bluuebunny/crossref_metadata_2025 huggingface dataset:
Suboptimal response to GnRH agonist trigger: causes and practical management
Authors: Humaidan Peter , Kol Shahar
Published: February 2021

Purpose of review

GnRH agonist products are used extensively worldwide to trigger ovulation and final oocyte maturation in in vitro fertilization cycles. The purpose of this article is to outline possible causes for a suboptimal response to the GnRH agonist trigger.

Recent findings

Risk factors for such a suboptimal response include prolonged hormonal contraceptive use, previous GnRHa-induced pituitary downregulation, a hypogonadotropic/hypogonadal condition, patient error, environmental conditions that may damage the GnRHa product used, GnRH and luteinizing hormone (LH) receptors polymorphisms, low baseline LH and low endogenous serum LH levels on trigger day as well as low BMI. The induction of an adequate LH surge can be ascertained by an LH urine test 12 h post trigger.

In most cases, GnRHa trigger elicits effective LH+follicle stimulating hormone surges, resulting in mature, fertilizable oocytes. Clinical awareness to conditions that may predispose to a suboptimal response to the GnRHa trigger may prevent failed oocyte retrial.
Third Toe Pulp Reconstruction Using the Contralateral Second Toe Hemi-pulp Free Flap
Authors: Kusuhara Hirohisa , Sueyoshi Yu , Nagumo Yoshiaki , Asamura Shinichi , Isogai Noritaka
Published: February 2021

A hemi-pulp flap is widely known as a flap useful for aesthetic and functional reconstruction of the fingers, and rarely used for toe reconstruction. We performed third toe pulp reconstruction using a free hemi-pulp flap harvested from the contralateral second toe to repair the tissue defect following toe replantation. An 18-year-old woman was injured with complete left third toe amputation and open fracture of the proximal phalanx of the left second toe in a traffic accident. On the same day, third toe replantation was urgently performed. After surgery, the third toe was partially taken, and had a toe pulp tissue defect due to necrosis. It was reconstructed with a free hemi-pulp flap prepared from the contralateral second toe. The flap was completely taken. Three years after surgery, the reconstructed left third toe was aesthetically favorable. Perception of the flap region was restored up to S2 without pain and there was no complication such as numbness, callus, and ulceration. In the flap donor site (right second toe), the skin graft was unnoticeable without pigmentation. Toe pulp reconstruction requires a sensory flap as low-invasive as possible with excellent sensory restoration, texture, feel, and shear property. This method is considered as one of the low-invasive, aesthetic, and functional reconstruction methods.
The Ideal Applicant to the Saudi Plastic Surgery Residency Program
Authors: Shah Mardan Qutaiba N. M. , Alamari Nouf A. , Alzahrani Hatan M. , Almarghoub Mohammed A. , Al Saud Nouf A. , Alqahtani Moraya S.
Published: February 2021

Background:

Securing a plastic surgery position is a demanding task for students. Although many papers have been published internationally discussing the traits and features deemed important from the point of view of plastic surgery program directors, a gap exists in the literature where this aspect is not covered in Saudi Arabia. The aim of this study was to fill this gap.

Methods:

In this cross-sectional study, a survey was developed targeting all current and former Saudi plastic surgery training program directors. SPSS was used to calculate frequencies and present percentages; independent t-test was done to look for mean differences. Ethical approval was obtained from a local institution.

Results:

All current and former Saudi plastic surgery program directors participated (n = 17), including the 8 (47.1%) current directors. When asked to rank 7 items on a scale of importance, they scored a mean of 6.2, 5.8, 5.4, 4.88, 4.82, 4.6, and 3.7 for good impression on interviews, prior experience, research experience, the grade point average (GPA), oral or poster presentations on events, the Saudi Medical Licensing Examination (SMLE), and attaining a post-graduate degree, respectively. The majority [n = 7 (41%)] considers the mode of communication, such as phone calls, as the most important aspect in recommendations. They prefer candidates who took electives/rotations at their department [n = 12 (71%)] and give more value to high-quality publications [n = 9 (47%)]. Applicant’s gender was not important.

Conclusion:

With early planning, this article could serve as a guide for medical students interested in plastic surgery to build their assets toward a successful interview.
Impact of Age in Acute Myocardial Infarction Cardiogenic Shock: Insights From the National Cardiogenic Shock Initiative
Authors: Lemor Alejandro , Basir Mir B. , Gorgis Sarah , Todd Josh , Marso Steve , Gelormini Joseph , Akhtar Yasir , Baker John , Chahin Juan , Abdul-Waheed Mohammad , Thukral Nandish , O’Neill William
Published: February 2021

Background:

Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality. Patients ≥75 years old represent an increasing proportion of those who present with AMICS and are at high risk for adverse outcomes.

Methods:

The National Cardiogenic Shock Initiative includes patients with AMICS treated using a standard shock protocol with early invasive hemodynamic monitoring, mechanical circulatory support (MCS), and percutaneous coronary intervention (PCI). We evaluated the outcomes of patients based on their age group, dividing them into <75 and ≥75 years old.

Results:

We included 300 consecutive patients: 238 were <75 years old (79.3%) and 62 patients ≥75 years old. There were significant differences in survival; patients <75 years old had a 75.6% survival, while those ≥75 years old had a 50% survival (adjusted OR: 10.4, P = 0.001). SCAI shock classification impacted survival as well; those <75 years old with class C or D shock had a survival of 84%, compared with 57% in those ≥75 years old. Patients ≥75 years old requiring 1 or 2 vasopressors had significantly lower survival rates (36% and 25%, respectively) when compared with patients <75 years old (76.7% with 1 and 60.5% with >1 vasopressor).

Conclusions:

Age is inversely proportional to survival; patients <75 years old have high rates of survival if treated using best practices with invasive hemodynamic monitoring, early MCS, and PCI. However, using a standardized protocol can improve survival in the elderly; therefore, age on its own should not be a reason to withhold PCI or MCS use.
MACULAR HOLE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION
Authors: Kim Kyoung Lae , Han Jeong Mo , Kim Min Seok , Park Sang Jun , Kim Seong-Woo , Kim Jae Hui , Kim Min , Lee Christopher Seungkyu , Kang Hyun Goo , Lee Joo Yong , Woo Se Joon
Published: February 2021

Purpose:

To ascertain the pathogenesis of macular hole (MH) associated with age-related macular degeneration (AMD) and its surgical outcomes.

Methods:

Patients with full-thickness MH associated with AMD (higher grades than intermediate) were enrolled. The mechanism of MH formation and closure rate after vitrectomy (surgical outcome) were determined using optical coherence tomography imaging.

Results:

The mechanism of MH formation (35 eyes) associated with AMD was classified into four types: vitreomacular traction (42.9%), gradual retinal thinning caused by subretinal drusen or pigment epithelial detachment (22.9%), massive subretinal hemorrhage (20.0%), and combined (14.3%). In the 41 eyes that underwent vitrectomy, the logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.82 (0.10–2.30) preoperative to 0.69 (0.10–2.30) postoperative (P = 0.001). Successful closure of the MH was achieved in 33 eyes (80.5%) after vitrectomy. No significant association was observed between the closure rate of MH after vitrectomy and mechanism of MH formation (P = 0.083).

Conclusion:

The mechanism of MH formation associated with AMD was classified into four types and was not related to its surgical outcome. Considering visual improvement and surgical outcome after vitrectomy in our study, active surgical treatment can be considered for MH associated with AMD.
Do Eye Bank Models and Competitive Practice Affect International Cornea Allocation?
Authors: Machin Heather , Sutton Gerard , Baird Paul N.
Published: February 2021

Purpose:

International export and import of corneas is dependent on the stakeholders involved in the process and how those organizations engage to move corneas from one point to another. Our article presents the pathway of corneal donation from the export nation until its use in the import nation. It presents opinion on how aspects, such as competition and promotional behaviors, the use of online systems, and third-party engagement may influence allocation.

Methods:

We interviewed n = 92 international eye tissue and eye bank (EB) professionals to garner their opinion. We used saturation and sentiment methods to extract and consolidate group opinion.

Results:

Interviewees indicated that competition and promotional behaviors existed in some EB nations—although it was not universal. They indicated that the behavioral approach used by the individual EB, rather than the act of information sharing, influenced allocation. They also indicated that organizational models and allocation systems (eg, online ordering) and engagement with nonstate actors were important in allocation practice and decision making.

Conclusion:

We mapped the pathways for corneas involved in export and import from the point of recovery to their point of transplantation. Although generalist in nature and limited by the paucity of the existing literature, our article outlines that different business models, partnerships, and applied methods influence corneal export and import.
Long-Term Outcomes of Phototherapeutic Keratectomy for Bullous Keratopathy
Authors: Hart Colby Thomas , Cleary Georgia , Chan Elsie
Published: February 2021

Purpose:

To report the long-term outcomes after phototherapeutic keratectomy (PTK) for the treatment of bullous keratopathy.

Methods:

This is a retrospective medical record review of all patients with symptomatic bullous keratopathy who underwent PTK between June 2005 and March 2019 at the Royal Victorian Eye and Ear Hospital who were followed up for at least 12 months after the procedure. Medical records were used to extract demographic data, etiology of bullous keratopathy, complication rates, and subsequent procedures after PTK. The main outcomes recorded were pain and recurrence of bullae, which were assessed according to three time periods: 0 to 3 months, 4 to 12 months, and greater than 12 months after PTK.

Results:

During the study period, 64 eyes of 64 patients underwent PTK for bullous keratopathy. The mean follow-up duration was 51 months (range 12–140). The most common indication was pseudophakic bullous keratopathy (44% of cases). Pain had resolved in 88% of eyes within 0 to 3 months, 77% of eyes between 3 and 12 months (P = 0.031, compared with 0–3 months), and 70% of eyes with greater than 12-month follow-up (P = 0.131, compared with 3–12 months). Bullae recurred in 17% of eyes within 0 to 3 months, 22% of eyes between 3 and 12 months (P < 0.001 compared with 0–3 months), and 33% of eyes after the 12-month follow-up (P < 0.001 compared with 3–12 months). Eighty-six percent of patients undergoing PTK had no postoperative complications, and 73% of cases did not require subsequent procedures.

Conclusions:

PTK is effective in providing long-term symptom relief from bullous keratopathy in most of the treated patients.
A Comparison of Clinical Outcomes After XEN Gel Stent and EX-PRESS Glaucoma Drainage Device Implantation
Authors: Stoner Ari M. , Capitena Young Cara E. , SooHoo Jeffrey R. , Pantcheva Mina B. , Patnaik Jennifer L. , Kahook Malik Y. , Seibold Leonard K.
Published: February 2021

Precis:

Although the XEN stent offers a lower risk of hypotony and choroidal effusions with fewer clinic visits postoperatively, its surgical success rate was inferior to the EX-PRESS shunt.

Purpose:

To compare the clinical efficacy and safety outcomes of the XEN stent and EX-PRESS glaucoma drainage device in glaucomatous eyes.

Materials and Methods:

One hundred eyes from 88 patients underwent ab interno XEN stent or EX-PRESS shunt implantation (52 XEN and 48 EX-PRESS) for uncontrolled glaucoma at the University of Colorado Eye Center. The primary outcome was surgical success defined as intraocular pressure (IOP) ≥6 and ≤18 mm Hg, without reoperation for uncontrolled glaucoma, loss of light perception, or use of glaucoma medications (complete success). Secondary outcomes were the same requirements allowing for medications (qualified success), mean IOP, medication use, adverse events, and number of postoperative clinic visits in the first 3 months.

Results:

Baseline characteristics including glaucoma type and severity were similar between groups, with the exception of XEN patients having fewer men (17% vs. 46%), older patients (median age, 78 vs. 68), and a higher percentage of white patients (89% vs. 69%). Adjusted hazard ratio of failure of XEN relative to EX-PRESS was 3.94 (95% confidence interval, 1.73-9.00, P=0.001) for complete success and 1.61 (95% confidence interval, 0.40-6.38, P=0.501) for qualified success. There were significantly fewer postoperative clinic visits during the first 3 months in the XEN group (5.3 vs. 9.1 visits, P<0.001). The incidence of serous choroidal effusions and hypotony was significantly less after XEN compared with EX-PRESS (1 vs. 9, P=0.02 and 15 vs. 25, P=0.023, respectively). Three XEN stents (5.8%) required removal.

Conclusions:

In this population, although the XEN stent offers a better safety profile and fewer postoperative clinic visits, complete surgical success was inferior to the EX-PRESS shunt.
Validation of the Rule of 7’s for Identifying Children at Low-risk for Lyme Meningitis
Authors: Garro Aris , Avery Robert A. , Cohn Keri A. , Neville Desiree N. , Balamuth Fran , Levas Michael N. , Bennett Jonathan E. , Kharbanda Anupam B. , Monuteaux Michael C. , Nigrovic Lise E.
Published: February 2021

Background:

The Rule of 7’s classifies children as low-risk for Lyme meningitis with the absence of the following: ≥7 days of headache, any cranial neuritis or ≥70% cerebrospinal fluid mononuclear cells. We sought to broadly validate this clinical prediction rule in children with meningitis undergoing evaluation for Lyme disease.

Methods:

We performed a patient-level data meta-analysis of 2 prospective and 2 retrospective cohorts of children ≤21 years of age with cerebrospinal fluid pleocytosis who underwent evaluation for Lyme disease. We defined a case of Lyme meningitis with a positive 2-tier serology result (positive or equivocal first-tier enzyme immunoassay followed by a positive supplemental immunoblot). We applied the Rule of 7’s and report the accuracy for the identification of Lyme meningitis.

Results:

Of 721 included children with meningitis, 178 had Lyme meningitis (24.7%) and 543 had aseptic meningitis (75.3%). The pooled data from the 4 studies showed the Rule of 7’s has a sensitivity of 98% [95% confidence interval (CI): 89%–100%, I
2 = 71%], specificity 40% (95% CI: 30%–50%, I
2 = 75%), and a negative predictive value of 100% (95% CI: 95%–100%, I
2 = 55%).

Conclusions:

The Rule of 7’s accurately identified children with meningitis at low-risk for Lyme meningitis for whom clinicians should consider outpatient management while awaiting Lyme disease test results.
Quantified TB Exposure Can Predict Prevalent TB Disease in Child Contacts
Authors: Malik Amyn A. , Amanullah Farhana , Siddiqui Sara , Creswell Jacob , Hussain Hamidah
Published: February 2021

In a matched case-control study in Pakistan, we found that quantified tuberculosis (TB) exposure using a 10-point score is associated with prevalent TB disease in pediatric household contacts. A 1 unit increase in TB exposure score increased the odds of TB disease by 44% (conditional odds ratio: 1.44, 95% confidence interval: 1.33–1.56). Collecting well-documented exposure history can help TB diagnosis in resource-limited settings.
Think of the Children
Authors: González-Donapetry Patricia , García-Clemente Paloma , Bloise Iván , García-Sánchez Consuelo , Sánchez Castellano Miguel Ángel , Romero María Pilar , Gutiérrez Arroyo Almudena , Mingorance Jesús , de Ceano-Vivas La Calle María , García-Rodriguez Julio
Published: February 2021

Background:

Real-time reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is the reference laboratory method to diagnose SARS-CoV-2 infection then requires equipment and is time-consuming. There is a crucial demand for rapid techniques such as antigen detection test. Considering the different diagnostic accuracy of tests with other respiratory viruses in adults and children, SARS-CoV-2 antigen test must be evaluated specifically in children.

Methods:

The purpose of this study was to evaluate the performance of Panbio COVID-19 Ag Rapid Test Device (Abbott) as a point-of-care test for diagnosis of SARS-CoV-2 in comparison to RT-qPCR in a pediatric population.

Results:

Four hundred forty nasopharyngeal swabs were tested. Amongst the 18 positive RT-qPCR samples, 14 were detected by the rapid antigen test, given an overall sensitivity of 77.7%. All the samples detected positive with the antigen rapid test were also positive with RT-qPCR.

Conclusion:

The sensitivity of Panbio COVID-19 Ag Rapid Test Device is lower in children than in adults. Nevertheless, considering the good values of specificity, negative and positive predictive values this test could be used as a frontline test to obtain quick results, although the negative values with COVID-19 high clinical suspicion should be confirmed using RT-qPCR.
Inclusive Classroom Profile Training Program
Authors: West Tracey , Soukakou Elena , Winton Pam J.
Published: February 2021

This article provides results of the effectiveness of a training program for a measure, the Inclusive Classroom Profile (ICP), that is designed to assess the quality of classroom practices that support the individualized needs of the children with disabilities in early childhood inclusive programs. The ICP training program was developed to train users of the ICP to administer the measure with accuracy and reliability. The study assessed the extent to which participants in the training program were able to learn to apply the measure with reliability, as well as the extent to which they found the training and the measure useful for their professional practice. Results indicated that participants of the ICP training successfully met the required reliability standards, rated the components of the training program highly, found the ICP measure easy to use, and continued to use the ICP measure following their participation in the training.
The Early Childhood Personnel Center
Authors: Bruder Mary Beth , Gundler Darla , Stayton Vicki , Kemp Peggy
Published: February 2021

There are concerns about the quantity and quality of personnel in early childhood intervention (ECI) as the numbers of infants and young children with delays and disabilities grow in number, needs, and diversity. The Early Childhood Personnel Center (ECPC) was funded to provide technical assistance (TA) to state systems of ECI and institutions of higher education (IHE) through the development of comprehensive systems of personnel development (CSPD). A CSPD is comprised of 6 interrelated subcomponents and each provides the infrastructure necessary to meet the current and future needs of a competent workforce. The subcomponents include recruitment and retention, personnel standards, preservice programs, in-service training, leadership and sustainability, and evaluation. TA audiences have included ECI administrators, IHE faculty, doctoral students, professional development providers, and families that jointly develop, implement, and evaluate effective personnel practices, policies, and systems. The purpose of this article is to provide an overview of the TA provided by the ECPC over the past 8 years.
Surface light scattering from 1-piece hydrophobic acrylic intraocular lenses with hydroxyethyl methacrylate: contralateral observation for 7 years
Authors: Kinoshita Katsuhito , Miyata Kazunori , Nejima Ryohei , Honbo Masato , Mori Yosai , Minami Keiichiro
Published: February 2021

Purpose:

To quantitatively and intraindividually compare surface light scattering for 7 years after implantation of Clareon and AcrySof intraocular lenses (IOLs).

Setting:

Miyata Eye Hospital, Miyazaki, Japan.

Design:

Retrospective comparative case series.

Methods:

Clinical records of eyes that had contralateral implantation of SN60WF and SY60WF IOLs were reviewed. Light scattering on the anterior surface of IOLs, corrected distance visual acuity (CDVA), and mesopic and photopic contrast sensitivities were examined at 1 year, 3 years, and 7 years postoperatively, and they were intraindividually compared.

Results:

34, 19, and 16 patients visited at 1 year, 3 years, and 7 years postoperatively, respectively. Surface light scattering in eyes with SY60WF IOL was significantly reduced, and the rate of increase was 2.74 computer compatible tapes per year. Although there were prominent increases in eyes with SN60WF IOL, no statistically significant difference was found in their CDVA and contrast sensitivities.

Conclusions:

In eyes with Clareon IOLs, the development of surface light scattering was suppressed up to 7 years. The increase rate demonstrated that the visual acuity would be least deteriorated up to 12 years postoperatively, whereas the influence of straylight induced should be investigated.
Delta opioid receptor regulation of calcitonin gene–related peptide dynamics in the trigeminal complex
Authors: Moye Laura S. , Siegersma Kendra , Dripps Isaac , Witkowski Wiktor , Mangutov Elizaveta , Wang Dong , Scherrer Grégory , Pradhan Amynah A.
Published: February 2021

Migraine is highly prevalent and is the sixth leading cause worldwide for years lost to disability. Therapeutic options specifically targeting migraine are limited, and delta opioid receptor (DOP) agonists were recently identified as a promising pharmacotherapy. The mechanisms by which DOPs regulate migraine are currently unclear. Calcitonin gene–related peptide (CGRP) has been identified as an endogenous migraine trigger and plays a critical role in migraine initiation and susceptibility. The aim of this study was to determine the behavioral effects of DOP agonists on the development of chronic migraine–associated pain and to investigate DOP coexpression with CGRP and CGRP receptor (CGRPR) in the trigeminal system. Chronic migraine–associated pain was induced in mice through repeated intermittent injection of the known human migraine trigger, nitroglycerin. Chronic nitroglycerin resulted in severe chronic cephalic allodynia which was prevented with cotreatment of the DOP-selective agonist, SNC80. In addition, a corresponding increase in CGRP expression in the trigeminal ganglia and trigeminal nucleus caudalis was observed after chronic nitroglycerin, an augmentation that was blocked by SNC80. Moreover, DOP was also upregulated in these head pain-processing regions following the chronic migraine model. Immunohistochemical analysis of the trigeminal ganglia revealed coexpression of DOP with CGRP as well as with a primary component of the CGRPR, RAMP1. In the trigeminal nucleus caudalis, DOP was not coexpressed with CGRP but was highly coexpressed with RAMP1 and calcitonin receptor–like receptor. These results suggest that DOP agonists inhibit migraine-associated pain by attenuating CGRP release and blocking pronociceptive signaling of the CGRPR.
A Glra3 phosphodeficient mouse mutant establishes the critical role of protein kinase A–dependent phosphorylation and inhibition of glycine receptors in spinal inflammatory hyperalgesia
Authors: Werynska Karolina , Gingras Jacinthe , Benke Dietmar , Scheurer Louis , Neumann Elena , Zeilhofer Hanns Ulrich
Published: February 2021

Glycinergic neurons and glycine receptors (GlyRs) exert a critical control over spinal nociception. Prostaglandin E2 (PGE2), a key inflammatory mediator produced in the spinal cord in response to peripheral inflammation, inhibits a certain subtype of GlyRs (α3GlyR) that is defined by the inclusion of α3 subunits and distinctly expressed in the lamina II of the spinal dorsal horn, ie, at the site where most nociceptive nerve fibers terminate. Previous work has shown that the hyperalgesic effect of spinal PGE2 is lost in mice lacking α3GlyRs and suggested that this phenotype results from the prevention of PGE2-evoked protein kinase A (PKA)-dependent phosphorylation and inhibition of α3GlyRs. However, direct proof for a contribution of this phosphorylation event to inflammatory hyperalgesia was still lacking. To address this knowledge gap, a phospho-deficient mouse line was generated that carries a serine to alanine point mutation at a strong consensus site for PKA-dependent phosphorylation in the long intracellular loop of the GlyR α3 subunit. These mice showed unaltered spinal expression of GlyR α3 subunits. In behavioral experiments, they showed no alterations in baseline nociception, but were protected from the hyperalgesic effects of intrathecally injected PGE2 and exhibited markedly reduced inflammatory hyperalgesia. These behavioral phenotypes closely recapitulate those found previously in GlyR α3-deficient mice. Our results thus firmly establish the crucial role of PKA-dependent phosphorylation of α3GlyRs in inflammatory hyperalgesia.
Screening, Brief Intervention, and Referral to Treatment/Motivational Interviewing School-Based Therapy Pilot Study
Authors: Williams Kimberly A. , Lee Eun Jin , Wilmoth Michele , Selwyn Candice , Bydalek Katherine
Published: February 2021

Substance abuse and comorbid psychological disorders are significant problems among adolescents. Hence, school-based interventions could be a promising approach for tackling substance use and mental health symptoms in at-risk youth. This pilot study was aimed at determining the effectiveness of interventions like Screening, Brief Intervention, and Referral to Treatment and motivational interviewing (MI) on depressive anxiety and substance use symptoms in middle school participants. Student psychiatric nurse practitioners who were trained and competent in MI conducted a combined Screening, Brief Intervention, and Referral to Treatment/MI intervention with 19 participants using measurement tools such as the Patient Health Questionnaire-9, the Generalized Anxiety Disorders-7, and the Car, Relax, Alone, Forget, Friends, Trouble Screening Test. Depressive and anxiety symptoms decreased after the intervention. Because the pre–post Car, Relax, Alone, Forget, Friends, Trouble screening period was 4 weeks, there were no significant pre–post differences.
Factors Associated With Relapse in Individuals With Opioid Use Disorder Receiving Suboxone in Rural Areas
Authors: Chang Yu-Ping , Raynor Traci
Published: February 2021

Background

Opioid use disorder (OUD), including opioid misuse, abuse, and overdose, has evolved into a national crisis with a lasting effect on society, individuals, and health care systems. Although an office-based treatment of Suboxone combined with counseling is a viable option for individuals with OUD and has been shown to reduce utilization of medical services, the relapse rate among those individuals remains high. There is a need to investigate factors associated with relapse to tailor treatment programs in an effort to prevent relapse. This study aimed to examine factors associated with relapse in individuals with OUD receiving Suboxone.

Methods

A convenience sample was recruited from an outpatient Suboxone facility located in a rural county of New York. Measures included urine drug testing obtained through the medical record, patterns of time to relapse as measured by the Time to Relapse Questionnaire, pain intensity, and a demographic questionnaire. Descriptive statistics, independent t test, and chi-square statistics were utilized for data analysis.

Results

Forty-six patients participated in the study. Length of time in a Suboxone program, scores in sudden and long delay relapse, and the type of treatment program were statistically associated with relapse.

Conclusion

This study provided insight regarding factors contributing to relapse and different time-to-relapse styles that could be incorporated into clinical practice to help prevent relapse.
The Healthy Addiction Treatment Recovery Model
Authors: Comiskey Catherine , Galligan Karen , Flanagan Jean , Deegan Joan , Farnann Jane , Hall Aine
Published: February 2021

The current model of nursing within international addiction services has been described as task oriented and reactive. Yet, it is known that nursing models should be led by client need and operate within the domain of the client and their wider environment. The aim of this study was to address this gap within addiction nursing and to develop an evidence-based addiction nursing model.

To objectively assess the needs of clients, a cross-sectional survey was implemented within a representative selection of six drug treatment clinics and a sample of clients in receipt of opiate agonist treatment in Dublin, Ireland. The Opiate Treatment Index with the General Health Questionnaire embedded was used to measure heroin use, polydrug use, infectious disease risk, physical health, psychological adjustment, criminality and social well-being. To develop the addiction model, a mapping of relevant features of potential nursing models was conducted by nurses working in addiction services.

The key finding from the client assessments was a lack of psychological adjustment; a cutoff score of 4 was recommended. The mean score among women was 11 (95% CI [8, 14]), and that among men was 8 (95% CI [6, 10]). Findings from the mapping of models highlighted the benefits of the BRENDA, FRAMES, and Tidal models. A focus on practical implementation and measurable outcomes was stressed. Results informed the development of the Healthy Addiction Treatment Recovery Model. The model refocused services on clients' objective needs and eradicated entrenched practices.
Investigating the Clinical Utility of the Combined Use of Objective and Subjective Measures of ADHD During Treatment Optimization
Authors: Martin-Key Nayra A. , Stevenson Amy , Roy Perry
Published: February 2021

Background

This study investigated the clinical utility of the combined use of objective and subjective measures of attention-deficit/hyperactivity disorder (ADHD) prepharmacological and postpharmacological treatment.

Methods

Adults with ADHD (N = 77) completed the Quantified Behavioral Test, self-ratings of ADHD-related symptoms, and quality of life measures pretreatment and posttreatment.

Results

The use of objective and subjective measures of ADHD-related symptoms during initiation and follow-up of pharmacological treatment resulted in significant improvements in quality of life after 6 months. Both objective and subjective measures captured changes in ADHD-related symptoms, with more patients showing clinically relevant treatment effects on objective measures. Convergence rates between objective and subjective measures were low to moderate, and improvements on these measures correlated with increased quality of life.

Conclusions

Objective and subjective measures of ADHD capture important components of the condition. The findings from this study have important implications for clinical practice.
Ambulatory Heart Rate Variability in Schizophrenia or Depression
Authors: Bengtsson Johan , Olsson Erik , Igelström Helena , Persson Jonas , Bodén Robert
Published: February 2021

Background

Heart rate variability (HRV) has been found reduced in patients with schizophrenia and depression. However, there is a lack of knowledge on how demographic, lifestyle, and pharmacological factors contribute to the reduction in HRV in these patients.

Methods

We recruited 37 patients with schizophrenia, 43 patients with unipolar depression, and 64 healthy controls. A combined chest-worn HRV and accelerometer device was used in an ambulatory measurement. Age, sex, anticholinergic burden of medication, nicotine use, body mass index, and ongoing physical activity were assessed in multiple regression models regarding their influence on HRV, measured as the standard deviation of all the RR intervals (SDNN).

Results

In the fully adjusted model, schizophrenia (β = −0.23, P = 0.019), depression (β = −0.18, P = 0.028), age (β = −0.34, P < 0.000), ongoing physical activity (β = −0.23, P = 0.001), and anticholinergic burden (β = −0.19, P = 0.025) influenced SDNN negatively. Sex, nicotine use, and BMI had negligible effects on SDNN.

Conclusions

We show for the first time that a quantified score of anticholinergic burden of medication has a negative relationship to HRV in patients with schizophrenia or depression, but that the diagnoses themselves still exhibit an effect on HRV.
Patient Satisfaction With the Quality of Counseling Provided by Advanced Practice Nurses Specialized in Multiple Sclerosis: A Quantitative Analysis
Authors: Weilenmann Melanie , Händler-Schuster Daniela , Petry Heidi , Zanolari Diana , Schmid-Mohler Gabriela , Beckmann Sonja
Published: February 2021

BACKGROUND: The challenges in dealing with multiple sclerosis (MS) have increased considerably in recent years. In addition to neurologists, MS nurse specialists are key to the management of MS patients, but there is a lack of evidence regarding their quality of counseling. METHODS: The data collection took place between October 2018 and March 2019 in the outpatient clinic of a university hospital. The quality of counseling was assessed using the APN-BQ, an instrument that contains 19 items that can be assigned to 4 dimensions. Participants were asked to rate their satisfaction on a scale from 0 to 3. General satisfaction was assessed on a scale from 0 to 100. RESULTS: The participants (n = 110) rated the quality of counseling and their general satisfaction high. The mean (SD) of the structure quality dimension was 2.64 (0.44), and satisfaction with length and frequency of consultations (2.53 [0.63]) scored better than outcome quality (1.99 [0.62]) and process quality (2.13 [0.60]). CONCLUSION: Overall, there was a high rate of satisfaction with the quality of counseling. In addition to the length and frequency of consultations, MS patients particularly appreciated the availability and expertise of MS nurse specialists.
Effectiveness of a Delirium Prevention Initiative on an Inpatient Neuroscience Unit
Authors: Cyrus Teresa , Wenthold Rebecca , Hall Brenda , Tu Lisa , Hedquist Katie , Omodt Jean , Kozub Elizabeth , Guthrie Patricia Finch
Published: February 2021

BACKGROUND: Delirium frequently develops in hospitalized patients and results in increased mortality, longer length of stay, and need for transitional care. Neurological patients are at an increased risk for developing delirium. There is a paucity of research on effective prevention strategies for this population. PURPOSE: The objectives of this project were to improve nurses' knowledge and confidence in delirium prevention, design a delirium volunteer program, and establish ongoing monitoring for continued improvement. METHODS: This study is a quality improvement project using a pretest-posttest design to examine the benefits of refocusing care from delirium management to delirium prevention. The sample included 304 patients pre and 332 post intervention. The interventions included delirium education for nurses and the recruitment of trained volunteers to implement nonpharmacological, multicomponent delirium prevention interventions. RESULTS: Forty-eight nurses completed delirium education, and 11 volunteers were recruited and trained. There was a significant increase in nursing knowledge (z = 3.967, P < .0005) and confidence (z = 3.989, P < .0005). Volunteers visited 54 patients and implemented 99 interventions post implementation. CONCLUSION: This pre-post improvement project provides beginning evidence that nursing education increased nurses' knowledge and confidence in preventing and treating delirium. Trained volunteers supported using nonpharmacological delirium prevention interventions, but ongoing evaluation is needed to determine the impact of volunteers on delirium rates.
Symptoms of Anxiety and Depression in Relation to Work Patterns During the First Wave of the COVID-19 Epidemic in Philadelphia PA
Authors: Burstyn Igor , Huynh Tran
Published: February 2021

Objective:

We investigated whether patterns of work during COVID-19 pandemic altered by effort to contain the outbreak affected anxiety and depression.

Methods:

We conducted a cross-sectional online survey of 911 residents of Philadelphia, inquiring about their working lives during early months of the epidemic, symptoms of anxiety and depression, plus demographics, perceived sources of support, and general health.

Results:

Occupational contact with suspected COVID-19 cases was associated with anxiety. Concerns about return to work, childcare, lack of sick leave, and loss/reduction in work correlated with anxiety and depression, even when there was no evidence of occupational contact with infected persons; patterns differed by sex.

Conclusions:

Heightened anxiety and depression during COVID-19 pandemic can be due to widespread disruption of working lives, especially in “non-essential” low-income industries, on par with experience in healthcare.
Sickness Absence and Sickness Presence Among Health and Care Employees in Sweden—Health Complaints, Health Behavior, and Future Long-Term Sickness Absence
Authors: Helgesson Magnus , Gustafsson Klas , Marklund Staffan , Aronsson Gunnar , Leineweber Constanze
Published: February 2021

Objective:

To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA).

Methods:

Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted.

Results:

Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses’ high SP and care assistants’ high SA elevated the LTSA risk.

Conclusions:

Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.
Academic Entitlement in Physician Assistant Students
Authors: Ellis Jill , Bacon-Baguley Theresa , Otieno Sango
Published: February 2021

Purpose

The purpose of this study was to identify the prevalence and characteristics of academic entitlement (AE) among physician assistant (PA) students in the United States.

Methods

A cross-sectional survey design was used to assess AE using 2 previously validated AE surveys. Current PA students were recruited via email, and survey data were analyzed using descriptive statistics and cumulative logistic regression.

Results

Overall, the 337 PA students who participated in the study reported low levels of AE. Students displayed the highest level of AE on statements related to the role of professors and the lowest level of entitlement on statements pertaining to student responsibility and grade entitlement. Students who struggled academically were more likely to report AE in relation to professors' roles. Older students were more likely to display AE related to provision of necessary resources by the university and less likely to display AE regarding the method of delivery for learning materials. Higher levels of grade-related AE were found in students in the didactic phase, female students, and students who did not identify as White. In addition, students who did not identify as White were more likely to display AE in relation to tests.

Conclusions

Literature shows that AE has increased and is a major concern in higher education. Although the overall study results indicated relatively low AE, we found increased AE in certain student groups. Earlier identification of students at increased risk for AE would allow educators to intervene more effectively in a timely manner.
Specialty-Specific Diagnoses in Pediatric Patients With Postconcussion Syndrome: Experience From a Multidisciplinary Concussion Clinic
Authors: Shah Ankoor S. , Raghuram Aparna , Kaur Karampreet , Lipson Sophie , Shoshany Talia , Stevens Rebecca , O'Brien Michael , Howell David , Fleischman Katie , Barnack Danielle , Molind Heather , Kuemmerle Karameh Hawash , Brodsky Jacob R.
Published: February 2021

Objective:

To describe the collaborative findings across a broad array of subspecialties in children and adolescents with postconcussion syndrome (PCS) in a pediatric multidisciplinary concussion clinic (MDCC) setting.

Design:

Retrospective analysis.

Setting:

Multidisciplinary concussion clinic at a pediatric tertiary-level hospital.

Patients:

Fifty-seven patients seen in MDCC for evaluation and management of PCS between June 2014 and January 2016.

Interventions:

Clinical evaluation by neurology, sports medicine, otolaryngology, optometry, ophthalmology, physical therapy, and psychology.

Main Outcome Measures:

Specialty-specific clinical findings and specific, treatable diagnoses relevant to PCS symptoms.

Results:

A wide variety of treatable, specialty-specific diagnoses were identified as potential contributing factors to patients' postconcussion symptoms. The most common treatable diagnoses included binocular vision dysfunction (76%), anxiety, (57.7%), depression (44.2%), new or change in refractive error (21.7%), myofascial pain syndrome (19.2%), and benign paroxysmal positional vertigo (17.5%).

Conclusions:

Patients seen in a MDCC setting receive a high number of treatable diagnoses that are potentially related to patients' PCS symptoms. The MDCC approach may (1) increase access to interventions for PCS-related impairments, such as visual rehabilitation, physical therapy, and psychological counseling; (2) provide patients with coordinated medical care across specialties; and (3) hasten recovery from PCS.
Would Women With Solid Organ Transplant Qualify for Triennial Cervical Cancer Screening as Recommended by the American College of Obstetricians and Gynecologists in 2016 and American Society for Colposcopy and Cervical Pathology in 2019?
Authors: Long Margaret E. , Chantigian Paula D. M. , Weaver Amy L.
Published: February 2021

Objective

The aim of the study was to assess the applicability and safety of cervical cancer screening guidelines recommended by the American College of Obstetricians and Gynecologists (2016) and American Society for Colposcopy and Cervical Pathology (2019) for women with solid organ transplants (SOTs).

Materials and Methods

We analyzed data previously abstracted through December 2015 for 971 women (18–60 y) who received their first SOT at Mayo Clinic (Rochester, MN) from January 17, 1995, through December 31, 2011. Inclusion criteria were initial benign findings on cervical cytology after SOT and at least 1 subsequent cytologic screening.

Results

Of 415 women whose initial cytologic findings were benign, 310 met inclusion criteria. The cumulative incidence of abnormal cervical cytology among these 310 women was 4.3% (95% CI = 1.9%–6.7%) by 30 months and 11.2% (95% CI = 7.1%–15.4%) by 60 months after their initial benign results. Considering all women with SOT, 68.4% (284/415) had no documented abnormal cytologic findings within 60 months (26 had abnormality; 284 no abnormality; and 105 not assessed). In women with negative tests for human papillomavirus, high-grade squamous intraepithelial lesions were not documented on cytology with variable duration of follow-up. No cervical squamous cell carcinoma was identified.

Conclusions

Of women with initial benign cervical cytology after SOT, more than two thirds would have been eligible for extended-interval screening. Further study is needed, particularly regarding the role of high-risk human papillomavirus testing.
Criminal Justice Involvement and Abnormal Cervical Cancer Screening Results Among Women in an Urban Safety Net Hospital
Authors: Jodry Dominique , Blemur Danielle , Nguyen Minh Ly , Kuhn Theresa , Easley Kirk , Wang Heqiong , Ramaswamy Megha , Birdsong George , Kohut Adrian , Manobianco Brittany , Flowers Lisa
Published: February 2021

Objective

The aim of the study was to elucidate the risk factors underlying abnormal cytology-based cervical cancer screening (Pap testing) in justice-involved women (JIW) compared with non-JIW in an urban safety net hospital.

Methods

Retrospective chart review of women with a history of correctional involvement who received care at Grady Health System between 2010 and 2018 and had a Pap test was performed (n = 191). An age-matched cohort of women with no correctional involvement and had a Pap test at Grady served as the control (n = 394). Variables of interest were age, HIV, smoking, race, mental health history, and history of incarceration. Outcomes of interests were rate of abnormal Pap tests and follow-up. χ2 and logistic regression models evaluated associations between the variables of interest and outcomes.

Results

Rates of abnormal Pap tests were significantly higher in JIW (35.6%) than controls (18.5%, p < .0001). Compared with controls, JIW were significantly more likely to have high-grade cervical cytology (odds ratio [OR] = 3.89, p < .0005) and be lost to gynecologic follow-up (OR = 8.75, p < .0001) and a history of severe mental illness (29.5% vs 4.3%, p < .0001). Those with abnormal Pap tests were likely to be HIV-positive (OR = 20.7, p < .001) and have a history of incarceration (OR = 2.33, p < .001). Predictors of high-grade Pap test were smoking history (OR = 0.16, p = .014), HIV-positive (OR = 3.66, p = .025), and history of incarceration (OR = 3.96, p < .0005).

Conclusions

Justice-involved women represent a high-risk subpopulation with significantly increased rates of high-grade cytology and lost to follow-up. This underscores the need for attention to screening programs and follow-up interventions for JIW.
Risk of Sensorineural Hearing Loss in Patulous Eustachian Tube
Authors: Masuda Masatsugu , Morita Masahiro , Matsuda Takehiro , Nakamura Takehiro , Matsumoto Jobu , Miyama Yoshiko , Kasakura-Kimura Natsuko , Kohno Naoyuki , Saito Koichiro
Published: February 2021

Objective:

To investigate whether the long-term presence of a patulous Eustachian tube (PET) is associated with sensorineural hearing loss (SNHL).

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Ears (n = 100) were classified into two groups based on duration of PET symptom(s), i.e., Short (≤3 mo; n = 47 ears) and Long (≥48 mo; n = 53 ears). Contralateral ears without PET (n = 28 ears) were classified as the Contralateral group.

Main Outcome Measures:

We used ISO 7029 to calculate the hearing thresholds of an age- and sex-matched population at a given frequency. Hearing loss was defined as >25% of these calculated values.

Results:

At 4 kHz, the Long PET group showed a higher prevalence of hearing loss (47%) at 4 kHz than did the Contralateral (21%) and Short PET (19%) groups (p = 0.0280 and 0.0043, respectively). Ears with breathing autophony or a sonotubometric low probe tone level showed a higher prevalence of hearing loss at 4 kHz than those without this symptom or with a high probe tone level (p = 0.0329 or 0.0103, respectively). At low frequencies, ≥89% of the ears in all groups showed mild hearing loss.

Conclusion:

Chronic PET was associated with SNHL at 4 kHz. PET patients showed low-frequency hearing loss regardless of disease duration. Further studies are needed to better understand the pathophysiology of SNHL in patients with PET.