bluuebunny/crossref_metadata_2025 huggingface dataset:
Generic and Disease-specific Health-related Quality of Life in Pediatric Intestinal Failure
Authors: McCaig Jessica K. , Henry Owen S. , Stamm Danielle A. , Dorval Gaby , Hurley Alexis , Han Sam M. , Hong Charles R. , Staffa Steven J. , Modi Biren P.
Published: February 2021

Objective:

The aim of the study was to assess overall and disease-specific health-related quality of life (hrQOL) in patients with pediatric intestinal failure (PIF) and caregivers and elucidate differences from healthy and chronic gastrointestinal (GI) illness cohorts.

Methods:

Cross-sectional study of patients with PIF and their caregivers managed at a multidisciplinary intestinal rehabilitation program using the PedsQL Generic Core and the Gastrointestinal Symptoms Module to assess generic and disease-specific hrQOL, respectively. These data were compared to established healthy and chronic GI disease controls.

Results:

A total of 53 patients (mean age 6.2 ± 3.9 years) and their caregivers were studied. Patients reported lower generic hrQOL than healthy children (73.0 vs 83.84, P < 0.001), but no difference from patients with chronic GI disease (73.0 vs 77.79). In contrast, PIF caregivers perceived similar generic hrQOL compared to a healthy cohort (78.9 vs 82.70), but higher when compared to the GI disease cohort (78.9 vs 72.74, P < 0.01). Patients with PIF and caregivers reported lower psychosocial health scores than healthy controls. Patients and caregivers reported similar disease-specific hrQOL to a cohort with chronic GI disease but significantly lower disease-specific hrQOL than a healthy cohort (P < 0.001 both groups).

Conclusions:

Patients with PIF and their caregivers have disparate perceptions of generic hrQOL when compared to healthy and chronic GI disease controls. Both patients and caregivers, however, had significantly lower scores in psychosocial health than healthy controls. In addition, disease-specific hrQOL was substantially lower than healthy controls for PIF patients and caregivers. Further investigation to expand on these findings and identify modifiable variables to improve the psychosocial health score and disease-specific factors would be of high value.
First Observation of HbM-Saskatoon at the Origin of Neonatal Cyanosis in a Tunisian Baby
Authors: Bouatrous Emna , Nouira Sonia , Ben Khaled Monia , Ouederni Monia , Abbes Salem , Menif Samia , Ouragini Houyem
Published: February 2021

Several causes are known to be at the origin of neonatal cyanosis among them methemoglobinemia is by inheritance of an hemoglobin (Hb) M variant. This is a rare condition never been reported in Tunisia so far. Here, we report a Tunisian newborn with refractory cyanosis since birth. As cardiac and respiratory diseases were ruled out, methemoglobinemia was suspected. Hematological parameters, concentration of methemoglobin, capillary electrophoresis, and amplification sequencing of the HBB gene were performed. Computational analysis was achieved by different in silico tools to investigate the mutation effect. The diagnosis was established by a raised MetHb, confirmed by the presence HbM-Saskatoon [Beta63 (E7) His>Tyr] by capillary electrophoresis and molecular analysis. The identified mutation occurred as a de novo mutation. In silico analysis confirmed the pathogenicity of the mutation. To our knowledge, this is the first time that this mutation has been reported in the Tunisian population. In view of its low incidence rate, clinicians might misdiagnose cyanosis caused by HbM, which can lead to inappropriate treatment and clinical complications. An up-to-date literature review of HbM disease is presented in this study.
A Novel Homozygous HAX1 Mutation in a Child With Cyclic Neutropenia: A Case Report and Review
Authors: Tayal Anshula , Meena Jagdish P. , Kaur Ravneet , Tanwar Pranay , Gupta Neerja , Kabra Madhulika , Kabra Sushil K.
Published: February 2021

Background:

Cyclic neutropenia is a rare genetic disorder causing the arrest of neutrophil function and is characterized by periodic neutropenia and recurrent infections. Patients with cyclic neutropenia with autosomal dominant, sporadic, and X-linked may have mutations in the ELANE gene, and autosomal recessive cases have homozygous/compound heterozygous variants in the HAX1 gene primarily.

Observation:

The authors describe a novel variant in the HAX1 gene, which was detected by next-generation sequencing in an 8-year-old male child who presented with recurrent infections and neutropenia.

Conclusion:

The patient extends the clinical variability associated with HAX1 variants and highlights the importance of genetic investigations in patients with suspected cyclic neutropenia.
Spontaneous Partial Remission in a Child With B-Lineage Acute Lymphoblastic Leukemia and Chickenpox: A Role For Acyclovir?
Authors: Chtioui Haithem , Ceppi Francesco , Renella Raffaele , Diezi Manuel
Published: February 2021

A 2.5-year-old boy presented to his pediatrician with progressive pallor, asthenia, fever, splenomegaly, and hematomas. Leukemia was suspected, and a bone marrow aspirate confirmed acute lymphoblastic leukemia. Before chemotherapy induction, the child developed a vesicular rash and was diagnosed clinically with chickenpox. Acyclovir treatment was initiated immediately, whereas induction chemotherapy was postponed by 10 days. At the time of chickenpox resolution, a spontaneous partial recovery of his blood counts and a 50% decrease of blastic bone marrow infiltration were noted. After a brief nonsystematic review, we discuss the potential beneficial effect of acyclovir and chickenpox infection in children with leukemia.
Thai Nurses' Experiences of Spiritual Care for Older Adults at End of Life
Authors: Wisesrith Wasinee , Soonthornchaiya Rangsiman , Hain Debra
Published: February 2021

Most Thai registered nurses who provide end-of-life care emphasize the physical dimension of care rather than spiritual care. There is a need to explore the experiences of Thai nurses who provide spiritual care. The purpose of the study was to explore the experiences of Thai palliative care nurses providing spiritual care for older adults at the end of life. A descriptive qualitative research design was used. The 8 participants were Thai nurses with experience of palliative care in hospitals in the central, northeastern, northern, and southern regions of Thailand. A focus group discussion was used for data collection. Content analysis was used to analyze data. Five themes were as follows: (1) spiritual care was searching for meaning in patients' lives, (2) spiritual self-preparation of nurses for making sense and connecting to patients' spirituality, (3) caring for patients' spiritual needs by recognizing psychological and religious beliefs, (4) facilitating ways to ease patients' suffering, and (5) assuring confidence of patients and relatives for receiving the best care. These findings that should be included in training registered nurses are honoring the patients' lives, addressing spiritual needs to decrease patients' suffering, and enhancing patients' perceptions of care through spiritual self-preparation and spiritual concern of nurses.
Personality Disorders as a Basis for Discharge and Denial of Benefits in the Military
Authors: Dean Charles E.
Published: February 2021

The US Department of Defense specifically states that intellectual disability and personality disorders are not diseases for compensation purposes, and disabilities from them may not be service connected absent a superimposed mental disorder. In addition, the diagnosis of a personality disorder led to the discharge of 31,000 troops during the years 2001 to 2010. I review the history of these developments, and how the Diagnostic and Statistical Manual of Mental Disorders enabled these actions. In contrast, the United Kingdom and Canada do not allow such actions. Whether our approach is logical seems highly questionable, especially given the significant problems with the DSM’s definitions of personality disorders, definitions at odds with the literature.
The Accuracy of Traumatic Memories in Posttraumatic Stress Disorder
Authors: Mattsson Astrid Maria , Sonne Charlotte , Carlsson Jessica
Published: February 2021

This review sought to investigate the accuracy of traumatic memories in persons with a diagnosis of posttraumatic stress disorder (PTSD). PubMed, PsycINFO, and Embase were searched for articles, and 11 studies were included. Three different methods of studying memory accuracy were identified in the included articles: coherence, change in recollection of trauma over time, and remembering details of trauma. Three studies found a deficiency in the accuracy of traumatic memory. Despite some inconsistencies, most of the studies concluded that the memory of trauma is as accurate in people with as in those without PTSD. The only recurring difference identified across studies was in recollection of trauma over time. The findings are of importance both clinically and for the legal system.
National Prevalence Rates of Suicidal Ideation and Suicide Attempts Among Adults With and Without Depression
Authors: Omary Areen
Published: February 2021

Using the 2018 National Survey on Drug Use and Health, this study examined the US national prevalence rates of suicidal ideation (SI) and suicide attempts (SA) among four demographic adult groups (race-sex, age, education, and marital status) with and without major depressive episode (MDE). The highest prevalence rates of SI for those with and without MDE occurred among adults 18 to 25 years, with some college education, White females and males, and unmarried and never been married. Among the same demographic groups, proportions of SA were also the highest for those with MDE. A Pearson chi-square test confirmed significant associations between MDE and SI and between MDE and SA. The model fit results showed that the four variables were significant predictors of SI and SA (p < 0.05). Serious mental health needs are unmet, especially among adults with depression. Population-based clinical interventions are needed to reduce rates of depression, SI, and SA.
Impact of the COVID-19 Pandemic on the Short-Term Course of Obsessive-Compulsive Disorder
Authors: Sharma Lavanya P. , Balachander Srinivas , Thamby Abel , Bhattacharya Mahashweta , Kishore Chethana , Shanbhag Vandita , Sekharan Jaisoorya T. , Narayanaswamy Janardhanan C. , Arumugham Shyam Sundar , Reddy Janardhan Y.C.
Published: February 2021

There is an understandable concern that obsessive-compulsive disorder (OCD) may worsen during the COVID-19 pandemic, but there are little empirical data. We report the impact of COVID-19 pandemic on the short-term course of OCD. A cohort of patients with a primary diagnosis of OCD (n = 240) who were on regular follow-up at a tertiary care specialty OCD clinic in India were assessed telephonically, about 2 months after the declaration of the pandemic (“pandemic” cohort). Data from the medical records of an independent set of patients with OCD (n = 207) who were followed up during the same period, 1 year prior, was used for comparison (historical controls). The pandemic group and historical controls did not differ in the trajectories of the Yale-Brown Obsessive-Compulsive Scale scores (chi-square likelihood ratio test of the group × time interaction = 2.73, p = 0.255) and relapse rate (21% vs. 20%; adjusted odds ratio, 0.81; 95% confidence interval, 0.41–1.59; p = 0.535). Preexisting contamination symptoms and COVID-19–related health anxiety measured by the COVID-Threat Scale did not predict relapse. Only a small proportion of patients (6%) reported COVID-19–themed obsessive-compulsive symptoms. The COVID-19 pandemic, at least in the short run, did not influence the course of illness.
Sexually Transmitted Infection Testing Using Online Companies: Benefits, Drawbacks, and Call for Official Guidance
Authors: Cannon Chase A. , Piraino Alyssa K. , Golden Matthew R. , Barbee Lindley A.
Published: February 2021

In this brief case series, we outline issues with some online sexually transmitted infection services and delayed reporting of results. Commercial entities providing sexually transmitted infection testing should ensure that all results are reported to local public health jurisdictions and that procedures exist to link persons to appropriate treatment and follow-up.
Case Report: Acute Retinal Necrosis after Intravitreal Ranibizumab for Exudative Macular Degeneration
Authors: Pan Ying , Huang Xiaoli , Wu Zhifeng , Lu Shui , Chen Tiantian , Zou Wenjun
Published: February 2021

SIGNIFICANCE

Acute retinal necrosis (ARN) may occur after intravitreal ranibizumab (IVR) treatment for patients with exudative age-related macular degeneration (AMD). Awareness of this unusual but devastating complication after IVR is needed. Early identification may help provide timely antiviral treatment and prevent irreversible visual loss.

PURPOSE

This study aimed to report a case of ARN after IVR in a patient with exudative AMD.

CASE REPORT

A 67-year-old male patient complained of blurred vision in his left eye for 1 month. The patient was diagnosed with exudative AMD after detailed ophthalmic clinical evaluations. He received IVR once in his left eye. Three days after IVR, he developed varicella-zoster virus–associated ARN, which was treated with systemic and intravitreal antiviral therapy. Because of progressive inflammation, the patient underwent 25G pars plana vitrectomy with silicone oil tamponade. Seven months later, the patient was administered intravitreal aflibercept once in his left eye. Three months after intravitreal aflibercept, he underwent removal of silicone oil, and retinal detachment occurred 2 weeks after the surgery because of low IOP, and the patient eventually discontinued treatment.

CONCLUSIONS

This study reports the first case of varicella-zoster virus–associated ARN after IVR. Early ARN may be very difficult to distinguish from intraocular inflammation after IVR. Therefore, early detection of viral DNA in the intraocular fluid using polymerase chain reaction is recommended. Immediate antiviral treatment may be beneficial to prevent severe visual loss.
Case Report: Combined Ischemic Optic Neuropathy and Central Retinal Artery Occlusion after Starting Hemodialysis
Authors: Carell Emily M.
Published: February 2021

SIGNIFICANCE

This case highlights ocular ischemia after hemodialysis resulting in permanent vision loss. Fifteen percent of the U.S. population suffers from chronic kidney disease. Eye care providers should recommend risk factor modifications to their patients with end-stage renal disease before hemodialysis is started to prevent loss of vision.

PURPOSE

The purpose of this study was to demonstrate a case of concurrent nonarteritic anterior ischemic optic neuropathy and central retinal artery occlusion in the setting of hemodialysis initiation.

CASE REPORT

A 68-year-old Irish man with end-stage renal disease undergoing dialysis presented, complaining of 3 weeks of progressive vision loss in his left eye. His medical history is complex and includes extensive cardiac disease, bilateral carotid stenosis, and peripheral vascular disease. His surgical history includes a right carotid endarterectomy, bilateral lower extremity amputations, and an aortic valve replacement. Clinical examination revealed light perception vision with an afferent pupillary defect in the left eye and count finger peripheral vision only in the superior temporal quadrant of his vision. The dilated fundus examination showed significant pallid disc edema and focal areas of retina whitening with attenuated peripapillary vasculature in the left eye. This edema was confirmed by optical coherence tomography and supported optic nerve and retinal infarction. A temporal artery biopsy confirmed no evidence of arteritis.

CONCLUSIONS

Hemodynamic disruption during dialysis in patients with end-stage renal disease and overlying anemia can result in optic nerve and retinal infarction. Patients who are predisposed to nonarteritic anterior ischemic optic neuropathy or central retinal artery occlusion should be educated on this before starting dialysis to ensure careful blood pressure monitoring.
Phentolamine Eye Drops Reverse Pharmacologically Induced Mydriasis in a Randomized Phase 2b Trial
Authors: Karpecki Paul M. , Foster Shane A. , Montaquila Stephen M. , Kannarr Shane R. , Slonim Charles B. , Meyer Alan R. , Sooch Mina P. , Jaber Reda M. , Charizanis Konstantinos , Yousif Jonah E. , Klapman Seth A. , Amin Arin T. , McDonald Marguerite B. , Horn Gerald D. , Lazar Eliot S. , Pepose Jay S.
Published: February 2021

SIGNIFICANCE

After a dilated eye examination, many patients experience symptoms of prolonged light sensitivity, blurred vision, and cycloplegia associated with pharmacological mydriasis. Phentolamine mesylate ophthalmic solution (PMOS) may expedite the reversal of mydriasis in patients, potentially facilitating return to functional vision and reducing barriers to obtaining dilated eye examinations.

PURPOSE

The protracted reversal time after pharmacologically induced pupil dilation impairs vision. We tested the hypothesis that PMOS rapidly reduces pupil diameter in this acute indication.

METHODS

In this double-masked placebo-controlled, randomized, two-arm crossover phase 2b trial, we evaluated the effects of one drop of 1% PMOS applied bilaterally in subjects who had their pupils dilated by one of two common mydriatic agents: 2.5% phenylephrine or 1% tropicamide. End points included change in pupil diameter, percent of subjects returning to baseline pupil diameter, and accommodative function at multiple time points.

RESULTS

Thirty-one subjects completed the study (15 dilated with phenylephrine and 16 with tropicamide). Change in pupil diameter from baseline at 2 hours after maximal dilation with 1% PMOS was −1.69 mm and was significantly greater in magnitude compared with placebo for every time point beyond 30 minutes (P < .05). At 2 hours, a greater percentage of study eyes given 1% PMOS returned to baseline pupil diameter compared with placebo (29 vs. 13%, P = .03), which was this also seen at 4 hours (P < .001). More subjects treated with PMOS in the tropicamide subgroup had at least one eye returning to baseline accommodative amplitude at 2 hours (63 vs. 38%, P = .01). There were no severe adverse events, with only mild to moderate conjunctival hyperemia that resolved in most patients by 6 hours.

CONCLUSIONS

Phentolamine mesylate ophthalmic solution at 1% reversed medically induced pupil dilation more rapidly than placebo treatment regardless of which mydriatic was used (adrenergic agonists and cholinergic blockers) with a tolerable safety profile.
Concise Reporting of Benign Endometrial Biopsies is an Acceptable Alternative to Descriptive Reporting
Authors: Kriplani Divya , Olivar Ana A. , Tchrakian Nairi , Butcher Deborah , Casey Laura , Crook Jonathan A. , Deo Nandita , Dilley James , Griffiths Richard , Hogg Matt , Jeyarajah Arjun R. , Khan Saima J. , Lawrence Alexandra , Lee Abigail , Leen Sarah L. , Leitch-Devlin Linda , Manchanda Ranjit , Masood Mariam , Nyarko Eric , Okaro Emeka , Phadnis Saurabh , Trevisan Giorgia , Tsang Jacqueline , Vimplis Sotiris , Wilmott Frederick , Brockbank Elly , Singh Naveena
Published: February 2021

In the United Kingdom, endometrial biopsy reports traditionally consist of a morphologic description followed by a conclusion. Recently published consensus guidelines for reporting benign endometrial biopsies advocate the use of standardized terminology. In this project we aimed to assess the acceptability and benefits of this simplified “diagnosis only” format for reporting non-neoplastic endometrial biopsies. Two consultants reported consecutive endometrial biopsies using 1 of 3 possible formats: (i) diagnosis only, (ii) diagnosis plus an accompanying comment, and (iii) the traditional descriptive format. Service users were asked to provide feedback on this approach via an anonymized online survey. The reproducibility of this system was assessed on a set of 53 endometrial biopsies among consultants and senior histopathology trainees. Of 370 consecutive benign endometrial biopsies, 245 (66%) were reported as diagnosis only, 101 (27%) as diagnosis plus a brief comment, and 24 (7%) as diagnosis following a morphologic description. Of the 43 survey respondents (28 gynecologists, 11 pathologists, and 4 clinical nurse specialists), 40 (93%) preferred a diagnosis only, with 3 (7%) being against/uncertain about a diagnosis only report. Among 3 histopathology consultants and 4 senior trainees there was majority agreement on the reporting format in 53/53 (100%) and 52/53 (98%) biopsies. In summary, we found that reporting benign specimens within standardized, well-understood diagnostic categories is an acceptable alternative to traditional descriptive reporting, with the latter reserved for the minority of cases that do not fit into specific categories. This revised approach has the potential to improve reporting uniformity and reproducibility.
Drug resistance mutations in HIV provirus are associated with defective proviral genomes with hypermutation
Authors: Li Yijia , Etemad Behzad , Dele-Oni Ruth , Sharaf Radwa , Gao Ce , Lichterfeld Mathias , Li Jonathan Z.
Published: February 2021

Background:

HIV proviral sequencing overcomes the limit of plasma viral load requirement by detecting all the ‘archived mutations’, but the clinical relevance remains to be evaluated.

Methods:

We included 25 participants with available proviral sequences (both intact and defective sequences available) and utilized the genotypic sensitivity score (GSS) to evaluate the level of resistance in their provirus and plasma virus. Defective sequences were further categorized as sequences with and without hypermutations. Personalized GSS score and total GSS score were calculated to evaluate the level of resistance to a whole panel of antiretroviral therapies and to certain antiretroviral therapy that a participant was using. The rate of sequences with drug resistance mutations (DRMs) within each sequence compartment (intact, defective and plasma viral sequences) was calculated for each participant.

Results:

Defective proviral sequences harbored more DRMs than other sequence compartments, with a median DRM rate of 0.25 compared with intact sequences (0.0, P = 0.014) and plasma sequences (0.095, P = 0.30). Defective sequences with hypermutations were the major source of DRMs, with a median DRM rate of 1.0 compared with defective sequences without hypermutations (0.042, P < 0.001). Certain Apolipoprotein B Editing Complex 3-related DRMs including reverse transcriptase gene mutations M184I, E138K, M230I, G190E and protease gene mutations M46I, D30N were enriched in hypermutated sequences but not in intact sequences or plasma sequences. All the hypermutated sequences had premature stop codons due to Apolipoprotein B Editing Complex 3.

Conclusion:

Proviral sequencing may overestimate DRMs as a result of hypermutations. Removing hypermutated sequences is essential in the interpretation of proviral drug resistance testing.
Primary Malignant Melanoma of the Oropharynx Presented on 18F-FDG PET/CT
Authors: Xiao JingXing , Su Min , Wang Dong
Published: February 2021

Primary malignant melanoma in the oropharynx is extremely rare. A 49-year-old man presented with a 3-month history of progressive dysphagia. An outside CT scan of the head and neck showed a space-occupying lesion in the oropharynx. Staging with FDG PET/CT demonstrated a hypermetabolic mass in the right wall of the oropharynx. A biopsy revealed malignant melanoma. The patient underwent total resection of the tumor, with no recurrence after 6-month follow-up.
A Clinical Study on Individualized Surgical Scheme of Hydrocephalus Complicated With Skull Defect
Authors: Zhou Jian-Yun , Zhang Xin , Gao Hai-Bin , Cao Ze , Sun Wei
Published: February 2021

Objective:

This study intends to discuss the individualized selection of surgical scheme of hydrocephalus complicated with skull defect.

Methods:

A total of 141 patients with hydrocephalus complicated with skull defect in our hospital from January 2012 to December 2018 were the main subjects of this study. Among these 141 patients, 78 patients underwent shunt and skull repair surgery in our hospital. In the present study, according to the classification of bone window tension, and combined with factors that affect the operation, different surgical schemes were selected, namely, repair surgery in the first phase and shunt surgery in the second phase, or simultaneous surgery, or shunt surgery in the first phase and repair surgery in the second phase.

Results:

The results of the present study show that an individualized surgical scheme can allow for the operation of hydrocephalus complicated with skull defect, without increasing the risk of complications, such as shunt infection, epidural hematoma, etc.

Conclusions:

The surgical scheme for hydrocephalus complicated with skull defect differs in clinic.
Uncertain Clinical Effect of Polymyxin B Hemoperfusion in Patients with Septic Acute Kidney Injury Requiring Continuous Renal Replacement Therapy
Authors: Lee Jong Min , Baek Seung Don , Kim Tae Hyun , Jeon Hwa Ran , Han Jin Hee , Chang Jai Won
Published: February 2021

Polymyxin B hemoperfusion (PMX-HP) may improve the clinical outcomes of patients with sepsis and gram-negative bacteremia by reducing endotoxin levels. However, the recent studies with the variable degree of renal support have shown that the improvement of survival rate by PMX-HP remains unclear in such patients. Therefore, we investigated whether the addition of PMX-HP to continuous renal replacement therapy (CRRT) could improve the survival rate than CRRT alone. This study included 231 patients with sepsis undergoing CRRT alone or PMX-HP with CRRT. Primary outcomes were 28-day and 90-day all-cause mortality. Urine output, ventilator support, and Sequential Organ Failure Assessment (SOFA) score were not significantly different between the two groups. Crude 28-day and 90-day mortality rates were higher in the PMX-HP with CRRT group than in the CRRT-alone group. To correct for disease severity, propensity score (PS) matching was performed with acute respiratory distress syndrome, mechanical ventilation support, extracorporeal membrane oxygenation, infection source (abdomen), age, inotropic score, SOFA score, C-reactive protein, and procalcitonin levels. Sixty-six PS-matched pairs revealed significantly higher 28-day and 90-day mortality rates in the PMX-HP with CRRT group than in the CRRT-alone group. Considering the mortality rates after PS matching, the additional use of PMX-HP does not improve the clinical outcomes of patients with sepsis and acute kidney injury requiring CRRT.
A Discrete Event Simulation-Based Model to Optimally Design and Dimension Mobile COVID-19 Saliva-Based Testing Stations
Authors: Saidani Michael , Kim Harrison
Published: February 2021

Summary Statement

The present COVID-19 brief report addresses: (1) the problem of optimal design and resource allocation to mobile testing stations to ensure rapid results to the persons getting tested; (2) the proposed solution through a newly developed discrete event simulation model, experienced in on-campus saliva-based testing stations at the University of Illinois at Urbana-Champaign; and (3) the lessons learned on how 10,000 samples (from noninvasive polymerase chain reaction COVID-19 tests) can be processed per day on campus, as well as how the model could be reused or adapted to other contexts by site managers and decision makers.
Vaginal Estrogen as First-Line Therapy for Recurrent Urinary Tract Infections in Postmenopausal Women and Risk Factors for Needing Additional Therapy
Authors: Chang Eric , Kent Laura , Prieto Isabel , Eggers Erica , Tanner Jean Paul , Bassaly Renee , Wyman Allison , Greene Kristie
Published: February 2021

Objectives

This retrospective cohort study aims to determine the proportion of postmenopausal women with recurrent urinary tract infections (rUTIs) who improve with vaginal estrogen cream alone and to identify risk factors for those who go on to require additional therapies.

Methods

Postmenopausal women presenting with rUTIs seen at a single institution over a 29-month period were identified. Patients who had not undergone previous treatment and were started on vaginal estrogen cream alone as first-line therapy were included in the study. Descriptive statistics were used to compare demographic and clinical characteristics between therapy groups. Log-binomial regression was used to explore the association between treatment failure (ie, the need for additional therapy for rUTIs) and patient sociodemographic and clinical characteristics.

Results

During the study period, 167 patients with rUTIs met inclusion criteria. Of these, 67.7% noted improvement or resolution in their symptoms with vaginal estrogen cream alone. Women with a concomitant diagnosis of urinary incontinence, as defined as subjective report of bothersome stress or urgency urinary incontinence, were 2.3 times more likely to need additional therapy compared with women not reporting urinary incontinence (relative risk, 2.28; 95% confidence interval, 1.06-4.90).

Conclusions

Sixty-eight percent of postmenopausal women with rUTIs treated with vaginal estrogen alone did not go on to receive additional therapy. A risk factor for needing additional therapy in our study population is the presence of urinary incontinence.
Association Between Hemoglobin A1 c and Midurethral Sling Complications in Diabetic Women: A Cohort Study
Authors: Ortega Marcus V. , Bangura Marie , Ayati Elnaz , James Kaitlyn , Mitchell Caroline , Weinstein Milena M. , Von Bargen Emily
Published: February 2021

Objective

We aimed to evaluate the association between hemoglobin A1
c (HbA1
c) levels and midurethral sling (MUS) complications.

Methods

This was a multihospital, retrospective cohort study from 2010 to 2020. We included all women with diabetes mellitus who underwent a synthetic mesh MUS procedure and had a preoperative HbA1
c within 3 months of surgery. The primary outcome was a composite of complications, including MUS mesh exposure, surgical site granulation tissue or infection, urinary tract infection, surgical site pain beyond 6 weeks postoperatively, and MUS failure. A sensitivity analysis analyzing MUS failure alone was performed.

Results

During the study period, 109 women met the inclusion criteria. Most were White (52.2%) and had a median body mass index of 31.2 kg/m2, and 84.9% were postmenopausal. Median HbA1
c was 7.2% (interquartile range, 6.3%–7.7%). Urinary tract infection was the most common complication in 12 (11.0%) women. Mesh exposure was diagnosed in 7 (6.4%) women. Seventeen (15.6%) had MUS failure. On univariate regression analysis, a higher HbA1
c was associated with increased odds of composite complications (odds ratio, 1.67; 95% confidence interval, 1.20–2.32; P = 0.002) and MUS failure (odds ratio, 1.81, 95% confidence interval, 1.26–2.60; P = 0.001). On multivariate analysis, higher HbA1
c levels were associated with a composite of complications and failure (P < 0.05). Based on the receiver operating characteristic curve, HbA1
c greater than 8% demonstrated a specificity of 85.7% and a sensitivity of 50% for MUS failure.

Conclusions

In diabetic patients, a higher HbA1c was associated with a higher risk of MUS complications and failure. Obtaining an HbA1
c within 3 months of surgery may help with risk stratification.
Autologous Fascia Lata for Combined Sacrocolpopexy and Rectopexy
Authors: Shaw Jonathan S. , Wilson Lauren R. , Wilson Matthew Z. , Ivatury S. Joga , Strohbehn Kris
Published: February 2021

We present a case series and video of our technique using autologous fascia lata for combined sacrocolpopexy and rectopexy, with or without resection.
Is Rapid Molecular Testing enough In Screening Resistant Tuberculosis In Community
Authors: Ashok Dhaker , Ashish Bahal , Vishal Mangal , Arun K Yadav , Anuj Singhal , Anoushka Gupta
Published: March 2021

Background

The study aimed to compare the sensitivity and specificity of cartridge based nucleic acid amplification test (CBNAAT) for diagnosis of Drug-Resistant tuberculosis (DRTB) with culture sensitivity assays.

Methods

Patients with cough symptoms for more than two weeks with any one symptom such as night sweats, fever, and unintentional weight loss were enrolled. Cases where Mycobacterium Tuberculosis was detected on sputum CBNAAT, were included in the study. Demographic variables, clinical features, and chest radiographs were collected. Each sputum sample was divided into three aliquots: smear microscopy, culture, and genotypic drug sensitivity testing (DST). Results of all three diagnostic modalities were compared with CBNAAT.

Results

Out of 236 patients with sputum positive CBNAAT, 49.4 % (117/236) were rifampicin-resistant while 50. 6 % (119/236) were Rifampicin sensitive. The genotypic DST assays carried out on all enrolled patients showed that 76. 3 % (181/236) patients were resistant to one or more first-line or second-line antitubercular (ATT) drugs, while 23.7 % (55/236) patients were sensitive to all ATT drugs. On concordant analysis of CB NAAT with DST assays, we found that among 119 CB NAAT rifampicin sensitive patients, 66 patients were resistant to first-line or second-line antitubercular drugs.

Conclusion

This study found that the screening of DRTB with CBNAAT at the community level is suboptimal compared to the gold standard. Although CBNAAT’s sensitivity in detecting DRTB is significantly higher, the specificity is lower in that population who have received ATT earlier.
Epidemiology and costs of post-sepsis morbidity, nursing care dependency, and mortality in Germany
Authors: Fleischmann-Struzek Carolin , Rose Norman , Freytag Antje , Spoden Melissa , Prescott Hallie C. , Schettler Anna , Wedekind Lisa , Ditscheid Bianka , Storch Josephine , Born Sebastian , Schlattmann Peter , Günster Christian , Reinhart Konrad , Hartog Christiane S.
Published: March 2021

Purpose

To quantify the frequency and co-occurrence of new diagnoses consistent with post-sepsis morbidity, mortality, new nursing care dependency, and total healthcare costs after sepsis.

Methods

Population-based cohort study using healthcare claims data from 23 million beneficiaries of a German health insurance provider. We included adult patients with incident hospital-treated sepsis identified by ICD-10 codes in 2013-2014. New medical, psychological and cognitive diagnoses associated with post-sepsis morbidity; mortality; dependency on nursing care; and total health care costs in survivors were assessed to 3 years after hospital discharge.

Results

Among 116,507 sepsis patients who survived hospitalization for sepsis, 74.3% had a new medical, psychological or cognitive diagnosis in the first year after discharge. 20.6% and 3.8% had new diagnoses in two and three domains, respectively. 31.5% were newly dependent on nursing care, and 30.7% died within the first year. In the second and third year, 65.8% and 59.4% of survivors had new diagnoses, respectively. Healthcare costs totaled an average 36,585 Euro/patient in three years, including index hospitalization costs. Occurrence of new diagnoses in predefined subgroups was: 73.7% (survivors of non-severe sepsis), 75.6% (severe sepsis), 78.3% (ICU-treated sepsis), 72.8% (non-ICU treated sepsis) and 68.5% (survivors without prior diagnoses).

Conclusions

New medical, psychological and cognitive diagnoses consistent with post-sepsis morbidity are common after sepsis, including among patients with less severe sepsis, no prior diagnoses, and younger age. This calls for more efforts to elucidate the underlying mechanisms, define optimal screening for common new diagnoses, and test interventions to prevent and treat post-sepsis morbidity.

Trial Registration

DRKS00016340

Take home message

This large population-based cohort of over 100,000 survivors of hospital-treated sepsis found high rates and a broad spectrum of new diagnoses consistent with post-sepsis morbidity, frequent new nursing care dependency, and high long-term mortality 1-3 years post sepsis. Post-sepsis morbidity was not limited to the oldest survivors or those with the most severe illness, but also affected younger survivors and those without pre-existing diagnoses.
Unwelcome memento mori or best clinical practice? Community end-of-life anticipatory medication prescribing practice: a mixed methods observational study
Authors: Bowers Ben , Pollock Kristian , Barclay Stephen
Published: March 2021

Background

Anticipatory medications are injectable drugs prescribed ahead of possible need for administration if distressing symptoms arise in the final days of life. Little is known about how they are prescribed in primary care.

Aim

To investigate the frequency, timing and recorded circumstances of anticipatory medications prescribing for patients living at home and in residential care.

Design

Retrospective mixed methods observational study using General Practitioner and community nursing clinical records.

Setting/participants

329 deceased adult patients registered with Eleven General Practitioner practices and two associated community nursing services in Hertfordshire and Cambridgeshire, England (30 most recent deaths per practice). Patients died from any cause except trauma, sudden death or suicide, between 4 March 2017 and 25 September 2019.

Results

Anticipatory medications were prescribed for 167/329 (50.8%) of the deceased patients, between 0 and 1212 days before death (median 17 days). The likelihood of prescribing was significantly higher for patients with a recorded preferred place of death (odds ratio [OR] 34; 95% CI 15-77; p < 0.001) and specialist palliative care involvement (OR 7; 95% CI 3-19; p < 0.001). For 66.5% of patients (111/167) anticipatory medications were recorded as being prescribed as part of a single end of-life planning intervention.

Conclusion

The variability in the timing of prescriptions highlights the challenges in diagnosing the end-of-life phase and the potential risks of prescribing far in advance of possible need. Patient and family preferences for involvement in anticipatory medications prescribing decision-making and their experiences of care warrant urgent investigation.

Summary Box

What is already known on this topic

The prescribing of injectable anticipatory medications to provide symptom relief in the last days of life care is recommended and widespread practice in a number of counties.

There is limited research concerning the frequency, timing and context of prescriptions.

What this paper adds

Half (50.8%) of 319 patients whose deaths were potentially predictable deaths were prescribed anticipatory medications, the timing of prescriptions ranging from 0 to 1212 days before death (median 17 days).

Anticipatory medications were frequently prescribed as standardised drugs and doses, and often as part of a single end-of-life care planning intervention.

The extent to which patients and family carers were involved in prescribing decisions was unclear.

Implications for practice, theory or policy

Patient and family preferences for involvement in anticipatory medications prescribing decision-making and their experiences of care warrant urgent investigation.

The presence of anticipatory medications for long periods of time may compromise patient safety unless robust systems are in place to review their continued appropriateness and safe use.
Opening schools and trends in SARS-CoV-2 transmission in European countries
Authors: Buja Alessandra , Paganini Matteo , Cristofori Vittorio , Baldovin Tatjana , Fusinato Riccardo , Boccuzzo Giovanna , Cocchio Silvia , Coretti Silvia , Rebba Vincenzo , Parpinel Maria
Published: March 2021

Background

It is important to understand the role of schools in the community transmission of SARS-CoV-2, bearing in mind that children and adolescents can spread the infection within families, even when their own symptoms are mild. The aim of this study was to examine the trends of contagion before and after schools reopened across 27 countries in the European Union.

Methods

All data on the number of people testing positive for COVID-19 in each European country were collected from 20 days before schools reopened to 45 days afterwards. The Joinpoint regression method was used to detect single change points on the trend of contagion. The Bayesian Information Criterion (BIC) was used for model selection purposes.

Results

We calculated 27 linear regression models for the daily case numbers of SARS-CoV-2 infection in the 27 countries from 20 days before schools reopened to 45 days afterwards. A significant increase in the number of daily infections was seen for 21 countries after a change point in the linear regression lines. The change points in different countries varied, ranging from 10 to 42 days after schools reopened, with the majority occurring beyond the 21st day.

Conclusion

This study analysed the trend of SARS-CoV-2 transmission before and after schools reopened in Europe. We observed a significant increase in the number of new daily cases in most countries. This issue poses a public health problem that needs to be taken into account in deciding strategies to contain the spread of COVID-19.
Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan
Authors: Yoshioka Takashi , Okubo Ryo , Tabuchi Takahiro , Odani Satomi , Shinozaki Tomohiro , Tsugawa Yusuke
Published: March 2021

Importance

The coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health of the population, leading to higher suicide rates, in many countries. However, little is known about risk factors associated with worsened mental health during the COVID-19 pandemic.

Objective

To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.

Design, Setting, and Participants

A cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan.

Exposures

Demographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment), the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19.

Main Outcomes and Measures

Prevalence of SPD, defined as Kessler 6 scale score ≥13.

Results

Among 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17–2.16; P=0.003), ages 15–29 (aOR compared with ages 45–59, 2.35; 95%CI, 1.64–3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16–2.49; P=0.007), providing caregiving to family members (aOR, 5.48; 95%CI, 3.51–8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81–8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55–2.48; P<0.001) were associated with a higher rate of SPD. Among women aged 15–29 years, who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher rate of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD.

Conclusions and Relevance

Economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women—who have a higher risk of suicide during the COVID-19 pandemic in Japan—similar factors, except economic situation, were associated with a higher rate of SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population’s mental health.
The institutional change in the role of the public sector accountant in facilitating accountability: a longitudinal study of Australian local councils
Authors: Williams Belinda , Lodhia Sumit , Arora Mitali Panchal , McManus Lisa
Published: February 2021

Purpose

With an increased focus on the need for higher levels of accountability and transparency in the public sector, this study aims to provide insights into non-financial reporting (NFR) practices as a mechanism in facilitating accountability. This study also aims to investigate the changing role of the public sector accountant in this process, specifically focusing on the Australian local government sector.

Design/methodology/approach

The authors used a mail survey across two time periods, 2009 and 2017, to analyse the role of accountants in NFR practices. Institutional theory provides a theoretical framing for the study.

Findings

The findings reveal an increase in the use of accountants across time in the preparation of voluntary information, being used in a variety of roles because of their financial abilities and analytical skills. The results also indicate a shift has occurred with more emphasis being placed on cross-departmental approaches to NFP incorporating the accountant. These results suggest a greater recognition of the role of accountants in NFR and a dilution of accountant’s boundaries in relation to their existing traditional focus.

Research limitations/implications

This study contributes to the academic NFR literature by providing evidence of an institutional shift that is occurring with the accountant’s role widening to a broader context beyond their traditional roles.

Practical implications

This longitudinal study provides practical evidence to management of the potential offered by accountants as the public sector seeks to achieve higher levels of accountability and transparency. Policy implications also arise in relation to the need for development of quality assurance guidelines and further education and training as the public sector embarks on the journey of NFR.

Originality/value

To the best of the authors’ knowledge, this study is the first that has explored the evolution of NFR over a period of time through its focus on the role of accountants.
Performance management systems promote job crafting: the role of employees' motivation
Authors: Berdicchia Domenico , Bracci Enrico , Masino Giovanni
Published: February 2021

Purpose

The purpose of this paper is to examine the influence of performance management systems (PMSs) and their perceived accuracy on job crafting behaviors via motivation.

Design/methodology/approach

By adopting a research design based on three waves, a mediation model was tested using survey data from 12 municipalities in Italy.

Findings

Perceived PMS accuracy positively influences “approach” job crafting behaviors through intrinsic motivation and “avoidance” job crafting behaviors through extrinsic motivation.

Practical implications

Organizations interested in promoting job crafting should ensure that PMSs are designed and implemented in a way that increases perceived PMS accuracy among employees.

Originality/value

The results of this study enrich the literature on job crafting by underlining the role of PMSs as an antecedent of job crafting and by clarifying how different motivational processes may intervene in this relationship.