bluuebunny/crossref_metadata_2025 huggingface dataset:
Research participation preferences as expressed through a patient portal: implications of demographic characteristics
Authors: Obeid Jihad S , Shoaibi Azza , Oates Jim C , Habrat Melissa L , Hughes-Halbert Chanita , Lenert Leslie A
Published: August 2018

Objective

As patient portals are increasingly used for research recruitment, it is important to examine the demographic makeup of research registries that are populated via portals and the factors that influence participation in these registries.

Methods

We examined the response to a routine research preference questionnaire among patients who were enrolled in a patient portal at an academic health center and characterized the sub-population that responded and was tracked in a research preferences registry. We examined the factors that influence choices in two research preferences: future contact for research opportunities and biobanking of de-identified specimens.

Results

Out of 79 834 patients to whom the questionnaire was sent, 32% responded. Of those 74% agreed to future contact and 77% to the biobank preference. We found significantly lower odds of agreement in both preferences in minority populations, especially in the population >65 years of age when stratified by race. Individuals with higher comorbidity indexes had significantly higher odds for agreement.

Discussion

The disparities in volunteerism as expressed by agreement to future contact and willingness to participate in biobanking are exacerbated by lower levels of enrollment in the patient portal by minorities, especially in the oldest age group. Future work should examine other socioeconomic factors and the differences across age groups, sicker individuals, and payer categories.

Conclusion

Although patient portals can be more efficient for recruitment, researchers have to be cognizant of, and proactively address, potential biases when recruiting participants from these registries.
Endoscopic Transsphenoidal Surgery of Microprolactinomas: A Reappraisal of Cure Rate Based on Radiological Criteria
Authors: Micko Alexander , Vila Greisa , Höftberger Romana , Knosp Engelbert , Wolfsberger Stefan
Published: August 2018

Background

Current standard treatment of microprolactinomas is dopamine agonist therapy. As this drug treatment is lifelong in up to 80% of cases, many patients consult pituitary surgeons regarding a surgical alternative.

Objective

To identify prognostic criteria for surgical remission, we reviewed outcomes of our series of microprolactinomas treated with endoscopic transsphenoidal surgery, with a special emphasis on magnetic resonance adenoma delineation and position.

Methods

Our study cohort comprises a single center series of 60 patients operated for histopathologically verified magnetic resonance imaging unequivocally identifiable endosellar microprolactinoma between 2003 and 2017. In 31 patients the adenoma was enclosed by pituitary gland (group ENC), in 29 patients the adenoma was located lateral to the gland adherent to the medial cavernous sinus wall (group LAT).

Results

After a mean follow-up of 37 mo (range 4-143 mo), remission rate was significantly higher in adenomas enclosed by pituitary gland (group ENC) than adenomas located lateral to the gland (group LAT), with 87% vs 45%,P = .01. Intraoperatively, 4 patients showed signs of invasiveness. Preoperative prolactin levels did not differ between the groups (mean 155 and 187 ng/ml in group ENC and LAT, respectively).

A binary logistic regression model revealed that only the radiological criteria applied showed a significant correlation (P = .003) with endocrine remission.

CONCLUSION

According to our results, remission rate is significantly higher in microprolactinomas enclosed by the pituitary gland. However, the decision for surgery should take into account surgeons experience and possibility of complications.
Imaging of Cardiac Aneurysms
Authors: Wahl Daniel R. , Yoon Susan , Chan Cynthia , Goykhman Igor , Hochhold John , Son Hongju
Published: August 2018

Cardiac aneurysms are uncommon, encompass a wide variety of pathologies, and can occur in several locations in the heart. Cardiac aneurysms are of varying clinical concern, with some warranting prompt attention and many others with no clinical significance. Cardiac aneurysms may be identified on electrocardiogram-gated CT or MRI and incidentally on nongated imaging examinations. As CT and MRI are requested increasingly to evaluate anatomic cardiac pathology, radiologists should become familiar with the imaging appearances, clinical significance, and management options of cardiac aneurysms.
CE: Too Much Sitting: A Newly Recognized Health Risk
Authors: Eanes Linda
Published: August 2018

While moderate-to-vigorous physical activity (MVPA) has been widely accepted as a major factor in promoting optimal health, emerging research specific to sedentary behavior suggests that MVPA alone may not be enough. This integrative literature review examines the evidence on sedentary behavior as an independent health risk for cardiometabolic health conditions, certain cancers, and all-cause mortality. In so doing, it reveals new insights into high-volume sitting and prolonged uninterrupted sitting and their relationship to adverse health conditions in order to increase awareness of sedentary behavior as an independent health risk factor, examine the potential effects of displacing sedentary time with light-intensity physical activity, and encourage nurses to advance the overall reduction of sedentary behavior.
Becoming a Clinical Teacher: Identity Formation in Context
Authors: Cantillon Peter , Dornan Tim , De Grave Willem
Published: August 2018

Purpose

Most clinical teachers have not been trained to teach, and faculty development for clinical teachers is undermined by poor attendance, inadequate knowledge transfer, and unsustainability. A crucial question for faculty developers to consider is how clinicians become teachers “on the job.” Such knowledge is important in the design of future workplace-based faculty development initiatives. The authors conducted a scoping review of research on the relationship between becoming a clinical teacher and the clinical environments in which those teachers work.

Method

In June 2017, using the scoping review design described by Levac et al (2010), the authors searched 12 databases. They subjected the articles discovered to four phases of screening, using iteratively developed inclusion/exclusion criteria. They charted data from the final selection of articles and used thematic analysis to synthesize findings.

Results

Thirty-four research reports met the inclusion criteria. Most (n = 24) took an individualist stance toward identity, focusing on how teachers individually construct their teacher identity in tension with their clinician identities. Only 10 studies conceptualized clinical teacher identity formation as a social relational phenomenon, negotiated within hierarchical social structures. Twenty-nine of the included studies made little or no use of explicit theoretical frameworks, which limited their rigor and transferability.

Conclusions

Clinicians reconciled their identities as teachers with their identities as clinicians by juggling the two, finding mutuality between them, or forging merged identities that minimized tensions between educational and clinical roles. They did so in hierarchical social settings where patient care and research were prioritized above teaching.
Using Machine Learning to Assess Physician Competence: A Systematic Review
Authors: Dias Roger D. , Gupta Avni , Yule Steven J.
Published: August 2018

Purpose

To identify the different machine learning (ML) techniques that have been applied to automate physician competence assessment and evaluate how these techniques can be used to assess different competence domains in several medical specialties.

Method

In May 2017, MEDLINE, EMBASE, PsycINFO, Web of Science, ACM Digital Library, IEEE Xplore Digital Library, PROSPERO, and Cochrane Database of Systematic Reviews were searched for articles published from inception to April 30, 2017. Studies were included if they applied at least one ML technique to assess medical students’, residents’, fellows’, or attending physicians’ competence. Information on sample size, participants, study setting and design, medical specialty, ML techniques, competence domains, outcomes, and methodological quality was extracted. MERSQI was used to evaluate quality, and a qualitative narrative synthesis of the medical specialties, ML techniques, and competence domains was conducted.

Results

Of 4,953 initial articles, 69 met inclusion criteria. General surgery (24; 34.8%) and radiology (15; 21.7%) were the most studied specialties; natural language processing (24; 34.8%), support vector machine (15; 21.7%), and hidden Markov models (14; 20.3%) were the ML techniques most often applied; and patient care (63; 91.3%) and medical knowledge (45; 65.2%) were the most assessed competence domains.

Conclusions

A growing number of studies have attempted to apply ML techniques to physician competence assessment. Although many studies have investigated the feasibility of certain techniques, more validation research is needed. The use of ML techniques may have the potential to integrate and analyze pragmatic information that could be used in real-time assessments and interventions.
The Effectiveness of Full-body EOS Compared With Conventional Chest X-ray in Preoperative Evaluation of the Chest for Patients Undergoing Spine Operations
Authors: Hey Hwee Weng Dennis , Chan Chloe Xiaoyun , Wong Ying Mei , Sng Jonathan Weizhong , Ong Han Yang , Tan Chuen Seng , Liu Gabriel Ka-Po , Wong Hee-Kit , Quek Swee-Tian
Published: August 2018

Study Design.

A prospective radiographic comparative study.

Objective.

The aim of this study was to compare full-body EOS with conventional chest X-ray (CXR) for use in the preoperative evaluation of the chest in patients undergoing spine operations.

Summary of Background Data.

The full-body EOS reproduces an image of the chest similar to a routine CXR. The potential for the former replacing the latter is plausible. This is especially applicable in spine patients who would routinely have a preoperative full-body EOS performed.

Methods.

A radiographic comparative study of 266 patients was conducted at a single tertiary center from January 2013 to July 2016. Each patient had EOS and CXR done in random order <2 weeks apart. Two radiologists reported the image findings using a checklist. A third radiologist was consulted in cases of discrepancy. Interobserver agreement was calculated using Gwet AC1 and a comparison between EOS and CXR findings was analyzed using paired Chi-squared test. Multivariate analysis was performed to identify predictors for abnormal radiological findings. The institutional ethics committee approved this prospective study and waiver of informed consent was obtained.

Results.

There were 84 males (31.6%) and 182 females (68.4%). The mean age was 38.9 years (SD = 25.0 years). High interobserver agreement was found for EOS and CXR (Gwet AC1 0.993 and 0.988, respectively). There were no significant differences between both imaging modalities. Rare diagnoses precluded comparison of certain conditions. Age >18 years [odds ratio (OR) 7.69; P = 0.009] and American Society of Anesthesiologists physical status 3 (OR 6.64; P = 0.018) were independent predictors of abnormal radiological findings.

Conclusion.

EOS is not inferior to, and may be used to replace CXR in preoperative radiological screening of thoracic conditions especially in low-risk patients ≤18 years old and patients with ASA <3. Preoperative assessment should never rely on a single modality. High-risk patients should be sent for a thorough work-up before spine surgery.

Level of Evidence: 4
Yoga for Teens With Irritable Bowel Syndrome
Authors: Evans Subhadra , Seidman Laura C. , Lung Kirsten , Sternlieb Beth , Zeltzer Lonnie K.
Published: August 2018

Irritable bowel syndrome (IBS) is a common condition associated with recurrent abdominal pain and altered bowel habits. It is particularly pernicious to youth, who may withdraw from life tasks due to pain, diarrhea, and/or fear of symptoms. Emotional stress exacerbates IBS symptoms, and mind-body interventions may be beneficial. In this mixed-methods study of 18 teens aged 14 to 17 years undertaking a 6-week Iyengar yoga intervention, we aimed to identify treatment responders and to explore differences between responders and nonresponders on a range of quantitative outcomes and qualitative themes related to yoga impact, goodness of fit, and barriers to treatment. Half of the teens responded successfully to yoga, defined as a clinically meaningful reduction in abdominal pain. Responders differed from nonresponders on postintervention quantitative outcomes, including reduced abdominal pain, improved sleep, and increased visceral sensitivity. Qualitative outcomes revealed that responders reported generalized benefits early in treatment and that their parents were supportive and committed to the intervention. Responders and nonresponders alike noted the importance of home practice to achieve maximal, sustained benefits. This study reveals the need for developmentally sensitive yoga programs that increase accessibility of yoga for all patients.
Opposing effects of cervical spinal cold block on spinal itch and pain transmission
Authors: Carstens Earl , Iodi Carstens Mirela , Akiyama Tasuku , Davoodi Auva , Nagamine Masaki
Published: August 2018

Inactivation of descending pathways enhanced responses of spinal dorsal horn neurons to noxious stimuli, but little is known regarding tonic descending modulation of spinal itch transmission. To study effects of cervical spinal cold block on responses of dorsal horn neurons to itch-evoking and pain-evoking stimuli, single-unit recordings were made from superficial dorsal horn wide dynamic range and nociceptive-specific-type neurons in pentobarbital-anesthetized mice. Intradermal histamine excited 17 units. Cold block stating 1 minute after intradermal injection of histamine caused a marked decrease in firing. The histamine-evoked response during and following cold block was significantly lower compared with control histamine-evoked responses in the absence of cold block. A similar but weaker depressant effect of cold block was observed for dorsal horn unit responses to chloroquine. Twenty-six units responded to mustard oil allyl isothiocyanate (AITC), with a further significant increase in firing during the 1-minute period of cold block beginning 1 minute after AITC application. Activity during cold block was significantly greater compared with the same time period of control responses to AITC in the absence of cold block. Ten units’ responses to noxious heat were significantly enhanced during cold block, while 6 units’ responses were reduced and 18 unaffected. Cold block had no effect on mechanically evoked responses. These results indicate that spinal chemonociceptive transmission is under tonic descending inhibitory modulation, while spinal pruriceptive transmission is under an opposing, tonic descending facilitatory modulation.
Monitoring of Metabolic, Cardiac, and Endocrine Indicators in Youth Treated With Antipsychotics as Reported by Health Care Professionals
Authors: Minjon Lenneke , van den Ban Els , de Jong Emma , Egberts Toine C.G. , Heerdink Eibert R.
Published: August 2018

Background

It is unclear how youth treated with antipsychotics are monitored. The purpose of this study was to assess monitoring of metabolic, cardiac, and endocrine indicators in youth (<18 years old) treated with antipsychotics as reported by health care professionals in the Netherlands.

Methods

A questionnaire was designed to collect information from health care professionals regarding the monitoring of youth treated with antipsychotics. Data were collected at a national conference.

Findings and Results

Fifty-nine health care professionals completed the questionnaire, of which 53 (89.8%) were child and adolescent psychiatrists (approximately 20% of all child and adolescent psychiatrists in the Netherlands). More than 80% of respondents reported monitoring physical indicators—weight, height, body mass index, heart rate, and blood pressure—and over 50% reported monitoring laboratory indicators—lipid profile, blood glucose, and prolactin level. Most of the respondents reported monitoring physical indicators more than twice per year and laboratory indicators once per year. Almost all respondents (56/59, 94.9%) reported monitoring according to a clinical guideline or protocol. Only 1 respondent reported monitoring the indicators completely according to the clinical guideline. Respondents mentioned that facilitating factors for monitoring, such as access to electrocardiogram facilities, were insufficiently available.

Conclusions

Although all health care professionals reported monitoring metabolic, cardiac, and endocrine indicators in youth treated with antipsychotics, great variability exists in reported monitoring practices. Factors contributing to this variability must be assessed to optimize the benefit-risk ratio for the individual patient.
Inflammatory Papules in Sun-Exposed Skin
Authors: Rasmussen Annelise , Jacob Sharon E.
Published: August 2018

Teledermatology describes dermatologic medical services provided through telecommunication technology. This case concerns inflamed, pink, scaled papules in sun-exposed areas.
Developing a Quality Measurement Strategy in an Academic Primary Care Setting: An Environmental Scan
Authors: Dalton Alexandra F. , Lyon Corey , Parnes Bennett , Fernald Douglas , Lewis Carmen L.
Published: August 2018

Purpose:

The purpose of this project was to: (1) develop a strategy for primary care quality measurement using an environmental scan and interviews to identify best practices and candidate measures; (2) present recommendations to facilitate successful measurement.

Methods:

Following stakeholder interviews and review of existing measures, we created a three-tiered recommendation system for selecting and implementing measures. We also developed a framework for reviewing and prioritizing measures and prepared a detailed project report.

Results:

Interviews provided a broader perspective on measuring quality, including implementing measures, measuring value, and identifying measurement gaps. Our recommendations fall into three tiers: Tier 1 measures can be implemented quickly and include clinical processes and outcomes for preventive care and disease states. Tier 2 measures require modifications to electronic health record, workflows, and/or staff preparation. Tier 3 (Strategic Vision) addresses topics that should be incorporated in the future to ensure high-quality primary care (adherence, patient activation, patient experience, teamness, staff satisfaction, and value), and infrastructure development to support ongoing quality measurement.

Conclusions:

Implementing a quality measurement strategy is challenging and labor-intensive but is necessary to improve healthcare quality. Our work demonstrates the effort and investment required to progress quality measurement and offers recommendations for successfully undertaking this type of endeavor.
Normative Data for the Sway Balance System
Authors: Brett Benjamin L. , Zuckerman Scott L. , Terry Douglas P. , Solomon Gary S. , Iverson Grant L.
Published: August 2018

Objective:

Static balance, postural stability, and reaction time are commonly impaired after a sport-related concussion. The Sway Balance System assesses postural sway (ie, stability) and simple reaction time using the triaxial accelerometer built into iOS mobile devices. The purpose of this study was to provide normative data for children and adolescents and to examine for age and sex differences on the Sway Balance System.

Design:

Cross-sectional study.

Setting:

Middle and high schools across the United States.

Participants:

Participants were 3763 youth aged 9 to 21 years who completed the Sway Balance System Sports protocol in accordance with the company's recommended methods (ie, 1 acclimation trial and 2-3 baseline tests).

Independent Variables:

Age and sex.

Main Outcome Measures:

Sway Balance score (0-100) and Sway Reaction Time score (0-100).

Statistical Analysis:

A multivariate analysis of variance examined the effects of age and sex on balance and reaction time scores.

Results:

Sway Balance and Reaction Time scores significantly differed by age [F(10, 7494) = 39.68,P< 0.001, V = 0.10, = 0.05] and sex [F(4, 7494) = 55.29,P< 0.001, V = 0.06, = 0.03]. Post hoc analyses revealed that older groups generally had better scores than younger groups on all balance comparisons (ps < 0.001) and many reaction time comparisons. Girls performed better than boys on balance [F(2, 3747) = 53.79,P< 0.001, = 0.03] and boys had faster reaction times [F(2, 3747) = 37.11,P< 0.001, = 0.02].

Conclusions:

Age and sex are important factors to consider when assessing Balance and Reaction Time scores using the Sway Balance System's Sports protocol in youth. We provide age- and sex-based normative values for the Sway Balance System, which will likely be helpful when using this technology to assess and manage concussions.
Concussion in Motorsport? Experience, Knowledge, Attitudes, and Priorities of Medical Personnel and Drivers
Authors: Adams Stephanie A. , Turner Anthony P. , Richards Hugh , Hutchinson Peter J.
Published: August 2018

Objective:

To assess concussion experiences, knowledge, and attitudes of motorsport medical personnel and drivers and to determine priority areas regarding concussion within the sport.

Design:

Sequential mixed-method design. Part 1: stakeholder interviews; part 2: cross-sectional online survey.

Setting:

United Kingdom.

Participants:

Part 1: key motorsport stakeholders (N = 8); part 2: motorsport medical personnel and drivers (N = 209) representing amateur and/or professional 4-wheeled motorsport.

Main Outcome Measures:

Concussion experience, knowledge, attitudes, and perceived priority areas.

Results:

Thirty-one percent of surveyed drivers (age = 37.91 ± 13.49 years: 89% male) reported suffering from concussion in motorsport. Eighty-seven percent of surveyed medical personnel (age = 48.60 ± 10.68 years: 74% male) reported experience with concussed drivers, and 34% reported feeling pressured to clear a driver with concussion. Gaps in knowledge and misperceptions about concussion were reported in both groups, and disparity between concussion attitudes emerged between drivers and medical personnel. Application of assessment and management procedures varied between medical personnel and there was evidence motorsport policy and concussion guidelines may not be directly followed. According to both medical personnel (77%) and drivers (85%), “education and training” is the top priority area for the sport.

Conclusions:

There is clear evidence of concussions in motorsport, but accurate knowledge about this injury is missing. Concussion education and training for all drivers and medical personnel is required. Additional investigations into concussion attitudes are advised to complement and advance simple educational initiatives. Further investigation is also required to determine how to best support motorsport medical personnel, and general practitioners, who hold significant responsibility in guiding drivers from diagnosis to return to racing, and to support the effective implementation of policy.
Nurse practitioners' recommendations for pharmacotherapy in the management of adolescent concussion
Authors: Graves Janessa M. , Klein Tracy A. , Panther Shannon G. , Moore Megan , Abshire Demetrius , Graham Jasmine
Published: August 2018

Background and purpose:

Nurse practitioners (NPs) frequently treat acute conditions presenting in children and adolescents in the outpatient setting. No evidence-based guidance exists pertaining to the treatment of concussion with medications. The purpose of this study was to examine recommendations by NPs for pharmacotherapy of acute symptoms for adolescent concussion.

Methods:

This is a secondary analysis of data from a web-based census survey of all licensed NPs in Oregon and Washington State, where they practice as independent providers with prescriptive authority. Based on a standardized adolescent patient scenario video, NPs were asked to indicate prescription or nonprescription medication recommendations for concussion symptoms. Open-ended descriptions of medication recommendations were coded, summarized, and described.

Conclusions:

In narrative text, 78.4% of the 991 respondents recommended at least one type of prescription or nonprescription medication. Prescription medications (recommended by 17.2%) included antiemetics and antimigraine medications; nonprescription medications (recommended by 75.5%) included nonsteroidal anti-inflammatory drugs, over-the-counter pain relievers, and herbal medications. Pharmacotherapy recommendations varied by NP practice setting and rurality.

Implications for practice:

Nurse practitioners have full prescriptive authority in many states. No guidelines inform medication use in managing acute concussion symptoms, yet many providers recommend their use.
Intra-Cochlear Electrocochleography During Cochear Implant Electrode Insertion Is Predictive of Final Scalar Location
Authors: Koka Kanthaiah , Riggs William Jason , Dwyer Robert , Holder Jourdan Taylor , Noble Jack H. , Dawant Benoit M. , Ortmann Amanda , Valenzuela Carla V. , Mattingly Jameson K. , Harris Michael M. , O’Connell Brendan P. , Litvak Leonid M. , Adunka Oliver F. , Buchman Craig Alan , Labadie Robert F.
Published: August 2018

Hypothesis:

Electrocochleography (ECochG) patterns observed during cochlear implant (CI) electrode insertion may provide information about scalar location of the electrode array.

Background:

Conventional CI surgery is performed without actively monitoring auditory function and potential damage to intracochlear structures. The central hypothesis of this study was that ECochG obtained directly through the CI may be used to estimate intracochlear electrode position and, ultimately, residual hearing preservation.

Methods:

Intracochlear ECochG was performed on 32 patients across 3 different implant centers. During electrode insertion, a 50-ms tone burst stimulus (500 Hz) was delivered at 110 dB SPL. The ECochG response was monitored from the apical-most electrode. The amplitude and phase changes of the first harmonic were imported into an algorithm in an attempt to predict the intracochlear electrode location (scala tympani [ST], translocation from ST to scala vestibuli [SV], or interaction with basilar membrane). Anatomic electrode position was verified using postoperative computed tomography (CT) with image processing.

Results:

CT analysis confirmed 25 electrodes with ST position and 7 electrode arrays translocating from ST into SV. The ECochG algorithm correctly estimated electrode position in 26 (82%) of 32 subjects while 6 (18%) electrodes were wrongly identified as translocated (sensitivity = 100%, specificity = 77%, positive predictive value = 54%, and a negative predictive value = 100%). Greater hearing loss was observed postoperatively in participants with translocated electrode arrays (36 ± 15 dB) when compared with isolated ST insertions (28 ± 20 dB HL). This result, however, was not significant (p = 0.789).

Conclusion:

Intracochlear ECochG may provide information about CI electrode location and hearing preservation.
No Squelch Effect After Sequential Bilateral Cochlear Implantation in Postlingually Deafened Adults: Is There a First Ear Advantage?
Authors: Kraaijenga Véronique J. C. , Smit Adriana L. , Ramakers Geerte G. J. , Stokroos Robert J. , van Zanten Gijsbert A.
Published: August 2018

Objectives:

To investigate whether a squelch effect develops in postlingually deafened adults after sequential bilateral cochlear implantation.

Study Design:

Prospective study as part of a randomized controlled trial on the difference between simultaneous versus sequential bilateral cochlear implantation.

Setting:

Tertiary referral center.

Participants:

Sixteen postlingually deafened adults.

Intervention:

Sequential bilateral cochlear implantation with a 2-year interimplant interval.

Main Outcome Measure:

A squelch effect was defined as a better bilateral score than unilateral score on a speech-intelligibility-in-noise test with spatially separated sources. The squelch effect was evaluated for the participants’ best performing cochlear implant (CI) ear, the left CI in the condition with speech from −60 degrees azimuth and noise from +60 degrees azimuth (S-60 N+60), the right CI (N-60 S+60), CI1 and CI2. Evaluations took place 1, 2 and median 4 years after sequential implantation.

Results:

No significant squelch effect was found, except for the right CI (N-60 S+60) after 2 years. No differences in speech perception-in-noise from straight ahead were seen between CI1 and CI2. Comparing performance of participants whose better or worse ear was implanted first did not reveal differences either. For the best performing situation, 7/16, 6/16, and 3/12 participants exhibited a squelch effect after 1, 2, and 4 years of follow-up.

Conclusions:

Participants who underwent sequential bilateral cochlear implantation with a 2-year interimplant interval did not develop an evident squelch effect on group level after a median follow-up of 4 years. Individual participants were able to make use of the squelch effect. The less evident squelch effect is at odds with our group of simultaneously implanted bilateral cochlear implant users. Neither a difference between CI1 and CI2, nor implanting the better or worse ear first could explain the less evident squelch effect in these patients.

Trial Registration:

Dutch Trial Register NTR1722.
Evolution of Acquired Middle Ear Cholesteatoma in Patients With Ectrodactyly, Ectodermal Dysplasia, Cleft Lip/Palate (EEC) Syndrome
Authors: Lourencone Luiz Fernando Manzoni , Koga Fernanda Dias Toshiaki , Oliveira Eduardo Boaventura , Jorge Jose Carlos , de Brito Rubens
Published: August 2018

Objective:

To review an institutional experience with the surgical and clinical management of acquired middle ear cholesteatoma in patients with ectrodactyly, ectodermal dysplasia, cleft lip/palate (EEC) syndrome.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Eight patients with medical history significant for EEC syndrome who underwent surgery for acquired middle ear cholesteatoma between 1996 and 2016.

Intervention(s):

Appropriate surgical interventions at the time of admission.

Main Outcome Measure(s):

History of ventilation tube insertion, status of the contralateral ear, surgical technique, cholesteatoma recidivism, presence of postoperative external auditory canal stenosis, pre and postoperative audiograms.

Results:

Cholesteatoma was diagnosed in all patients, 3 (37.5%) unilateral and 5 (62.5%) bilateral, totalizing 13 ears. Six ears (46.2%) underwent a canal wall up mastoidectomy but required conversion to a canal wall down technique in a second procedure due to recurrent cholesteatoma. In the remaining seven ears (53.8%) a canal wall down mastoidectomy was performed. Of all meatoplasty performed, seven (53.8%) evolved with stenosis of the external auditory canal.

Conclusions:

Our results suggest that most patients with EEC syndrome and middle ear cholesteatoma should be considered for a canal wall down mastoidectomy due to extensive disease and a high rate of recidivism. In addition, a high percentage of postoperative stenosis of the external auditory canal was found in this group.
Reducing Radiation Dose for High-resolution Flat-panel CT Imaging of Superior Semicircular Canal Dehiscence
Authors: Mekabaty Amgad El , Pross Seth E. , Martinez Mesha , Carey John P. , Pearl Monica S.
Published: August 2018

Objective:

High-resolution flat panel computed tomography (FPCT) is useful for the evaluation of temporal bone pathologies. While radiation exposure remains a concern, efforts have been devoted to reduce dose, while maintaining image quality. We hypothesize that removing the antiscatter grid (ASG) results in decreased radiation exposure, while maintaining diagnostic image quality for the evaluation of superior semicircular canal dehiscence (SSCD).

Methods:

Ten patients with clinical suspicion for SSCD participated in this prospective study. Two sequential collimated 20-second FPCT acquisitions were performed (first: grid in; second: grid removed) in all patients. Secondary reconstructions were created by manually generating the volume of interest to include the middle ear using a voxel size of 0.1 mm and 512 × 512 matrix. Radiation dose parameters (air kerma (Ka,r) in mGy and dose area product (DAP) in μGym2) were recorded. Three reviewers analyzed images for the ability to diagnose SSCD, to identify the stapes crurae, and to determine if an ASG was present.

Results:

The average Ka,r and DAP for the grid-in acquisitions were 246.7 mGy (SD 47.9) and 2838.0 μGym2 (SD 862.8), versus 160.2 mGy (SD 33.2) and 2026.3 μGym2 (SD 644.8) for the grid-out acquisitions, respectively (p<0.001 for both Ka,r and DAP). Radiation exposure was reduced by approximately 30% solely by removing the ASG. All reviewers correctly identified all patients with SSCD (confirmed at surgery), with mean AUC of 0.99 (κ = 0.90).

Conclusion:

Removing the antiscatter grid during FPCT imaging of the temporal bones is a simple and effective way to reduce radiation exposure while maintaining diagnostic image quality for the evaluation of SSCD.
Further Beneficial Effect of Hearing Aids on Speech Recognition Performance Besides Amplification: Importance of the Restoration of Symmetric Hearing
Authors: Kwak Min Young , Kang Yong Kyung , Kim Dong Hyun , An Yong-Hwi , Shim Hyun Joon
Published: August 2018

Objective:

To identify the improvement in auditory spectral resolution, temporal resolution, and speech recognition conferred with various hearing-aid (HA) technologies when the amplification effect of the HA is excluded, and to compare the beneficial effects depending on the restoration of symmetric hearing with different amplification settings in various hearing impairment conditions.

Study Design:

Prospective study.

Setting:

Tertiary referral center.

Subjects:

Sixty-two subjects who had used HAs for more than 3 months were divided into four groups: group 1, bilateral HAs (n = 28); group 2, unilateral HA in the better ear (n = 12); group 3, unilateral HA in the worse ear (n = 12); group 4, unilateral HA with symmetric hearing thresholds (n = 10).

Methods:

Aided performance and unaided performance were compared in each group. Four different psychoacoustic measurements were made: 1) spectral ripple discrimination; 2) temporal modulation detection; 3) speech recognition threshold in white noise; and 4) speech discrimination score (SDS) under quiet conditions. All test signals were presented by a loudspeaker located 1 m in front of the subject in a sound-attenuating booth, at their most comfortable levels, with or without HAs.

Results:

In group 1, the use of HAs significantly improved both SDS under quiet conditions and speech recognition in noise compared with the unaided condition. Group 2 showed better SDS under quiet conditions with HAs, and group 3 showed improved speech recognition in noise with HAs. In contrast, in group 4, no measurements differed with or without HAs.

Conclusions:

These results demonstrate the benefits of HAs on speech perception in noise, in addition to their amplification effect, but only when HA restores symmetric hearing.
Weight Gain Trajectory Predicts Long‐term Overweight and Obesity After Pediatric Liver Transplant
Authors: Swenson Sonja Marie , Perito Emily Rothbaum
Published: August 2018

Objective:

The aim of the study is to identify early predictors of long‐term overweight and obesity in pediatric liver transplant recipients.

Methods:

Single‐center, retrospective review of children who underwent liver transplant before age 6 years. Body mass index (BMI), weight, and height percentiles at transplant and post‐transplant were calculated. BMI, weight gain trajectories, and failure‐to‐thrive (FTT) were examined as predictors of overweight/obesity at 3 and 5 years post‐transplant.

Results:

Children (n = 70) were median 0.9 years at transplant. Median BMI percentile increased from 37 (interquartile range (IQR) 12–73) at transplant to 83 (IQR 64–97) at 12 months, with median weight percentile 47 (IQR 26–67) and height percentile 9 (IQR 2–32). Overweight/obesity prevalence peaked at 3 years post‐transplant (44%). Children who were overweight/obese at 3 years post‐transplant were more likely to be overweight/obese at transplant, and at 6 and 12 months post‐transplant (odds ratio (OR): 9.4, P = 0.02; OR: 6.7, P = 0.013, OR: 6.4, P = 0.007, respectively). The prevalence of overweight/obesity decreased to 26% at 5 years. Rapid weight gain post‐transplant did not predict overweight/obesity at 3 or 5 years. Over one‐third of children who were FTT at transplant were overweight/obese at 3 or 5 years, but FTT at transplant did not increase later obesity risk.

Conclusions:

Most children gain weight rapidly after liver transplant. Nearly half of transplant recipients are overweight/obese at 3 years, but the prevalence decreases by 5 years. Those who become overweight/obese tend to do so within 1 year post‐transplant, making this an important time to identify high‐risk children and provide counseling.
Domestically Acquired Aural Myiasis in a Tennessee Girl
Authors: Pappano Dante Allen , Trout Fryxell Rebecca , Bernard Ernest , Radu Heather
Published: August 2018

We present the rare case of a 12-year-old girl from Tennessee with domestically acquired aural myiasis.
Nationwide Survey of Hospitalization Due to Pediatric Food-Induced Anaphylaxis in the United States
Authors: Okubo Yusuke , Nochioka Kotaro , Testa Marcia A.
Published: August 2018

Objective

Anaphylaxis is a common, serious, systemic allergic reaction. In the United States, the change of annual hospitalization rates by anaphylaxis-trigger foods and risk factors associated with severity remain unclear.

Methods

Hospital discharge records of food-induced anaphylactic reactions of individuals younger than 20 years were obtained from Kids' Inpatient Database in 2006, 2009, and 2012 and were weighted to estimate the number of hospitalizations in the United States. We identified annual hospitalization rates by patients' characteristics and anaphylaxis-trigger foods and investigated factors associated with severity and use of mechanical ventilation with multivariable logistic regression.

Results

A total of 3427 hospitalizations were obtained, and annual hospitalization rates showed a significantly increasing trend from 1.2 per 100,000 children in 2006 to 1.5 per 100,000 children in 2012 (P < 0.001). The leading causes of hospitalizations due to food-induced anaphylaxis were peanuts (0.35–0.48 per 100,000 children), tree nuts and seeds (0.20–0.32 per 100,000 children), and milk products (0.09–0.13 per 100,000 children), with significantly increasing trends during 2006–2012. Milk products were significantly associated with severity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3–2.9). Ages between 13 and 20 years (OR, 2.7; 95% CI, 1.4–5.1) and comorbidity of asthma (OR, 2.1; 95% CI, 1.3–3.4) were significantly associated with the use of mechanical ventilation.

Conclusions

The annual hospitalization rates in the entire United States showed an increasing trend during 2006–2012. The rates of peanuts, tree nuts and seeds, and milk products demonstrated upward trends. Milk products, ages between 13 and 20 years, and comorbidities of asthma were related to severity and morbidity.
A Review of Validated Quality-of-Life Patient-Reported Outcome Measures in Pediatric Plastic Surgery
Authors: Roller Janine M. , Courtemanche Rebecca J. M. , Courtemanche Douglas J.
Published: August 2018

Background:

There has been an exponential increase in the number of patient-reported outcome measures in plastic surgery. The authors reviewed the reliability, validity, and practicality of the most frequently used patient-reported outcome measures in pediatric plastic surgery research.

Methods:

A review of the literature from January of 2010 to June of 2015 was conducted to identify patient-reported outcome measures in pediatric plastic surgery. Patient-reported measures used in five articles with two validation studies were included for analysis and classified as generic, disease-specific, and mental health. The type of validation used and reliability scores were compared across each class of outcome measure. The practicality of each measure was determined by the frequency of use and the number of items and cost.

Results:

Of the 173 unique patient-reported outcome measures identified, 14 were included for analysis and classified as generic (n = 7), disease-specific (n = 4), and mental health (n = 3). The majority of all measures used construct validity. Disease-specific measures had the highest distribution of domains related to physical functioning, the same domain also found to have the highest reliability scores. A patient-reported outcome measure’s frequency of use was not associated with its number of items or cost.

Conclusions:

This review found that generic patient-reported outcome measures were used most often, construct validity was used most frequently, physical functioning domains had the highest reliability, and the number of items or cost of a patient-reported outcome measure was not related to its frequency of use. Considered together, this information may inform the future development or selection of patient-reported outcome measures in pediatric plastic surgery.
Simultaneous Reconstruction of the Lower Lip with Gracilis Functioning Free Muscle Transplantation for Facial Reanimation: Comparison of Different Techniques
Authors: Lin Jerry Tsung-Kai , Lu Johnny Chuieng-Yi , Chang Tommy Nai-Jen , Chuang David Chwei-Chin
Published: August 2018

Background:

Functioning free muscle transplantation is currently the gold standard for the reconstruction of facial paralysis, focusing more on the upper lip reconstruction rather than on the lower lip. This study aimed to compare different lower lip reconstructive methods when performing functioning free muscle transplantation for facial reanimation.

Methods:

A retrospective review of functioning free muscle transplantation for facial reanimation from 2007 to 2015 was performed. Patients were divided into three groups: in group 1 (n = 15), a free plantaris tendon graft anchored to the gracilis muscle was passed into the lower lip to create a loop within; in group 2 (n = 12), an aponeurosis tail of the gracilis muscle was attached to the lower lip; and in group 3 (n = 18), no suspension of the lower lip was performed. All patients had at least 2 years of follow-up. Outcomes were assessed by photographs and videos, including subjective evaluation of midline deviation and horizontal tilt and objective analysis of smile dimensions and area.

Results:

A total of 45 patients were included. Results from the subjective evaluation demonstrate group 1 patients having the best improvement (overall score: p = 0.004 and p = 0.005, Fisher’s exact test). The objective evaluation showed group 1 and 2 patients with better results compared with group 3 (horizontal component, p = 0.009; vertical component, p = 0.004; area distribution, p < 0.001, Kruskal-Wallis test).

Conclusions:

Both plantaris tendon graft and gracilis aponeurosis achieved better improvement in subjective and objective evaluations than those who had no reconstruction of the lower lip. In particular, the plantaris tendon graft can achieve the most lower lip excursion with overall improved symmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Cephalic Rotation of the Nasal Tip
Authors: Afrooz Paul N. , Carboy Jourdan A. , Mendez Bernardino M. , Rohrich Rod J.
Published: August 2018

The position of the nasal tip holds important aesthetic significance. Cephalic rotation of the nasal tip is a frequent motivating factor for patients seeking rhinoplasty. The position of the nasal tip is a complex interplay of the size, morphology, and position of several anatomical components of the lower one-third of the nose. Cephalic rotation can be achieved by means of six different methods. The indirect methods promote passive cephalic rotation and include cephalic trim of the lower lateral cartilages, caudal trim of the upper lateral cartilages, and caudal septal trim. Direct methods involve precise repositioning of the domes and include shortening the lateral crura, lateral domal relocation, and the tip rotation suture. Used alone or in combination, these techniques and their subtle variations represent comprehensive and effective methods to achieve cephalic rotation of the nasal tip.
Mechanical Loading Improves Engineered Tendon Formation with Muscle-Derived Cells: An In Vivo Analysis
Authors: Chen Bo , Ding Jinping , Zhao Zhenxia , Jin Ji , Zhu Shan , Zang Mengqing , Xue Bingjian , Liu Yuanbo
Published: August 2018

Background:

The authors’ previous study showed that muscle-derived cells could regenerate strong engineered tendon with better tissue structure. However, little was known about the mechanism of neotendon built by muscle-derived cells, and the development and maturation of the cells. The authors hypothesized that mechanical loading modulated this process. The aim of this study was to investigate whether mechanical loading could regulate muscle-derived cell–based engineered tendon formation and maturation.

Methods:

Muscle-derived cells were isolated, expanded, and seeded onto polyglycolic acid fibers that formed a cell-scaffold complex. After in vitro culture for 2 weeks, half of them were implanted without loading and the other half were sutured to mouse fascia that could provide a natural dynamic loading. At 12 and 24 weeks after implantation, histologic examinations, ultrastructure, and biomechanical characteristics were evaluated.

Results:

Gross observation results showed that under mechanical loading, neotendon tissue could be generated with muscle-derived cells and the tissue structure became more mature with the increase of culture time. Well-organized aligned collagen fibers and elongated morphologic cells were observed on histologic examination under mechanical loading. In contrast, the nonload group failed to form neotendon, but formed disorganized fibrous tissue with significantly worse mechanical properties and poor collagen fibril structure.

Conclusions:

This study demonstrates that mechanical loading is indispensable in tendon tissue engineering with muscle-derived cells. Although muscle-derived cells have a potential advantage in neotendon regeneration, stress deprivation resulted in a distinctly inferior maturity level of engineered tendon.