bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated Approaches to Treating Lung Diseases in the Geriatric Population
Authors: Rao Seema
Published: January 2018

Structural and functional changes in the aging lung and body predispose the older patient to pulmonary diseases such as asthma, chronic obstructive pulmonary disease, and chronic dyspnea. Pulmonary diseases of the aging population have a negative impact on morbidity and mortality and quality of life and increase the burden on health care costs. Pharmacological treatment remains the standard of care, but polypharmacy in the older patients can be an issue and has been associated with negative consequences. Integrative or nonpharmacological approaches can be used in conjunction with conventional therapy and can decrease dependence on pharmacological drugs. Integrative approaches include nutrition, breathing exercises, yoga, acupuncture, use of botanicals and supplements, tai chi, and mind–body therapy. This chapter examines the evidence for integrative or nonpharmacological approaches and provides recommendations for their use in pulmonary diseases of older adults.
Neurodegenerative Diseases: Parkinson’s and Alzheimer’s Diseases
Authors: Ellenstein Aviva , Prather Christina , Kogan Mikhail
Published: January 2018

Neurodegenerative diseases increase in prevalence with aging. This chapter begins with a discussion of Parkinson’s disease. Optimally individualized treatment includes dopaminergic medications, physiotherapy, and multidisciplinary care. Evidence for integrative approaches is limited. Advances in genetics and biomarkers hold promise for subtype-specific, precision treatment in the near future. The second part of this chapter focuses on Alzheimer’s disease. Standard evaluation includes assessment for possible contributing factors that may worsen cognition, and management includes optimizing factors that may improve cognitive function. No disease-modifying medical approaches yet exist, but increasing emphasis on interventions to limit chronic inflammation and optimize brain metabolism remain fundamental in the integrative approach to Alzheimer’s disease. The new metabolic approach first described by Dr. Dale Bredesen is summarized and the importance of multidisciplinary care, with emphasis on early transition to palliative care when appropriate, is reviewed.
Falls
Authors: Dinescu Anca , Kogan Mikhail
Published: January 2018

Falls in the elderly are very common, and their frequency increases with aging. At a personal level, falls are associated with a subsequent fear of falling, a decline in function, increased nursing home placement, and increased use of medical services, and complications resulting from falls represent the leading cause of death from injury in geriatric population. At the more global level, falls in the elderly are associated with increased use of medical services and increased cost directly to the patient and also indirectly, if we add the number of hours of work lost by caregivers who will assume care of that elderly person after the fall. This chapter covers the definition and relevance of falls in the elderly population; etiology and risk factors for falls; evaluation and management; and assessment for and correction of risk factors. Integrative management approaches discussed in this chapter are movement and exercise, nutrition and supplements, and hormone replacement.
Skin, Vision, and Hearing
Authors: Seidel Ilana , Sevier Justin
Published: January 2018

Over time, organs may lose their ability to adapt to the oxidative stressors from internal and external environments. Exercise and other lifestyle factors may slow the effects of aging. This chapter focuses on changes in three organ systems: skin, vision, and hearing. Alternative recommendations are given for preventing or delaying age-related skin conditions, eye diseases, and hearing loss. Topics covered are melanoma, skin cancer, sun exposure, xerosis, pressure ulcers, cataracts, macular degeneration, glaucoma, and presbycusis. Mock case studies are provided to further explain risk factors.
Functional Laboratory Studies
Authors: Orceyre Deirdre , Mehta Ronak , Kogan Mikhail
Published: January 2018

Functional laboratory studies involve blood, urine, stool, and saliva tests that evaluate physiological function. While most conventionally used lab tests identify pathology, functional lab studies allow identification of health risks before frank pathology develops. Reference ranges of these tests are identified as “optimal” rather than by a statistical average. Functional lab testing is also used to evaluate systems as opposed to pathology—for example, comprehensive digestive analysis or functional hormone/endocrine analysis. Functional lab testing may help with the complex task of identifying food sensitivities. As the area of genomics develops, functional evaluations of an individual’s genome may provide insight into possible directions for diet, supplement, and lifestyle interventions.
Primary Care for Homebound Patients
Authors: Jayes Robert L. , Kaiser Robert M.
Published: January 2018

Home-based primary care is on the rise for several reasons: an aging population for which office-based care is less convenient, favorable changes in Medicare fee-for-service reimbursement, and a greater recognition that the care of sick homebound adults may be better done in their home. Home care practices can care for homebound patients with multiple comorbidities more efficiently, with lower costs and equivalent or superior outcomes. Home care is invaluable for individuals who may not be able to travel easily to a clinician’s office. Integrative Medicine may provide helpful treatment modalities for individuals being cared for at home—in particular, complementary treatments for common conditions such as chronic pain, falls, depression, anxiety, and insomnia. The home has also become an important educational setting in which learners can readily acquire the knowledge, skills, and attitudes that are essential in providing optimal care for complex, frail patients.
Long-Term Care/Residential Care
Authors: Lodhi Tahira I. , Alchalabi Tania
Published: January 2018

Given the increase in the geriatric population, the norms of long-term care systems will be forced to change in societies all over the world. This chapter provides an overview of the different levels of care available, from independent living to inpatient, subacute, rehab, assisted living facilities, group homes, and long-term care. A case study is provided of a couple’s declining health trajectory and worsening functional status, identifying resources that pay for various levels of care. Given that care plans must be tailored to the patient’s needs and circumstance, this review provides the foundation to build the structure of a transition or discharge plan. The use of complementary and alternative medicine in long-term care facilities is briefly covered.
Bioethical Issues in Integrative Geriatrics
Authors: Roth Katalin
Published: January 2018

Many older persons use complementary and alternative medicine (CAM), and an integrative approach is very consistent with the holistic model of geriatric “slow medicine.” Ethical practice requires an understanding of the patient’s values and goals of care. The core ethical principles of beneficence, autonomy, and justice are applied to geriatric concerns such as decision-making capacity, prognosis, and advance care planning. Informed consent requires that patients understand the goals of treatment, conventional options, and the evidence and safety of CAM therapies. Legal issues affecting CAM providers such as licensing, referrals, and malpractice are reviewed.
Integrative Palliative Care
Authors: Lee Angela , Cheng Stephanie , Lupu Dale
Published: January 2018

Integrative medicine and palliative medicine share many tenets. This chapter reviews integrative approaches to the most common symptoms needing palliation among geriatric patients at the end of life, including pain, nausea and vomiting, constipation, dyspnea, and fatigue. Several palliative care approaches to communication about patient goals and advance care planning for a time when the patient is unable to make decisions are described. Resources to support advance care planning are provided. Finally, issues that need to be addressed by either primary care geriatrics or in consultation with palliative care in the last weeks, days, and hours of life are described.
Positive Aging
Authors: Sierpina Michelle , Lunsford Beverly
Published: January 2018

While we cannot control all the factors involved in aging, there is much we can do as individuals and as a society to contribute to continued improvements in our well-being and longevity. Tomorrow’s healthy aging requires creating options for older adults by funding and providing exceptional, evidence-supported aging services within our communities. It also involves educating health care providers and older adults and their families about the most current interventions for optimizing dynamic, positive aging. Those options include creative expression through music, dance and other physical activities, art, theater, poetry, journaling, life reflection, meditation, and more. Healthy lifestyle choices can and must become a norm for positive aging.
Herpes simplex Virus
Authors: Alyazidi Raidan , Gantt Soren
Published: January 2018

Herpes simplex virus (HSV) types 1 and 2 cause several important syndromes, including congenital and perinatal infections that can cause devastating consequences in newborns (i.e., neonatal HSV). Most neonatal HSV infections are acquired intrapartum in the infected maternal birth canal. Since genital HSV infections are common, neonatal HSV is an important complication in infected women, even if maternal symptoms are absent. As a result of the developmental status of the fetal and newborn immune system, neonatal HSV infection is associated with life-threatening disease. This chapter reviews the clinical presentations of neonatal HSV infection, as well as advances in diagnosis and therapy. Skin vesicles and fever are often absent, which contributes to a delay in initiating effective therapy. Early recognition is key. Despite significant advances in diagnostic testing and antiviral treatment for neonatal HSV, morbidity and mortality remain high and no vaccine is currently available for clinical use.
Human Papillomavirus
Authors: Negari Shelly Ben-Harush , Kahn Jessica A.
Published: January 2018

Human papillomavirus (HPV) is a ubiquitous, single-stranded DNA virus that is commonly sexually transmitted and an important cause of cervical cancer. Manifestations of infection in the perinatal and childhood periods are recurrent respiratory papillomatosis (RRP) and anogenital warts (AGWs). Children with respiratory papillomatosis most commonly develop papillomas in the larynx, but papillomas may develop in any location along the respiratory tract. Although RRP is rare, it is the most common benign neoplasm of the larynx among children and the second-most-frequent cause of childhood hoarseness. AGWs are uncommon in the perinatal period and typically benign. They may develop on the vulva, hymen, vagina, urethra, or perianal area in girls and on the perianal area in boys. The clinical manifestations, epidemiology, diagnostic studies, and management strategies pertinent to these infections are reviewed.
Zika Virus
Authors: Read Jennifer S.
Published: January 2018

Although generally asymptomatic or mildly symptomatic in the general population, infection with the Zika virus (ZIKV) during pregnancy may lead to severely adverse fetal and infant outcomes, including the congenital Zika syndrome (CZS). Characteristics of this syndrome that are unique to it or are not typically observed with other congenital infections comprise anomalies of the brain and cranial morphology, ocular anomalies, congenital contractures, and neurological sequelae. The full spectrum of outcomes of mother-to-child transmission (MTCT) of ZIKV appears to be large, ranging from asymptomatic infection at birth, with possible later manifestation of significant abnormalities, to obvious and severe abnormalities in the fetus and infant. Although our understanding of pathogenesis, rates, and manifestations of CZS has improved rapidly and dramatically, much remains unknown or poorly understood regarding this potentially devastating congenital infection. Because of this, a broad research agenda regarding ZIKV is being implemented.
Ethical Issues Related to Religious Considerations in Psychiatric Diagnosis
Authors: Josephson Allan M.
Published: January 2018

Diagnosis in psychiatry connotes thoroughly knowing the patient. This diagnostic approach of necessity includes consideration of the patient’s religious, spiritual, and worldview perspectives and commitments. This chapter reviews the clinical relevance of these considerations in dealing with moral distress, a loss of meaning, concerns about autonomy in relation to authority, and disordered behavior (e.g., personality disorders, conduct disorder). As the basis for effective treatment, diagnosis has important ethical implications. Harmful misdiagnosis can result from a truncated view of the person, from religious or pharmacological bias, or from cultural pressures to conform. This complexity requires clinicians to be aware of the influence of their own commitments. Both clinical observations and research efforts suggest that taking religion, spirituality, and worldview into account in making a diagnosis is congruent with ethical practice: It is good for the patient and can be done without doing harm.
Forensic Psychiatry
Authors: Norko Michael A.
Published: January 2018

This chapter represents a first effort at exploring ethics concerns at the intersections of forensic psychiatry and religion. It surveys several areas where this convergence occurs: criminal cases in which religious delusions of the defendant figured prominently in the defense; civil cases involving the right to refuse treatment secondary to religious beliefs; the complexities of applying empathy to forensic evaluations where the physician’s task is not focused on healing the individual; the challenges of permitting certain forms of religious practice in maximum security forensic hospitals; and the interplay of constructs of forgiveness, reconciliation, remorse, and insight in treating persons found not guilty by reason of mental illness of serious, violent crimes. The choice of these particular topics is not meant to exhaust the conjunction of these interdisciplinary interests but hopefully provides a place to begin their consideration.
Ethical Considerations Regarding Religion/Spirituality in Psychiatric Research
Authors: Moreira-Almeida Alexander , Cordeiro Quirino , Koenig Harold G.
Published: January 2018

Research on religious/spiritual needs to follow all international guidelines for studies involving human subjects. However, some specific aspects related to ethical controversies are discussed here. First is the ethical duty to study religious/spiritual in psychiatry, since it impacts mental health and is a topic valued by psychiatric patients. Second is the ethics of performing interventions involving spirituality (e.g., to develop a patient’s spirituality or change negative religious coping): What is the limit? Third is bias and conflict of interest based on spiritual/anti-spiritual view of the researcher or clinician; this includes the obligation to publish findings irrespective of whether they support the views held by researchers, supporters, or society. Fourth is the need to respect patients’ religious/spiritual in designing and discussing a study. And fifth is dealing with sensationalism or distortion in media coverage of scientific findings regarding religious/spiritual.
Overview and epidemiology
Authors: Limaye Vidya Sadanand
Published: January 2018

The term idiopathic inflammatory myopathies (IIM) encompasses a heterogeneous group of muscle-dominant systemic autoimmune syndromes, including polymyositis (PM), dermatomyositis (DM), sporadic inclusion body myositis (sIBM), and immune-mediated necrotizing myopathy (IMNM). The reported incidence of IIM ranges from 5 to 10 × 10–6. Patients with PM, DM, and IMNM characteristically present with the insidious onset of symmetric proximal weakness, while in sIBM the weakness can be asymmetric, and involve the distal upper limbs and quadriceps. Dermatomyositis may also be accompanied by a range of cutaneous manifestations. Raised serum creatine kinase levels, the presence of characteristic myositis-specific antibodies, myopathic triad on electromyography, and myoedema on muscle magnetic resonance imaging are helpful in supporting a diagnosis of IIM. Muscle biopsy is the definitive diagnostic test and serves to distinguish subsets of disease, which each have characteristic histopathological changes reflecting underlying differences in pathogenesis. Mortality remains elevated in patients with IIM, despite the advent of immunosuppressive therapies.
Association with malignancy
Authors: Selva-O’Callaghan Albert , Trallero-Araguás Ernesto
Published: January 2018

Nearly one-third of adult myositis patients additionally have some type of associated cancer, observed most commonly in dermatomyositis patients. The relationship between cancer and myositis is generally considered a paraneoplastic phenomenon; that is, in one way or another, the two conditions are related. A parallel course of the diseases—myositis improves after cancer is cured and when cancer recurs, myositis worsens—is considered a classical paraneoplastic criterion. Nevertheless, this parallel clinical course does not always occur in true cancer-associated myositis, or perhaps it cannot be seen because of the interference of therapy. Based on epidemiologic studies, the current gold standard for the diagnosis of cancer-associated myositis is a temporal criterion: diagnosis of the two diseases within a 3-year period, although to a certain extent, this is an arbitrary standard.
Imaging of skeletal muscle
Authors: Pipitone Nicolo
Published: January 2018

Imaging techniques play a key role in the assessment of patients with the idiopathic inflammatory myopathies (IIM). Magnetic resonance imaging (MRI) can reveal muscle inflammation similarly to muscle scintigraphy and 18F-Fluorodeoxyglucose positron emission tomography, but is also able to visualize findings of chronic muscle damage such as muscle atrophy or fat replacement. Ultrasonography has a more limited role because it can only depict the superficial muscle layers. Imaging findings are not specific to IIM, but in the appropriate clinical context they support the diagnosis. MRI is also useful to target biopsy to affected muscles, thus increasing biopsy yield. In addition, because different myopathies present with different patterns of muscle involvement, imaging studies can provide differential diagnostic clues. Finally, imaging studies—especially MRI—can be used to monitor the effects of treatment by serially evaluating changes in muscle inflammation and damage.
Treatment of the idiopathic inflammatory myopathies
Authors: Mann Heřman , Vencovský Jiří
Published: January 2018

The management of idiopathic inflammatory myopathies (IIM) poses a challenge due to disease heterogeneity, variable responses to treatment and limited data from controlled studies. High dose glucocorticoids, often combined with other immunosuppressive drugs, represent the most common pharmacotherapeutic approach. The importance of early commencement of supervised exercise is also stressed. In treatment resistant cases, the introduction of drug combinations is recommended, and intravenous immunoglobulins may also be effective. Currently available data do not support use of most biological agents in the treatment of IIM, except possibly rituximab, which appears potentially effective in patients with myositis specific autoantibodies. The presence of organ involvement should prompt more aggressive treatment. A multidisciplinary approach should be adopted in most IIM patients.
Bosnia and Herzegovina
Authors: Karkin-Tais Amira
Published: January 2018

Bosnia and Herzegovina is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Denmark
Authors: Handberg Gitte , Palsson Thorvaldur Skuli
Published: January 2018

Denmark is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Greece
Authors: Anastassiou Emmanouil P.
Published: January 2018

Greece is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Kosovo
Authors: Bytyqi Adem , Bytyqi Agron , Sylaj Bashkim
Published: January 2018

Kosovo is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Portugal
Authors: Valentim Ana , Ferreira Pedro
Published: January 2018

Portugal is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Russia
Authors: Yakhno Nikilay N. , Kukushkin Michael L. , Churyukanov Maxim V.
Published: January 2018

Russia is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
San Marino
Authors: Battelli Daniele
Published: January 2018

San Marino is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Slovakia
Authors: Kulichová Marta
Published: January 2018

Slovakia is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Sweden
Authors: Bjarnegård Anna , Carlsson Carina , Gåve Eva , Karlsten Rolf , Lindbäck Malin , Persson Elisabeth , Ernberg Malin
Published: January 2018

Sweden is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
United Kingdom
Authors: Taylor Ann
Published: January 2018

Ukraine is a member of the European Pain Federation (EFIC). The national pain society works to support the needs of patients with pain, including those with acute pain, chronic pain, cancer pain, pain in later life, and at the end of life. In this chapter of European Pain Management we describe first the geography and history of the country as it relates to the recent demographics of the population, the prevalence of pain and needs for pain management, the pain workforce and its organization, the system pain specialists work within, and specific issues that have been tackled to improve the delivery of pain care. An example of recent innovation is also described.
Pain in later life
Authors: Pickering Gisèle
Published: January 2018

The population of Europe is ageing, caused by fewer births and increased longevity. Increasingly the demand for pain assessment and treatment will change and the patients requesting help will present with more complex demands. In this chapter of European Pain Management we focus on the need for translational research, evidence-based randomized clinical trials, and non-pharmacological approaches in older persons, to assess the real-life risk/benefit ratio of recommendations in a context of multiple medication, co-morbidity, cognitive impairment, and frailty. It is essential to study the cognitive and emotional consequences of pain and analgesia in older persons, who are often prone to depression, and to improve their quality of life. Therapeutic education must be developed for older patients, who often have a fatalistic attitude toward pain, with age-related expectations and demands. Pain prevention remains the key to avoiding the consequences of pain, maintaining autonomy, and enabling healthy ageing.
European pain management: Future directions
Authors: Eccleston Christopher , Wells Christopher , Morlion Bart
Published: January 2018

In this final chapter of European Pain Management the editors summarize what has been learned from taking stock of the experiences in the 37 countries. There are common issues, such as the need to keep pace with the change in demand as demographics change, the requirements for creating specialty status in pain management, and the need to update and innovate with new methods and new science, and the challenges of working within different policy requirements, especially in regard to the control of medicines. There are examples of innovation in practice in all countries. Finally, we discuss the need for greater planning across Europe in order to innovate novel, sustainable models of the organization and delivery of care.
The brain as the subject’s heir?
Authors: Fuchs Thomas
Published: January 2018

‘The brain as the subject’s heir?’ critiques the claims according to which subjectivity is to be regarded as an epiphenomenon of neuronal processes and thus one’s experience of agency and freedom of choice should be seen as an illusion. First it is shown that the subjectivity of ‘experiential facts’ cannot be reduced to objective or physical facts about brain processes. Likewise, the reduction of the intentionality of consciousness to relations of representation is refuted. Moreover, the identification of the subject with the brain leads to fundamental category mistakes which are examined as the ‘mereological fallacy’ and the ‘localization fallacy’. On this basis, a critique of the thesis of the powerlessness of the subject is developed. The summary analyses the basic ‘naturalistic fallacy’ of an objectifying account of consciousness which believes it can remove itself from its rootedness in the lifeworld.
The brain as an organ of the person
Authors: Fuchs Thomas
Published: January 2018

‘The brain as an organ of the person’ examines the socially and culturally scaffolded development of the human brain, especially in early childhood. Beginning with early intersubjectivity and intercorporeality in the mother–child relationship, it first focuses on interactive forms of implicit memory. As a neurological basis of this development, the attachment system and the social resonance system (‘mirror neurons’) are discussed. Secondary intersubjectivity manifests itself towards the end of the first year of life, among others, in the development of joint attention. Understanding others as intentional agents lays the foundation for later perspective-taking and thus for the ‘eccentric position’ of human beings. On this basis, language acquisition is examined as the anchoring of an embodied interpersonal practice, connected with the biological resonance system of mirror neurons.
Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Glioblastoma of the Corpus Callosum
Authors: Beaumont Thomas L , Mohammadi Alireza M , Kim Albert H , Barnett Gene H , Leuthardt Eric C
Published: January 2018

BACKGROUND

Glioblastoma of the corpus callosum is particularly difficult to treat, as the morbidity of surgical resection generally outweighs the potential survival benefit. Laser interstitial thermal therapy (LITT) is a safe and effective treatment option for difficult to access malignant gliomas of the thalamus and insula.

OBJECTIVE

To assess the safety and efficacy of LITT for the treatment of glioblastoma of the corpus callosum.

METHODS

We performed a multicenter retrospective analysis of prospectively collected data. The primary endpoint was the safety and efficacy of LITT as a treatment for glioblastoma of the corpus callosum. Secondary endpoints included tumor coverage at thermal damage thresholds, median survival, and change in Karnofsky Performance Scale score 1 mo after treatment.

RESULTS

The study included patients with de novo or recurrent glioblastoma of the corpus callosum (n = 15). Mean patient age was 54.7 yr. Mean pretreatment Karnofsky Performance Scale score was 80.7 and there was no significant difference between subgroups. Mean tumor volume was 18.7 cm3. Hemiparesis occurred in 26.6% of patients. Complications were more frequent in patients with tumors >15 cm3 (RR 6.1, P = .009) and were associated with a 32% decrease in survival postLITT. Median progression-free survival, survival postLITT, and overall survival were 3.4, 7.2, and 18.2 mo, respectively.

CONCLUSION

LITT is a safe and effective treatment for glioblastoma of the corpus callosum and provides survival benefit comparable to subtotal surgical resection with adjuvant chemoradiation. LITT-associated complications are related to tumor volume and can be nearly eliminated by limiting the procedure to tumors of 15 cm3 or less.
A Single Center, Prospective, Randomized, Sham-Controlled, Double-Blinded, Split-Face Trial Using Microinjections of Transparent Hyaluronic Acid Gel for Cheek Rejuvenation
Authors: Jones Isabela T. , Vanaman Wilson Monique J. , Bolton Joanna , Zaleski-Larsen Lisa , Wu Douglas C. , Goldman Mitchel P.
Published: January 2018

BACKGROUND

“Skin boosting” with injections of hyaluronic acid has been demonstrated to improve aged skin.

OBJECTIVE

The aim of this study was to determine the efficacy and safety of small-particle hyaluronic acid with lidocaine (SP-HAL) microaliquots for the correction of fine lines of the cheeks.

MATERIALS AND METHODS

Twenty subjects with mild to moderate static mid to lower cheek rhytides were enrolled. The right or left cheek was randomized to receive 1 mL of SP-HAL using a microdroplet technique, with the contralateral cheek treated with sham injection of sterile normal saline. The degree of cheek wrinkling and elastosis based on the Fitzpatrick-Goldman Wrinkle and Elastosis Scale was assessed at baseline and 7, 14, 30, 90, and 180 days after treatment. Subjects rated their satisfaction at days 90 and 180.

RESULTS

Fourteen patients completed the study. There were no statistically significant improvements in wrinkling or elastosis of the SP-HAL–treated cheek or control cheek at any time point. In addition, there were no significant differences in wrinkling, elastosis, or patient satisfaction between the treatment cheek and control cheek.

CONCLUSION

One treatment of intradermal microdroplet injections of SP-HAL to the mid to lower cheek failed to show superiority over normal saline in improving clinical signs of skin wrinkling and elastosis.
The Effects of Postoperative Intralesional Corticosteroids in the Prevention of Recurrent Earlobe Keloids: A Multispecialty Retrospective Review
Authors: Gold Daniel A. , Sheinin Renee , Jacobsen Gordon , Jones Lamont R. , Ozog David M.
Published: January 2018

BACKGROUND

Effective treatment of keloids is challenging because the recurrence rate after surgical excision is high. Data on the best treatment practices are lacking.

OBJECTIVE

To investigate the recurrence rate after surgical excision of earlobe keloids based on a postoperative intralesional corticosteroid injection protocol.

MATERIALS AND METHODS

Retrospective chart review was performed from January 1, 2005, to March 31, 2016, of patients who had excision of ear keloids within the departments of dermatology, otorhinolaryngology, and plastic surgery. The number of postoperative injections was recorded, recurrence was reported by the patient, and the efficacy of an injection protocol was evaluated.

RESULTS

There were 277 charts reviewed. Appropriate data were available for 184 patients. A statistically significant difference was found with recurrence associated with a lower number of injections (p < .001). Keloids were more likely to recur if they were not treated with a planned serial injection protocol (p < .001) or if they were treated outside the department of dermatology (p < .001).

CONCLUSION

Intralesional corticosteroid injection after surgical excision of earlobe keloids statistically minimizes the risk of recurrence.
Association between HIV status and psychological symptoms in perimenopausal women
Authors: Looby Sara E. , Psaros Christina , Raggio Greer , Rivard Corinne , Smeaton Laura , Shifren Jan , Grinspoon Steven , Joffe Hadine
Published: January 2018

Objective:

HIV-infected women are burdened by depression and anxiety, which may impact adherence to antiretroviral therapy and overall quality of life. Yet, little is known about the scope of psychological symptoms in the growing number of HIV-infected women reaching menopause, when affective symptoms are more prevalent in the general population. We conducted a longitudinal study to compare affective symptoms between perimenopausal HIV-infected and non-HIV-infected women.

Methods:

The Center for Epidemiologic Studies Depression Scale (CES-D), and the Generalized Anxiety Disorder scale (GAD-7) were completed at baseline and 12 months among 33 HIV-infected and 33 non-HIV-infected perimenopausal women matched by race, age, menstrual patterns, and BMI. Linear regression models estimated the relationship of baseline GAD-7 and CES-D scores with clinical factors.

Results:

All women were perimenopausal at baseline, and the vast majority remained perimenopausal throughout follow-up. HIV status was associated with higher baseline CES-D scores (median [interquartile range] 21 [12, 29] vs 10 [5, 14]; P = 0.03) and GAD-7 scores (7 [5, 15] vs 2 [1, 7]; P = 0.01), controlling for smoking, substance use, and antidepressant use. Depressive symptoms and anxiety remained significantly higher in the HIV-infected women at 12 months (P ≤ 0.01). Significant relationships of depressive symptoms (P = 0.048) and anxiety (P = 0.02) with hot flash severity were also observed.

Conclusions:

Perimenopausal HIV-infected women experienced a disproportionately high level of affective symptom burden over a 12-month observation period. Given the potential for these factors to influence adherence to HIV clinical care and quality of life, careful assessment and referral for treatment of these symptoms is essential.
Hormone therapy and urine protein excretion: a multiracial cohort study, systematic review, and meta-analysis
Authors: Kattah Andrea G. , Suarez Maria L.G. , Milic Natasa , Kantarci Kejal , Zeydan Burcu , Mosley Thomas , Turner Stephen T. , Ware Erin B. , Kardia Sharon L.R. , Garovic Vesna D.
Published: January 2018

Objective:

Experimental models suggest estrogen has a renoprotective effect, but human studies show variable results. Our objective was to study the association of hormone therapy (HT) and albuminuria in postmenopausal women and to synthesize the results with outcomes from prior studies.

Methods:

We analyzed data from postmenopausal women who participated in the second study visit (2000-2004) of the Genetic Epidemiology Network of Arteriopathy (GENOA) study. The exposure was self-reported HT use and the outcome was albuminuria (urine albumin-to-creatinine ratio >25 mg/g creatinine). We also conducted a systematic review and meta-analysis on the association of HT and urine protein in postmenopausal women. Continuous and dichotomous measures of protein excretion were converted to a standardized mean difference (SMD) for each study.

Results:

In the GENOA cohort (n = 2,217), there were fewer women with albuminuria among HT users than nonusers (9% vs 19%, P < 0.001). HT use was associated with decreased odds of albuminuria (odds ratio 0.65, 95% confidence interval (CI), 0.45-0.95), after adjusting for significant differences in age, race, education, comorbidities, and the age at and cause of menopause. The SMD of the effect of HT on urine proteinuria/albuminuria in the randomized control trials (n = 3) was 0.02 (95% CI, −0.29 to 0.33) and −0.13 (95% CI, −0.31 to 0.05) in the observational studies (n = 9). There was significantly less albuminuria among HT users (SMD −0.15, 95% CI, −0.27 to −0.04) in the 9 studies that only reported albuminuria as an outcome and in the 10 studies with a comparator arm (SMD −0.15, 95% CI, −0.26 to −0.04).

Conclusions:

HT is associated with decreased odds of albuminuria, but some of the observed benefits may be related to reported outcomes, the presence of a comparator arm, and the type of study design.
What's in a name: are menopausal “hot flashes” a symptom of menopause or a manifestation of neurovascular dysregulation?
Authors: Miller Virginia M. , Kling Juliana M. , Files Julia A. , Joyner Michael J. , Kapoor Ekta , Moyer Ann M. , Rocca Walter A. , Faubion Stephanie S.
Published: January 2018

Hot flashes have typically been classified as “symptoms of menopause” that should be tolerated or treated until they resolve. However, mounting evidence points to hot flashes as a manifestation of one or several underlying pathophysiological processes. Associations exist between the presence, timing of onset, severity, and duration of hot flashes, and the risk of several neurological (affecting sleep, mood, and cognition) and cardiovascular conditions. In addition, four consistent patterns of vasomotor disturbances have been identified across different countries, making it unlikely that these patterns are solely explained by socioeconomic or cultural factors. The changing hormonal environment of menopause may unmask differences in the autonomic neurovascular control mechanisms that put an individual woman at risk for chronic conditions of aging. These differences may have a genetic basis or may be acquired across the life span and are consistent with the variability of the clinical manifestations of aging observed in women after bilateral oophorectomy. It is time to investigate the pathophysiological mechanisms underlying the four patterns of vasomotor symptoms more closely, and to shift from describing hot flashes as symptoms to be tolerated to manifestations of an underlying autonomic neurovascular dysregulation that need to be addressed.
Mandibulofacial dysostosis Guion-Almeida type caused by novel EFTUD2 splice site variants in two Asian children
Authors: Yu Kris P.T. , Luk Ho-Ming , Gordon Christopher T. , Fung Genevieve , Oufadem Myriam , Garcia-Barcelo Maria M. , Amiel Jeanne , Chung Brian H.Y. , Lo Ivan F.M. , Tiong Yang Tan
Published: January 2018

Mandibulofacial dysostosis type Guion-Almeida (MFDGA) is a rare disease entity that results in congenital craniofacial anomalies that are caused by abnormal development of the first and second pharyngeal arches. MFDGA is characterized by malar and mandibular hypoplasia, microcephaly, developmental delay, dysplastic ears, and a distinctive facial appearance. Extracraniofacial malformations include esophageal atresia, congenital heart disease, and radial ray abnormalities. Heterozygous mutations in the elongation factor Tu GTP-binding domain containing 2 (EFTUD2) gene have been shown to result in MFDGA. To date, there have been a total of 108 individuals reported in the literature, of whom 95 patients have a confirmed EFTUD2 mutation. The majority of individuals reported in the literature have been of White ethnic origin. Here, we report two individuals of Asian ancestry with MFDGA, each harboring a novel, pathogenic splice site variant in EFTUD2.
Abdominal prehospital ultrasound impacts treatment decisions in a Dutch Helicopter Emergency Medical Service
Authors: Ketelaars Rein , Holtslag Jasper J.M. , Hoogerwerf Nico
Published: January 2018

Objective

The aim of this study was to determine the impact of abdominal prehospital ultrasound (PHUS) on patient care in a Dutch physician-staffed Helicopter Emergency Medical Service (HEMS) and to determine its diagnostic performance.

Patients and methods

We carried out a retrospective analysis of abdominal ultrasound (US) examinations performed by the HEMS of Nijmegen, the Netherlands, from January 2007 until December 2016. Data including patient demographics, type of incident, abdominal US findings, impact on treatment decisions, and the physicians’ narrative report were retrieved from the HEMS database and analyzed. PHUS diagnostic performance was compared with computed tomography scan or laparotomy.

Results

Of 17 077 recorded scrambles and 8699 patients treated, 1583 underwent 1631 abdominal US examinations. After eliminating missing data, 251 impacts on treatment in 194 out of 1539 PHUS examinations were identified (12.6%, 95% confidence interval: 10.9–14.3). This affected 188 out of 1495 (12.6%) patients. The four main categories of treatment decisions impacted by PHUS were information provided to the destination hospital (45.4%); mode of transportation (23.5%); choice of destination hospital (13.1%); and fluid management (11.6%). The sensitivity of prehospital abdominal US for hemoperitoneum was 31.3%, specificity was 96.7%, and accuracy was 82.1%.

Conclusion

Abdominal PHUS in our setting impacts treatment decisions significantly. Therefore, it is a valuable tool in the Dutch HEMS setting and probably beyond.
Predictors of Caregiver Distress in the Community Setting Using the Home Care Version of the Resident Assessment Instrument
Authors: Pauley Tim , Chang Byung Wook , Wojtak Anne , Seddon Gayle , Hirdes John
Published: January 2018

Purpose of Study:

The purpose of this study was to identify factors predictive of new onset and improved caregiver distress among informal caregivers providing assistance for clients receiving home care.

Primary Practice Settings:

Home care.

Methodology and Sample:

The sample included 323,409 clients receiving home care from a Community Care Access Centre between March 2002 and March 2015 for whom data were available from two subsequent Resident Assessment Instrument-Home Care (RAI-HC) assessments. Separate multivariate logistic regression models were created for onset of and improvement in caregiver distress.

Results:

Variables that increase the odds in onset of caregiver distress included primary caregiver is not satisfied with support received from family and friends; client lives with primary caregiver; 65 years and older; has Alzheimer and other related dementia; has condition or disease that makes cognition, activities of daily living, mood, or behavior patterns unstable; took sedatives in the last 7 days; Method for Assigning Priority Levels (MAPLe) score 4 or more; demonstrates persistent anger; has difficulty using the telephone; is married; requires 20 hr or more of informal help weekly; and Clinical Risk Scale score 4 or more. Variables that increased the odds of improved caregiver distress include client now lives with other persons (as compared with 90 days ago); demonstrates good prospects for recovery; treatment changes in last 30 days; surgical wound; female; one or more hospital visits in last 90 days; greater number of months between RAI-HC assessments; and two or more hours of physical activities in the last 3 days. Variables that decreased the odds of improved caregiver distress (i.e., persistent distress) include MAPLe score 4 or more; persistent anger; difficulty using telephone; Alzheimer, related dementia; requires interpreter; and lives with primary caregiver.

Implications for Case Management Practice:

Informal caregivers provide essential support for home care clients. Factors predictive of new onset and improved caregiver distress can be used by case managers for comprehensive care planning that addresses the collective needs of the client–caregiver dyad.