95% confidence interval (CI) .833–.906). The optimal cut-off value of hsTnI in peritoneal dialysis patients was 144 ng/L, with 100.00% sensitivity and 83.10% specificity. AUC was .943 (95% CI .893–.992).

The dialysis modality should also be considered when diagnosing MI using hsTnI in ESRD patients.
Surgical treatment of metastatic mesenchymal chondrosarcoma to the spine
Authors: Liu Shuzhong , Zhou Xi , Song An , Huo Zhen , Wang Yipeng , Liu Yong
Published: January 2020

Introduction:

Metastatic mesenchymal chondrosarcoma of the spine is a highly unusual disease without standard curative managements yet. The objective of this case report is to present a very rare case of metastatic chondrosarcoma to the spine successfully operated by surgical treatment. The management of these unique cases has yet to be well-documented.

Patient concerns:

A 34-year-old woman presented with a 4-month history of continuous and progressive back pain and a 1-month history of radiating pain of bilateral lower extremities. The patient, who had been diagnosed of mesenchymal chondrosarcoma of maxillary sinus for 3 years, received surgical treatment of palliative endoscopic-assisted total left maxillary resection via mini Caldwell-Luc approach, and palliative enlarged resection due to the progress of residual lesions, followed by no adjuvant therapy. Multiple lytic, expanding lesions of the spine and paraspinal region with severe epidural spinal cord compression was identified.

Diagnosis:

CT, MRI and bone scan of spine showed spinal cord compression secondary to the epidural component of the metastatic lesions. Post-operative pathology confirmed the diagnosis of metastatic spinal mesenchymal chondrosarcomas.

Interventions:

The patient underwent posterior spinal canal decompression, resection of T12 and L3 lesions, internal fixation of T11-L5 pedicles, and cement augmentation of T12 and L3.

Outcomes:

The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 1-year follow-up visit. There were no complications associated with the spinal surgery during the follow-up period.

Conclusion:

Metastatic spinal mesenchymal chondrosarcoma, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression and total resection of the metastatic chondrosarcoma when the tumor has caused neurological deficits or other severe symptoms. Osteoplasty by cement augmentation is also a good choice for surgical treatment in some patients.
Acute hydrocephalus secondary to traumatic perimesencephalic pneumocephalus
Authors: Li Guichen , Wang Guangming , Luan Tengfei , Hou Kun , Yu Jinlu
Published: January 2020

Introduction:

Acute hydrocephalus is a common complication of spontaneous or traumatic intracranial bleeding with extensive subarachnoid hemorrhage (SAH) or ventricular extension. However, it has never been reported to be secondary to pneumocephalus.

Patient concerns:

A 32-year-old man was admitted following a motorcycle accident. Head computed tomography (CT) performed right after the accident revealed a skull base fracture and mild perimesencephalic SAH. Three days later, repeated CT revealed delayed perimesencephalic pneumocephalus and an evident enlargement of the ventricular system.

Diagnosis:

The patient was diagnosed with acute obstructive hydrocephalus, which was secondary to pneumocephalus and traumatic SAH.

Interventions:

The patient was treated with temporary external ventricular drainage (EVD).

Outcomes:

The patient experienced an unremarkable recovery process. At follow-up 3 months later, he showed no recurrence of the hydrocephalus and the score of Glasgow Outcome Scale was 5.

Conclusion:

Transient mechanical obstruction of CSF circulation and disturbance of CSF physiology might conjointly lead to the acute obstructive hydrocephalus.
The presence of De Winter electrocardiogram pattern following elective percutaneous coronary intervention in a patient without coronary artery occlusion
Authors: Chen Shi , Wang Hua , Huang Liwei
Published: January 2020

Rationale:

The De Winter electrocardiogram (ECG) pattern is considered as a ST elevated myocardial infarction (STEMI)-equivalent pattern. Due to its rare nature, it is unclear whether this ECG pattern suggests the presence of some other condition.

Patient concerns:

We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI).

Diagnoses:

An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction.

Intervention:

The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin.

Outcomes:

After a few hours, his symptoms were alleviated. The patient was discharged after 6 days of hospitalization without any complications.

Lessons:

The De Winter ECG pattern can be observed in patients without significantly coronary arteries occlusion. The newly onset De Winter ECG pattern after PCI procedure may indicate perioperative myocardial infarction caused by impaired microvascular perfusion.
Effects of traditional Chinese exercise on lumbar disc herniation
Authors: Yuan Sheng , Lin Xuxin , Hong Jieshan , Qiu Chen , Chen Dong
Published: January 2020

Background:

A large number of randomized controlled trials (RCTs) have shown that traditional Chinese exercises (TCE) have certain advantages in the treatment of lumbar disc herniation (LDH). However, due to the diversity of TCE methods, their relative effectiveness has not been studied and explained. Therefore, based on the network meta-analysis (NMA), this study will compare the differences in the effectiveness of TCE methods in the treatment of LDH, in order to provide a reference for clinical treatment.

Methods:

We will search PubMed, MEDLINE, Embase, the Cochrane Library, China National Knowledge Infrastructure (CHKD-CNKI), WANFANG database (Chinese Medicine Premier), Chinese Biomedical Literature database VIP for relevant RCTs of ACU treatments for POP, from their inceptions to March 18, 2019. STATA 15.0 and GEMTC software will be used to perform a NMA. The evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation approach and the type 1 error rate will be assessed by trial sequential analysis.

Results:

The results of this review will be submitted to a recognized journal for publication.

Conclusion:

This proposed systematic review will evaluate the different advantages of various types of TCE in the treatment of LDH.
Effect of retrograde autologous priming based on miniaturized cardiopulmonary bypass in children undergoing open heart surgery
Authors: Meng Baoying , Wu Keye , Wang Yuanxiang , Zhang Sheshe , Zhou Xing , Ding Yiqun
Published: January 2020

To evaluate the effectiveness of retrograde autologous priming (RAP) based on miniaturized cardiopulmonary bypass (CPB) circuit in children undergoing open heart surgery.

We performed a retrospective analysis of all patients (≤15 kg) who underwent open heart surgery with CPB in our center from January 1, 2017, to July 31, 2019. Propensity score matching was used to adjust for significant covariates, and multivariable stratified analysis was used to assess the association of the RAP technique with clinical outcomes.

A total of 1111 patients were analyzed. There were 355 (32.0%) children who underwent RAP, and 756 (68.0%) were in the non-RAP group. After propensity score matching, there were a total of 638 patients, with 319 patients in each group. The bloodless priming rate was significantly higher (P = .013), and the ultrafiltration rate was significantly lower (P = .003) in the RAP group than in the non-RAP group. Compared with patients in the non-RAP group, patients in the RAP group had a shorter postoperative mechanical ventilation time (P < .001) and shorter lengths of stay in the intensive care unit (ICU) (P < .001) and the hospital (P < .001). No differences were noted in postoperative hematocrit (P = .920), postoperative 24-hour blood loss (P = .435), and hospital mortality (P = .563). In the stratified analysis, the difference remained statistically significant (P < .05) when the patient weight was >4 kg or the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT) category was <3. However, when the patient weight was ≤4 kg or the STAT category was ≥3, there was no significant difference between the 2 groups in terms of bloodless priming, ultrafiltration, postoperative mechanical ventilation time, or length of stay in the ICU or the hospital (P > .05).

The RAP technique based on miniaturized CPB system was safe and effective for children who underwent congenital heart surgery. The RAP technique can significantly reduce the priming volume, improve the rate of bloodless priming, and reduce blood product application. It was also associated with a shorter postoperative mechanical ventilation time and shorter lengths of stay in the ICU and the hospital.
Complex reconstruction technique applied in advanced head and neck cancer
Authors: Gan Weigang , Xiang Yu , Lv Dan , Liu Jun , Wang Haiyang , Deng Di , Wang Ji , Li Linke , Ma Tengfei , Liu Shixi , Chen Fei
Published: January 2020

Complex reconstruction skills in advanced head and neck cancer (HNC) could resolve the key problem of large defects after tumor resection. We combined the anterolateral thigh free flap, fascia lata flap, and greater saphenous vein graft in the reconstruction process of salvage surgery. Seven patients suffering from advanced HNC who experienced the failure of multiple therapeutic methods were enrolled in our study between June 2017 and January 2018. They all agreed to voluntarily undergo the tumor excision and complex reconstruction procedure we developed. The total flap size ranged from 20 × 13 cm to 30 × 15 cm. The length of the greater saphenous vein graft ranged from 4 to 11 cm. The hospitalization period ranged from 7 to 33 days. All of the flaps were viable, but in 1 patient, oral flap edge infection and necrosis necessitated partial debridement on day 7 postoperatively. All donor sites were closed primarily. We report our experience with this surgical method for complex reconstruction in advanced HNC patients.
An infected urachal cyst presenting as acute abdominal pain in a child
Authors: Tsai I-Shan , Lin Lung-Huang , Hung Shih-Pin
Published: January 2020

Introduction:

Urachal cyst is an exceptionally rare disease in children caused by the incomplete obliteration of the urachal remnant. Urachal cysts seldom cause symptoms unless a secondary infection occurs. The symptoms of an infected urachal cyst are nonspecific and may be similar to acute appendicitis or other acute abdominal conditions. However, complications attributable to a delayed diagnosis can endanger the life of a patient.

Patient concerns:

A 5-year-old boy presented with a 3-day history of severe intermittent lower abdominal pain.

Diagnosis:

Infected urachal cyst.

Interventions:

The patient was treated with surgical resection of the urachus, followed by intravenous antibiotics during the hospitalization.

Outcomes:

The patient was discharged without incident 7 days after the operation. With his follow-up in our out-patient department, he recovered well without any sequelae in the 6 months post-surgery.

Conclusion:

We suggested using the abdominal echo scan to differentiate the urachal cyst because of its high sensitivity and nonradioactive characteristic, and computed tomography is a typical diagnostic tool for urachal cysts. The mainstream management of an infected urachal cyst remains surgical excision. Complete excision of urachal cysts is relatively easy in a pediatric patient and the risk of subsequent infection is low; however, patients tend to have a low, although possible, risk of potential malignant transformation over their lifetimes.
Comparison between topping-off technology and posterior lumbar interbody fusion in the treatment of chronic low back pain
Authors: Wang Wei , Sun Xiangyao , Zhang Tongtong , Sun Siyuan , Kong Chao , Ding Junzhe , Li Xiangyu , Lu Shibao
Published: January 2020

Background:

The difference between topping-off technique and posterior lumbar interbody fusion (PLIF) in postoperative outcomes is still controversial. The aim of this study is to compare all available data on outcomes of topping-off technique and PLIF in the treatment of chronic low back pain.

Methods:

Articles in PubMed, EMBASE and Cochrane were reviewed. Parameters included radiographical adjacent segment disease (RASD), clinical adjacent segment disease, range of motion (ROM), global lumbar lordosis (GLL), visual analog scale (VAS), visual analog scale of back, (VAS-B) and visual analog scale leg (VAS-L), Oswestry disability index, Japanese Orthopaedic Association (JOA) score, duration of surgery, estimated blood loss (EBL), reoperation rates, complication rates.

Results:

Rates of proximal RASD (P = .001) and CASD (P = .03), postoperative VAS-B (P = .0001) were significantly lower in topping-off group than that in PLIF group. There was no significant difference in distal RASD (P = .07), postoperative GLL (P = .71), postoperative upper intervertebral ROM (P = .19), postoperative VAS-L (P = .08), DOI (P = .30), postoperative JOA (P = .18), EBL (P = .21) and duration of surgery (P = .49), reoperation rate (P = .16), complication rates (P = .31) between topping-off group and PLIF.

Conclusions:

Topping-off can effectively prevent the adjacent segment disease from progressing after lumbar internal fixation, which is be more effective in proximal segments. Topping-off technique was more effective in improving subjective feelings of patents rather than objective motor functions. However, no significant difference between topping-off technique and PLIF can be found in the rates of complications.