bluuebunny/crossref_metadata_2025 huggingface dataset:
Ozone-Induced Dysregulation of Neuroendocrine Axes Requires Adrenal-Derived Stress Hormones
Authors: Henriquez Andres R , House John S , Snow Samantha J , Miller Colette N , Schladweiler Mette C , Fisher Anna , Ren Hongzu , Valdez Matthew , Kodavanti Prasada R , Kodavanti Urmila P
Published: August 2019

Acute ozone inhalation increases circulating stress hormones through activation of the sympathetic-adrenal-medullary and hypothalamic-pituitary-adrenal axes. Rats with adrenalectomy (AD) have attenuated ozone-induced lung responses. We hypothesized that ozone exposure will induce changes in circulating pituitary-derived hormones and global gene expression in the brainstem and hypothalamus, and that AD will ameliorate these effects. Male Wistar-Kyoto rats (13 weeks) that underwent sham surgery (SHAM) or AD were exposed to ozone (0.8 ppm) or filtered-air for 4 h. In SHAM rats, ozone exposure decreased circulating thyroid-stimulating hormone (TSH), prolactin (PRL), and luteinizing hormone (LH). AD prevented reductions in TSH and PRL, but not LH. AD increased adrenocorticotropic hormone approximately 5-fold in both air- and ozone-exposed rats. AD in air-exposed rats resulted in few significant transcriptional differences in the brainstem and hypothalamus (approximately 20 genes per tissue). In contrast, ozone-exposure in SHAM rats resulted in either increases or decreases in expression of hundreds of genes in the brainstem and hypothalamus relative to air-exposed SHAM rats (303 and 568 genes, respectively). Differentially expressed genes from ozone exposure were enriched for pathways involving hedgehog signaling, responses to alpha-interferon, hypoxia, and mTORC1, among others. Gene changes in both brain areas were analogous to those altered by corticosteroids and L-3,4-dihydroxyphenylalanine, suggesting a role for endogenous glucocorticoids and catecholamines. AD completely prevented this ozone-induced transcriptional response. These findings show that short-term ozone inhalation promotes a shift in brainstem and hypothalamic gene expression that is dependent upon the presence of circulating adrenal-derived stress hormones. This is likely to have profound downstream influence on systemic effects of ozone.
Health-related Quality of Life With Ulipristal Acetate for Treatment of Uterine Leiomyomas: A Randomized Controlled Trial
Authors: Lukes Andrea S. , Soper David , Harrington Amanda , Sniukiene Vilma , Mo Yifan , Gillard Patrick , Shulman Lee
Published: August 2019

(Abstracted from Obstet Gynecol 2019;133:869–878)

A significant health issue for women in the United States is the occurrence of uterine leiomyomas. The estimated cumulative incidence of uterine leiomyomas by age 50 years is more than 80% in black women and nearly 70% in white women.
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
Authors: van der Pol Liselotte M. , Tromeur Cecile , Bistervels Ingrid M. , Ni Ainle Fionnuala , van Bemmel Thomas , Bertoletti Laurent , Couturaud Francis , van Dooren Yordi P. A. , Elias Antoine , Faber Laura M. , Hofstee Herman M. A. , van der Hulle Tom , Kruip Marieke J. H. A. , Maignan Maxime , Mairuhu Albert T. A. , Middeldorp Saskia , Nijkeuter Mathilde , Roy Pierre-Marie , Sanchez Olivier , Schmidt Jeannot , ten Wolde Marije , Klok Frederikus A. , Huisman Menno V.
Published: August 2019

(Abstracted from N Engl J Med 2019;380:1139–1149)

Acute pulmonary embolism is one of the leading causes of maternal death, with the overall incidence reported to be 1.72 cases per 1000 deliveries, accounting for approximately 1 death in every 100,000 deliveries. Since the d-dimer test has low specificity and sensitivity, it is common for pregnant women with suspected pulmonary embolism to undergo computed tomography (CT) pulmonary angiography or ventilation-perfusion (V/Q) scanning, both of which involve radiation exposure to the mother and fetus.
A Randomized Trial of Progesterone in Women With Bleeding in Early Pregnancy
Authors: Coomarasamy Arri , Devall Adam J. , Cheed Versha , Harb Hoda , Middleton Lee J. , Gallos Ioannis D. , Williams Helen , Eapen Abey K. , Roberts Tracy , Ogwulu Chriscasimir C. , Goranitis Ilias , Daniels Jane P. , Ahmed Amna , Bender-Atik Ruth , Bhatia Kalsang , Bottomley Cecilia , Brewin Jane , Choudhary Meenakshi , Crosfill Fiona , Deb Shilpa , Duncan W. Colin , Ewer Andrew , Hinshaw Kim , Holland Tom , Izzat Feras , Johns Jemma , Kriedt Kathiuska , Lumsden Mary-Ann , Manda Padma , Norman Jane E. , Nunes Natalie , Overton Caroline E. , Quenby Siobhan , Rao Sandhya , Ross Jackie , Shahid Anupama , Underwood Martyn , Vaithilingam Nirmala , Watkins Linda , Wykes Catherine , Horne Andrew , Jurkovic Davor
Published: August 2019

(Abstracted from N Engl J Med 2019;380:1815–1824)

The hormone progesterone plays a critical role in preparing the endometrium for implantation of the embryo and continues to be produced throughout pregnancy. Historically, progesterone supplementation has been initiated during early pregnancies to prevent miscarriages in asymptomatic women who have a history of recurrent miscarriages or to rescue a pregnancy in women who have started to bleed during early pregnancy.
Extreme Risk Protection Orders: An Opportunity to Improve Gun Violence Prevention Training
Authors: Gondi Suhas , Pomerantz Alexander G. , Sacks Chana A.
Published: August 2019

States are increasingly enacting extreme risk protection order (ERPO) laws, also known as “red flag” or gun violence restraining order laws, as one part of a multidisciplinary approach to address the national gun violence epidemic. Passed into law in more than 10 states and under consideration by legislatures in approximately 30 others, ERPO laws create a legal process to temporarily remove firearms from people who may pose a risk to themselves or others. By enabling family or household members, law enforcement, and, in some cases, health care professionals to petition courts when they are concerned about a potential crisis, these laws can potentially prevent firearm-related violence and save lives. Most states with ERPO laws do not give health care professionals a direct role in filing petitions; still, physicians may serve as a resource for patients or their families by counseling on firearm safety and raising awareness of this legal pathway. In this way, the success of ERPO laws depends, in part, on the ability of physicians to accurately assess risk. However, physicians are often not proficient in making these types of risk assessments, largely because of insufficient training, particularly in the context of firearm-related violence. The authors review the literature on physician skill in violence-related risk assessment, medical education in gun violence prevention, and the capacity for training to improve such risk assessments. The authors then make recommendations for integrating focused gun violence prevention training into undergraduate, graduate, and continuing medical education, reviewing notable examples.
The Inevitable Interim: Transitional Leaders in Academic Medicine
Authors: Merritt Chris , Clyne Brian
Published: August 2019

This Invited Commentary calls attention to the growing phenomenon of interim leadership, temporary leadership during which a permanent leader is sought, in academic medicine and the gap in intentional, formal leadership training of future health care leaders. The authors consider interim leadership from the perspectives of the organization, the appointing authority, and the interim leader. The authors highlight a fundamental challenge facing interim leaders—providing stability during periods of significant change. They also stress the strategic importance of interim periods and the need for succession planning within academic medicine organizations. Drawing on personal experiences and existing literature, the authors offer a 4-stage framework for considering interim leadership at academic medicine organizations and strategies for success at each stage: (1) expectations and exploration, (2) adjusting expectations, (3) accommodation, and (4) phasing out. This Invited Commentary is intended to serve as a resource for interim leaders, those responsible for appointing them, and the organizations they are called upon to lead.
Consensus on the Role of Antibiotic Use in SSI Following Spinal Surgery
Authors: Kepler Christopher K. , Divi Srikanth N. , Russo Glenn S. , Segar Anand H. , Boody Barrett S. , Bronson Wesley H. , Tarazona Daniel A. , Cifuentes Elizabeth , Asma Ali , Galetta Matthew S. , Goyal Dhruv K.C. , Fang Taolin , Schroeder Gregory D. , Vaccaro Alexander R.
Published: August 2019

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Development of a Peer Support Model Using Experience-Based Co-Design to Improve Critical Care Recovery
Authors: Haines Kimberley J. , Holdsworth Clare , Cranwell Kathryn , Skinner Elizabeth H , Holton Sara , MacLeod-Smith Belinda , Bates Samantha , Iwashyna Theodore J. , French Craig , Booth Sarah , Carmody Jacki , Henningham Lucy , Searle Grey , Shackell Melina , Maher Lynne
Published: August 2019

Objectives:

To use experience-based co-design to identify the key design requirements of a peer support model for critical care survivors; understand the use of the experience-based co-design method from clinician, patients, and family perspectives.

Design:

Using experience-based co-design, qualitative data about participants’ preferences for a peer support model were generated via workshops. Participants’ perspectives of experience-based co-design were evaluated with focus groups.

Setting:

University-affiliated hospital in Melbourne, Australia.

Subjects:

Snowball sampling was used to recruit clinicians from across the care spectrum (ICU-community); critical care survivors and nominated family members were recruited using convenience sampling.

Measurements and Main Results:

Consensus on a peer support model was reached through the experience-based co-design process, with the following key themes: 1) socialization and group cohesion; 2) management of potential risks; and 3) individualized needs of patients and families. Evaluation of participants’ perspectives of the experience-based co-design method identified five key themes: 1) participation as a positive experience; 2) emotional engagement in the process; 3) learning from patients and family members; 4) feeling heard; and 5) practical challenges of experience-based co-design and readiness to participate.

Conclusions:

Experience-based co-design was a feasible approach to developing a peer support model for use with critical care survivors and was well received by participants. Future testing of the co-designed peer support model in a pilot randomized controlled trial will enhance understanding of peer support in critical care and the use of experience-based co-design as a design methodology.
Should Every Patient With Atrial Fibrillation and a CHA2DS2-VASc Score of 1 Be Anticoagulated? A Systematic Review of 37,030 Patients
Authors: Neefs Jolien , Klamer Thomas A. , Krul Sébastien P. J. , de Groot Joris R.
Published: August 2019

Patients with atrial fibrillation (AF) are at risk of thromboembolic events. The CHA2DS2-VASc (congestive heart failure, hypertension, age 65–74, diabetes, female sex and vascular disease, which all count for 1 point, and previous transient ischemic stroke/stroke or age ≥ 75 years, which count for two points) score stratifies this risk and consequently indicates whether anticoagulation is required but leaves room for debate regarding patients with a CHA2DS2-VASc score of 1, irrespective of sex. A score of 1, irrespective of sex, is derived from varying risk factors and may represent different risks. We systematically searched PubMed from inception to July 31, 2017, for studies describing thromboembolic risk per risk factor of the CHA2DS2-VASc score in patients with AF not treated with an anticoagulant. Two independent reviewers selected, appraised, and extracted the data to determine the thromboembolic risk per risk factor. Per study, risk factors were ranked for highest through lowest risk. Five studies were included, comprising 37,030 subjects with a CHA2DS2-VASc score of 1. Numerically, the highest event rates were seen in patients without comorbidities, but aged 65–74 years, while event rates in patients with vascular disease tended to be the lowest. Age 65–74 years is associated with the highest risk, hazard ratios ranging from 1.9 (95% confidence interval, 1.7–2.1) to 3.9 (95% confidence interval, 2.3–6.6), while comorbid cardiovascular conditions are associated with lower, but still considerably increased, risks. The thromboembolic risk differed between the risk factors of the CHA2DS2-VASc score in patients with AF, with age 65–74 years associated with the highest and most consistent risk. However, all show a significantly and clinically relevant increased thromboembolic risk. Besides the differences between risk factors of the CHA2DS2-VASc score, differences within risk factors may also alter stroke risk.
Transitions, Suicidality, and Underappreciated Autism Spectrum Disorder in a High School Student
Authors: Ignaszewski Martha J. , Munshi Kaizad , Fogler Jason , Augustyn Marilyn
Published: August 2019

CASE:

Alex is a 14-year-old Portuguese-American boy with a psychiatric history starting at age 5 who presents to your primary care practice after an insurance change.

He was delivered prematurely at 32 weeks and diagnosed with congenital hypothyroidism at the age of 6 weeks and growth hormone deficiency at the age of 2 years; he is in active treatment for both. He otherwise met developmental milestones on time yet continues to have significant fatigue despite adequate sleep and vitamin D supplementation.

His family history is remarkable for maternal anxiety, depression, suicidal thoughts, and previous attempted suicide, as well as anxiety, alcoholism, depression, and attention-deficit/hyperactivity disorder (ADHD) in the extended family.

Alex has had multiple psychiatric diagnoses by sequential providers. He was diagnosed with generalized anxiety disorder and ADHD by 5 years of age, major depressive disorder by 11 years of age, persistent depressive disorder by 12 years of age, and ultimately disruptive mood dysregulation disorder because of severe and persistent temper outbursts associated with negative mood and behavioral dysregulation, leading to recurrent crisis evaluations. He has been psychiatrically hospitalized twice, in the fifth and seventh grade, for suicidal ideation (SI) and elopement from home, respectively. He recently completed a 2-week acute residential placement, during which no medication changes were made. Current medications include escitalopram 20 mg daily, guanfacine 1 mg 3 times daily, sustained release bupropion 100 mg twice daily, levothyroxine, vitamin D, and a weekly somatropin injection. He has not been able to tolerate psychostimulants or nonstimulant agents because of treatment-emergent SI.

Now in the ninth grade, he continues to be easily distracted by peers, with impulsive behaviors and reduced self-regulation. Despite receiving special education services since the fifth grade, his academic performance has been poor, and he has limited motivation. Previous testing indicated average in an intelligence quotient test, with relative deficits in working memory compared with above average strength in fluid reasoning. He dislikes school and has few friends. He has always been noted to be “immature.” He displays temper tantrums at home and school around transitions and behavioral expectations and has complained of feeling “different” and misunderstood by peers in addition to having difficulty reading social cues. His interests include acting and playing Fortnite and other video/computer games. His screen time is limited to 1 to 2 hr/d by the family.

As the new clinician, you raise the possibility of undiagnosed autism spectrum disorder as a unifying/underlying diagnosis with his mother, who disagrees and does not consent to additional workup despite your recommendations. How would you proceed with next steps to best support your patient and his family in obtaining further clarifying evaluation?
Management of Malignant Large-Bowel Obstruction
Authors: Hsu June , Sevak Shruti
Published: August 2019

CASE SUMMARY:

An otherwise healthy 59-year-old man presented to the emergency department with 2 weeks of narrowed stools, 5 days of obstipation, and 1 day of abdominal pain, nausea, and vomiting. Computed tomography revealed an obstructing sigmoid mass without evidence of metastatic disease, and the CEA was 1.2 ng/mL. Flexible sigmoidoscopy confirmed a circumferentially obstructing distal sigmoid neoplasm. Endoscopic stent placement was immediately followed by a firm distended abdomen. An upright radiograph obtained following the procedure demonstrated free intraperitoneal air. An emergent Hartmann procedure was performed for iatrogenic colon perforation in a patient with malignant obstruction and chronic dilation of the proximal colon.
Safety of Combination Laser or Intense Pulsed Light Therapies and Doxycycline for the Treatment of Rosacea
Authors: Schilling Laura M. , Halvorson Christian R. , Weiss Robert A. , Weiss Margaret A. , Beasley Karen L.
Published: August 2019

BACKGROUND

Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity.

OBJECTIVE

The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline.

METHODS

Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed.

RESULTS

No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance.

CONCLUSION

The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.
Validation of the English Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) Questionnaire
Authors: Yu Wesley Y. , Waalboer-Spuij Rick , Bremer Rebecca , Lu Brian , Aroyan Christine , Crow Lauren , Grekin Roy , Neuhaus Isaac , Yu Siegrid , Arron Sarah T. , Hollestein Loes M.
Published: August 2019

BACKGROUND

Keratinocyte carcinomas (KC) impact patient quality of life (QoL). There is a need for validated QoL instruments specific to KC. The Basal and Squamous Cell Carcinoma QoL (BaSQoL) questionnaire was developed to comprehensively measure issues of importance to patients with KC.

OBJECTIVE

To validate and characterize the BaSQoL questionnaire for QoL measurement after diagnosis and treatment of KC.

METHODS

This was a prospective, observational study. Patients with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) were asked to fill out BaSQoL, Skin Cancer Index (SCI), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Descriptive statistics and classical test theory were used to assess validity.

RESULTS

One hundred eighty-seven subjects enrolled in this study: 122 with BCC and 65 with SCC. One hundred seventy-one subjects (91.4%) completed questionnaires at all 3 time points; 16 patients (8.6%) were lost to follow-up. Overall performance using classical test theory was good, with good internal consistency (Cronbach's α 0.63–0.80). BaSQoL subscales were strongly correlated with subscales of the SCI, demonstrating convergent validity, and weakly correlated with HADS, showing divergent validity.

CONCLUSION

The English language version of BaSQoL has good face, content, and construct validity. This study validates BaSQoL for use in English-speaking patients with BCC and SCC.
Impact of Great Saphenous Vein Foam Sclerotherapy on Quality of Life and Photoplethysmography Findings in Chronic Venous Insufficiency: One-Year Follow-up
Authors: Neto Felipe Coelho , Gomes de Oliveira Rodrigo , Thomazinho Fernando , Weinhardt Batista Anna Paula , Moraes Kessler Iruena
Published: August 2019

BACKGROUND

Ultrasound-guided foam sclerotherapy (UGFS) for treatment of chronic venous insufficiency (CVI) has been attracting significant interest over the past 20 years. It is a minimally invasive technique that comprises a safe treatment option and has yielded good results, especially in cases of advanced disease, with high rates of wound healing.

OBJECTIVE

To examine clinical, ultrasound, and photoplethysmography outcomes after a 1-year follow-up of UGFS for CVI.

MATERIALS AND METHODS

Twenty-nine legs classified as C4, C5, or C6 of the CEAP classification were included. Patients answered the VEINES questionnaire on quality of life and symptoms. and their venous filling time (VFT) was measured using photoplethysmography before and 45, 180, and 360 days after treatment of CVI with UGFS.

RESULTS

The results showed statistically significant improvements in VEINES quality-of-life and symptom scores and in VFT measured by photoplethysmography and a reduction in great saphenous vein diameter (p < .0001) at 45, 180, and 360 days after treatment with UGFS.

CONCLUSION

Ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels, confirmed by improvement in questionnaire scores, venous refilling time, and ultrasound findings.
Censoring for Loss to Follow-up in Time-to-event Analyses of Composite Outcomes or in the Presence of Competing Risks
Authors: Lesko Catherine R. , Edwards Jessie K. , Moore Richard D. , Lau Bryan
Published: August 2019

Background:

In time-to-event analyses, there is limited guidance on when persons who are lost to follow-up (LTFU) should be censored.

Methods:

We simulated bias in risk estimates for: (1) a composite event of measured (outcome only observable in a patient encounter) and captured events (outcome observable outside a patient encounter); and a (2) measured or (3) captured event in the presence of a competing event of the other type, under three censoring strategies: (i) censor at the last study encounter; (ii) censor when LTFU definition is met; and (iii) a new, hybrid censoring strategy. We demonstrate the real-world impact of this decision by estimating: (1) time to acquired immune deficiency syndrome (AIDS) diagnosis or death, (2) time to initiation of antiretroviral therapy (ART), and (3) time to death before ART initiation among adults engaged in HIV care.

Results:

For (1) our hybrid censoring strategy was least biased. In our example, 5-year risk of AIDS or death was overestimated using last-encounter censoring (25%) and under-estimated using LTFU-definition censoring (21%), compared with results from our hybrid approach (24%). Last-encounter censoring was least biased for (2). When estimating 5-year risk of ART initiation, LTFU-definition censoring underestimated risk (80% vs. 85% using last-encounter censoring). LTFU-definition censoring was least biased for (3). When estimating 5-year risk of death before ART initiation, last-encounter censoring overestimated risk (5.2% vs. 4.7% using LTFU-definition censoring).

Conclusions:

The least biased censoring strategy for time-to-event analyses in the presence of LTFU depends on the event and estimand of interest.
Gabapentin Decreases Narcotic Usage: Enhanced Recovery after Surgery Pathway in Free Autologous Breast Reconstruction
Authors: Fan Kenneth L. , Luvisa Kyle , Black Cara K. , Wirth Peter , Nigam Manas , Camden Rachel , Won Lee Dong , Myers Joseph , Song David H.
Published: August 2019

Background:

The opioid crisis is public health emergency, in part due to physician prescribing practices. As a result, there is an increased interest in reducing narcotic use in the postsurgical setting.

Methods:

From January 1, 2018, to October 31, 2018, we employed a multidisciplinary, multimodal Enhanced Recovery After Surgery (ERAS) pathway abdominally based free tissue transfer involving the rectus. Preoperative, intraoperative, and postoperative nonnarcotic modalities were emphasized. Factors in reducing narcotic consumption, pain scores, and antiemetic use were identified.

Results:

Forty-two patients were included for a total of 66 free flaps, with a 98.4%(65/66) success rate. Average postoperative in-hospital milligram morphine equivalent (MME) use was 37.5, but decreased 85% from 80.9 MME per day to 12.9 MME per day during the study period. Average pain scores and antiemetic doses also decreased. Postoperative gabapentin was associated with a significant 59.8 mg decrease in postoperative MME use, 21% in self-reported pain, and a 2.5 fewer doses of antiemetics administered but increased time to ambulation by 0.89 days. Postoperative acetaminophen was associated with a significant 3.0 point decrease in self-reported pain.

Conclusions:

This study represents our early experience. A shift in the institutional mindset of pain control was necessary for adoption of the ERAS protocol. While the ERAS pathway functions to reduce stress and return patients to homeostasis following surgery, postoperative gabapentin resulted in the greatest reduction in postoperative opioid use, self-reported pain, and postoperative nausea vomiting compared to any other modality.
Noninvasive Monitoring of Allograft Rejection Using a Novel Epidermal Sampling Technique
Authors: Rabbani Piul S. , Rifkin William J. , Kadle Rohini L. , Rao Nakul , Diaz-Siso J. Rodrigo , Abdou Salma A. , Rodriguez Eduardo D. , Ceradini Daniel J.
Published: August 2019

Despite promising short- and long-term results to date in vascularized composite allotransplantation (VCA), acute rejection remains the most common major complication in recipients. Currently, diagnosis of acute rejection relies on clinical inspection correlated with histopathological analysis. However, disagreement exists regarding the value of full-thickness skin and mucosal biopsies and histopathology remains semiquantitative, subject to sampling bias, and prone to intra- and inter-observer variabilities. Additionally, biopsies may cause infection, scarring, and/or potentially incite rejection through immune activation after injury. Noninvasive methods to diagnose rejection represent a critical unmet need for the emerging field of VCA. Here, we propose a novel technique utilizing skin stripping of the epidermis and subsequent molecular analysis to detect known markers of acute rejection. Using a small animal VCA model, we sought to validate our epidermal sampling technique as a noninvasive diagnostic test for acute rejection.
Aerobic Exercise Effects on Quality of Life and Psychological Distress After an Implantable Cardioverter Defibrillator
Authors: Dougherty Cynthia M. , Burr Robert L. , Kudenchuk Peter J. , Glenny Robb W.
Published: August 2019

Purpose:

The purpose of this study was to evaluate quality of life (QOL), psychological function, and self-efficacy outcomes in the Anti-Arrhythmic Effects of Exercise After an ICD Trial.

Methods:

In the Anti-Arrhythmic Effects of Exercise After an ICD Trial, 160 patients (124 men and 36 women) who had an implantable cardioverter defibrillator for primary (43%) or secondary (57%) prevention were randomized to exercise (EX, n = 84) or usual care (UC, n = 76). The EX consisted of 8 wk of home walking 1 hr/d 5 d/wk, followed by 16 wk of maintenance home walking for 150 min/wk. Adherence was determined from exercise logs, ambulatory HR recordings, and phone calls. Assessments were conducted at baseline, 8, and 24 wk for QOL: Patient Concerns Assessment and Short Form-36; anxiety: State Trait Anxiety Inventory; depression: Physician Health Questionnaire-Depression; and self-efficacy: Self-Efficacy for Walking Scale.

Results:

Participants averaged 55 ± 12 yr of age with ejection fraction = 40.6 ± 15.7%. The EX significantly decreased depression severity (EX: 1.33 ± 0.64; UC: 1.51 ± 0.86,P= .05) and improved self-efficacy (EX: 7.65 ± 1.97; UC: 6.85 ± 2.40,P= .05) at 8 wk. There were no significant effects at 24 wk. Adherent exercisers had significant improvements in QOL, psychological, and self-efficacy outcomes at 8 and 24 wk compared with those who were nonadherent. There were no implantable cardioverter defibrillator shocks associated with exercise.

Conclusions:

The EX conferred significant effects on depression and self-efficacy at 8 wk, without effects on QOL. Adherent exercisers experienced significant improvements in outcomes over those who were nonadherent or received UC.
DETECTION OF NEUROSENSORY RETINAL DETACHMENT COMPLICATING DEGENERATIVE RETINOSCHISIS BY ULTRA-WIDEFIELD FUNDUS AUTOFLUORESCENCE IMAGING
Authors: Francone Anibal , Kothari Nikisha , Farajzadeh Matthew , Hosseini Hamid , Prasad Pradeep , Schwartz Steven , Hubschman Jean Pierre
Published: August 2019

Purpose:

To determine whether neurosensory retinal detachment complicating degenerative retinoschisis (RS) can be reliably detected with ultra-widefield fundus autofluorescence evaluation.

Methods:

Consecutive patients diagnosed with RS who had ultra-widefield fundus autofluorescence imaging were included in this retrospective case series. According to the fundus autofluorescence patterns, we divided the eyes into two groups: 1) eyes with RS and a hyperautofluorescent leading edge and 2) eyes with RS and without hyperautofluorescence. Peripheral spectral domain optical coherence tomography images at the level of RS were obtained.

Results:

Thirty-eight eyes that met eligibility criteria were identified. Review of ultra-widefield fundus autofluorescence demonstrated 21/39 (55%) eyes with distinctive hyperautofluorescence over the area of RS (Group A) and 17/38 (45%) eyes without any form of hyperautofluorescence (Group B). Spectral domain optical coherence tomography images confirmed the presence of full-thickness neurosensory retina separation from the underlying retinal pigment epithelium in the areas of hyperautofluorescence in 10/10 eyes (100%) from Group A. None (0/11; 0%) of the eyes from Group B showed full-thickness neurosensory retina separation on the spectral domain optical coherence tomography imaging of the retina–RS interface.

Conclusion:

Hyperautofluorescent findings suggest the presence of a neurosensory retinal detachment. Retinal detachment associated with RS can be reliably detected on ultra-widefield fundus autofluorescence and may be a useful diagnostic imaging modality.
The Effect of Ocular Demodex Colonization on Schirmer test and OSDI Scores in Newly Diagnosed Dry Eye Patients
Authors: Ayyildiz Taha , Sezgin Fikriye Milletli
Published: August 2019

Objective:

To determine whether ocular Demodex colonization results in differences in Schirmer test scores and Ocular Surface Disease Index (OSDI) questionnaire values in individuals with dry eye disease (DED) diagnosed for the first time.

Method:

Eighty-eight adults aged 40 to 68 years who were admitted to Ophthalmology outpatient clinic for routine ophthalmological examination or presbyopia examination and diagnosed with DED for the first time and who do not have any chronic disease were included in the study. All the patients were asked to complete the OSDI, which is widely used for assessing dry eye symptom severity and vision-related functioning. The Schirmer test was performed, and then two eyelashes were taken from the inferior eyelids of each eyes. After saline (0.09% NaCl) was added to the sample, it was quickly taken to the microbiology laboratory, which is located next to the Ophthalmology policlinic. The sample was evaluated by a parasitologist experienced in Demodex.

Results:

One hundred sixty-eight eyes of 84 patients were included in the study. Average Schirmer test score was 2.1±0.5, the OSDI questionnaire score was 61.82±10.95, and the mean age was 55.36±8.74 years in patients who had Demodex colonization (n=30), whereas the average Schirmer test score was 6.6±0.9 score, OSDI questionnaire score was 40.96±12.73, and the mean age was 49.12±6.87 years in patients without Demodex colonization (n=58). It has been observed that dry eye patients with Demodex colonization had a higher mean age (P: 0.001), higher mean OSDI score (P: 0.001), and lower average Schirmer test score (P: 0.001) compared with those without Demodex. The significant relationship between lower Schirmer test score and higher OSDI rates and occurrence of Demodex infestation continued after adjusting for mean age values (P=0.012; P=0.035).

Conclusion:

It was determined that the presence of ocular Demodex colonization was associated with the average Schirmer test scores, OSDI scores, and age values in patients with newly diagnosed DED. Demodex quantity was found increased in older aged patients, but the significant relationship between lower Schirmer test score and higher OSDI rates and Demodex infestation persisted even after controlling the mean age values. Supporting these findings with large-numbered and randomized-controlled studies will help in clarifying the association of the Demodex infestation with etiopathogenesis of dry eye.
Use of Second-line Medications and Treatment Outcomes in Children With Tuberculosis in a Single Center From 2007 to 2018
Authors: Chiappini Elena , Matucci Tommaso , Lisi Catiuscia , Petrolini Chiara , Venturini Elisabetta , Tersigni Chiara , de Martino Maurizio , Galli Luisa
Published: August 2019

Background:

The incidence of drug-resistant forms of tuberculosis (DR-TB) and the number of children treated with second-line drugs (SLDs) are increasing. However, limited amount of information is available regarding the use of SLDs in this population.

Methods:

To describe the treatment of pediatric TB with SLDs and factors associated with use of SLDs in children with and without documented DR-TB, records of pediatric TB patients referred to a center in Italy from 2007 to 2018 were reviewed retrospectively.

Results:

Of 204 children diagnosed with active TB during the study period, 42 were treated with SLDs because of confirmed or probable drug resistance (42.8%), adverse reactions to first-line drugs (7.1%), central nervous system involvement (11.9%) or unconfirmed possible drug resistance (38.1%). There were no deaths or adverse reactions to SLDs reported. Treatment was successful in 85.2% children treated with first-line drugs and 92.9% children treated with SLDs. After adjusting for calendar period, the only factor associated with DR-TB was <2 years old [odds ratio (OR): 5.24 for <2 years vs. 5–18 years; P = 0.008]. Factors associated with treatment with SLDs were TB at 2 or more sites (OR: 11.30; P < 0.001), extrapulmonary TB (OR: 8.48; P < 0.001) or adverse reactions to first-line drugs (OR: 7.48; P = 0.002). No differences were noted in age or region of origin.

Conclusions:

A substantial proportion of TB children were treated with SLDs. The main reason for using SLDs was failure of a first-line drug regimen, suggesting possible DR-TB and underestimation of DR-TB in children. The use of SLD regimens was associated with a high success rate and good tolerability profile.
Infectious Complications of Mucositis in Postchemotherapy Neutropenic Cancer Patients
Authors: Shah Neepa , Adashek Jacob J. , Molinas Natalia L. , Ramsakal Asha , Greene John N.
Published: August 2019

Mucositis is a common, painful, and potentially dangerous adverse effect of many chemotherapy regimens. The mucosal barrier can be compromised from oncologic therapies resulting in high levels of exposure to organisms. These are often normal flora that become opportunistic pathogens, especially in these patients who already have compromised cellular immunity from neutropenia and humoral immunity from cytotoxic agents. The combination of a hampered immune system along with breakdown of the mucosa can lead to severe infections and lead to complications that undermine patient outcomes. The most common types of infections that are seen in neutropenic patients are bacterial, followed by viral, and then fungal. This case series will outline 3 vignettes of patients who developed mucositis secondary to chemotherapy-induced neutropenia and will review the most common infections seen in this delicate patient population plus empiric treatment strategies. For this review, a literature search was made using Google Scholar Database. Key words searched included bacterial, fungal, viral, mucositis, and leukemia. Articles published between 1983 and 2018 were selected.
Role of Inflammatory Markers in Diagnosing Diabetic Foot Infection
Authors: Majeed Aneela , Mushtaq Adeela , Iftikhar Ahmad , Zahid Umar , Malik Mustafa Nadeem , Razzaq Faryal , Al Mohajer Mayar
Published: August 2019

Background

Inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT) are frequently ordered in suspected cases of diabetic foot infection (DFI). We did a meta-analysis to compare diagnostic performance of these inflammatory markers for detecting DFI.

Materials and Methods

The meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used bivariate random-effects regression model to pool the sensitivity and specificity of the targeted biomarkers.

Results

A comprehensive literature search identified 73 studies. Twelve studies met our inclusion criteria. The number of studies reporting data on each individual biomarker was as follows: 11 for ESR, 7 for CRP, and 5 for PCT. For Infectious Diseases Society of America grade I versus grade II, we calculated pooled sensitivity and specificity for ESR to be 0.86 and 0.82, positive likelihood ratio (LR+) of 4.7, negative likelihood ratio (LR−) of 0.17, and area under receiver operating characteristic curve (AUROC) of 0.91. Pooled sensitivity and specificity for CRP were found to be 0.54 and 0.91, LR+ of 6.2, LR− of 0.50, and AUROC of 0.80. Pooled sensitivity and specificity for PCT were 0.72 and 0.96, LR+ of 18.4, LR− of 0.29, and AUROC of 0.84. For Infectious Diseases Society of America grade II versus grade III, we calculated pooled sensitivity and specificity for ESR to be 0.81 and 0.80, LR+ of 4.0, LR− of 0.24, and AUROC of 0.84.

Conclusions

Erythrocyte sedimentation rate has the highest AUROC of 0.91 followed by PCT (0.84) and CRP (0.80) to diagnose DFI. For osteomyelitis, ESR has a diagnostic accuracy of 0.84. Erythrocyte sedimentation rate could be beneficial in ruling out infection in persons who have low suspicion of disease (lowest −LR). For those who have high suspicion of disease, PCT could be helpful in ruling in infection (highest +LR). All inflammatory markers need standardization of threshold levels for detecting infection.
Acute Bacterial Parotitis in Adult Hematologic Malignancy
Authors: Shabani Sepehr , Cheema Asima , Nanjappa Sowmya , Ramsakal Asha , Greene John N.
Published: August 2019

Acute bacterial parotitis (ABP) is an uncommon condition in immunosuppressed adult cancer patients. Here, we report 2 cases of parotitis in immunocompromised patients; one with a diagnosis of extranodal marginal zone B-cell lymphoma and the other with acute myeloid lymphoma. Both patients were treated with antibiotics and local management with resolution of their parotitis. Per review of literature, this is the first article describing ABP in patients with bone marrow transplantation and hematologic malignancies. Moreover, this is also the first article reporting ABP due to Stenotrophomonas maltophilia, an opportunistic gram-negative rod bacterium.
Supportive Care Needs of Patients With Lung Cancer in Mainland China: A Cross-Sectional Study
Authors: ZHANG Tian , HE Hongye , LIU Qunhui , LV Xiaoqing , SONG Yongxia , HONG Jingfang
Published: August 2019

Background

The diagnosis and treatment of lung cancer necessitate a variety of supportive care needs. To our knowledge, no studies have been conducted that target specifically the supportive care needs of patients with lung cancer in Mainland China. Cross-cultural studies indicate that supportive care needs vary by cultural background. Thus, it is necessary to investigate the supportive care needs of patients with lung cancer in the cultural context of China.

Purpose

This study aimed to describe the level of supportive care required by patients with lung cancer in China and to examine the relationships between supportive care needs and demographic factors and between supportive care needs and treatment variables.

Methods

A cross-sectional descriptive study design was adopted. Five hundred fifty-four patients with lung cancer were recruited using a convenience sampling method from inpatient departments in four tertiary teaching hospitals that are affiliated with a medical university in Anhui Province, China. The Nursing Professional Social Support Needs Scale and background information list were used as the data collection instruments. A Wilcoxon rank sum test and a Kruskal–Wallis rank sum test were conducted to examine the differences among the professional supportive care needs of patients of different demographic characteristics and under different treatment conditions.

Results

Participants self-reported the highest scores in the domain of informational needs (M = 3.67, interquartile range = 1.25). The most common supportive care need was “to be cared for by nurses with skilled venipuncture techniques.” There were significant differences in needs across different genders, age groups, educational levels, and income levels (p < .05). Patients with metastasis and other illnesses had greater supportive care needs in terms of total and subscale scores in Stages III and IV (p < .05).

Conclusions

Patients with serious diseases and heavy socioeconomic burdens have greater supportive care needs. Therefore, healthcare providers should improve their awareness and expertise to identify the needs of their patients and to provide supportive care to patients with lung cancer. In addition, patients with high supportive care needs should be identified.
A nurse practitioner–led medication reconciliation process to reduce hospital readmissions from a skilled nursing facility
Authors: Anderson Rachel , Ferguson Rita
Published: August 2019

Background and purpose:

Skilled nursing facilities (SNFs) are penalized for hospital readmissions within 30 days. Medication errors often precipitate hospital returns. The Centers for Medicare and Medicaid Services mandates that health care providers must determine whether medications pose significant risks and implement corrective actions. Federal restrictions exist regarding nurse practitioners (NPs) in long-term care; however, NPs are efficient in the health care of patients requiring a SNF, including completing thorough medication reconciliation and correcting deficiencies.

Local Problem:

A needs assessment of a 90-bed SNF revealed inadequate medical coverage and no formalized program to reduce hospital readmissions, including a mandated medication reconciliation process. The problem contributed to an average 30-day readmission rate of 24.15%.

Methods:

The investigators sought to determine whether an NP-led medication reconciliation on admission would reduce hospital readmissions from a SNF. A pre- and postimplementation design was used to compare 30-day hospital readmission rates over a 30-day project period.

Interventions:

An evidence-based workflow process for systematic medication reconciliation was designed. A full-time NP used the workflow process to complete stabilization visits with medication reconciliation on each facility admission.

Results:

Results revealed a hospital readmission rate of 19.2% preimplementation and 13.5% postimplementation, reflecting a 29.7% decrease in the rate of hospital readmissions within a 30-day period.

Conclusion:

A chi-square analysis conveyed no statistical significance; yet, the positive benefits of NP intervention included reduced hospitalizations, increased revenue, improved quality measures and survey results, and preparation for the Centers for Medicare and Medicaid Services mandates.

Implications for practice:

Nurse practitioners have the necessary education and skills to provide quality care as well as achieving CMS mandates and improving quality measures in SNF settings.
Debate as a learning tool in an online environment
Authors: DeClerk Leonie , LaBorde Pam , Smith-Olinde Laura
Published: August 2019

Debate offers an opportunity to increase student interaction and develop critical thinking and presentation skills. The investigators used an online debate during a first-semester Doctor of Nursing Practice (DNP) course. The purpose of this evaluation was to 1) evaluate the feasibility of conducting a live-streamed debate and 2) assess students' perceived gained skills. Student pairs were assigned to speak for or against a statement applicable to professional practice of a DNP-prepared nurse approximately 4 weeks before the scheduled debates. During the debate, each pair presented opening arguments, formulated and presented a rebuttal, and provided closing statements. The faculty debriefed immediately after each debate, and all 15 students completed an online instrument evaluating perceived critical thinking and presentation skills after the debate. Completing the live-stream online debate was feasible. Students had statistically significant increases in skills of applying literature to support a position, defending a position, and predicting and countering opposing arguments, self-assurance in delivering a professional presentation, and establishing and persuading the listener with credibility. Skills not demonstrating statistical improvement included selecting, analyzing, and evaluating literature and composing a clear and well-organized oral presentation. Live-stream online debate was a feasible and effective learning tool for DNP students exploring professional issues. Debate should be evaluated with other content such as health policy, ethics, and clinical management.
Pharmacological treatments for patients with irritable bowel syndrome
Authors: Qin Di , Yue Ling , Xue Bin , Chen Min , Tang Tai-Chun , Zheng Hui
Published: August 2019

Introduction:

Several pharmacological treatments are beneficial for patients with irritable bowel syndrome (IBS), and there are numbers of systematic reviews evaluating the effectiveness of these treatments. However, the overall quality of the evidence has not been quantitatively assessed. The aim of this study is to evaluate the possible biases in the published systematic reviews and determine the treatments with reliable evidence.

Methods and analysis:

We will perform an umbrella review to identify eligible systematic reviews. A comprehensive literature search will be conducted in MEDLINE, EMBASE, and the Cochrane library for systematic reviews. We will describe the general information such as participants, interventions, outcome measurements, and conclusion. Additionally, the heterogeneity and inconsistency between trials will be assessed by the I
2 statistical test and Cochrane Q test. We will assess risk of bias, and summarize the strength evidence.

Conclusion:

The umbrella reviews will assess the reliability of the evidence so that doctors and patients can make better medical choices.

PROSPERO registration number:

CRD42018109597