bluuebunny/crossref_metadata_2025 huggingface dataset:
Addressing cancer signal transduction pathways with antisense and siRNA oligonucleotides
Authors: Juliano Rudolph L
Published: September 2020

Signal transduction pathways play key roles in the initiation, progression and dissemination of cancer. Thus, signaling molecules are attractive targets for cancer therapeutics and enormous efforts have gone into the development of small molecule inhibitors of these pathways. However, regrettably, there has been only moderate progress to date, primarily in connection with the RAS signaling pathway. Oligonucleotide-based drugs potentially offer several advantages for addressing signaling pathways, including their exquisite selectivity and their ability to exploit both enzymatic and nonenzymatic targets. Nonetheless, there are problems inherent in the oligonucleotide approach, not the least being the challenge of effectively delivering these complex molecules to intracellular sites within tumors. This survey article will provide a selective review of recent studies where oligonucleotides were used to address cancer signaling and will discuss both positive aspects and limitations of those studies. This will be set in the context of an overview of various cancer signaling pathways and small molecule approaches to regulate those pathways. The survey will also evaluate the challenges and opportunities implicit in the oligonucleotide-based approach to cancer signaling and will point out several possibilities for future research.
Manual Shunt Connector Tool to Aid in No-Touch Technique
Authors: Lai Grace Y , Voyer-Nguyen Pascal , Looi Thomas , Drake James M , Hanak Brian W
Published: September 2020

BACKGROUND

Given the morbidity and cost associated with cerebrospinal fluid shunt infections, many neurosurgical protocols implement “no-touch” technique to minimize infection. However, current surgical tools are not designed specifically for this task and surgeons often resort to using their hands to connect the shunt catheter to the valve.

OBJECTIVE

To develop an efficient and effective shunt assembly tool.

METHODS

Prototypes were designed using computer assisted software and machined in stainless steel. The amount of time and number of attempts it took volunteers to connect a Bacticel shunt catheter to a Delta valve were recorded using the new tool and standard shodded mosquitos. Scanning electron microscopy (SEM) was done on manipulated catheters to assess potential damage. Practicing neurosurgeons provided feedback.

RESULTS

Nonsurgeon (n = 13) volunteers and neurosurgeons (n = 6) both completed the task faster and with fewer attempts with the new tool (mean 7.18 vs 15.72 s and 2.00 vs 6.36 attempts, P < .0001; mean 2.93 vs 5.96 s and 1.06 vs 2.94 attempts, P < .001, respectively). SEM of 24 manipulated catheters showed no microscopic damage. 100% of neurosurgeons surveyed (n = 10) would adapt the tool in their practice, 90% preferred use of the new tool compared to their existing method, and 100% rated it easier to use compared to existing instruments.

CONCLUSION

The new tool shortened the time and number of attempts to connect a shunt catheter to a valve. Neurosurgeons preferred the new tool to existing instruments. There was no evidence of catheter damage with the use of this tool.
A Meta-Analysis of Group-Based Pain Management Programs: Overall Effect on Quality of Life and Other Chronic Pain Outcome Measures, with an Exploration into Moderator Variables that Influence the Efficacy of Such Interventions
Authors: Romm Marnin Joseph , Ahn Soyeon , Fiebert Ira , Cahalin Lawrence Patrick
Published: September 2020

Objectives

Group-based pain management programs (GPMPs) have been found to significantly improve quality of life and other pain outcome measures in patients with chronic musculoskeletal pain. The aims of this meta-analysis were to reevaluate the overall effect of GPMPs on various pain outcomes for individuals experiencing chronic musculoskeletal conditions and to explore moderator variables that potentially contribute to the overall efficacy of GPMPs.

Methods

Using the R package called metaphor and RevMan, we estimated the overall effectiveness of GPMPs on various pain outcome measures. The differential effectiveness of GPMPs was examined by conducting a mixed-effects meta-analytic model using various study-level characteristics. Moderator analyses included three content moderator variables and seven format moderator variables. Receiver operating characteristic curves investigated optimal points in some of the moderator variable analysis results.

Results

Significant overall main effects of GPMPs were found on all the explored outcome measures in this study (P < 0.05). In moderator analyses, it was found that the structure of GPMPs, rather than the content, significantly improved outcomes (P < 0.05). Receiver operating characteristic curve analyses identified the optimal number of GPMP sessions and number of participants per group.

Discussion and Clinical Relevance

GPMPs have a statistically significant overall effect on all explored pain outcome measures. The investigation into content and structural moderators suggests that certain GPMP design factors have a greater effect on pain outcomes than do content factors. Therefore, GPMP structural designs appear to be important in reducing pain and improving quality of life for patients with chronic pain and warrant further investigation.
Conventions under Heterogeneous Behavioural Rules
Authors: Newton Jonathan
Published: September 2020

Strategies of players in a population are updated according to the behavioural rules of agents, where each agent is a player or a coalition of players. It is known that classic results on the stochastic stability of conventions are due to an asymmetry property of the strategy updating process. We show that asymmetry can be defined at the level of the behavioural rule and that asymmetric rules can be mixed and matched whilst retaining asymmetry of the aggregate process. Specifically, we show robustness of asymmetry to heterogeneity within an agent (Alice follows different rules at different times); heterogeneity between agents (Alice and Bob follow different rules); and heterogeneity in the timing of strategy updating. These results greatly expand and convexify the domain of behavioural rules for which results on the stochastic stability of conventions are known.
What the Radiologist Needs to Know About Biceps Tenodesis: Normal Postprocedure Imaging Appearance and Complications
Authors: Oettel David J. , Cecava Nathan D. , Bui-Mansfield Liem T.
Published: September 2020

Proximal long head biceps tendon (LHBT) pathology is a common and well-recognized cause of anterior shoulder pain.1–4 Various surgical procedures have been developed to address LHBT pathology. Postoperative imaging can be confusing if the radiologist is not aware of the various surgical techniques. An astute radiologist may be the first to identify a postoperative complication. An understanding of the LHBT anatomy, surgical indications, surgical procedures, and both normal and abnormal postoperative imaging appearance will enhance the radiologist's accuracy in imaging interpretation and interactions with referring providers.
Using Combined Tabletop and Simulation Activities to Improve Nursing Students’ Attitudes About Quality Improvement: A Feasibility Study
Authors: Gaffney Mary K. , Lawrence Kay , Chargualaf Katie A.
Published: September 2020

Nursing students’ attitudes about quality improvement (QI) reflect poor understanding of its importance. In a mixed-method interventional feasibility study, students received instruction about QI processes, plus information about factors contributing to central line-associated bloodstream infection (CLABSI) rates at a hypothetical hospital. Experimental group students observed a high-fidelity simulation bedside report for a CLABSI-affected patient. Both groups independently completed tabletop QI exercises to solve the CLABSI problem and had equivalent improvement in attitudes. Joint debriefing revealed how experimental group students developed greater understanding of interrelated, system-wide contributing factors. Hybrid learning activities with tabletop and simulation positively influence students’ attitudes about QI.
Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach
Authors: Busel Gennadiy , Mir Hassan R. , Merimee Stephanie , Patel Raahil , Atassi Omar , De La Fuente Guadalupe , Donohue David , Maxson Ben , Infante Anthony , Shah Anjan , Watson David , Downes Katheryne , Sanders Roy W.
Published: September 2020

Objective:

To evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs).

Design:

Retrospective.

Setting:

Level 1 and level 2 academic centers.

Patients:

Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs.

Methods:

Patients were identified based on Current Procedural Terminology code and chart review. All operative calcaneal fractures treated between 2012 and 2018 by fellowship-trained orthopaedic trauma surgeons were evaluated. Those with both postoperative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): <1 mm step, <5 mm gap, and/or <5° of angulation, fair (F): 1–3 mm step, 5–10 mm gap, and/or 5–15° angulation; and poor (P): >3 mm step, >10 mm gap, and/or >15° angulation.

Results:

Seventy-seven patients with 83 fractures were included. Average age was 42 years (range, 18–74 years), with 57 men. Four fractures were open. There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA. Average days to surgery were 5 for STA and 14 for ELA (P < 0.001). A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (P < 0.001). There was no difference by approach for Gissane angle (P = 0.5). ELA had better overall reduction quality (P = 0.02). For Sanders II, there was no difference in reduction quality with STA versus ELA (P = 0.51). For Sanders III, ELA trended toward better reduction quality (P = 0.06).

Conclusions:

The ELA had a better overall reduction of Bohler angle on plain radiographs and of the posterior facet and tuberosity on postoperative CT scans. For Sanders type II DIACFs, there was no difference between STA and ELA. Importantly, for Sanders III DIACFs, ELA trended toward better reduction quality. In addition to fracture reduction, surgeon learning curve, early wound complications, and long-term outcomes must be considered in future studies comparing the ELA and STA.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Pilot Study of End-Tidal Carbon Dioxide in Prediction of Inhospital Cardiac Arrests
Authors: Mucksavage Jeffrey J. , He Kevin J. , Chang James , Panlilio-Villanueva Maria , Wang Tianxiu , Fraidenburg Dustin , Benken Scott T.
Published: September 2020

Objectives:

A validated means to predict inhospital cardiac arrest is lacking. The purpose of this study was to evaluate the changes in end-tidal carbon dioxide, as it correlates with the progression to inhospital cardiac arrest in ICU patients.

Design, Setting, and Patients:

Single-center, retrospective cohort study of mechanically ventilated ICU patients (age > 18 yr old) having inhospital cardiac arrest with advanced cardiac life support and continuous end-tidal carbon dioxide monitoring at a single academic center from 2014 to 2017. Demographics, clinical variables, and outcomes were collected. End-tidal carbon dioxide was collected from 5 to 2,880 minutes before inhospital cardiac arrest. Data were analyzed using descriptive statistics, and model estimates were generated using a repeated-measures categorical model with restricted maximum likelihood estimation and fully specified (autoregressive) covariance to assess the effect of time on changes in end-tidal carbon dioxide.

Measurements and Main Results:

A total of 788 patients were identified and 104 met inclusion criteria, where 62% were male with an average age of 58.5 years. Seventy-four percent required vasopressors and 72% experienced pulseless electrical activity. Mean end-tidal carbon dioxide 5 minutes prior to inhospital cardiac arrest was significantly lower than all evaluated time points except 180 minutes (p < 0.05). One patient survived to hospital discharge. In multivariate logistic regression modeling for return of spontaneous circulation, a greater change in the prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum was associated with a decreased likelihood of return of spontaneous circulation (odds ratio 0.903; 95% CI, 0.832–0.979; p = 0.014). Additionally, a change from prearrest end-tidal carbon dioxide maximum to prearrest end-tidal carbon dioxide minimum greater than 17 mm Hg was associated with a decreased likelihood of return of spontaneous circulation and odds ratio 0.150; 95% CI, 0.036–0.66; p = 0.012).

Conclusions:

Mean end-tidal carbon dioxide is significantly lower immediately before inhospital cardiac arrest. The statistical and clinical significance of end-tidal carbon dioxide may highlight its utility for predicting inhospital cardiac arrest in ICU patients. Comparison analysis and modeling explorations in a larger cohort are needed.
Rescue of Nimodipine-Induced Refractory Vasoplegia With Hydroxocobalamin in Subarachnoid Hemorrhage: A Case Report
Authors: Clifford Katherine M. , Madhok Jai , Murray Nick M. , Mohindra Vibha
Published: September 2020

Background:

We report a case of refractory vasoplegia after nimodipine administration that was unresponsive to triple vasopressor therapy and was rescued by IV hydroxocobalamin.

Case Summary:

An 84-year-old male presented comatose from a subarachnoid hemorrhage and developed severe hypotension unresponsive to three vasopressors following a single dose of enteral nimodipine. Multisystem point-of-care ultrasonography ruled out alternate etiologies of shock, indicating that this was likely a vasoplegic state caused by nimodipine. We administered 5 grams of IV hydroxocobalamin over 15 minutes due to the possibility of impaired nitric oxide metabolism as the driver of vasoplegia. This led to immediate improvement in hemodynamics and rapid discontinuation of vasopressors. The patient experienced chromaturia but no other adverse effects due to hydroxocobalamin.

Conclusions:

Nimodipine administration is a standard practice for patients with aneurysmal subarachnoid hemorrhage to reduce unfavorable outcomes from cerebral vasospasm. Although mild hypotension is a common side effect of nimodipine, in rare cases, it may become profound, leading to refractory vasoplegia. There is no evidence-base for reversal agents for nimodipine-induced vasoplegia, and this case is the first to demonstrate successful use of hydroxocobalamin as a potential rescue therapy. We also propose an algorithm for treatment of vasoplegia with consideration of medications that act on nitric oxide–mediated vasodilation and their side-effect profiles.
Persevering With Prone Ventilation in Coronavirus Disease 2019 Pneumonia
Authors: Byrne Matthew , Kler Prabhjoyt , Bandla Nageswar , Scott Timothy
Published: September 2020

Background:

As well as placing unprecedented demands on resources and staff involved in the care of these patients, there has been significant uncertainty regarding the optimal management of patients with coronavirus disease 2019 pneumonia. Randomized controlled trials have shown clear benefits of both neuromuscular blockade and prone positioning in treating moderate to severe acute respiratory distress syndrome, as defined by the Berlin Criteria.

Case Summary:

We present a case of a 53-year-old patient with a severe coronavirus disease 2019 pneumonia who has made a remarkable recovery following a turbulent period on intensive care. During his stay, he was prone positioned on 16 consecutive occasions and is an exemplar of the many patients we treated who benefited considerably from this intervention.

Conclusion:

We believe that sustained administration of prone position ventilation was instrumental in saving his life. While there is associated morbidity, we encourage clinicians to continue with this strategy beyond their normal practice.
Exploring the Relational Intervention of Storytelling: A Qualitative Study of the Patient Stories Project in a Single ICU
Authors: Gurney Lara , MacPhee Maura , Howard A. Fuchsia , Rodney Patricia
Published: September 2020

Objectives:

Our study objective was to explore nurses’ experiences of how the Patient Stories Project, an intervention consisting of garnering and sharing ICU survivor stories with the ICU team, influenced their perceptions of the value of their work and their nurse-patient relationships.

Design:

This was a qualitative descriptive case study that used thematic analysis.

Setting:

This study was conducted in a single, 34-bed adult ICU in a Canadian tertiary care teaching hospital, serving a mixed medical and surgical patient population and employing over 200 nurses.

Subjects:

Semistructured focus groups with 12 ICU nurses were conducted between June 2019 and July 2019.

Intervention:

The Patient Stories Project is a systematic process for collecting and sharing former patients’ stories. On a regular basis, former ICU patients return to the ICU to say, “thank you,” share their experiences, and tell their stories to staff.

Measurements and Main Results:

Storytelling through the Patient Stories Project gives meaning to nurses’ work and provides avenues for nurses to think about their work more positively. Key themes were as follows: 1) perspective taking, 2) emphasizing the value in caring, 3) providing positive closure, 4) engendering team belonging, and 5) building a sense of hope.

Conclusions:

This study addresses the Critical Care Societies Collaboratives “call to action” to create a healthy work environment. Nurse focus group participants articulated how an initiative such as the Patient Stories Project may augment the relational aspects of work that are important to nurses, as well as their patients and families. Our study results have implications for the importance of using storytelling as a relational strategy to protect against depersonalization and cynicism, elements of burnout.
An integrative approach identifies dysregulated long non-coding RNAs as microRNA decoys during nevus to melanoma transformation
Authors: Chang Li-Wei , Badal Brateil , Lu Ching-Jung , Solovyov Alexander , Greenbaum Benjamin D. , Celebi Julide Tok
Published: September 2020

Mounting evidence supports a role for dysregulated long non-coding RNAs (lncRNA) in the development of many cancers. A recently discovered function of lncRNAs is to act as microRNA (miR) decoys or competing endogenous RNAs, which sequester specific miRs and relieve negative regulation of mRNA expression by miRs. Although a large number of non-coding RNAs are thought to function as competing endogenous RNAs, miR-sequestering lncRNAs involved in nevus to melanoma transformation remain largely unknown. In this study, we applied a bioinformatics approach to a unique dataset of benign melanocytic nevi and primary melanomas of the skin in order to fill this research gap. We modified a previously published miR target prediction algorithm, RNAhybrid, and improved its search efficiency. We reported the presence of many lncRNAs and miRs deregulated when transitioning from a senescence-like state of nevi to melanoma. We provided evidence of a relatively new and understudied mechanism of gene regulation during this process and identified for the first time lncRNAs (n = 122) that may potentially function as miR decoys as well as their target miRs during nevus to melanoma transformation. The knowledge presented here can be employed for developing biomarkers for diagnostic and risk stratification purposes.
Male Mammary Paget Disease: A Tale of 2 Contrasting Cases
Authors: Roy Madhuchhanda , Teshome Mediget , Damodaran Senthilkumar , Sahin Aysegul A. , Khazai Laila , Arribas Elsa , Candelaria Rosalind P. , Scoggins Marion E. , Lane Deanna L. , Giordano Sharon H. , Albarracin Constance T. , Prieto Victor G. , Nagarajan Priyadharsini
Published: September 2020

Mammary Paget disease (MPD) comprises 1.45% all male breast cancers, compared with only 0.68% of all female breast cancers. Patients usually present in the fifth and sixth decades of life with ulceration, eczematous changes, discharge, bleeding, itching, and induration of the nipple and areola. Typically, there is a delay in definitive diagnosis and treatment from the onset of symptoms because most patients are initially treated for a rash. At the time of diagnosis, about half of the patients may have palpable breast mass, positive lymph nodes, or both. In this article, we present 2 cases of male MPD representing the extremes of clinical, radiologic, and histopathologic spectrum of the disease. One patient presented with a rash of the nipple of several months duration without an underlying lesion, whereas the other presented with sensitivity and pain of the nipple for 1 year and an underlying mass. Biopsies were diagnostic of MPD in both cases, and definitive surgery revealed an underlying ductal carcinoma in situ in the first case and an invasive ductal carcinoma in the second, highlighting the importance of early biopsy to initiate appropriate management.
Can Breathing Exercise or Pranayama Affect the Intraocular Pressure in the Short-term?
Authors: Paidimarri Suharsha , Bhardwaj Rishi , Pathak-Ray Vanita
Published: September 2020

Purpose:

To demonstrate any transient short-term effect of a particular type of breathing exercise (alternate nostril breathing of Nadi Shuddhi type of pranayama exercise) on the intraocular pressure (IOP) in glaucomatous as well as healthy eyes.

Methods:

A prospective, nonrandomized, observational, cross-sectional study was conducted in a tertiary eyecare hospital setup recruiting 3 groups of subjects—glaucoma group and a normal group that underwent the breathing exercise as well as a normal group that did not. IOP was recorded at baseline, then at 4 minutes after 10 cycles of the breathing exercise and also after 10 minutes of rest—corresponding to IOPb, IOPc, and IOPr of all the study groups. Only those subjects were recruited who were above 18 and under 80 years and were naive to breathing exercise.

Results:

A total of 56 normal eyes (28 subjects, Normalb) and 33 glaucomatous eyes (19 subjects) were recruited for the breathing exercise and were compared with the IOP as obtained for 26 eyes of 26 subjects that did not undergo the breathing exercise (Normalnb). IOPb did not differ between both normal groups (13.7±1.4 mm Hg in Normalb vs. 13.9±1.6 mm Hg in Normalnb, P=0.183) but was significantly different between groups (16.7±3.1 mm Hg in the glaucoma group and 13.7±1.4 in Normalb, P<0.001 and Normalnb 13.9±1.6 mm Hg, P<0.001) but analysis of variance was not significant within groups comparing IOPb, IOPc, and IOPr of all the study groups.

Conclusion:

There is no short-term transient effect of alternate nostril breathing exercise on IOP; a longitudinal study is recommended.
Psychometric Examination of the Dutch Objective Burden Inventory in Heart Failure Caregivers
Authors: Grant Joan S. , Graven Lucinda J. , Prapanjaroensin Aoyjai , Azuero Andres , Luttik Marie Louise
Published: September 2020

Background

Psychometric properties of the 38-item version of the Dutch Objective Burden Inventory (DOBI) have been evaluated primarily in older female caregivers, with no published studies that vary by a different gender and age distribution.

Objective

The aim of this study was to test the construct validity and reliability of the DOBI in caregivers of individuals with heart failure from the United States and other countries.

Methods

This secondary analysis from a cross-sectional study used an online survey. Factorial validity was tested with confirmatory factor analysis, item performance was examined with ordinal item response analysis, and convergent validity was tested correlating DOBI subscale scores with Bakas Caregiving Outcomes Scale scores. Internal consistency reliability was assessed with Cronbach α.

Results

Item response analysis removed 14 items. Confirmatory factor analysis retained the original 4-factor solution. Original and reduced instruments demonstrated good internal consistency. Validity was supported by meaningful associations with the Bakas Caregiving Outcomes Scale.

Conclusions

Both the original 38-item DOBI and the reduced 24-item DOBI had support for their construct validity and internal consistency. The 24-item DOBI may be a useful alternative to the 38-item version, because it maintains psychometric properties of the original instrument while decreasing data collection burden. However, more research is needed to assess whether the shorter version is useful in assessing objective caregiving burden.
Knowledge, attitudes, and practices related to human papillomavirus vaccination among college students in a state university: Implications for nurse practitioners
Authors: D'Errico Maria Poggio , Tung Wei-Chen , Lu Minggen , D'Errico Rhone
Published: September 2020

Background:

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and disproportionately affects adolescents and young adults. Although a safe and efficacious vaccine is available, many college students are unimmunized against HPV. Most students presenting to college health centers are within the age range for catch-up immunization, giving nurse practitioners (NPs) in this setting an opportunity to increase vaccination rates. More information is needed about college students' HPV knowledge, attitudes, and vaccination uptake so that NPs can make effective vaccine recommendations to this population.

Purpose:

To examine (a) Knowledge and attitudes about HPV and its vaccine; (b) HPV immunization practices; and (c) factors associated with HPV knowledge, attitudes, and vaccination among college students in a US university.

Methods:

This cross-sectional quantitative study collected data from participants in a state university student health center. Data collected included knowledge, attitudes, and practices about HPV and its vaccine from 627 students.

Results:

Participants had a moderately low HPV knowledge but positive attitudes toward HPV and its vaccine. Participants with a higher level of HPV knowledge were US born, health-related majors, married or divorced, and had positive attitudes. Higher HPV knowledge, vaccine uptake, and a family history of cervical cancer were associated with positive attitudes. Predictors for vaccine uptake include being a health-related major and positive vaccine attitudes.

Implications for practice:

The results of this study help NPs, registered nurses, and other health care providers make effective HPV vaccine recommendations to college students. Students with positive HPV attitudes can serve as peer educators to increase HPV vaccination awareness in this population.
Development of an advanced practice preceptor evaluation tool
Authors: Klein Colleen J. , Chan Garrett K. , Pierce Lisa , Van Keuren-Parent Korinne , Cooling Melinda
Published: September 2020

Background:

Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor.

Purpose:

The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program.

Methodological orientation:

A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation.

Sample:

The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years.

Conclusions:

All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role.

Implications for practice:

This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties.
The Cervical Dysplasia Worksheet: A Longitudinal Map of Cervical Dysplasia Cytology and Histology Tests and Procedures
Authors: Johnson Camille A. , Madrigal Jessica M. , Metoyer Kelly , Zhukovsky Sara D. , Patel Ashlesha
Published: September 2020

Objective

Our objectives were to describe the Cervical Dysplasia Worksheet (CDW), provide evidence of its feasibility to view patient cervical dysplasia results over time, and evaluate patient attitudes toward the tool in the setting of abnormal result follow-up.

Materials and Methods

The CDW augments the ASCCP guidelines for managing abnormal cervical cancer screenings by visually depicting cervical cytological and histological history along a color gradient showing severity. We evaluated tool feasibility by graphing a retrospectively reviewed convenience sample of patient data. A cross-sectional evaluation of the tool was then performed to assess patient attitudes in the setting of either dysplasia or colposcopy clinic. Patients had their data graphed on the CDW and explained to them before their clinical encounter. They then gave general comments about the tool and filled out a short evaluation survey.

Results

The large majority of retrospective patient data (N = 167) fit well within the CDW with roughly 20% requiring space for additional comments. Among the 30 patients who participated in our evaluation, almost all agreed (n = 29, 96.7%) that the tool helped them understand their history and results and that they would use the tool in the future.

Conclusions

The CDW is a novel tool to display a patient's cervical dysplasia history to visualize treatment and future care while enhancing patient-provider communication. Patient evaluation of the tool was largely positive, and suggestions will be taken into consideration for future modification. Further evaluation of the CDW among healthcare providers is needed to analyze its efficacy in the clinical setting.
Sound Quality Ratings of Amplified Speech and Music Using a Direct Drive Hearing Aid: Effects of Bandwidth
Authors: Vaisberg Jonathan , Folkeard Paula , Levy Suzanne , Dundas Drew , Agrawal Sumit , Scollie Susan
Published: September 2020

Objective:

To determine sound quality for extended bandwidth amplification using a direct drive hearing device.

Study Design:

Prospective double-blind within-subjects repeated measures study.

Setting:

University hearing research laboratories.

Patients:

Fifteen experienced hearing aid users with symmetric mild-sloping-to-severe sensorineural hearing loss.

Intervention(s):

Sound quality ratings of speech and music passages were obtained using the Multiple Stimulus with Hidden References and Anchors (MUSHRA) protocol after wearing a direct drive hearing aid for at least 4 weeks. Passages were processed to filter out low-frequency (below 123 and 313 Hz) and high-frequency (above 4455, 5583, 6987, and 10,869 Hz) energy.

Main Outcome Measure(s):

Comparison of sound quality ratings for speech and music between low and high-pass filter frequencies measured from 0 to 100, where 0 represents “bad” and 100 represents “excellent.”

Results:

Wider bandwidth stimuli received higher sound quality ratings compared with narrower bandwidth stimuli. Conditions with more low-frequency energy (full-band and 123 Hz cut-off) were rated as having higher sound quality. More low-frequency energy in the 123 Hz condition was rated as having higher sound versus the 313 Hz condition (mean difference: 11.2%, p = 0.001). Full-band conditions with more low- and high-frequency energy were higher than the other high-frequency cutoff conditions (mean difference range: 12.9–15%, p < 0.001).

Conclusions:

The direct drive system provides higher sound quality of both speech and music compared to narrowband conditions. Sound quality improvements were mainly attributable to low-frequency sound, but stimuli with specific high-frequency content were rated with higher sound quality when additional high-frequency energy was present.
Accuracy of Fibrosis-4 index and non-alcoholic fatty liver disease fibrosis scores in metabolic (dysfunction) associated fatty liver disease according to body mass index: failure in the prediction of advanced fibrosis in lean and morbidly obese individuals
Authors: Eren Fatih , Kaya Eda , Yilmaz Yusuf
Published: September 2020

Background and aim

While non-invasive scores are increasingly being used to screen for advanced fibrosis in metabolic (dysfunction) associated fatty liver disease (MAFLD), the effect of BMI on their clinical utility remains uncertain. This study assessed the usefulness of the Fibrosis-4 index (FIB-4) and the non-alcoholic fatty liver disease fibrosis score (NFS) in lean, overweight, obese, severely obese, and morbidly obese patients with biopsy-proven MAFLD.

Methods

A total of 560 patients (28 lean, 174 overweight, 229 obese, 89 severely obese, 40 morbidly obese) were included. Diagnostic performances and optimal cut-off values for FIB-4 and NFS were calculated using receiver operating characteristic (ROC) curve analysis.

Results

In both lean and morbidly obese patients with MAFLD, both FIB-4 and NFS failed to discriminate advanced fibrosis. Conversely, both scores showed acceptable diagnostic performances in exclusion of advanced fibrosis in overweight, obese, and severely obese patients. FIB-4 was able to exclude advanced fibrosis with the highest diagnostic accuracy in the subgroup of overweight patients (area under the ROC curve: 0.829, 95% confidence interval: 0.738−0.919).

Conclusion

FIB-4 and NFS can confidently be used to exclude advanced fibrosis in overweight, obese, and severely obese patients. However, they do not appear clinically useful in lean and morbidly obese patients.
Safety and efficacy of outpatient continuous terlipressin infusion for the treatment of portal hypertensive complications in cirrhosis
Authors: Gow Paul J. , Sinclair Marie , Thwaites Phoebe A. , Angus Peter W. , Chapman Brooke , Terbah Ryma , Testro Adam G.
Published: September 2020

Background/Aim

Therapeutic options are limited for patients with hepatorenal syndrome (HRS), diuretic refractory ascites and hepatic hydrothorax who are awaiting liver transplant. We assessed the safety and efficacy of continuous terlipressin infusion (CTI) for treating these conditions in an outpatient setting.

Method

All patients treated with CTI from May 2013 through March 2018 at our institution were initiated in-hospital on bolus dose terlipressin therapy for 24−72 h prior to commencing CTI for home therapy. Daily home visits for clinical assessment and medication administration were provided. Adverse events, effects of treatment on renal function, model for end-stage liver disease (MELD) score, and paracentesis/thoracentesis requirements were assessed.

Results

Twenty-three patients were included (HRS = 17; refractory ascites = 4; refractory hepatic hydrothorax = 2). Median (range) duration of outpatient CTI was 50 (1–437) days with a total of 2482 patient days of treatment. Fourteen patients (60.9%) received a liver transplant; of whom 13 (92.9%) were alive at the end of the study period. There were no cardiac or ischemic complications and no serious adverse events reported. In patients with HRS, median serum creatinine significantly decreased from 202.0 μmol/L at baseline to 125.5 μmol/L at day 14 of CTI (P = 0.0003) and remained stable thereafter. Median MELD score decreased from 22.5 to 19.0 at end of CTI (P = 0.008). Median frequency of paracentesis/thoracentesis was 4 per month prior to CTI versus 1.52 during treatment.

Conclusion

Transplant-eligible and otherwise stable patients can be managed with CTI at home for an extended duration under supervision without adverse consequences.
Improving Cervical Screening in Trans and Gender-Diverse People
Authors: Kerr Lucille , Fisher Christopher M. , Jones Tiffany
Published: September 2020

Background

Trans and gender-diverse people with a cervix experience difficulties accessing cervical cancer screening because of structural, interpersonal, and individual barriers.

Objective

The aim of this study was to explore issues with cervical cancer screening participation, awareness, and healthcare provider recommendation for trans and gender-diverse people.

Methods

A national Australian survey was conducted in 2018 to 2019. Participants included 196 trans and gender-diverse people with a cervix. Data were analyzed using descriptive and multiple regression analyses. Two awareness items related to cervical cancer screening, healthcare provider recommendation, and cervical cancer screening participation were assessed. Four variables associated with cervical cancer screening were included in the regression: age, healthcare provider recommendation, like for body, and gender.

Results

The sample was young; half (52.6%) were aged 20 to 24 years. Almost half (44.6%) had never had a healthcare provider recommend cervical cancer screening to them. Around half (48.0%) had never participated, with 21.9% reporting that they are regular screeners. More than a quarter (27.5%) of people who had screening had an abnormal result. The most common reasons for not participating in screening were that it is emotionally traumatic for them (55.3%) and inability to find a healthcare provider with whom they are comfortable (38.3%).

Conclusions

Trans and gender-diverse Australians with a cervix are unlikely to be regular participants in cervical cancer screening. To continue reducing cervical cancer rates, healthcare providers must address underscreening in this community.

Implications for Practice

Gender diversity training needs to be provided to healthcare providers. In addition, healthcare providers need to promote participation in cervical screening in this trans and gender-diverse community.
Caregiver Burden Among Primary Family Caregivers of Patients Undergoing Hematopoietic Stem Cell Transplantation
Authors: Xie Lili , Shen Chen , Shi Yaqin , Li Huiling
Published: September 2020

Background

Patients undergoing hematopoietic stem cell transplantation (HSCT) require extensive care, and their caregivers were previously found to experience high levels of caregiver’s burden. However, the current status of HSCT patient caregiver burden in Suzhou, China, is still unknown.

Objective

To investigate the current status of caregiver burden among family caregivers of HSCT patients from Suzhou, China, and explore the related factors of caregiver burden.

Methods

This cross-sectional study enrolled 116 HSCT patient-caregiver dyads. The following measurement tools were used: a demographic questionnaire, Zarit Burden Interview, and World Health Organization Quality of Life questionnaire (brief version). Multiple regression model was used to analyze the factors associated with caregiver burden, and the relationship between caregiver burden and quality of life was analyzed.

Results

Caregivers’ marital status, family monthly income, duration of caregiving, daily caregiving time, other cocaregivers, transplant-related complications, and relapse were closely related to caregiver burden, and 75.4% of the variance in caregivers’ burden was explained by these factors. A negative correlation between caregiver burden and quality of life was noted.

Conclusion

The HSCT patient caregivers’ burden noted in this study was higher than that found in previous studies. The quality of life of HSCT patient caregivers is lower than that of the average Chinese population and decreases with a greater sense of burden.

Implications for Practice

Hematopoietic stem cell transplantation patient caregivers should be given appropriate social support to reduce their burden of care. Factors identified in this study may help center future intervention programs on caregivers who need help the most.
Acute Aortic Regurgitation Due to Endocarditis Caused by Disseminated Gonococcal Infection: A Case Report
Authors: Neto Ana , Sevilha Joana , Seabra Daniel , Oliveira Inês , Santos Rui Pontes , Andrade Aurora , Pinho Paulo , Costa Paula Martins , Viana Mariana , Pinto Paula
Published: September 2020

A 23-year-old man presented with cough and progressive shortness of breath. Echocardiogram showed a biscupid aortic valve with a large vegetation causing severe regurgitation. Blood cultures were positive for Neisseria gonorrhoeae sensitive to cefotaxime and penicillin. Despite direct antibiotherapy, the patient required cardiac surgery with aortic valve replacement.
Chlamydia Screening Among Women Aged 15 to 44 Years Who Reported Anal Sex During the Past 12 Months in the United States, 2013 to 2017
Authors: Kumar Sagar , Patel Chirag G. , Tao Guoyu
Published: September 2020

Using the 2013–2017 National Survey of Family Growth, 37.6% of women with ≥1 anal sex partner in the last 12 months reported chlamydia testing at unspecified anatomic sites in the past 12 months. Women whose medical provider asked about type of sex (i.e., vaginal, oral, anal), compared with those whose provider did not, reported higher chlamydia testing.
Risk-stratified and stepped models of care for back pain and osteoarthritis: are we heading towards a common model?
Authors: Kongsted Alice , Kent Peter , Quicke Jonathan G. , Skou Søren T. , Hill Jonathan C.
Published: September 2020

The overall quality of care for musculoskeletal pain conditions is suboptimal, partly due to a considerable evidence-practice gap. In osteoarthritis and low back pain, structured models of care exist to help overcome that challenge. In osteoarthritis, focus is on stepped care models, where treatment decisions are guided by response to treatment, and increasingly comprehensive interventions are only offered to people with inadequate response to more simple care. In low back pain, the most widely known approach is based on risk stratification, where patients with higher predicted risk of poor outcome are offered more comprehensive care. For both conditions, the recommended interventions and models of care share many commonalities and there is no evidence that one model of care is more effective than the other. Limitations of existing models of care include a lack of integrated information on social factors, comorbid conditions, and previous treatment experience, and they do not support an interplay between health care, self-management, and community-based activities. Moving forwards, a common model across musculoskeletal conditions seems realistic, which points to an opportunity for reducing the complexity of implementation. We foresee this development will use big data sources and machine-learning methods to combine stepped and risk-stratified care and to integrate self-management support and patient-centred care to a greater extent in future models of care.
Brief Report: Bacterial Vaginosis and Risk of HIV Infection in the Context of CD101 Gene Variation
Authors: Wanga Valentine , Mackelprang Romel D. , Thomas Katherine K. , Donnell Deborah , Cohen Craig R. , Mugo Nelly R. , Bukusi Elizabeth A. , de Bruyn Guy , Irungu Elizabeth , Celum Connie , Baeten Jared M. , Lingappa Jairam R. ,   for the Partners in Prevention HSV/HIV Transmission Study and the Partners PrEP Study
Published: September 2020

Background:

Whether bacterial vaginosis (BV) and CD101 immunoglobulin-like (Ig-like) variants independently increase HIV risk through mucosal inflammation is not well understood. We evaluated whether the impact of BV on HIV acquisition in women differs by the presence or absence of candidate CD101 Ig-like variants.

Methods:

We used data from 2 studies of HIV serodiscordant couples in east (Kenya, Tanzania, and Uganda) and southern (Botswana, South Africa, and Zambia) Africa, which longitudinally assessed HIV acquisition (by ELISA) and BV (by Nugent score ≥7). We used previously generated CD101 sequence data for each case and control participant to create a binary variable indicating the presence/absence of any of 5 CD101 Ig-like variants.

Results:

Confirming previously shown results in this cohort, Ig-like variants increased HIV-infection risk (adjusted hazard ratio [aHR], = 2.63; 95% confidence interval [CI], 1.41 to 4.89). BV was associated with 2.5-fold higher HIV-infection risk only in the absence of Ig-like variants (aHR = 2.47; 95% CI, 0.99 to 6.15; P = 0.052), whereas in the presence of Ig-like variants, BV was not associated with higher HIV-infection risk (aHR = 0.87; 95% CI, 0.35 to 2.15; P = 0.765); however, a test for interaction was nonsignificant (P = 0.116).

Conclusions:

We hypothesized that both BV and CD101 Ig-like variants facilitate HIV acquisition by augmenting similar genital inflammation pathways. Our findings indicate that inflammatory mucosal effects of Ig-like variants may influence the impact of BV on HIV risk. Host-defined inflammatory pathways may be useful targets for HIV prevention.
Cardiac Magnetic Resonance–Derived Indexed Volumes and Volume Ratios of the Cardiac Chambers Discriminating Group 2 Pulmonary Hypertension From Other World Health Organization Groups
Authors: Sakrana Amal Abdelsattar , Abdel Razek Ahmed Abdel khalek , Yousef Aida M. , El Tahlawi Mohammad abdalla , Gadelhak Basma Nabil
Published: September 2020

Objective

The aims of the study were to assess the performance of cardiac magnetic resonance (CMR)-derived cardiac chamber volumes and volume ratios to identify group 2 pulmonary hypertension (PH) patients and to determine their cutoff values with the highest sensitivity and specificity.

Methods

One hundred six patients underwent CMR, 2 months after the diagnosis of PH by right heart catheterization. We classified patients with pulmonary capillary wedge pressure of greater than 15 mm Hg as group 2 PH. Cardiac chamber volumes indexed to the body surface area and volume ratios were correlated to the type of PH. Their sensitivity and specificity to detect group 2 PH were examined at various cutoff points.

Results

The most appropriate cutoff values to designate group 2 PH patients with high sensitivity and specificity were as follows: left atrium volume index of 54.72 mL/m2 or greater, right ventricle volume/left atrium volume of 2.07 or less, and right atrium volume/left atrium volume of 1.61 or less.

Conclusions

Cardiac magnetic resonance–derived cardiac chamber volume indices and volume ratios can determine group 2 PH diagnosis with high sensitivity and specificity.