bluuebunny/crossref_metadata_2025 huggingface dataset:
LONG-TERM REMISSION OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION WITH AS-NEEDED ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY
Authors: Muftuoglu Ilkay Kilic , Alam Mostafa , You Qi Sheng , Gaber Raouf , Ramkumar Hema L. , Mendoza Nadia , Meshi Amit , Freeman William R.
Published: February 2017

Purpose:

To determine the presenting characteristics of patients with neovascular age-related macular degeneration with long-term remission (LTR), which was defined as the absence of intraretinal/subretinal fluid, or hemorrhage, and absence of leakage on fluorescein angiography for longer than 6 months while on as-needed antivascular endothelial growth factor treatment.

Methods:

The presenting characteristics of patients with LTR were compared with a control group including 32 eyes of 28 age-, gender-, and ethnicity-matched patients who did not achieve LTR.

Results:

Seventy-four percent of patients in the LTR group had Type 1 choroidal neovascular membrane and 18.5% had retinal angiomatous proliferation. In the control group, 28 eyes had Type 1 choroidal neovascular membrane (87.5%), and none of the patients had retinal angiomatous proliferation; overall, there was a significant difference in lesion types between the 2 groups (P = 0.036). Eyes with LTR at presentation had significantly thinner subfoveal choroidal thickness (147 vs. 178 μm, P = 0.04). There was more intraretinal fluid and less subretinal fluid at the presentation in the remission group (59.3% intraretinal fluid and 11.1% subretinal fluid) compared with the control group (28.1% intraretinal fluid and 34.4% subretinal fluid, P = 0.03).

Conclusion:

The presence of retinal angiomatous proliferation, thinner choroidal thickness, more intraretinal fluid, and less subretinal fluid at presentation were associated with LTR in patients receiving as-needed treatment for age-related macular degeneration.
DOUBLE ARCUATE RELAXING RETINOTOMY FOR A LARGE MACULAR HOLE
Authors: Karacorlu Murat , Sayman Muslubas Isil , Hocaoglu Mumin , Arf Serra , Ersoz Mehmet Giray
Published: February 2017

Purpose:

To describe double arcuate relaxing retinotomy as an alternative surgical technique in a case with a secondary large macular hole.

Methods:

The management of a patient who developed a large macular hole and macular tractional rhegmatogenous retinal detachment after pars plana vitrectomy for proliferative diabetic retinopathy was retrospectively assessed. Despite surgical procedures, such as dissection of a preretinal membrane from the retina and peeling of the retinal internal limiting membrane, the macular hole could not be closed. In the absence of an alternative method, superior and inferior posterior arcuate, 120° relaxing retinotomies were performed.

Results:

At the follow-up, the macular hole closure was confirmed by clinical examination and optical coherence tomography imaging, and visual acuity improved. There were no intraoperative or postoperative complications.

Conclusion:

In cases of large macular holes, double arcuate relaxing retinotomy can reduce traction, leading to hole closure.
ZIKA-RELATED MACULOPATHY
Authors: Wong Chee Wai , Ng Si Rui , Cheung Chui Ming Gemmy , Wong Tien Yin , Mathur Ranjana
Published: February 2017

Purpose:

To report a case of unilateral maculopathy associated with acute Zika virus infection.

Methods:

Observational case report of one patient.

Results:

A 22-year-old man presented with acute blurring of vision 10 days after symptoms of Zika virus infection. Findings resembling unilateral acute idiopathic maculopathy of the right eye were noted on ophthalmoscopy, fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Localized macular dysfunction in the right eye was noted on multifocal electroretinography. The left eye was normal. He was managed conservatively with resolution of symptoms in 3 weeks.

Conclusion:

We describe a case of unilateral acute idiopathic maculopathy–like disease in a patient with reverse transcriptase polymerase chain reaction–confirmed Zika virus infection.
Ophthalmic Manifestations of Facial Dog Bites in Children
Authors: Bratton Emily M. , Golas Liliya , Wei Leslie A. , Davies Brett W. , Durairaj Vikram D.
Published: February 2017

Purpose:

To characterize ophthalmic manifestations and periocular injuries of pediatric facial dog bites.

Methods:

A retrospective review of all children younger than 18 years who sought medical attention after a dog bite to the face between January 1, 2003 and May 22, 2014 was performed at a large tertiary pediatric hospital. Data on type and location of injury, surgical intervention, and complications were collected.

Results:

A total of 1,989 children aged 0.19 to 17 years were identified with dog bites. Dog bites to the face occurred in most patients (n = 1, 414 [71%]). Of those children with facial dog bite injuries, 230 (16%) suffered ophthalmic manifestations. The average age was 4.3 years. Eyelid injuries occurred in 227 (99%) of children, 47 (20%) sustained canalicular system injuries, 3 (1.3%) suffered corneal abrasions, and 2 patients sustained facial nerve injury resulting in lagophthalmos. No patients suffered vision loss. Complications occurred in 32 patients (14%), with the most common being epiphora in 9 patients (28%), upper eyelid ptosis in 8 (25%), and prominent scar formation in 4 patients (13%). Thirteen children (5.7%) needed one or more secondary procedure to correct complications.

Conclusions:

The authors report the clinical features and management on the largest series of ophthalmic and periocular injuries associated with pediatric facial dog bites. These injuries occur in about 1 in 6 dog bites to the face and primarily involve the ocular adnexa. Despite early and appropriate surgical management, complications and the need for revision surgery are relatively common.
Orbital Emphysema as a Rare Complication of Retina Surgery
Authors: Rodríguez-Cabrera Lourdes , Rodríguez-Loaiza José L. , Tovilla-Canales José L. , Zuazo Francisca
Published: February 2017

Three patients with a history of previous pars-plana vitrectomy, 2 of them with perfluoropropane, and 1 with sulfur hexafluoride used, experienced eyelid swelling and pain after travelling to a higher altitude city. Gas was found in the orbit and periocular tissues, causing orbital compartment syndrome in 2 of the patients. The gas persisted on these patients despite surgical intervention, so hyperbaric oxygen therapy was advised. One patient refused, the other patient responded well to this therapy and the gas disappeared. The patient without an orbital compartment syndrome made a full recovery without needing medical or surgical intervention.
Thermal Burn Scar-Related Squamous Cell Carcinoma in the Eyelid
Authors: Yazici Bulent , Aliyeva Gamer , Ferik Zarema
Published: February 2017

A 63-year-old woman presented with a large, ulcerokeratotic mass in her right lower eyelid that had grown over the last 2 months in a burn scar. She had experienced a thermal burn involving both inferior periorbital areas 35 years ago and received medical treatment. The lesion was excised with wide margins. The histologic diagnosis was squamous cell carcinoma. No recurrence was observed during a 22-month follow up. In the previous literature, a total of 10 cases of eyelid burn scar neoplasm, of which 9 were basal cell carcinoma, have been reported. To the authors’ knowledge, this is the first reported case of thermal burn-related squamous cell carcinoma of the eyelid.
Optimal Epinephrine Concentration and Time Delay to Minimize Perfusion in Eyelid Surgery: Measured by Laser-Based Methods and a Novel Form of Extended-Wavelength Diffuse Reflectance Spectroscopy
Authors: Sheikh Rafi , Dahlstrand Ulf , Memarzadeh Khashayar , Blohmé Jonas , Reistad Nina , Malmsjö Malin
Published: February 2017

Objective:

This study investigates the hypoperfusion effects of epinephrine in local anesthesia in eyelid surgery. A novel form of extended-wavelength diffuse reflectance spectroscopy was evaluated.

Methods:

Blood perfusion in porcine eyelid flaps was measured using laser Doppler velocimetry and laser speckle contrast imaging, whereas the tissue response was measured using diffuse reflectance spectroscopy with a broad spectrum (450–1550 nm). Epinephrine was either injected cumulatively, 0.1 (1:10,000,000), 1.0 (1:1,000,000), 10 (1:100 000), and 100 μg/ml (1:10 000), to determine the dose–response relation, or given as a single dose (10 μg/ml). Control experiments were performed with saline or lidocaine.

Results:

Increasing concentrations of epinephrine resulted in a gradual decrease in tissue perfusion, measured by laser Doppler velocimetry and laser speckle contrast imaging, approaching a minimum after the injection of 10 μg/ml. Similar tissue response was observed with diffuse reflectance spectroscopy. The time from the injection of epinephrine (10 μg/ml) to the stabilization of hypoperfusion was 75 seconds. After administration of 10 μg/ml epinephrine, about 20% of the blood perfusion remained, supporting the use of epinephrine in eyelid flaps with a narrow pedicle.

Conclusions:

10 μg/ml epinephrine appears to be adequate for vasoconstriction before oculoplastic surgery. Incisions need only be delayed for about 1 minute. Extended-wavelength diffuse reflectance spectroscopy appears to be a promising technique for monitoring the tissue response following changes in blood perfusion in plastic surgery reconstructions. However, more rigorous validation of the technique is required before it can be implemented in clinical practice.
Identification, Associated Factors, and Prognosis of Symptom Clusters in Taiwanese Patients With Heart Failure
Authors: Huang Tsuey-Yuan , Moser Debra K. , Hwang Shiow-Li
Published: February 2017

Background:

Patients with heart failure (HF) have multiple distressing symptoms that are associated with poor outcomes. These symptoms do not occur in isolation from each other but likely occur as discrete clusters that may prove helpful to clinicians trying to counsel patients about symptom monitoring and management. Defining common symptom clusters and determining the associations between symptom clusters and outcomes may improve patient management.

Purpose:

The aim of this study was to define symptom clusters and their association with event-free survival in terms of cardiac hospitalization and all-cause mortality in patients with HF.

Methods:

Patients were recruited from outpatient HF clinics. Physical symptoms (dyspnea, fatigue, edema, sleeplessness, anorexia, and poor memory) were measured using the modified Pulmonary Function Status and Dyspnea Questionnaire and the Minnesota Living with Heart Failure Questionnaire. A two-stage cluster analysis was conducted to identify subgroups of patients based on the self-perceived severity of the six symptoms. The Kaplan–Meier survival curve and log-rank test were used to assess whether symptom clusters were associated with event-free survival through a 12-month follow-up.

Results:

Two hundred fifty-eight patients (mean age = 61.2 ± 12.3 years, 75% male, 41% New York Heart Association class III/IV) participated. Three symptom clusters were identified based on the severity of symptoms. These clusters were called the nonsevere symptom cluster (all symptoms were rated with low severity), the typical severity symptom cluster (high level of severity for dyspnea and fatigue, low level of severity for edema, and moderate level of severity for all other symptoms), and the atypical severity symptom cluster (low level of severity for dyspnea and fatigue, high level of severity for edema, and moderate level of severity for all other symptoms). Symptom clusters were associated with event-free survival (p < .001). A post hoc comparison showed that the prognosis was better in the nonsevere symptom cluster than both the typical symptom (p < .001) and nontypical symptom (p < .001) clusters and that the prognoses for the latter two clusters did not differ significantly.

Conclusions/Implications for Practice:

Symptom clusters play an important role in the prognoses of patients with HF. Both patients and healthcare providers may use the information that is provided by this study to improve the surveillance and management of related symptoms.
Pharmacy Use in the First Year of the Veterans Choice Program
Authors: Gellad Walid F. , Cunningham Francesca E. , Good Chester B. , Thorpe Joshua M. , Thorpe Carolyn T. , Bair Brandi , Roman KatieLynn , Zickmund Susan L.
Published: February 2017

Background:

The Veterans Choice Program (VCP) was created to ensure timely access to health care in the Department of Veterans Affairs (VA). Under this program, medications may be ordered by select non-VA clinicians to be dispensed by VA pharmacies, creating new challenges in ensuring medication safety.

Objectives:

To examine pharmaceutical use during the first year of the VCP and to understand barriers and facilitators for VA pharmacists to dispensing medications under the VCP.

Study Design:

Mixed-methods evaluation.

Methods:

We captured all prescriptions dispensed through the VCP and described the demographics of VCP users and their medications. We also conducted semistructured interviews of VA pharmacists, focusing on VA formulary management and experiences dispensing opioid and hepatitis C (HCV) medications. Codebook development and coding followed iterative qualitative methods.

Results:

Overall, 17,346 Veterans received 56,426 VCP prescriptions from November 7, 2014 through November 7, 2015. The total medication cost was $27 million, 90% of which was for only 2772 HCV prescriptions. Topical eye drops and opioids represented the most commonly dispensed prescriptions (15.6% and 9.2% of all prescriptions, respectively). Pharmacists reported numerous challenges to dispensing VCP medications, including time required to contact non-VA clinicians about formulary issues, requiring controlled substance prescriptions to be hand delivered to VA pharmacies, and lack of access to laboratory data required to safely dispense medications.

Conclusions:

HCV-related medication costs predominated the first year of VCP, but this is likely to change going forward. The safe use of opioids, efficient management of nonformulary medications, and unintended new barriers to access created by the VCP must be addressed.
The Veterans Choice Act
Authors: Mattocks Kristin M. , Mengeling Michelle , Sadler Anne , Baldor Rebecca , Bastian Lori
Published: February 2017

Background:

Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 [Veterans Choice Act (VCA)] to improve access to timely, high-quality health care for Veterans. Although Congress mandated that VCA must begin within 90 days of passage of the legislation, no guidelines were provided in the legislation to ensure that Veterans had access to an adequate number of community providers across different specialties of care or distinct geographic areas, including rural areas of the country.

Objective:

To examine VCA policy implementation across a sampling of Veterans Health Administration (VHA) Medical Centers.

Research Design:

We conducted a qualitative study of 43 VHA staff and providers by conducting in-person interviews at 5 VA medical centers in the West, South, and Midwest United States. Interview questions focused on perceptions and experiences with VCA and challenges related to implementation for VHA staff and providers.

Results:

We identified 3 major themes to guide description of choice implementation: (1) VCA implemented too rapidly with inadequate preparation; (2) community provider networks insufficiently developed; and (3) communication and scheduling problems with subcontractors may lead to further delays in care.

Conclusions:

Our evaluation suggests that VCA was implemented far too rapidly, with little consideration given to the adequacy of community provider networks available to provide care to Veterans. Given the challenges we have highlighted in VCA implementation, it is imperative that the VHA continue to develop care coordination systems that will allow the Veterans to receive seamless care in the community.
Community Clinicians and the Veterans Choice Program for PTSD Care
Authors: Finley Erin P. , Noël Polly H. , Mader Michael , Haro Elizabeth , Bernardy Nancy , Rosen Craig S. , Bollinger Mary , Garcia Hector , Sherrieb Kathleen , Pugh Mary Jo V.
Published: February 2017

Background:

In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lower frequency among civilians.

Objectives:

To compare characteristics and attitudes of community-based primary care and mental health providers reporting interest or no interest in VCP participation during early implementation; and to examine perceptions and experiences of VCP among “early adopters.”

Research Design:

Cross-sectional surveys with 2 samples: a stratified random sample of mental health and primary care prescribers and psychotherapists drawn from state licensing boards (Community Sample); and a stratified random sample of prescribers and psychotherapists identified as VCP-authorized providers (VCP-Authorized).

Subjects:

Five hundred fifty-three respondents in the Community Sample and 115 in the VCP-Authorized (total, n=668; 21.1% response).

Measures:

Surveys assessed provider and practice characteristics, attitudes to VA and VCP, and experiences and satisfaction with the VCP; an open-ended survey item assessed providers’ reasons for interest or lack of interest in VCP participation.

Results:

Few providers reported VCP participation during this period. Interest in VCP participation was associated across provider groups with factors including being a veteran and receiving VA reimbursement; currently providing treatment for PTSD was associated with interest in VCP participation among psychotherapists, but not prescribers.

Conclusions:

Developing networks of VCP providers to serve Veterans with PTSD is likely to require targeting more receptive provider groups, reducing barriers to participation, and more effectively communicating the value of VCP participation to providers.
Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation
Authors: Vanneman Megan E. , Harris Alex H.S. , Asch Steven M. , Scott Winifred J. , Murrell Samantha S. , Wagner Todd H.
Published: February 2017

Background:

The Veterans Choice Program (VCP), enacted by Congress after concerns surfaced about access, enables veterans to receive care outside Veterans Health Administration (VHA) facilities. Veterans who face long wait times, large driving distances, or particular hardships are eligible for VCP. Prior purchased care programs were comparatively limited in scope.

Objectives:

We sought to describe utilization of VHA-provided and purchased outpatient care by veterans eligible for VCP before and after VCP implementation. We focused on veterans recently eligible for VHA as they are of particular policy relevance and might have less established care patterns.

Research Design:

We identified all Iraq and Afghanistan veterans who were eligible for VCP in 2015. We tabulated their use of VHA and purchased outpatient care for 3 years before (FY2012–2014) and 1 year after VCP implementation (FY2015).

Subjects:

Our study population consisted of 214,449 Iraq and Afghanistan veterans who were eligible for VCP due to wait-time, distance, or hardship issues.

Results:

In the first year of the program, 3821 (2%) of these Iraq and Afghanistan veterans used non-VHA services through VCP. Per capita VHA utilization tended to decline slightly after VCP implementation, but these changes varied by type of outpatient care.

Conclusions:

There was low uptake of VCP services in the first year of the program. Data from additional years are needed to better understand the impact of this policy.
The Impact of Alternative Payment in Chronically Ill and Older Patients in the Patient-centered Medical Home
Authors: A. Salzberg Claudia , Bitton Asaf , Lipsitz Stuart R. , Franz Cal , Shaykevich Shimon , Newmark Lisa P. , Kwatra Japneet , Bates David W.
Published: February 2017

Background:

Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH.

Objectives:

We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization.

Research Design:

Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change.

Results:

Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization.

Conclusions:

We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions.
Changes in Emergency Department Utilization After Early Medicaid Expansion in California
Authors: Sabik Lindsay M. , Cunningham Peter J. , Tehrani Ali Bonakdar
Published: February 2017

Background:

Medicaid expansions aim to improve access to primary care, which could reduce nonemergent (NE) use of the emergency department (ED). In contrast, Medicaid enrollees use the ED more than other groups, including the uninsured. Thus, the expected impact of Medicaid expansion on ED use is unclear.

Objectives:

To estimate changes in total and NE ED visits as a result of California’s early Medicaid expansion under the Affordable Care Act. In addition to overall changes in the number of visits, changes by payer and safety net hospital status are examined.

Methods:

We used a quasi-experimental approach to examine changes in ED utilization, comparing California expansion counties to comparison counties from California and 2 other states in the same region that did not implement Medicaid expansion during the study period.

Results:

Regression estimates show no significant change in total number of ED visits following expansion. Medicaid visits increased by 145 visits per hospital-quarter in the first year following expansion and 242 visits subsequent to the first year, whereas visits among uninsured patients decreased by 129 visits per hospital-quarter in the first year and 175 visits in subsequent years, driven by changes at safety net hospitals. We also observe an increase in NE visits per hospital-quarter paid for by Medicaid, and a significant decrease in uninsured NE visits.

Conclusions:

Medicaid expansions in California were associated with increases in ED visits paid for by Medicaid and declines in uninsured visits. Expansion was also associated with changes in NE visits among Medicaid enrollees and the uninsured.
A Comparison of Self-reported Medication Adherence to Concordance Between Part D Claims and Medication Possession
Authors: Savitz Samuel T. , Stearns Sally C. , Zhou Lei , Thudium Emily , Alburikan Khalid A. , Tran Richard , Rodgers Jo E.
Published: February 2017

Objective:

Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation to self-reported medication adherence.

Materials and Methods:

We matched Part D claims for 6 common medications to medications brought to a study visit in 2011–2013 for the Atherosclerosis Risk in Communities study. The combined data consisted of 3027 medication events (claims, medications possessed, or both) for 2099 Atherosclerosis Risk in Communities study participants. Multinomial logistic regression estimated the association of concordance (visit only, Part D only, or both) with self-reported medication adherence while controlling for sociodemographic characteristics, veteran status, and availability under Generic Drug Discount Programs.

Results:

Relative to participants with high adherence, medication events for participants with low adherence were approximately 25 percentage points less likely to match and more likely to be visit only (P<0.001). The results were similar but smaller in magnitude (approximately 2–3 percentage points) for participants with medium adherence. Compared with females, medication events for male veterans were approximately 11 percentage points less likely to match and more likely to be visit only. Events for medications available through Generic Drug Discount Programs were 3 percentage points more likely to be visit only.

Conclusions:

Part D claims were substantially less likely to be concordant with medications possessed at study visit for participants with low self-reported adherence. This result supports the construction of adherence proxies such as proportion days covered using Part D claims.
Using Serum IgE Antibodies to Predict Esophageal Eosinophilia in Children
Authors: Erwin Elizabeth A. , Rhoda Dale A. , Redmond Margaret , Ly Jean B. , Russo John M. , Hill Ivor D. , Platts‐Mills Thomas A.E.
Published: February 2017

Objectives:

Symptoms of eosinophilic esophagitis are variable and can be nonspecific. Food‐specific serum immunoglobulin E (IgE) antibodies are frequently found in patients with eosinophilic esophagitis and are obtained using a widely available blood test. Our objective was to evaluate the ability of food‐specific IgE antibodies to predict the presence of esophageal eosinophilia.

Methods:

We reviewed 144 medical records for pediatric patients having esophageal biopsy and serum analysis for IgE antibodies to food (exploratory group). We performed logistic regression using sex and number of positive food‐specific IgE tests to develop a model that predicts ≥15 eosinophils/high‐power field (hpf) in the esophagus. We tested the model using 142 additional patients (validation group).

Results:

The probability of having ≥15 eosinophils/hpf in the esophagus was higher in boys and increased with the number of positive food‐specific IgE tests from 12% (95% confidence interval 4.8–26) in girls with 0 foods positive to 86% (95% confidence interval 71–94) for boys with 4 or 5 foods positive. The statistical model using sex and number of positive IgE tests to predict patients having ≥15 eosinophils/hpf showed acceptable discriminative ability (area under the receiver operating characteristic curve 0.80). The performance metrics for the model to predict ≥15 eosinophils/hpf in the validation group were similar (area under the receiver operating characteristic curve 0.75).

Conclusions:

Requiring only a blood test and a simple algorithm, analysis for IgE antibodies to food may expedite an esophagogastroduodenoscopy and decrease delays in the diagnosis and treatment of patients with nonspecific gastrointestinal symptoms who have increased eosinophils in the esophagus.
Acute Liver Failure During Deferasirox Chelation: A Toxicity Worth Considering
Authors: Menaker Nathan , Halligan Katharine , Shur Natasha , Paige John , Hickling Matthew , Nepo Anne , Weintraub Lauren
Published: February 2017

This case report details a unique case of acute, reversible liver failure in a 12-year-old male with sickle cell anemia on chronic transfusion protocol and deferasirox chelation. There is substantial literature documenting deferasirox-induced renal injury, including Fanconi syndrome, but less documentation of hepatic toxicity and few reports of hepatic failure. The case highlights the importance of close monitoring of ferritin, bilirubin, and transaminases for patients on deferasirox.
Body Mass Index and the Association With Vaso-occlusive Crises in Pediatric Sickle Cell Disease
Authors: Zivot Andrea , Apollonsky Nataly , Gracely Edward , Raybagkar Deepti
Published: February 2017

Background:

Children with sickle cell disease (SCD) historically have been underweight and have poor overall growth. Recent studies have demonstrated a trend toward obesity in pediatric SCD populations.

Materials and Methods:

Through retrospective chart review of patients with SCD followed at our center, we collected patient’s data, including body mass index (BMI), weight percentiles, sickle cell genotype, baseline hemoglobin, medical and psychiatric comorbidities, 25-hydroxy vitamin D level, treatment with hydroxyurea, and chronic transfusions. We identified hospitalizations to St. Christopher’s Hospital for vaso-occlusive crisis (VOC) and duration of hospitalization and intravenous opioid use were recorded. Student t test, Mann-Whitney U test, and analysis of variance were used to examine associations between variables and frequency and duration of hospitalizations for VOC.

Results:

Among 328 patients with SCD, overweight and obese children constituted 19% of hospitalized and nonhospitalized patients. BMI status did not influence frequency (P=0.90) or duration of hospitalization (P=0.65) for VOC. Obesity was more associated with HbSC than HbSS (P=0.025) genotype.

Conclusions:

Our study did not demonstrate an association between extremes of BMI of patients and hospitalization for VOC. Considering current trend toward obesity, further prospective and interventional research are required to define the effects of extremes of BMI on pain crises in SCD.
Moyamoya Syndrome Associated With Hereditary Spherocytosis: An Emerging Clinical Entity
Authors: Gait-Carr Eleanor , Connolly Daniel J.A. , King David
Published: February 2017

Moyamoya syndrome is an unusual cerebrovascular disorder, which has rarely been reported in association with hereditary spherocytosis. We present the case of a 6-year-old boy with hereditary spherocytosis who was diagnosed with Moyamoya syndrome following a stroke. We discuss why these conditions may coexist and briefly outline the management of such children.
Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship
Authors: Hulett Jennifer M. , Armer Jane M. , Leary Emily , Stewart Bob R. , McDaniel Roxanne , Smith Kandis , Millspaugh Rami , Millspaugh Joshua
Published: February 2017

Background:

Psychoneuroimmunological theory suggests a physiological relationship exists between stress, psychosocial-behavioral factors, and neuroendocrine-immune outcomes; however, evidence has been limited.

Objective:

The primary aim of this pilot study was to determine feasibility and acceptability of a salivary cortisol self-collection protocol with a mail-back option for breast cancer survivors. A secondary aim was to examine relationships between religiousness/spirituality (R/S), perceptions of health, and diurnal salivary cortisol (DSC) as a proxy measure for neuroendocrine activity.

Methods:

This was an observational, cross-sectional study. Participants completed measures of R/S, perceptions of health, demographics, and DSC.

Results:

The sample was composed of female breast cancer survivors (n = 41). Self-collection of DSC using a mail-back option was feasible; validity of mailed salivary cortisol biospecimens was established. Positive spiritual beliefs were the only R/S variable associated with the peak cortisol awakening response (r
s = 0.34, P = .03). Poorer physical health was inversely associated with positive spiritual experiences and private religious practices. Poorer mental health was inversely associated with spiritual coping and negative spiritual experiences.

Conclusions:

Feasibility, validity, and acceptability of self-collected SDC biospecimens with an optional mail-back protocol (at moderate temperatures) were demonstrated. Positive spiritual beliefs were associated with neuroendocrine-mediated peak cortisol awakening response activity; however, additional research is recommended.

Implications for Practice:

Objective measures of DSC sampling that include enough collection time points to assess DSC parameters would increase the rigor of future DSC measurement. Breast cancer survivors may benefit from nursing care that includes spiritual assessment and therapeutic conversations that support positive spiritual beliefs.
An Integrative Review of Psychosocial Concerns Among Young African American Breast Cancer Survivors
Authors: Nolan Timiya S. , Frank Jennifer , Gisiger-Camata Silvia , Meneses Karen
Published: February 2017

Background:

African American (AA) women are more likely to be given a diagnosis of breast cancer at an early age, experience morbidity after treatment, and exhibit disparities in survivorship. Although psychosocial well-being is largely studied among breast cancer survivors, data are sparse regarding young AA survivors.

Objective:

This integrative review examined psychosocial concerns in survivorship among young AA survivors using a quality-of-life framework.

Methods:

PubMed, CINHAL, EMBASE, PsychINFO, and Scopus were searched for articles exploring psychosocial well-being in young AA survivors.

Results:

The search yielded 237 articles that were retrieved and reviewed for relevance. Of these, 16 articles were selected based on inclusion/exclusion criteria. Data were evaluated and synthesized based on the quality-of-life model. Selected articles omitted the study of several psychological subconstructs and identified existing psychosocial concerns that require mitigation.

Conclusions:

The review revealed key areas of psychosocial concerns among young AA survivors including ongoing anxiety/depression, cognitive changes, and relationships. Identified gaps include paucity of research with young AA survivors and their residual psychosocial concerns.

Implications for Practice:

Review findings indicate a need to increase survivorship research on young AA survivors. Researchers, clinicians, and young AA survivors must partner in efforts to understand psychosocial concerns and translate findings into clinical practice (ie, use of psychosocial distress tools, distress de-escalation protocols, and individualized survivorship care plans) toward reduction of quality-of-life health disparities among young AA survivors.
Comorbid Dementia and Cancer in Residents of Nursing Homes
Authors: Blytt Kjersti Marie , Selbæk Geir , Drageset Jorunn , Natvig Gerd Karin , Husebo Bettina S.
Published: February 2017

Background:

Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored.

Objectives:

The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer.

Methods:

This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored.

Results:

Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P< .05). Compared with patients without dementia but with cancer, patients with comorbid dementia and cancer had significantly more NPS, including sleep disturbances and agitation.

Conclusions:

Patients with comorbid dementia and cancer receive more analgesics than patients with dementia but still display more agitation and sleep disturbances than patients with cancer and patients with neither dementia nor cancer, suggesting that symptoms may not be treated adequately.

Implications for Practice:

The results indicate a considerable strain for patients with comorbid dementia and cancer and highlight essential challenges for the clinician who is responsible for treatment and care. Nurses should pay attention to agitation and sleep disturbances among patients with comorbid dementia and cancer.
The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers
Authors: Tung Hong-Yi , Lin Yu-Hua , Kao Chia-Chan , Wu Shu-Fen
Published: February 2017

Background:

Previous studies have demonstrated that posttraumatic stress symptoms (PTSS) affect women with breast cancer. However, few studies have explored the relationships among PTSS, symptom distress, and depression in association with cancers specific to women in Taiwan.

Objective:

The aim of this study was to explore the relationships among symptom distress, PTSS, and depression in women given a diagnosis of female-specific cancers.

Methods:

A cross-sectional design was used, and 220 women given a diagnosis of female-specific cancer were recruited from a general hospital in southern Taiwan. The outcome measures included the subjects’ scores on a symptom distress scale, the Chinese Davidson Trauma Scale, and the Center for Epidemiologic Studies-Depressive Scale; their personal characteristics; and disease-related variables.

Results:

There were significant positive relationships among the frequency of PTSS, the severity of PTSS, symptom distress, and depressive symptoms. Logistic regression analysis demonstrated that educational level, symptom distress, and the frequency of PTSS were significant predictors of depression.

Conclusions:

The study demonstrated a high prevalence of depression in women with female-specific cancer, and the results confirm the relationship between PTSS and depression. In addition, educational level and physical distress were also found to be predictors of depression.

Implications for Practice:

Screening for depressive symptoms should be a component of routine screening in women with female-specific cancer. Oncology nurses should be aware of the distress symptoms experienced by these women and recognize PTSS in patients who are given a diagnosis of female-specific cancer. Awareness will reduce the multiple risks of posttraumatic stress disorder and depression and decrease the depressive symptoms of women after surviving cancer.
Identification of Optic Nerve Swelling Using Point-of-Care Ocular Ultrasound in Children
Authors: Marchese Ronald F. , Mistry Rakesh D. , Binenbaum Gil , Liu Grant T. , Scarfone Richard J. , Woodford Ashley L. , Chen Aaron E.
Published: February 2017

Objective

The aim of this study was to determine the feasibility and accuracy of point-of-care (POC) ocular ultrasound (US) when performed by a pediatric emergency medicine (PEM) physician to detect optic nerve abnormalities concerning for swelling, as compared with the fundus examination performed by an ophthalmologist.

Methods

This was a single-center, prospective cohort pilot study of children aged 12 months to 18 years who required optic disc evaluation by an ophthalmologist. Eligible subjects were enrolled from the emergency department, inpatient wards, and neuro-ophthalmology outpatient clinic of an urban, tertiary care children’s hospital. Point-of-care ocular US, specifically assessing optic nerve sheath diameter and optic disc elevation, was performed. Findings on US were compared with findings identified by an ophthalmologist on dilated fundus examination.

Results

Seventy-six subjects were enrolled; 20 (26%) of 76 had findings concerning for optic nerve swelling diagnosed by an ophthalmologist on fundus examination. Using a sonographic definition for optic nerve swelling of optic nerve sheath diameter greater than 4.5 mm or the presence of optic disc elevation, the sensitivity and specificity were 90% and 55%, respectively. The success rate of POC ocular US was 100%, and the mean time to completion was 8 minutes. For emergency department subjects in whom direct fundus examination was attempted, the PEM physician could visualize the optic disc and assess for swelling in only 40% (14/35) of examinations.

Conclusions

The results of our study suggest that POC ocular US performed by PEM physicians was feasible and determined to be sensitive but nonspecific in the detection of optic nerve swelling. Additional larger studies may determine generalizability to other nonophthalmologist physicians performing POC ocular US.
Meta-analysis of the Unintentional Death of Children Aged 0 to 5 Years in China Between 1995 and 2015
Authors: Su Baoning , Yu Jian’er
Published: February 2017

Objectives

The aim of this study was to identify the primary cause of and a means by which to prevent the unintentional injury and death of children aged 0 to 5 years in China.

Methods

A systematic review of literature published in this area between 1995 and 2015, accessible via Chongqing VIP, Wanfang, CNKI, and PubMed databases, in addition to other electronic databases and related magazines and professional information, was conducted. The data were retrieved using Cochrane Systematic review methods. All information was judged using the Jadad method. A meta-analysis was carried out on homogeneous studies. RevMan 5.3 software was used to analyze the gathered information.

Results

A total of 125 related pieces of literature were retrieved. Of the 14 that met the inclusion criteria, 6 were of moderate quality and 8 of general quality. The meta-analysis showed that in a comparison of unintentional injury and death of male and female children, the odds ratio was [1.73 to 1.95] for a 95% confidence interval (P < 0.00001). In a comparison of urban and rural areas, the odds ratio was [0.02, 0.02] for a 95% confidence interval (P < 0.00001).

Conclusions

Based on accessible literature, the incidence of unintentional injury and death of boys is higher than that in girls and is also higher in rural areas than in urban areas of China. Considering the significant difference in the latter comparison, developing and implementing methods to reduce the unintentional injury and death of children in rural areas should receive greater attention.
A Practice Guideline for Postreduction Management of Intussusception of Children in the Emergency Department
Authors: Kwon Hyuksool , Lee Jin Hee , Jeong Jin Hee , Yang Hye Ran , Kwak Young Ho , Kim Do Kyun , Kim Kyuseok
Published: February 2017

Objectives

The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence.

Methods

We developed a practice guideline of postreduction management of intussusception in the PED. The practice guideline involved feeding 2 hours after reduction and discharge 2 hours after successful feeding. The guideline was implemented on October 1, 2012. Retrospective quasi-experimental study was conducted for evaluation of the difference in LOS in the PED after reduction of intussusceptions, and the recurrence rate of intussusceptions between the preimplementation and postimplementation periods. Piecewise regression was performed to determine the differences between groups.

Results

In total, 45 and 52 patients were included in the preimplementation and postimplementation periods, respectively. The median LOS in the postimplementation period was significantly shorter than that in the preimplementation period (289 vs 532 minutes, respectively; P = 0.001). The slope of the LOS changed from 0.68 to −0.29. The slope decreased by 0.97 after practice guideline implementation. This difference was not statistically significant (P = 0.123), but it changed from a positive to negative gradient. The recurrence rate was not significantly different between the 2 periods (P = 0.605).

Conclusions

Implementation of a practice guideline involving early feeding and discharge after reduction of intussusception resulted in a reduced LOS from reduction of intussusception in the PED and was not associated with recurrence of intussusception.
Effect of an Asthma Guideline in 2 Pediatric Emergency Departments and an Urgent Care Center
Authors: Dilts Jennifer J. , Humiston Sharon G. , Lee Brian R. , Allen Nancy H. , Michael Jeffrey G.
Published: February 2017

Objectives

The objective of this study was to evaluate ordering of albuterol via metered-dose inhaler with spacer (MDI-spacer), length of stay (LOS), and 72-hour return rates before and after publication of an internally developed pediatric asthma clinical practice guideline (CPG).

Methods

The internally developed CPG reflected national recommendations. It was explained at faculty meetings by a respected clinician and published on the intranet on February 6, 2012. We performed a retrospective study of visits from January 1, 2009, to October 31, 2014, by children aged 2 to 17 years with a primary diagnosis of asthma and discharged from a target site (2 pediatric emergency departments and 1 urgent care center). We excluded critical/emergent visits and those by patients who transferred to the emergency department/urgent care center from another facility or were admitted. We extracted data for 37 months before and 33 months after CPG implementation (post-CPG) using a single electronic health record system.

Results

Albuterol delivery via MDI-spacer increased by 33.95% (P < 0.0001) during 1-month post-CPG implementation with no significant subsequent decrease. An unexpected decline was noted for median LOS before CPG implementation (−1.24 minutes; P < 0.0001). For MDI-spacer–treated patients post-CPG, decreased median LOS was maintained and there was decreased variability of the median LOS (P < 0.001). For nebulizer-treated patients post-CPG, median LOS increased (.95 minutes; P = 0.033). No change was observed for 72-hour return rates.

Conclusions

Implementation of an asthma CPG increased ordering of albuterol via MDI-spacer. The increase was sustained over time in all study sites. Decreased variability in median LOS for MDI-spacer patients was observed post-CPG. Median LOS for those treated with MDI-spacer exclusively remained unchanged in the post-CPG period, whereas post-CPG LOS increased in those who received nebulized albuterol.
Acute Focal Dystonia After a Single Dose of Oral Cetirizine in a 9-Year-Old Boy
Authors: Sharawat Indar Kumar , Dawman Lesa
Published: February 2017

Common cold is an acute illness affecting pediatric population in particular. The use of antihistamines is a common practice, with cetirizine being a frequently used drug with a good safety profile. However, adverse events due to the use of antihistamines have been rarely reported, such as drug-induced dystonia with the use of cetirizine. In our present case, dystonia due to the intake of cetirizine was observed, which the patient responded well to the use of benzodiazapines, namely, clonazepam. We report this case to highlight the occurrence of this adverse event with the use of cetirizine.