bluuebunny/crossref_metadata_2025 huggingface dataset:
The Classification of VACTERL Association into 3 Groups According to the Limb Defect
Authors: Al-Qattan Mohammad M.
Published: February 2021

The VACTERL association (VA) is defined as the nonrandom co-occurrence of 6 anomalies: vertebral anomalies (V), Anal atresia (A), Cardiac defects (C), Tracheo-esophageal fistula (TE), Renal defects (R), and Limb anomalies (L). The current communication presents an argument that patients with VA should be classified into three district groups based on their limb defects: VACTERL1: patients with normal limbs; VACTERL2: patients with limb anomalies other than radial ray defects of the upper limbs; and VACTERL3: patients with radial ray defects of the upper limbs. The author will demonstrate that the rationale behind the L1-3 classification in patients in VA is based on the embryogenesis of the 6 affected anatomical areas in VA. The pathogenesis of VACTERL1 is secondary to perturbations of Sonic Hedgehog (SHH) interactions. SHH signaling is known to have a major role in the normal development of the vertebrae, ano-rectal area, heart, tracheo-esophageal area, and kidney. However, SHH is not involved in the development of the radial ray; hence, patients present with no limb defects. The pathogenesis of VACTERL2 is variable depending on the type of gene mutation. The pathogenesis of VACTERL3 is related to errors in a group of proteins (namely, the proteins of the TBX5-SALL4-SALL1 loop and the FGF8-FGF10 loop/ pathway). These proteins are essential for the normal development of the radial ray and they interact in the development of the other anatomical areas of VA including the heart and kidney. Hence, VACTERL3 patients present with radial ray deficiency.
The gender pay gap in medicine: A systematic review
Authors: Hoff Timothy , Lee Do Rim
Published: February 2021

Background

Women are becoming doctors in greater numbers. Despite this, there is evidence of female doctors’ continued differential treatment compared to their male counterparts.

Purpose

The aim of this study was to review systematically the extant literature on the gender-based pay gap in medicine across time, different medical specialties, and different countries of clinical practice.

Methods

Systematic search of three databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies needed to be empirical and contain either an unadjusted or adjusted gender-based finding related to pay.

Results

A total of 46 articles published since 2000 contained a gender-based finding related to physician pay. Thirty-two of these 46 articles presented either adjusted or unadjusted means comparisons (or both) comparing pay between male and female physicians. Eighteen of the 46 articles controlled for one or more variables in examining pay between the two groups. Across almost all studies, female doctors earn significantly less than men, often tens of thousands of dollars less annually, despite similar demographic and work-related profiles. This earnings gap is persistent across time, medical specialty, and country of practice.

Practice Implications

The gender-based pay gap is an ongoing crisis within medicine that must be addressed. From a practice perspective, women physicians may benefit from greater organizational awareness of potential workplace bias and the implementation of more supportive policies aimed at better equalizing compensation through greater support and transparency related to salary negotiations, promotional opportunities, and pay scales across various job titles.
The Right to Say No: Why Adult Sexual Assault Patients Decline Medical Forensic Exams and Sexual Assault Kit Evidence Collection
Authors: Campbell Rebecca , Javorka McKenzie , Gregory Katie , Vollinger Lauren , Ma Wenjuan
Published: February 2021

Introduction

The International Association of Forensic Nurses (2018) affirms the importance of evidence-based, trauma-informed, patient-centered forensic nursing services that engage patients as autonomous decision makers. Past research indicates that forensic nurses consistently respect patients' choices and control as they navigate the decisions of medical forensic examinations (MFEs) and sexual assault kit (SAK) collection. Building on that work, this study examined which options patients decline and what factors are associated with those declination decisions.

Method

We collected prospective data from seven state-funded sexual assault nurse examiner programs. Forensic nurses recorded information about all adult sexual assault patients (N = 783) regarding four primary decisions: whether to have a MFE, whether to consent to all parts of the MFE or to decline specific services, whether to have a SAK collected, and whether to release the SAK to law enforcement for forensic DNA testing.

Results

Most patients consented to a MFE (95%), to all parts of the MFE (81%), to SAK collection (99%), and to release the SAK for forensic DNA testing (80%). Younger patients and those with disabilities were more likely to decline some options. Patients who had not disclosed the assault to others before seeking sexual assault nurse examiner care were also more likely to decline a MFE. Whether patients sought post assault care for more health-focused reasons or legally focused reasons was associated with declination decisions.

Conclusions

Healthcare providers should communicate clearly about each step in post assault care and allow patients to decline services as they choose.
Does Jaundice in Newborn Infants Affect Exclusivity and Duration of Breastfeeding in Taiwan?
Authors: CHU Kuei-Hui , TENG Sen-Wen , TAI Chen-Jei , CHANG Ching-Mei , CHIEN Li-Yin
Published: February 2021

Background

Cases of breastfeeding- and breast-milk-related jaundice tend to increase with increased rates of breastfeeding. Diagnoses of jaundice often lead mothers to discontinue breastfeeding because of assumptions that breastfeeding may exacerbate neonatal jaundice and lengthen the duration of phototherapy treatment.

Purpose

This study was designed to explore the effect of neonatal jaundice on breastfeeding duration and exclusivity during the first 4 months postpartum.

Methods

This study applied a two-group comparative and follow-up design. The two groups comprised 135 and 160 mothers of infants, respectively, with and without neonatal jaundice. All of the participants were recruited from three certified baby-friendly hospitals in northern Taiwan. Follow-up was conducted by telephone at 1 and 4 months postpartum.

Results

Mean breastfeeding duration was longer in the group of participants whose infants had neonatal jaundice (group with neonatal jaundice) than in the group whose infants did not have this condition (group without neonatal jaundice; 102.00 vs. 89.85 days, p = .007). The degree of breastfeeding was higher in the group with neonatal jaundice, although the difference was significant only at 1 month postpartum and not during hospitalization or at 4 months postpartum. The results of a Cox regression model showed that the group without neonatal jaundice was more likely to discontinue breastfeeding (adjusted hazard ratio = 1.68, 95% CI [1.08, 2.62]). A generalized estimating equation model suggests that infants with neonatal jaundice had a higher likelihood of being breastfed for at least half of their feedings (adjusted OR = 1.53, 95% CI [1.04, 2.25]).

Conclusions

On the basis of the results of this study, neonatal jaundice is not an obstacle to breastfeeding in pro-breastfeeding hospital environments. Participants whose infants developed neonatal jaundice were found in this study to breastfeed more often, which promotes breastfeeding success.
The Professional Identity of Nursing Students and Their Intention to Leave the Nursing Profession During the Coronavirus Disease (COVID-19) Pandemic
Authors: NIE Shengxiao , SUN Chao , WANG Lei , WANG Xia
Published: February 2021

Background

The COVID-19 pandemic has affected China and other countries since December 2019. The effects of this pandemic on nursing students in terms of their professional identity, intention to leave the nursing profession, and perception of clinical nursing work remain unclear.

Purpose

The aims of this study were, first, to investigate nursing students' professional identity, intention to leave the nursing profession, and perception of clinical nursing work during the COVID-19 pandemic and, second, to explore factors influencing professional identity to help develop effective strategies to enrich and strengthen this factor in the future.

Methods

This cross-sectional, descriptive survey study was conducted on 150 nursing students in China in February 2020.

Results

The 14 (9.3%) participants who reported intending to leave the nursing profession earned lower scores for professional identity than their peers who reported intending to remain. The participants who believed that the COVID-19 pandemic had made them “more passionate about clinical nursing work” earned the highest scores, followed by those who believed the pandemic had “no effect.” The lowest scores were earned by those who believed clinical nursing work to be “too dangerous to engage in.” COVID-19 knowledge scores, the perceived effectiveness of preventive and control measures, the number of cases seen on the day the study survey was taken, and time spent daily on COVID-19 events were the variables found to influence professional identity.

Conclusions

COVID-19 outbreak is not merely a time of crisis but also an opportunity to reconstruct the professional identity of nursing students.
Happiness in Pregnant African American Women
Authors: Jallo Nancy , Brown Lisa , Elswick R. K. , Kinser Patricia , Salisbury Amy L.
Published: February 2021

The detrimental effects of prenatal stress on maternal-infant well-being have been well established and highlight increased concern for pregnant African American women. Research supports the notion that positive emotions may have a beneficial impact on the stress process and outcomes. However, the data have been largely restricted to non-African American pregnant women.

This study's purpose was to examine potential relationships of both positive (happiness) and negative (stress, anxiety, and depressive symptoms) emotions and pro-inflammatory cytokines (interleukins-1β, -6, -8, -12, -17, tumor necrosis factor, and interferon-γ) in 72 pregnant African American women for a more complete picture of the stress process in this at-risk population.

Results of this exploratory secondary data analysis show strong positive correlations between negative emotions and strong negative correlations between happiness and negative emotions. Interleukin-8 was positively correlated with negative emotions and negatively correlated with happiness. Results show mean ratings of negative emotions were higher than previously reported with more heterogeneous samples, while happiness ratings were in the moderate range. Findings suggest that pregnant African American women may experience higher stress and depressive symptoms than women in more heterogeneous samples. However, moderate levels of happiness might contribute to buffering the stress response.
A Program Evaluation of Behavioral Health Integration in a Freestanding Birth Center
Authors: Holmquist Jessie , Fischl Andrea F. R. , Niemczyk Nancy A.
Published: February 2021

The objective of this evaluation was to evaluate the integration of behavioral health services at a freestanding birth center. Program evaluation included (1) retrospective health record reviews and (2) provider and client evaluation of satisfaction. In May 2017, an urban freestanding birth center initiated grant-funded integrated behavioral health services. Participants included women receiving perinatal care from May 2016 to April 2018 (n = 831). Clients (n = 414) and providers (n = 9) were surveyed through e-mail, with 166 (40%) and 7 (78%) responses, respectively. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale. Screening and treatment of depression were identified from health records. The on-site therapist saw 21% of women who birthed during the program's first year. Compared with the year before the program began, in the program's first year, more women were screened for depression at least once (401/415 (96.6%) vs 413/415 (99.5%), P = .002) and more women with an indication received treatment (62.5% [105/168] vs 34.5% [38/110], P < .001). Provider and client satisfaction was high. The on-site therapist provided services easily integrated into the freestanding birth center practice, resulting in increased depression screening and treatment, with overwhelming client and provider satisfaction.
Risk and Resilience Factors of Postpartum Depression in Arab Women Living in the Palestinian Occupied Territories
Authors: Gith Emad
Published: February 2021

The research focuses on postpartum depression (PPD) among modern Arab women living in traditional societies. The purpose of the project is to explore the potential impact of the hitherto unstudied factors of level of modernism/traditionalism and the quality of spousal relationship. This study included 1202 participants of different levels of modernism, who completed research questionnaires. The finding showed that 15.2% of the participants suffered from PPD. Modern women suffered from PPD more than their traditional peers. Problematic spousal relationship did not affect PPD among the modern women. About one-third of the respondents were not familiar with the concept of PPD. Depressed respondents refused to disclose their predicament because of the negative stigma attached to PPD and the fear that the husband would marry a second wife. Traditional orientation serves as a resilience factor, which decreases the risk for PPD. It is highly recommended to design and implement antenatal and postnatal education programs for all married women and raise their awareness of PPD and feasible solutions. It is highly important to promise and secure full confidentiality while providing professional treatment. It is also recommended to offer marital counseling for couples who experience problematic relationship communication.
Effect of a Parent Empowerment Program on Parental Stress, Satisfaction, and Length of Stay in the Neonatal Intensive Care Unit
Authors: Nieves Holly , Clements-Hickman Alyssa , Davies Claire C.
Published: February 2021

Parental stress is high when infants are admitted to a neonatal intensive care unit in community-based hospital. This quasi-experimental study explored the effect of implementing the “Creating Opportunities for Parent Empowerment” (COPE) program on parental stress, postpartum depression, parental satisfaction with care, and length of stay in a community-based hospital. A cohort of nurses completed a 1-day “COPE for HOPE” parent empowerment training session. A nurse implemented the COPE parent training at the bedside soon after birth and extended throughout hospitalization. The following instruments were used to collect data: a demographic data sheet, Parental Stress Scale: Neonatal Intensive Care Unit, Edinburgh Postnatal Depression Scale, and an investigator-designed parent satisfaction survey. Forty-nine parent sets participated in the study (29 in the intervention group, 20 in the comparison group). A significant difference was found between the groups related to lower parental stress. There was no difference in terms of parental depression scores or length of hospital stay. However, clear trends revealed that parents in the COPE group exhibited lower depression scores. Parents in both groups reported being greater than 95% satisfied with care across all items. These findings may motivate administrators in other community-based hospitals to implement this intervention.
An Integrative Review of Fathers' Needs in the Neonatal Intensive Care Unit
Authors: Merritt Linda
Published: February 2021

Having a child admitted to the neonatal intensive care unit (NICU) is traumatic for both parents, but mothers and fathers may have different experiences, and thus, different needs. The purpose of this integrative review was to identify the needs of fathers of premature infants. A systematic review of 7 databases was conducted, and studies were evaluated by the Critical Appraisal Programme checklist. To provide structure for searching and reporting findings, the Whittemore and Knafle interpretive methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were used. A total of 19 articles were identified. The resulting themes included: need to be close to infant and involved in infant's care; need for information; need for a better NICU environment; need for emotional support; and need for a relationship with the NICU staff.
NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress
Authors: Sharp Meghan , Huber Nichelle , Ward L. G. , Dolbier Christyn
Published: February 2021

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.
Infant-Family Mental Health in the NICU
Authors: Driver Myisha , Mikhail Sandra , Carson Melissa C. , Lakatos Patricia P. , Matic Tamara , Chin Steven , Williams Marian E.
Published: February 2021

Parents and infants in the neonatal intensive care unit (NICU) are exposed to considerable stress, and infant-family mental health (IFMH) services foster emotional well-being in the context of the parent-infant relationship. This mixed-methods study examined the role of an IFMH program introduced in a level 4 NICU. The study included (1) retrospective medical record review of NICU patients who were referred to the IFMH program and (2) qualitative interviews with NICU nurse managers, neonatologists, and medical social workers to explore their understanding of the IFMH program, explore the referral pathways and factors that supported family engagement, and identify specific recommendations for program improvement. Of the 311 infant-parent dyads referred to the IFMH program, 62% had at least one session and Spanish-speaking families were more likely to engage. Of those families receiving services, about one-third had brief intervention, one-third had 4 to 10 sessions, and one-third had long-term services, including in-home after-discharge services. Qualitative interviews with health providers identified unique qualities of the IFMH program and why families were and were not referred to the program. Recommendations centered on adding a full-time IFMH mental health provider to the NICU and increasing communication and integration between the IFMH program and the medical team.
Defining Key Elements for Effective Physical Therapist–Physical Therapist Assistant Working Relationships: A Qualitative Study
Authors: Hayward Lorna , Sellheim Debra O. , Scholl Jessica , Joyce Christopher
Published: February 2021

Introduction.

Education of doctor of physical therapist (DPT) and physical therapist assistant (PTA) students about their roles and responsibilities for working collaboratively is required for entry-level clinical practice. Research maintains that DPTs graduate with inadequate knowledge regarding the roles, scope of work, utilization and supervision of PTAs. Study objectives were to uncover the characteristics that comprise an effective physical therapist (PT) - PTA working relationship from 3 perspectives; and identify pedagogy that might inform the relationship development.

Methods.

Using purposive sampling, we recruited PT and PTA clinician recipients of the APTA Outstanding PT-PTA team award; and DPT students and PTA students from 3 academic institutions. Qualitative case study with a phenomenological approach. Interview questions explored participant perceptions and experiences regarding: effective PT-PTA relationships; barriers and gaps in DPT and PTA educational preparation for intra-professional teaming; and educational strategies for addressing deficiencies in students' knowledge and skills.

Results.

Thirty-two semi-structured interviews were conducted. Four with PT and 5 with PTA Outstanding PT-PTA award recipients. Fifteen interviews were conducted with DPT students, eight were conducted with PTA students. Data resulted in 4 themes; communication, trust and respect, environment, and bonding. The themes described the PT-PTA relationship and included a triad (PT-PTA-patient) with the patient centrally located.

Discussion and Conclusion.

Respondents indicated that DPT and PTA programs should create curriculum that develops both cognitive and affective clinical skills pertaining to the PT-PTA relationship. Academic and clinical practice settings play an integral role in creating pedagogy and environments conducive to effective PT-PTA teaming. Role clarification may optimize health care performance, patient satisfaction, cost of care and reduce problems related to miscommunication.
Use of multifunctional electronic health records and burnout among primary care nurse practitioners
Authors: Abraham Cilgy M. , Zheng Katherine , Norful Allison A. , Ghaffari Affan , Liu Jianfang , Topaz Maxim , Poghosyan Lusine
Published: February 2021

Background:

Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients.

Purpose:

This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout.

Method:

This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items—computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout.

Results:

Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13–0.71, p = .01).

Implications for practice:

With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout.
Tubomanometry Measurement Success Rate in Clinical Practice
Authors: Lindfors Oskari H. , Oehlandt Heidi , Sinkkonen Saku T.
Published: February 2021

Objectives:

Tubomanometry (TMM) is an objective method for investigating Eustachian tube (ET) function, but difficulties in technique and interpretation may reduce its usability. The objective of our study was to investigate common difficulties with TMM in different ET dysfunction (ETD) patient groups and at different pressures (30, 40, and 50 mbars) when first introducing TMM to otologic practice. Furthermore, we wanted to investigate whether it would be possible to perform TMM at only one pressure and obtain a representative result.

Methods:

A retrospective chart review of a 2-year cohort of 114 patients with a history of ETD treated at a tertiary referral center. Primary outcome was the success rate of TMM, secondary the reasons for unsuccessful measurements. Tertiary outcome was the correlation of TMM results at adjacent pressures.

Results:

TMM success rate was 91%, varying 81 to 94% in different ETD patient groups and 87 to 94% at different pressures. Unsuccessful measurements resulted from air-leaks from the external ear canal, abnormal ear canal pressure curves (R < 0) and at 50 mbar, difficulties in reaching sufficient nasopharyngeal pressure. TMM results were similar in 88% of cases at 30 and 40 mbars and in 86% of cases at 40 and 50 mbars.

Conclusions:

TMM success rate seems sufficiently high for clinical diagnostics, and most difficulties may be overcome with proper interpretation during the TMM measurement session, and thus repeating the measurements when necessary. Considering the diagnostic information that would be lost if using only a single, predefined pressure, we suggest using all three pressures.
Endoscopic Transcanal Push-Trough Myringoplasty for Different Types of Tympanic Membrane Perforations
Authors: Chen Yubin , Jiang Xiaoyu , Yang Luoying , Wang Jianyan , Li Peng
Published: February 2021

Objective:

This study aims to explore the feasibility of endoscopic transcanal push-trough myringoplasty (ETPM) for all types of tympanic membrane perforations (TMPs), and compare the outcomes with those of endoscopic type 1 tympanoplasty (ETT) with meatal flap elevation.

Study Design:

A prospective, controlled study.

Methods:

In the present study, inpatients with TMPs were divided into two groups according to the manner of tympanic membrane repair: one group received ETPM without raising the meatal flap, and the other received ETT. The operation duration, postoperative healing rate, visual analogue scale (VAS) of pain, and complication rates were compared between these two groups.

Results:

Regardless of the size and location of the perforation, and its relationship with the malleus manubrium, myringoplasty can be completed using the ETPM method. The operation duration for different types of TMPs was shorter in the ETPM group than in the ETT group, and the difference was statistically significant (p<0.05). However, there was no statistical difference in the short-term healing rate (p>0.05) and pain VAS score (p>0.05) between these two groups. Furthermore, no intraoperative or postoperative complications occurred in both groups.

Conclusion:

ETPM without raising the meatal flap can be applied for all types of TMPs, regardless of how large the perforation is, or where it is located. This can shorten the operation duration, and has a high healing rate comparable to ETT and mild postoperative pain. Mastering some essential surgical skills under the endoscope would be helpful to ensure the success of the surgery.
Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a)
Authors: Wilson Don P. , Koschinsky Marlys L. , Moriarty Patrick M.
Published: February 2021

Purpose of review

Summarize recent recommendations on clinical management of adults and youth with elevated lipoprotein(a) [Lp(a)] who are at-risk of or affected by cardiovascular disease (CVD).

Recent findings

There is ample evidence to support elevated Lp(a) levels, present in approximately 20% of the general population, as a causal, independent risk factor for CVD and its role as a significant risk enhancer. Several guidelines and position statements have been published to assist in the identification, treatment and follow-up of adults with elevated levels of Lp(a). There is growing interest in Lp(a) screening and strategies to improve health behaviors starting in youth, although published recommendations for this population are limited. In addition to the well established increased risk of myocardial infarction, stroke and valvular aortic stenosis, data from the coronavirus pandemic suggest adults with elevated Lp(a) may have a particularly high-risk of cardiovascular complications. Lp(a)-specific-lowering therapies are currently in development. Despite their inability to lower Lp(a), use of statins have been shown to improve outcomes in primary and secondary prevention.

Considerable differences exist amongst published guidelines for adults on the use of Lp(a) in clinical practice, and recommendations for youth are limited. With increasing knowledge of Lp(a)'s role in CVD, including recent observations of COVID-19-related risk of cardiovascular complications, more harmonized and comprehensive guidelines for Lp(a) in clinical practice are required. This will facilitate clinical decision-making and help define best practices for identification and management of elevated Lp(a) in adults and youth.
Artificial Intelligence‐based Analytics for Diagnosis of Small Bowel Enteropathies and Black Box Feature Detection
Authors: Syed Sana , Ehsan Lubaina , Shrivastava Aman , Sengupta Saurav , Khan Marium , Kowsari Kamran , Guleria Shan , Sali Rasoul , Kant Karan , Kang Sung‐Jun , Sadiq Kamran , Iqbal Najeeha T. , Cheng Lin , Moskaluk Christopher A. , Kelly Paul , Amadi Beatrice C. , Asad Ali Syed , Moore Sean R. , Brown Donald E.
Published: February 2021

Objectives:

Striking histopathological overlap between distinct but related conditions poses a disease diagnostic challenge. There is a major clinical need to develop computational methods enabling clinicians to translate heterogeneous biomedical images into accurate and quantitative diagnostics. This need is particularly salient with small bowel enteropathies; environmental enteropathy (EE) and celiac disease (CD). We built upon our preliminary analysis by developing an artificial intelligence (AI)‐based image analysis platform utilizing deep learning convolutional neural networks (CNNs) for these enteropathies.

Methods:

Data for the secondary analysis was obtained from three primary studies at different sites. The image analysis platform for EE and CD was developed using CNNs including one with multizoom architecture. Gradient‐weighted class activation mappings (Grad‐CAMs) were used to visualize the models’ decision‐making process for classifying each disease. A team of medical experts simultaneously reviewed the stain color normalized images done for bias reduction and Grad‐CAMs to confirm structural preservation and biomedical relevance, respectively.

Results:

Four hundred and sixty‐one high‐resolution biopsy images from 150 children were acquired. Median age (interquartile range) was 37.5 (19.0–121.5) months with a roughly equal sex distribution; 77 males (51.3%). ResNet50 and shallow CNN demonstrated 98% and 96% case‐detection accuracy, respectively, which increased to 98.3% with an ensemble. Grad‐CAMs demonstrated models’ ability to learn different microscopic morphological features for EE, CD, and controls.

Conclusions:

Our AI‐based image analysis platform demonstrated high classification accuracy for small bowel enteropathies which was capable of identifying biologically relevant microscopic features and emulating human pathologist decision‐making process. Grad‐CAMs illuminated the otherwise “black box” of deep learning in medicine, allowing for increased physician confidence in adopting these new technologies in clinical practice.
Evidence-Based Virtual Learning Experiences for the Clinical Nurse Leader Capstone
Authors: Hinic Katherine
Published: February 2021

Background:

The global COVID-19 pandemic resulted in abrupt changes in the delivery of health care and nursing education, particularly in highly affected areas of the country.

Problem:

Many hospitals suspended nursing students' learning on-site due to concerns related to virus transmission and lack of clear guidance on safe and effective learning. This Model C Clinical Nurse Leader (CNL) direct entry MSN program needed to meet graduating students' capstone learning needs in a virtual format.

Approach:

A review of the literature along with CNL competencies and other American Association of Colleges of Nursing resources informed this evidence-based virtual capstone experience.

Outcomes:

Students achieved learning outcomes in a virtual format and reported high levels of satisfaction with learning activities.

Conclusions:

Virtual learning activities were essential at the height of the pandemic and may prove useful in other circumstances that limit clinical site availability. These activities can also complement in-person learning experiences.
Using Photo-Elicitation Interviews With Families of Children and Adolescents With Chronic Illness
Authors: Leite Ana Carolina A. B. , García-Vivar Cristina , Nascimento Lucila C.
Published: February 2021

Background

Despite the increasing number of studies using photo-elicitation for data collection in qualitative research, there is a need to further explore its use among families of children and adolescents living with chronic illness.

Objective

The aim of this study was to discuss methodological and pragmatic considerations about the use of photo-elicitation interviews (PEIs) for data collection with families of children and adolescents living with chronic illness.

Methods

We discussed methodological aspects of using PEIs as reported in publications. A search of the literature was carried out to identify articles presenting information on methodological aspects of the use of PEIs in qualitative data collection, regardless of age group. In pursuit of complementing the evidence with pragmatic considerations of using PEIs, we illustrate with an example of a recent qualitative study of our own that aimed to understand the narratives about hope of families of children and adolescents living with chronic illness.

Results

We synthesized common aspects that need to be considered when using PEIs with different populations: ethical issues, cameras, guidance, and interviews. We also presented our experience of using the PEI technique to collect data from families. Because of our experience, we denominate our method as the “family photo-elicitation interview” (FPEI). Our method goes beyond the PEI technique because it integrates aspects of family nursing theories when conducting interviews with families. FPEIs strengthen family interaction and allow family members to share their perspectives.

Discussion

We present a new perspective of PEIs—the FPEI—in the pediatric context. Previous studies have not addressed considerations about using PEIs for families. We hope our results assist novice researchers in planning and implementing FPEIs in qualitative research. We recommend that researchers explore the use of FPEIs in other contexts, such as geriatrics or palliative care.
Longitudinal Moderated Mediation Analysis in Parallel Process Latent Growth Curve Modeling in Intervention Studies
Authors: Zhu Shijun , Sagherian Knar , Wang Yan , Nahm Eun-Shim , Friedmann Erika
Published: February 2021

Background

Intervention studies are used widely in nursing research to explore the efficacy of intervention programs for changing targeted health outcomes. However, the analyses of such studies have focused predominantly on their main intervention effects; most studies ignore the mechanisms underlying how the intervention programs work partly because of lack of application details of the longitudinal mediation analysis techniques.

Objectives

The aim of this study was to illustrate an application of parallel process latent growth curve modeling (PP-LGCM) to examine longitudinal moderated mediation effects.

Methods

Longitudinal data from an online bone health intervention study were used to demonstrate the step-by-step application of PP-LGCM with Mplus statistical software.

Results

With modification indices, we were able to achieve adequate model fit for PP-LGCM in our data. The mediation effects of self-efficacy on the intervention effects on exercise were nonsignificant for the entire sample. However, the conditional indirect effect showed the mediation effects were moderated by age group.

Discussion

PP-LGCM provides an efficient way to analyze and explain the underlying mechanisms for the intervention effects in a trial, especially when the intervention program is guided by a theory.
A Peek Into the Future: How a Pandemic Resulted in the Creation of Models to Predict the Impact on Sexually Transmitted Infection(s) in New York State (Excluding New York City)
Authors: Joshi Manjiri , Yuan Yingchao , Miranda Wilson , Chung Rakkoo , Rajulu Deepa T. , Hart-Malloy Rachel
Published: February 2021

During the initial height of COVID-19 in New York State excluding New York City in March 2020, reports of sexually transmitted infections declined. Prediction models developed to estimate the incidence of early syphilis and gonorrhea during the COVID-19 pandemic were used to study impact on STI diagnoses/reporting and inform sexual health program planning.
Prevalence and Epidemiology of Mycoplasma genitalium in a Pacific-Region Military Population
Authors: Horseman Timothy S. , Crecelius Elena M. , Miller Mechelle A. , Lustik Michael B. , Lee Benjamin C. , Brazer Miriam L. , O'Neal Lindsey L. , Kim Dong M. , Fong Keith S.K. , Chang Tom W.
Published: February 2021

Background

Mycoplasma genitalium is an important emerging sexually transmitted pathogen commonly causing urethritis in men, cervicitis, and pelvic inflammatory disease in women with potential of infertility. Accumulating evidence identifies the prevalence of M. genitalium similar to long recognized pathogens, Chlamydia trachomatis and Neisseria gonorrhoeae. The purpose of this study was to establish the prevalence and epidemiology of M. genitalium in a mid-Pacific military population.

Methods

A prospective analysis was conducted from routine specimens collected as standard of care for sexually transmitted infection (STI) testing at Tripler Army Medical Center on Oahu, HI. The prevalence of M. genitalium was determined using the Aptima M. genitalium assay, a transcription-mediated amplification test. A multivariate analysis was performed to assess the associations for this infection with other STIs and demographic factors.

Results

A total of 1876 specimens were tested in a 6-month period including 6 sample types from 1158 females and 718 males. Subject ages ranged from 18 to 76 years, with a median of 24 years (interquartile range, 21–29 years). The prevalence of M. genitalium was 8.8% overall (n = 165), 7.1% in females and 11.6% in males. Coinfection with M. genitalium occurred with another sexually-transmitted pathogen in 43 patients (18.3%), with C. trachomatis as the most common organism (n = 38).

Conclusions

These data contribute to the evidence base for M. genitalium and STI screening in an active-duty military.
Case Report: Alagille Syndrome Presenting with Angioid Streaks
Authors: Katsoulos Konstantinos F. , Kapsala Zoi , Livir-Rallatos Gerasimos
Published: February 2021

SIGNIFICANCE

Alagille syndrome is rare genetic disease, which affects liver and heart function. Cases are frequently diagnosed late, and a complete ocular examination aids in the diagnosis. Although ophthalmic manifestations are usually benign, occasionally, sight-threatening complications occur.

PURPOSE

The case presented herein highlights a rare condition, which usually can be diagnosed by the ophthalmological findings. However, in this particular case report, the complication of angioid streaks and choroidal neovascularization is reported for the first time in Alagille syndrome.

CASE REPORT

Α 32-year-old woman diagnosed with Alagille syndrome presented with diminution of vision in the left eye. The cause was choroidal neovascularization related to angioid streaks. She was treated with intravitreal injections of ranibizumab but developed an extensive macular scar. A few years later, she developed the same complication in the right eye and was treated similarly.

CONCLUSIONS

Alagille syndrome has many ophthalmic manifestations, most of them benign with minimal threat to vision. Herein for the first time, we present a case of Alagille syndrome with angioid streak–related choroidal neovascularization, which resulted in severe vision loss.
Factors for Maintaining Abstinence at 2 and 6 Months After Alcohol Withdrawal
Authors: PAREAUD MARINE , GIRARD MURIELLE , NUBUKPO PHILIPPE
Published: February 2021

Objectives:

Relapse rates in subjects with an alcohol use disorder who have undergone alcohol detoxification are high, and risk factors vary according to the studied population and the context in which withdrawal occurred. Subjects being treated in psychiatric settings require increased monitoring at the moment of detoxification and during follow-up. It is thus important to identify specific risk factors for relapse in such patients. The objective of this study was to determine factors associated with maintenance of abstinence 2 months after alcohol withdrawal (M2) and to characterize factors associated with later relapses 6 months after withdrawal (M6) among those who were abstainers at M2.

Methods:

We conducted an ancillary study of a specific psychiatric cohort of subjects with an alcohol use disorder who were followed after withdrawal, by analyzing clinical and biological data collected at M2 and M6.

Results:

The specific factors predictive of future relapse were age, intensity of craving, number of standard glasses consumed, psychiatric comorbidity (depression), and employment and family/marital status. Substance use (other than the use of tobacco) decreased the likelihood of abstinence at M2, whereas a depressive state at the time of alcohol withdrawal increased the likelihood of abstinence at M2. Consumption of other substances and a greater intensity of craving at the time of alcohol withdrawal decreased the likelihood of abstinence at M6.

Conclusions:

The results of this study highlight the importance of identifying craving, multiple substance use, and psychiatric comorbidities (depression) during comprehensive interviews in follow-up after alcohol withdrawal. In caring for patients after alcohol detoxification, priority should be given to factors that have been shown to enhance the beneficial effects of abstinence, such as mood enhancement.
Medical and Endoscopic Management of Crohn Disease
Authors: Deepak Parakkal , Ludwig Daniel R. , Fidler Jeff L. , Guglielmo Flavius F. , Bruining David H.
Published: February 2021

In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.
MRI of Perianal Crohn Disease
Authors: Santillan Cynthia S. , Huang Chenchan , Eisenstein Samuel , Al-Hawary Mahmoud M.
Published: February 2021

Magnetic resonance imaging (MRI) has emerged as the imaging method of choice for evaluation of perianal fistulizing disease. As treatment of Crohn disease and associated perianal fistulas has evolved to include a combination of systemic treatments and surgical interventions, perianal MRI provides critical information to guide treatment selection and timing. Radiologists need to be familiar with the normal regional anatomy to accurately describe perianal fistulas and any associated complications which can then be used to classify fistulas based on several available classification systems. Following treatment, MRI can provide information that suggests treatment success or failure. We propose a perianal fistula reporting template that includes the necessary information to convey fistula complexity, guide treatment, and evaluate treatment response. This review article will also discuss the postoperative appearance of many treatments currently used for management of perianal fistulizing disease and some associated complications.
YouTube as a Source of Information for Craniofacial Distraction Osteogenesis
Authors: Coban Gokhan , Buyuk Suleyman Kutalmiş
Published: February 2021

Objective:

The aim of this study was to evaluate the content and quality of YouTube videos about distraction osteogenesis (DO) in the craniofacial region.

Methods:

The term “distraction osteogenesis” was searched on YouTube. After sorting by relevance, 80 videos were selected from 128 search results for analysis of general characteristics, primary purpose, information reliability, audiovisual quality, global quality scale (GQS), and viewers’ interaction index. Viewing rate formulae were calculated for each YouTube video. The Mann–Whitney U test and Spearman correlation coefficient were used for statistical analysis.

Results:

We classified 22 (27.5%) of the 80 videos as moderate/high-content and 58 (72.5%) as low-content. Most YouTube videos about DO were uploaded by doctors (45%) and information about DO was the most covered topic (61%). Videos from commercial companies had significantly higher GQS scores than videos uploaded by other groups (P = 0.040). In low-information content videos, GQS was highly correlated with the number of likes, whereas in moderate/high-content videos it was highly correlated with viewing rates.

Conclusions:

YouTube is insufficient source of information about DO and academic institutions have more responsibility in developing this situation and directing patients to reliable social media or Internet sources.