bluuebunny/crossref_metadata_2025 huggingface dataset:
Leveraging Teledermatology for Patient Triage
Authors: Maloney Megan
Published: November 2019

Nurses in outpatient settings face challenges balancing heavy patient caseloads while accommodating unplanned acute visits. Nurses also spend significant time triaging patients' symptoms on the telephone. Patients often find it difficult to accurately describe symptoms, and without accompanying images, unnecessary office visits are scheduled. Teledermatology, involving the exchange of digital images remotely between patient and provider, has shown promise in accurately triaging patients and decreasing unnecessary visits. At one outpatient dermatology site at a multisite comprehensive cancer center, a 6-month performance improvement initiative was conducted to evaluate the effectiveness of teledermatology using an electronic patient portal. Nurses instructed prescreened patients to send digital images via the portal. On the basis of image appearance and patients' symptoms, nurses provided assessment and education over the phone, and patients either kept their future appointments or came in for an earlier evaluation. More complex cases were escalated to the physician. This initiative reduced the number of unnecessary patient visits, which opened more visit slots for those with acute issues. Teledermatology improved overall efficiency of care, and patients and clinicians have reported satisfaction with the process.
Safe and Effective Laser Hair Removal Treatments
Authors: Moore Christine
Published: November 2019

Objective

The aim of this study was to review the current literature regarding safe and effective laser hair removal (LHR) treatments.

Methods

Significant and current studies (2008–2017) were retrieved through a series of searches conducted in CINAHL, Cochrane, and MEDLINE databases using Boolean terms/phrases. Pertinent results are explained in narrative form with supporting tables and figures.

Results

Today, there is a vast amount of current literature on the need for LHR treatments and on its side effects and comparative studies using various lasers on the market. There is an ongoing concern associated with the lack of standards and guidelines.

Conclusion

Practitioners interested in offering LHR within the primary care setting must verify that operating a Class 4 medical device is within their scope of practice. Despite the increased popularity of LHR treatments and the advancement of technology, there are limited up-to-date information on safe and effective treatment parameters and minimal information regarding the importance of patient education. More research is necessary to determine the efficacy of LHR treatments in both men and women of all ages and skin types. With no LHR guidelines in place, the best practice for LHR treatments is contained within this literature review using the most recent research available to date.
Scaled Papules in an HIV-Positive Patient
Authors: Wesner Erin , Bernard Marcia , Jacob Sharon E.
Published: November 2019

Teledermatology is the term used to describe the provision of dermatologic medical services through telecommunication technology. The following is a teledermatology case of scaled papules in an HIV-positive patient.
Kava-Induced Ichthyosis
Authors: Peterman Kaeleigh , Reynolds Emily
Published: November 2019

Acquired ichthyosis is an uncommon finding in the outpatient dermatology clinic. This case portrays a presentation of ichthyosis induced by the medicinal drink, kava, which is becoming a more mainstream beverage in American culture. This case provides an overview of the clinical presentation of ichthyosis and a historical background on kava as well as recent studies on kava-induced ichthyosis or kava dermopathy. It also highlights the need to consider the use of herbal and alternative therapies when considering the underlying causes of skin disorders.
Lack of an Exposure Response and Interaction With HLA-DPβ1 and DRβ1 Polymorphisms in the Development of Beryllium Toxicity in a High Beryllium Exposure Cohort
Authors: Widyaningsih Vitri , Rosenman Kenneth , Reilly Mary Jo , Wang Ling , Pathak Dorothy R. , Gardiner Joseph C. , Rice Carol , Monos Dimitri , Rossman Milton
Published: November 2019

Objective:

To evaluate interaction of HLA-DPβ1 and DRβ1 polymorphisms with metrics of beryllium exposure, in the development of beryllium sensitization (BeS) and chronic beryllium disease (CBD).

Methods:

A matched case-control study of 61 CBD, 41 BeS, and 259 controls from two beryllium-processing facilities.

Results:

BES and CBD were significantly associated with presence of DPβE69. Dose response of exposure was not observed for the development of BES and CBD with/without adjustment for DPβE69 (P > 0.05). The DRβE71 polymorphism was more common in BeS than CBD after adjusting for exposure and maybe a protective factor (aOR 0.4, 95% CI 0.2 to 0.9) against the progression of BeS to CBD.

Conclusion:

No exposure–response association was found, which may reflect that the workers in this high exposure cohort were above a threshold level where an exposure–response could be observed.
Male and Female Adolescent Athletes' Readiness to Return to Sport After Anterior Cruciate Ligament Injury and Reconstruction
Authors: Kostyun Regina O. , Burland Julie P. , Kostyun Kyle J. , Milewski Matthew D. , Nissen Carl W.
Published: November 2019

Objective:

The purpose of this study was to examine whether readiness to return to sport (RTS) differed between adolescent male and female athletes after anterior cruciate ligament reconstruction (ACLR).

Design:

Longitudinal, prospective cohort.

Setting:

Outpatient office associated with tertiary-care hospital.

Patients:

A total of 93 adolescent athletes, 17 years of age and younger, who underwent ACLR surgery with a hamstring autograft were included.

Independent Variables:

Male and female athletes.

Main Outcome Measures:

Anterior cruciate ligament–return to sport after injury (ACL-RSI) completed at 3 time points: (1) preoperatively (Pre-op), (2) approximately 3 months into rehabilitation (Post-op 1), and (3) during RTS phases of recovery (Post-op 2).

Results:

There was a significant main effect for both sex (P < 0.010) and time (P < 0.0001) with male athletes having higher ACL-RSI scores than female athletes at all 3 time points; however, there was no significant time by sex interaction. All ACL-RSI scores increased significantly across time, regardless of sex. There were no statistically significant differences between ACL-RSI scores at all 3 time points between individuals who did and did not receive physician clearance.

Conclusions:

This study provides a longitudinal depiction of adolescent athletes' readiness to RTS after ACL injury throughout recovery. Both male and female athletes demonstrated diminished ACL-RSI scores before undergoing surgery, with increasing scores at both postoperative time points for both sexes. Overall, female athletes reported lower readiness to RTS at all 3 time points compared with male athletes.
Long-Term Stability and Functional Outcome of an Active Middle Ear Implant Regarding Different Coupling Sites
Authors: Spiegel Jennifer L. , Kutsch Luise , Jakob Mark , Weiss Bernhard G. , Canis Martin , Ihler Friedrich
Published: November 2019

Objectives:

Indication and implantation of active middle ear implants (AMEI) are well established. Choice of the coupling site depends from the individual anatomical situation. Long-term stability of different coupling sites in terms of functional outcome and complications are rare and were investigated in this study.

Design:

Retrospective analysis of 41 consecutive patients (45 ears) with coupling of the AMEI at the incus, stapes, and round window. Analysis of preoperative, postoperative, and long-term results of pure-tone average, speech discrimination in quiet at 65 dB (German language Freiburg Monosyllabic Test) and noise (German language Oldenburger Sentence Test), rate of revision surgeries as well as explantations and the novel parameter patient years (py).

Results:

Mean of follow-up was 3.0 ± 1.7 years resulting in a total of 135.6 py. Bone conduction was stable in all patients pre- to postoperatively as well as preoperatively to the long-term. Round window patients had the broadest air-bone gap (31.4 ± 19.4 dB HL) benefitting the most from the AMEI (functional gain = 39.0 ± 12.8 dB HL). Regarding speech discrimination, incus patients performed the best both in quiet (77.7 ± 22.8%) and noise (3.4 ± 2.9 dB SNR). In terms of revision surgery and explantations, round window patients exhibited the highest rates (20%).

Conclusions:

Regarding all coupling sites, satisfying long-term stability results and comparable complication rates were reported with best performance of coupling to the incus. Implementation of patient years might be a novel parameter for the comparison of revisions and explantations.
Electrode Array Type and Its Impact on Impedance Fluctuations and Loss of Residual Hearing in Cochlear Implantation
Authors: Thompson Nicholas J. , Dillon Margaret T. , Buss Emily , Park Lisa R. , Pillsbury Harold C. , O’Connell Brendan P. , Brown Kevin D.
Published: November 2019

Hypothesis/Objective:

Determine variables associated with electrode impedance fluctuations and loss of residual hearing in cochlear implant (CI) recipients.

Background:

CI recipients with postoperative hearing preservation demonstrate superior speech perception with an electric-acoustic stimulation (EAS) device as compared with a CI-alone device. Maintaining superior speech perception over time relies on long-term hearing preservation; therefore, understanding variables that may contribute to loss of residual hearing is needed. Recent reports suggest a relationship between changes in electrode impedance and loss of residual hearing. The variables influencing this relationship have yet to be determined.

Methods:

Review of pediatric and adult CI cases from 2013 to 2016 who presented with preoperative residual hearing. Regression analysis was performed to evaluate effects of array type (lateral wall vs. perimodiolar), manufacturer, age at implantation, and preoperative hearing on impedance. The correlation between peak impedance change and change in low-frequency hearing was determined.

Results:

One hundred forty-six CI recipients presented with preoperative residual hearing. A multivariate regression analysis demonstrated a statistically significant association between preoperative hearing thresholds (p = 0.017), device manufacturer (p = 0.011), and array type (p = 0.038) on postoperative impedance changes. Hearing preservation rates and change in impedance differed by electrode array type. The association between peak impedance changes and loss of residual hearing differed between manufacturers (R2 = 0.208, p = 0.029 vs. R2 = 0.016, p = 0.609).

Conclusion:

Impedance fluctuation appears to be a marker for loss of residual hearing for specific electrode array types and manufacturers. Specific arrays may affect the cochlear microenvironment differently, with different effects on postoperative hearing preservation.
The Importance of the Temporal Bone 3T MR Imaging in the Diagnosis of Menière's Disease
Authors: Paškonienė Aistė , Baltagalvienė Renata , Lengvenis Givi , Beleškienė Vilma , Ivaška Justinas , Markevičiūtė Vėtra , Mickevičienė Vaiva , Lesinskas Eugenijus
Published: November 2019

Background:

The aim of this study was to evaluate endolymphatic hydrops using the 3T temporal bone magnetic resonance imaging (MRI), performed according to the chosen protocol, and determine whether it could be applied as an objective diagnostic tool for Menière's disease.

Methods:

105 participants diagnosed with probable (n = 50) and definite (n = 55) Menière's disease were included in this prospective study at Vilnius University Hospital, Santaros Clinics. Audiometry, vestibular function tests, videonystagmography, and computer posturography were performed before MRI. The 3T MRI with gadolinium contrast was performed to evaluate the endolymphatic hydrops. Imaging protocol consisted of 3D-FLAIR and 3D T2DRIVE sequences. Vestibular endolymphatic sac was interpreted as enlarged if occupied more than 50% of the vestibular area.

Results:

78.1% of subjects had abnormal MRI findings other than hydrops, and it was more than 90% (50/55) of patients in the definite MD group (p < 0.001). Changes in caloric test were observed in 63.8% of subjects in general, and in 76.4% of patients with a definite Menière's disease. The side of the endolymphatic hydrops observed on MR imaging corresponded to the clinical diagnosis of the Menière's disease based on the results of audiometry (p < 0.001) and unilateral weakness (p < 0.001). Endolymphatic hydrops on MRI and directional preponderance in caloric test were two independent predictors of the definite Menière's disease.

Conclusions:

Temporal bone 3T MRI with gadolinium contrast is clinically superior to confirm the diagnosis of Menière's disease. Grade II endolymphatic hydrops on MRI, directional preponderance, and unilateral weakness on caloric test were independent predictors for the definite Menière's disease.
Systematic Review and Network Meta-analysis of Cognitive and/or Behavioral Therapies (CBT) for Tinnitus
Authors: Landry Evie C. , Sandoval Xochitl Citlalli Romo , Simeone Calla N. , Tidball Glynnis , Lea Jane , Westerberg Brian D.
Published: November 2019

Objective:

To evaluate the efficacy of cognitive and/or behavioral therapies in improving health-related quality of life (HRQOL), depression, and anxiety associated with tinnitus.

Data Sources:

EMBASE, MEDLINE, PubMed, PsycINFO, and the Cochrane Registry were used to identify English studies from database inception until February 2018.

Study Selection:

Randomized controlled trials (RCTs) comparing cognitive and/or behavioral therapies to one another or to waitlist controls for the treatment of tinnitus were included.

Data Extraction:

Quality and risk were assessed using GRADE and Cochrane's Risk of Bias tool respectively.

Data Synthesis:

Pairwise meta-analysis (12 RCTs: 1,144 patients) compared psychological interventions to waitlist controls. Outcomes were measured using standardized mean differences (SMDs) and 95% confidence intervals (CI). I2 and subgroup analyses were used to assess heterogeneity. Network meta-analysis (NMA) (19 RCTS: 1,543 patients) compared psychological therapies head-to-head. Treatment effects were presented by network diagrams, interval plots, and ranking diagrams indicating SMDs with 95% CI. Direct and indirect results were further assessed by inconsistency plots.

Conclusions:

Results are consistent with previously published guidelines indicating that CBT is an effective therapy for tinnitus. While guided self-administered forms of CBT had larger effect sizes (SMD: 3.44; 95% CI: −0.022, 7.09; I2: 99%) on tinnitus HRQOL, only face-to-face CBT was shown to make statistically significant improvements (SMD: 0.75; 95% CI: 0.53, 0.97; I2: 0%). Guided self-administered CBT had the highest likelihood of being ranked first in improving tinnitus HRQOL (75%), depression (83%), and anxiety (87%), though statistically insignificant. This NMA is the first of its kind in this therapeutic area and provides new insights on the effects of different forms of cognitive and/or behavioral therapies for tinnitus.
3D-Printed Microneedles Create Precise Perforations in Human Round Window Membrane in Situ
Authors: Chiang Harry , Yu Michelle , Aksit Aykut , Wang Wenbin , Stern-Shavit Sagit , Kysar Jeffrey W. , Lalwani Anil K.
Published: November 2019

Hypothesis:

Three-dimensional (3D)-printed microneedles can create precise holes on the scale of micrometers in the human round window membrane (HRWM).

Background:

An intact round window membrane is a barrier to delivery of therapeutic and diagnostic agents into the inner ear. Microperforation of the guinea pig round window membrane has been shown to overcome this barrier by enhancing diffusion 35-fold. In humans, the challenge is to design a microneedle that can precisely perforate the thicker HRWM without damage.

Methods:

Based on the thickness and mechanical properties of the HRWM, two microneedle designs were 3D-printed to perforate the HRWM from fresh frozen temporal bones in situ (n = 18 total perforations), simultaneously measuring force and displacement. Perforations were analyzed using confocal microscopy; microneedles were examined for deformity using scanning electron microscopy.

Results:

HRWM thickness was determined to be 60.1 ± 14.6 (SD) μm. Microneedles separated the collagen fibers and created slit-shaped perforations with the major axis equal to the microneedle shaft diameter. Microneedles needed to be displaced only minimally after making initial contact with the RWM to create a complete perforation, thus avoiding damage to intracochlear structures. The microneedles were durable and intact after use.

Conclusion:

3D-printed microneedles can create precise perforations in the HRWM without damaging intracochlear structures. As such, they have many potential applications ranging from aspiration of cochlear fluids using a lumenized needle for diagnosis and creating portals for therapeutic delivery into the inner ear.
Postoperative Healthcare Utilization of Elderly Adults After Cochlear Implantation
Authors: Raymond Mallory J. , Dong Andy , Naissir Samir Ballestas , Vivas Esther X.
Published: November 2019

Objective:

To determine the association between geriatric age and postoperative healthcare utilization after cochlear implantation.

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Older adults (>59 yr) who underwent unilateral cochlear implantation from 2009 until 2016.

Intervention(s):

Standard electrode length cochlear implantation.

Main Outcome Measure(s):

Postoperative surgical and audiological visit rate after cochlear implantation for those aged 60 to 69, 70 to 79, and 80+ years.

Results:

Fifty-nine older adult patients were included in the study with a mean age of 71.5 ± 6.9 years (range, 60–88 yr), mean duration of hearing loss of 25.4 ± 19.6 years (range, 0.25–67 yr), and mean length of follow up of 37 ± 24.6 months (range, 6–107 mo). There was no significant difference in the mean number of surgical and audiological visits over both the first and second postoperative years between those aged 60 to 69, 70 to 79, and 80+ years. Additionally, on one-way multivariate analysis of covariance (MANCOVA), there was no significant difference in cumulative postoperative healthcare utilization measures between each age group, when controlling for postoperative AzBio scores, estimated household income, and driving distance to the hospital.

Conclusions:

Older geriatric adults do not have higher rates of postoperative healthcare utilization after cochlear implantation than their younger, geriatric hearing impaired counterparts, despite presumed higher rates of frailty and comorbidity.
Comparing Nonopioids Versus Opioids for Acute Pain in the Emergency Department: A Literature Review
Authors: Sin Billy , Sikorska Gabriela , YauLin Joi , Bonitto Rianne A. , Motov Sergey M.
Published: November 2019

Background:

Pain is the most common reason for patient visits in the emergency department (ED). Opioids have been long considered the standard of care for acute pain in the ED. Because of the opioid crisis, investigation and implementation of novel practices to manage pain is needed. The use of various nonopioids has been suggested as a plausible alternative to opioids, with emerging literature to support its use for acute pain in the ED.

Study Question:

To evaluate the safety, efficacy, opioid-sparing effects of nonopioids in patients who present with acute pain in the ED.

Data Sources:

We systematically searched PubMed and EMBASE (July 1970 to January 2019).

Study Design:

Randomized controlled trials that evaluated nonopioids versus opioids in the ED were eligible. The clinical outcomes measured were change in pain scores compared with baseline, the incidence of adverse events, and use of rescue analgesia.

Results:

Twenty-five randomized controlled trials that evaluated the use of nonopioids in 2323 patients [acetaminophen (APAP) (n = 651), diclofenac (n = 547), ketamine (n = 272), ketorolac (n = 225), lidocaine (n = 219), ibuprofen (n = 162), ibuprofen & APAP (n = 162), hydroxyzine & dihydroergotamine (n = 85)] met inclusion criteria. Four trials found significant greater reductions in pain scores, favoring nonopioids. In all trials, the duration of pain relief provided by nonopioids was not sustained over an extended period. Eighteen trials reported no significant differences in reduction of pain scores. Two trials reported improved pain reduction with opioids and one trial reported noninferiority.

Conclusions:

Evidence from primary literature suggests that nonopioids could be a feasible alternative to opioids for management of acute pain in the ED as it is effective, safe, and decreases the need for rescue analgesia.
Orthopaedic care of the child with arthrogryposis: a 2020 overview
Authors: van Bosse Harold J.P.
Published: November 2019

Purpose of review

The orthopaedic treatment of children with arthrogryposis multiplex congenita has evolved steadily over the past two decades. Interrelated factors have spurred this on, including better appreciation of the functional potential of persons with arthrogryposis, development of newer procedures specific for the arthrogrypotic deformities, and outcomes studies that provide understanding of the overall capabilities of adults with arthrogryposis and follow-up to determine which treatments were beneficial and which were not. This article briefly sketches out of some of these advances and indicates areas that need further development.

Recent findings

Outcome studies show that the majority of adults with arthrogryposis are ambulatory but less than half are fully independent. Adults frequently experience ongoing pain, particularly foot and back pain, limiting ambulation and standing. Advancements in the upper extremity treatment include improving elbow function, wrist repositioning, and improving thumb positioning. In the lower extremities, correction of hip and knee contractures leads to improved ambulatory potential, and treating clubfeet with serial casting decreases poor outcomes.

Clinical evaluation, both physical examination and assessment of the patient's needs, are important in directing treatment in arthrogryposis. Further outcomes studies are needed to continue to refine procedures and define the appropriate candidates.
Immunologic Effects of Sirolimus in Patients With Vascular Anomalies
Authors: Nozawa Akifumi , Ozeki Michio , Yasue Shiho , Endo Saori , Kawamoto Norio , Ohnishi Hidenori , Fumino Shigehisa , Furukawa Taizo , Tajiri Tatsuro , Maekawa Takanobu , Fujino Akihiro , Souzaki Ryota , Fukao Toshiyuki
Published: November 2019

Emerging data have suggested that sirolimus may be a treatment option for complicated vascular anomalies (VAs). The present study aimed to investigate the immunologic effects of sirolimus treatment for 6 months in patients with VAs. Blood samples obtained from the patients enrolled in 2 multicenter studies to investigate the efficacy of sirolimus for VAs before and after sirolimus treatment for 6 months were used. Data for total white blood cell count, absolute lymphocyte count, serum immunoglobulins (Igs) levels (IgG, IgA, IgM), lymphocyte proliferation assays with mitogens including phytohemagglutinin and concanavalin A, and flow cytometric analysis of lymphocyte subsets were evaluated. A total of 18 patients with VAs receiving sirolimus treatment were included in the study. Comparisons of white blood cell, absolute lymphocyte count, IgG, IgA, IgM, and reaction rates of phytohemagglutinin and concanavalin A revealed no significant differences before and after treatment. No significant differences were observed in the absolute counts of lymphocyte subtypes before and after treatment, except for regulatory T-cell counts, which were significantly decreased after treatment. Severe infections were not observed during sirolimus treatment. The immunologic parameters assessed in the present study were hardly affected by sirolimus treatment for 6 months in patients with VAs.
Sweating Blood: A Case Series of 2 Siblings With Hematohidrosis
Authors: Hoover Alex , Fustino Nicholas , Sparks Andrea Olivares , Rokes Christopher
Published: November 2019

Hematohidrosis is a condition that presents with the excretion of blood from intact skin. Reported cases suggest emotional stress reactions as the most common inciting events. The pathogenesis of the condition is not well understood. We describe a 9-year old boy and his 6-month old half-sister with a history of bleeding episodes from the ears, eyes, and scalp, as well as other sites. Symptoms in both children have shown a positive response to propranolol, with decreased frequency and severity of bleeding. There are no prior reports of siblings with hematohidrosis, suggesting a possible genetic predisposition.
Social Determinants of Health and Emergency Department Use Among Children With Sickle Cell Disease
Authors: Cortright Lindsay , Buckman Cierra , Tumin Dmitry , Holder David , Leonard Sarah
Published: November 2019

Sickle cell disease (SCD) is associated with disproportionate emergency department (ED) use. This study described the social determinants of health associated with ED visits and hospital admission from the ED among children with SCD using a nationally representative dataset. We analyzed data from 126 children 0 to 17 years of age with SCD included in the 2011 to 2017 rounds of the National Health Interview Survey (mean age, 8 y; 50% female individuals; 74% African American). Study variables were summarized using weighted means and proportions and compared according to ED use and admission by Wald tests. Fifty-two identified children had visited the ED within the last 12 months and 21 were admitted to the hospital after their most recent ED visit. Children living in a single-mother household were more likely to visit the ED (P=0.040), as were younger children (mean age, 6 vs. 9 y;P=0.034), with no evaluated social determinants of health significantly impacting hospital admission from the ED. The lack of association between ED use and either poverty or insurance type may be related to the overall high level of social disadvantage among children with SCD. Our findings demonstrate the need to better characterize specific social factors impacting acute care use among children with SCD.
The Effects of a Tripod Approach for Cancer Patients on Illness Stress, Health-Promoting Lifestyle, Hope, and Resilience
Authors: Sung Kyung Mi , Yu Mi , Kang Young Sil , Gu Mee Ock , Jung Myun Sook , Eun Young , Jeon Mi Yang
Published: November 2019

Background

Health-related exercise and education program for cancer patients are necessary to provide physical and emotional support to enable efficient and appropriate self-management at home.

Objective

This study aimed to investigate the effects of a tripod approach including physical exercise, education, and emotional support program on illness stress, health promotion lifestyle, hope, and resilience in cancer patients.

Interventions/Methods

This was a quasi-experimental repeated-measures study using a pre-post design with a nonhomogeneous control group. A total of 72 cancer patients (experimental group = 37, control group = 35) who were currently receiving treatment and staying at home were enrolled.

Results

The experimental group showed significantly lower illness stress scores (F = 17.35, P < .001) and increase in health promotion lifestyle scores (F = 4.05, P = .048) compared with the control group, especially social relationships (t = 1.85, P = .073) and stress management (t = 2.30, P = .027). However, there were no effects on hope and resilience. Also, illness stress showed significant changes after 6 weeks (t = −3.35, P = .001) and after 10 weeks (t = −5.04, P < .001). Overall health promotion lifestyle showed changes after 10 weeks (t = 2.25, P = .030), with meaning of life (t = 2.57, P = .014), stress management (t = 2.30, P = .027), and medical behaviors (t = 2.46, P = .019) especially showing significant changes.

Conclusions

The results showed that the tripod approach had positive effects on illness stress and health promotion lifestyle of cancer patients staying at home. Further study to improve positive emotions such as hope and resilience is needed.

Implications for Practice

Based on our findings, combining nursing intervention with physical exercise, education, and emotional support could be incorporated into cancer patients in community and early survivorship care plans in clinical practice.
Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study
Authors: Dyal Brenda W. , Abudawood Khulud , Schoppee Tasha M. , Jean Stacy , Smith Valandrea M. , Greenlee Amelia , Staton Lindsey M. , Duckworth Laurie , Mandernach Molly W. , Black Vandy , Heldermon Coy D. , Yao Yingwei , Wilkie Diana J. , Ezenwa Miriam O.
Published: November 2019

Background

The experiences of African American adult patients before, during, and after acute care utilization are not well characterized for individuals with sickle cell disease (SCD) or cancer.

Objective

To describe the experiences of African Americans with SCD or cancer before, during, and after hospitalization for pain control.

Methods

We conducted a qualitative study among African American participants with SCD (n = 15; 11 male; mean age, 32.7 ± 10.9 years; mean pain intensity, 7.8 ± 2.6) or cancer (n = 15; 7 male; mean age, 53.7 ± 15.2 years; mean pain intensity, 4.9 ± 3.7). Participants completed demographic questions and pain intensity using PAINReportIt and responded to a 7-item open-ended interview, which was recorded and transcribed verbatim. We used content analysis to identify themes in the participants’ responses.

Results

Themes identified included reason for admission, hospital experiences, and discharge expectations. Pain was the primary reason for admission for participants with SCD (n = 15) and for most participants with cancer (n = 10). Participants of both groups indicated that they experienced delayed treatment and a lack of communication. Participants with SCD also reported accusations of drug-seeking behavior, perceived mistreatment, and feeling of not being heard or believed. Participants from both groups verbalized concerns about well-being after discharge and hopeful expectations.

Conclusions

Race-concordant participants with SCD but not with cancer communicated perceived bias from healthcare providers.

Implications for Practice

Practice change interventions are needed to improve patient-provider interactions, reduce implicit bias, and increase mutual trust, as well as facilitate more effective pain control, especially for those who with SCD.
Health-Related Quality of Life and Its Associated Factors in Prostate Cancer Patients Who Receive Androgen Deprivation Therapy
Authors: Chien Ching-Hui , Chuang Cheng-Keng , Liu Kuan-Lin , Wu Chun-Te , Pang See-Tong , Chang Ying-Hsu
Published: November 2019

Background

Presently, few studies have examined the impact of positive thinking on the HRQoL of prostate cancer patients who receive androgen deprivation therapy (ADT).

Objectives

We explored the factors that affect health-related quality of life (HRQoL), particularly positive thinking, of prostate cancer patients who receive ADT.

Methods

A cross-sectional design was used. A total of 132 prostate cancer patients, drawn from outpatient clinics of 2 medical centers, who were receiving ADT were included. Structured questionnaires, including a basic information sheet, the Positive Thinking Scale, Social Support Scale, and Functional Assessment of Cancer Therapy–Prostate (FACT-P), were used for data collection. Statistical analysis was performed by using independent-sample t tests, one-way analysis of variance, Pearson correlation, and multiple regression.

Results

Prostate cancer patients who were receiving ADT were more likely to engage in positive thinking, which was correlated with better social/family well-being, emotional well-being, functional well-being, prostate cancer concern, and a higher score on the FACT-P. Improved self-reported health status was correlated better with all subdimensions of HRQoL and better scores on the FACT-P. Greater social support was correlated with high social/family well-being.

Conclusions

Positive thinking, self-reported health status, and social support are important associated factors of HRQoL in prostate cancer patients who receive ADT.

Implications for Practice

Oncology nurses can improve HRQoL by improving positive thinking, self-reported health status, and social support of prostate cancer patients who receive ADT.
The Heart Failure Journey Board to Discharge
Authors: Kranz Clare , Spencer Delois , Polancich Shea , Curry Carolyn , Miltner Rebecca S.
Published: November 2019

Background:

Patients with heart failure (HF) require lifestyle changes to improve functional status and health outcomes.

Local Problem:

Heart failure was the most common readmitting diagnosis, with costs per patient of $5332, length of stay (LOS) of 5.9 days, and readmission rate of more than 30%.

Implementation:

The purpose was to adapt and implement a journey board discharge tool for adults with HF.

Methods:

A journey board was created, piloted, and trialed on 1 nursing unit. Large journey boards were attached to communication boards in patient rooms for nurses to mark off topics, listed in the form of a tile (n = 19), as complete following education sessions.

Results:

Nurses reported the tool helped them know what educational topics were covered by previous shifts. Following implementation, the average LOS was 5.3 days, patient cost per patient was $4848, and readmission rate was 28%.

Conclusions:

Utilizing journey board discharge education tools with patients can improve communication and evidence-based self-care instruction.
Reducing Blood Culture Contamination in the Emergency Department
Authors: McLeod Casey G.
Published: November 2019

Background:

Blood culture contamination results in delayed or unnecessary treatments, increased morbidity risk, extended lengths of hospital stay, and increased health care costs. Collecting 2 sets of blood cultures from separate sites helps differentiate bloodstream infections (BSIs) from contamination.

Local Problem:

Blood culture contamination rates trailed the national threshold of less than 3% in one southeastern US emergency department (ED). Same-site and single-set collection issues were also identified.

Methods:

This pre-/postintervention quality improvement study included 1137 patients (preintervention: n = 560; postintervention: n = 577) of all ages with blood culture orders in a 13-bed tertiary care ED.

Interventions:

A staff educational program, blood culture collection checklist with protocol, and monthly collective and individual feedback were implemented.

Results:

Blood culture contamination rates decreased from 3.39% to 2.6%. Same-site collection rates decreased from 15.13% to 4.14%.

Conclusions:

The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs.
Standardizing Nurse Leader Safety Rounds to Promote Highly Reliable Care
Authors: Meyer Priya , Hill Cindy , Baker Deborah
Published: November 2019

Background:

Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent.

Local Problem:

A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams.

Methods:

Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended.

Results:

Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%.

Conclusions:

A&F reinforced quality and accountability for daily safety rounds. HRO theory–guided feedback offered an innovative way to translate HRO influence into nurse leader practice.
Alert Types and Frequencies During Bar Code–Assisted Medication Administration
Authors: Sloss Elizabeth A. , Jones Terry L.
Published: November 2019

Background:

Existing literature explores the effectiveness of bar code–assisted medication administration (BCMA) on the reduction of medication administration error as well as on nurse workarounds during BCMA. However, there is no review that comprehensively explores types and frequencies of alerts generated by nurses during BCMA.

Purpose:

The purpose was to describe alert generation type and frequency during BCMA.

Methods:

A systematic review of the literature using PRISMA guidelines was conducted using CINAHL, PubMed, EMBASE, and Ovid Medline databases.

Results:

After screening for inclusion and exclusion criteria, a total of 8 articles were identified and included in the review. Alert types included patient mismatch, wrong medication, and wrong dose, though other alert types were also reported. The frequency of alert generation varied across studies, from 0.18% to 42%, and not all alerts were clinically meaningful.

Conclusions:

This systematic review synthesized literature related to alert type and frequency during BCMA. However, further studies are needed to better describe alert generation patterns as well as factors that influence alert generation.
Assessment of Tumor-infiltrating Lymphocytes Using International TILs Working Group (ITWG) System Is a Strong Predictor of Overall Survival in Colorectal Carcinoma
Authors: Fuchs Talia L. , Sioson Loretta , Sheen Amy , Jafari-Nejad Kambin , Renaud Christopher J. , Andrici Juliana , Ahadi Mahsa , Chou Angela , Gill Anthony J.
Published: November 2019

The presence of increased tumor-infiltrating lymphocytes (TILs) is established as a positive prognostic factor in many malignancies including colorectal carcinoma (CRC). However, multiple different approaches have been used to assess TILs. In 2014, the International TILs Working Group (ITWG) proposed a standardized methodology for evaluating TILs, initially in the context of breast cancer, but subsequently expanded to other malignancies. To date, the efficacy of the ITWG system has not been investigated in a large cohort of all-stage CRC. We, therefore, sought to validate this system in CRC. We used the ITWG system to assess the density of stromal TILs in an unselected cohort of 1034 CRC patients undergoing primary tumor resection at our institution. The percentage TILs’ score was categorized into 3 groups: low (0% to 10%), intermediate (15% to 50%), and high (55% to 100%). The mean survival was 53, 67, and 75 months, respectively (P=0.0001). This survival benefit remained statistically significant in multivariate analyses (P=0.0001) and subgroup analyses of mismatch repair–proficient CRCs (P=0.0001), mismatch repair–deficient CRCs (P=0.031), BRAFV600E-mutant CRCs (P=0.0001), and BRAF wild-type CRCs (P=0.001). The predictive value of TILs assessed using the ITWG system was superior to the assessment of intraepithelial lymphocyte performed prospectively using a standard system requiring ≥5 lymphocytes per high-powered field in direct contact with tumor cells or between tumor clusters. We conclude that the ITWG system for assessing TILs is a powerful predictor of all-cause survival in CRC independent of many prognostic factors and superior to the assessment of intraepithelial lymphocytes using a traditional system.
HPV-related Sinonasal Carcinoma
Authors: Jiromaru Rina , Yamamoto Hidetaka , Yasumatsu Ryuji , Hongo Takahiro , Nozaki Yui , Hashimoto Kazuki , Taguchi Kenichi , Masuda Muneyuki , Nakagawa Takashi , Oda Yoshinao
Published: November 2019

The prevalence and prognostic value of human papillomavirus (HPV) infection and epidermal growth factor receptor (EGFR) alteration in sinonasal squamous cell carcinoma (SNSCC) are not known. The reliability of p16 overexpression as a surrogate for HPV infection in SNSCC is also unclear. We investigated the prognostic and diagnostic significances of HPV infection, EGFR alteration, and p16 expression in SNSCC. We analyzed high-risk HPV infection by HPV-RNA in situ hybridization and EGFR gene copy number gain (CNG) by chromogenic in situ hybridization and by determining the protein expressions of p16, Rb, and EGFR by immunohistochemistry in 101 SNSCC cases. HPV infection (n=9, 8.9%) and p16 overexpression (n=15, 14.9%) were associated with better overall survival (P=0.0042 and 0.005, respectively). The HPV+ cases were located predominantly at the nasal cavity with nonkeratinizing histology and partial loss of Rb. Notably, 40% (6/15) of p16+ SNSCCs were HPV−. Two of these cases showed complete loss of Rb expression by immunohistochemistry, suggesting a reason for the above discrepancy. EGFR CNG, detected in 30.5% of the SNSCCs, was correlated with EGFR protein overexpression (P=0.0001). HPV infection and EGFR CNG were mutually exclusive. The HPV+/EGFR CNG− group had significantly better overall survival than the HPV−/EGFR CNG− and HPV−/EGFR CNG+ groups (P=0.0471 and 0.0343, respectively). Our results suggest that HPV infection is a favorable prognostic marker in SNSCC, but p16 is not a perfect surrogate marker; the Rb expression pattern may improve the diagnostic accuracy. The molecular subclassification of SNSCCs based on HPV infection and EGFR copy number status might provide important information for therapeutic strategies.
Transcriptionally Active HPV and Targetable EGFR Mutations in Sinonasal Inverted Papilloma
Authors: Mehrad Mitra , Stelow Edward B. , Bishop Justin A. , Wang Xiaowei , Haynes Wesley , Oliver Dwight , Chernock Rebecca D. , Lewis James S.
Published: November 2019

Sinonasal inverted papillomas (IPs) commonly recur, and transform to malignancy in 5% to 10% of patients. It has long been debated whether IPs are caused by high-risk or low-risk (lr) human papillomavirus (HPV) and whether the HPV is transcriptionally active. EGFR mutations have also been recently implicated in the pathogenesis of IP with an unclear relationship to HPV status. IP cases over a 10-year period were tested for p16 by immunohistochemistry and for transcriptionally active hrHPV and lrHPV by reverse-transcriptase real-time polymerase chain reaction and RNA in situ hybridization, respectively. EGFR tyrosine kinase domain Sanger sequencing was performed on all lrHPV RNA positive and 15 randomly selected lrHPV RNA negative IPs. Seven sinonasal nonkeratinizing squamous cell carcinomas (SCCs) without associated IP were included as controls. Of the 44 IPs, 5 (11.4%) were associated with SCC, all keratinizing type. All IPs and associated SCCs were negative for p16 and hrHPV. lrHPV RNA was detected in 5/42 (12%) cases, including 3/5 (60%) with associated SCC (P=0.009). All 5 lrHPV RNA positive IPs involved the nasal cavity, had a distinct, condylomatous morphology, and were EGFR wild-type. In contrast, 11/15 (73.3%) lrHPV RNA negative IPs that were sequenced had EGFR exon 19 or 20 mutations. All control nonkeratinizing SCCs were lrHPV RNA negative, but 5/7 (71.4%) were p16 and high-risk HPV RNA positive. This study shows that a subset of IPs involving the nasal cavity have transcriptionally active lrHPV, condylomatous morphology, and possibly increased risk of malignancy. Furthermore, lrHPV positivity is mutually exclusive with EGFR mutations, which suggests alternate mechanisms of pathogenesis.
Decreasing Time from Decision to Intubation in Premedicated Neonates: A Quality Improvement Initiative
Authors: Glenn Tara J. , Grathwol Melissa M. , McClary Jacquelyn D. , Wainwright Rebecca J. , Gorman Sara M. , Rodriguez Ashley M. , Bhola Monika
Published: November 2019

Introduction:

Endotracheal intubation carries the risk of discomfort, decompensation, oral trauma, and endotracheal tube malposition. Treatment with premedications reduces complications, increases overall intubation safety, improves pain control, and improves first-pass success. However, time is frequently a barrier to administration. We aimed to decrease the decision-to-intubation time interval from a baseline of 40 minutes to less than 35 minutes over 6 months.

Methods:

We used the Model for Improvement with multiple plan–do–study–act cycles to reduce the time from decision to successful intubation in nonemergent neonatal intubations. Key drivers were timely administration of medications, availability of skilled personnel and equipment, and efficient use of time.

Results:

During this project, time from the decision to successful intubation decreased from a historical mean of 40 minutes to a new baseline of 27 minutes. This change represents a 33% decrease, with 80% of intubations occurring within 35 minutes. During this time, success rates remained stable, and medication errors and side effects did not increase.

Conclusions:

Standard processes to prepare and administer premedications decreased the time from decision to intubation without significant adverse effects, allowing the benefit of premedication administration in a safe and timely manner in nonemergent neonatal intubations.
Sciatic Nerve Variants in Patients Diagnosed With Sciatica: Is There a Correlation?
Authors: Khan Hayat , Ling Stephen , Ali Sayed , Jonnalagadda Padmaja , Ramsey Frederick , Weiner Mark , Awan Omer
Published: November 2019

Purpose

Compression of the sciatic nerve in its path along the piriformis muscle can produce sciatica-like symptoms. There are 6 predominant types of sciatic nerve variations with type 1 being the most common (84.2%), followed by type 2 (13.9%). However, there is scarce literature on the prevalence of sciatic nerve variation in those diagnosed with sciatica.

Materials and Methods

The charts of 95 patients clinically diagnosed with sciatica who had a magnetic resonance imaging of the pelvis/hip were retrospectively studied. All patients had T1-weighted axial, coronal, and sagittal images. Magnetic resonance imagings were interpreted separately by 2 board-certified fellowship-trained musculoskeletal radiologists to identify the sciatic nerve variant.

Results

Seven cases were excluded because of inadequate imaging. Of the remaining 88 patients, 5 had bilateral sciatica resulting in a sample size of 93 limbs. Fifty-two (55.9%) had type 1 sciatic nerve anatomy, 39 (41.9%) had type 2, and 2 (2.2%) had type 3. The proportions of type 1 and 2 variations were significantly different from the normal distribution (P < 0.001), whereas type 3, 4, 5, and 6 variants were not (P = 1.00).

Conclusions

There is strong statistical significance regarding the relationship between sciatic nerve variation and the clinical diagnosis of sciatica. Preoperative magnetic resonance imaging can be considered in sciatica patients to prevent iatrogenic injury in pelvic surgery.