bluuebunny/crossref_metadata_2025 huggingface dataset:
A high-fidelity simulator for needle cricothyroidotomy training is not associated with increased proficiency compared with conventional simulators
Authors: Katayama Atsuko , Nakazawa Harumasa , Tokumine Joho , Lefor Alan Kawarai , Watanabe Kunitaro , Asao Takayuki , Yorozu Tomoko
Published: February 2019

Background:

A high-fidelity task simulator for cricothyroidotomy was created using data from a 3-dimensional (3D) computed tomography scan using a 3D printer. We hypothesized that this high-fidelity cricothyroidotomy simulator results in increased proficiency for needle cricothyroidotomy compared with conventional simulators.

Methods:

Cricothyroidotomy-naive residents were recruited and randomly assigned to 2 groups, including simulation training with a conventional simulator (Group C) and with a high-fidelity simulator (Group 3D). After simulation training, participants performed cricothyroidotomy using an ex vivo porcine larynx fitted with an endoscope to record the procedure. The primary outcomes were success rate and procedure time. The secondary outcome was a subjective measure of the similarity of the simulator to the porcine larynx.

Results:

Fifty-two residents participated in the study (Group C: n = 27, Group 3D: n = 25). There was no significant difference in the success rate or procedure time between the 2 groups (success rate: P = .24, procedure time: P = .34). There was no significant difference in the similarity of the simulators to the porcine larynx (P = .81).

Conclusion:

We developed a high-fidelity simulator for cricothyroidotomy from 3D computed tomography data using a 3D printer. This anatomically high-fidelity simulator did not have any advantages compared with conventional dry simulators.
Thyroid hormone resistance and the value of genetics
Authors: Xiao Xiao , Lv Chen , Zhu Tianxiao , Chen Huiling
Published: February 2019

Rational:

Thyroid hormone resistance (RTH) is a rare disease that is characterised by a lowered sensitivity of the target organs to thyroid hormone. Herein, we present 3 cases of confirmed RTH, with the support of clinical lab results and/or gene sequencing at diagnosis.

Patient concerns:

The 3 included patients were found to have elevated levels of free T3 (FT3), free T4 (FT4), and non-supressed levels of thyroid stimulating hormone (TSH).

Diagnosis:

All patients were tested for thyroid antibodies, somatostatin suppression, vision and hearing at diagnosis. Electrocardiography (ECG), thyroid ultrasonography, and magnet resonance imaging (MRI) of the sellar region were also performed. Furthermore, gene sequencing was used to detect the thyroid hormone receptor beta (THRB) gene mutation.

Interventions:

Patient treatment was individualised. Patients were given levothyroxine sodium or a low dose of thyroiodin, depending on the individual symptoms.

Outcomes:

After treatment, thyroid function was stable in 2 of the teenage patients. No evidence of worsening thyrotoxicosis was observed.

Lessons:

Gene sequencing should be considered together with clinical lab results, including somatostatin suppression testing, before approaching a diagnosis of RTH.
The association between body lead levels and childhood rickets
Authors: Zhang Yong-fang , Xu Jiang-wei , Yang Yao , Huang Xueqin , Yu Xin-qiao
Published: February 2019

China has serious lead pollution and a high incidence of childhood rickets. High lead levels have been reported in childhood rickets, but the results were inconsistent.

To evaluate the association between body lead levels and childhood rickets.

After a systematic literature search, we identified 15 studies determining body lead levels between rickets children and healthy controls, and 4 studies focusing on the cases of different disease severity. Standard mean differences (SMD) and the corresponding 95% confidence intervals (CI) were pooled to compare the lead levels between different groups.

Sixteen case-control studies were included with a total of 5082 cases and 6054 controls. Compared with healthy controls, the body lead levels in rickets children were significantly higher (SMD (95%CI): 0.67 (0.41–0.93)), and subgroup analyses showed consistent results. The cases with moderate-to-severe disease activity also had a significantly higher lead level than mild-to-moderate cases (SMD (95%CI): 0.64 (0.31–0.97)).

This meta-analysis suggested an association between body lead levels and childhood rickets, and lead exposure might be a risk factor for rickets.
Effect of mGluR7 on proliferation of human embryonic neural stem cells
Authors: Zhang Jing , Zhao Junmei , Chen Yani , Shi Haiyan , Huang Xiaoyong , Wang Yanfeng , Wang Yu , Wei Yameng , Xue Wanjuan , Han Jiming
Published: February 2019

This study is to investigate the effect of metabotropic glutamate receptor 7 (mGluR7) on the proliferation of human embryonic neural stem cells (NSCs) and its molecular mechanism.

Human embryonic NSCs were isolated. The pCMV2-GV146-GFP-mGluR7 plasmid was transfected to over-express mGluR7 while mGluR7 siRNA was transfected to knockdown mGluR7. MTT assay was used to analyze cell proliferation. Flow cytometry was used to detect cell cycle and apoptosis. Protein and mRNA levels were analyzed by Western blot and RT-qPCR, respectively.

The viability of human NSCs and the diameter of neurospheres after 24 hours, 48 hours, and 72 hours of transfection significantly increased by mGluR7 overexpression whereas significantly decreased by mGluR7 knockdown. Ki-67 expression was up-regulated by mGluR7 overexpression whereas down-regulated by mGluR7 siRNA, indicating a promotive effect of mGluR7 on NSC proliferation. After mGluR7 overexpression, G1/G0 phase cell ratio dropped significantly compared with control group, while the S phase cell ratio increased. mGluR7 silencing arrested human NSCs at G1/G0 phase. After 48 hours of transfection, there was a decrease of apoptosis by mGluR7 overexpression, while mGluR7 silencing induced apoptosis of human NSCs. Additionally, overexpression of mGluR7 up-regulated the expression of p-serine/threonine kinase (AKT), cyclin D1, and cyclin-dependent kinase 2 (CDK2). The mGluR7 knockdown had opposite effects. Similarly, mGluR7 down-regulated the expression of Caspase-3/9, while the mGluR7 knockdown promoted this.

mGluR7 can promote the proliferation of human embryonic cortical NSCs in vitro. This effect may be mediated by promoting cell cycle progression, inhibiting cell apoptosis, activating the AKT signaling pathway, and inhibiting the Caspase-3/9 signaling pathway.
Novel SCN2A mutation in a family associated with juvenile-onset myoclonus
Authors: Huang Qi , Yu Lu , Ma Meigang , Qi Hengchang , Wu Yuan
Published: February 2019

Rationale:

The phenotypic spectrum caused by SCN2A mutations includes benign neonatal/infantile seizures, Ohtahara syndrome, infantile spasms, West syndrome, and other unclassified epileptic phenotypes. Mutations in SCN2A have been implicated in neonatal seizure cases. Here, we described a Chinese family with 2 members having juvenile-onset myoclonus and identified a novel SCN2A point mutation within this family.

Patient concerns:

The 21-year-old male proband suffered from frequent myoclonus at 11 years old with subsequent progressive ataxia. His elder maternal half-sister also experienced myoclonus. Genomic DNA of the patients was extracted from the peripheral blood cells of the proband, elder maternal half-sister, parents, and uncle of the proband. Targeted next-generation sequencing was used to screen gene mutations in the proband. The potential functional effects of mutations within SCN2A were predicted In silico analyses.

Diagnoses:

Genetic testing revealed a novel SCN2A variant, c.T4820C, which contains a highly conserved amino acid substitution within segment S5 (p.V1607A). This mutation was predicted to produce a dysfunctional Nav1.2 protein by Mutation Taster and Protein Variation Effect Analyzer (PROVEAN). Genotype–phenotype correlation showed an incomplete penetrance of p.V1607A.

Interventions:

The proband was treated by multiple antiepileptic drugs. These included carbamazepine, oxcarbazepine, valproate, and topiramate.

Outcomes:

The duration of follow up was 2 years, and the proband developed drug-resistant epilepsy.

Lessons:

The case gives us the lesson that SCN2A mutation can contribute to juvenile-onset myoclonus. Our findings extend the spectrums of SCN2A mutations and the clinical features of patients with SCN2A mutations.
Acute rib fracture caused by preoperative positioning for direct lateral interbody fusion
Authors: Hong Chang Hwa , Jung Ki Jin , Soh Jae Wan , Won Sung Hun , Hong Si John , Kim Chang Hyun , Lee Hong Seop , Wang Soon Do , Lee Won Seok , Kim Woo Jong
Published: February 2019

Rationale:

Degenerative spondylolisthesis is defined as forward slippage of a vertebra with respect to the underlying vertebra and is associated with the induction of lumbar canal stenosis. The use of anterior column support for degenerative lumbar conditions has been well documented. Direct lateral interbody fusion (DLIF) gains access via a lateral approach through the retroperitoneal fat and psoas muscle. It avoids many of the access-related complications yet comes with its own risks and limitations. The location of the iliac wing precludes exposure of the L5–S1 disc space and may make L4–5 surgery difficult. Therefore, accurate preoperative patient positioning is essential.

Patient concerns:

A 71-year-old female with a body mass index (BMI) of 39.2 kg/m2 (height 155.9 cm, weight 79.5 kg) presented with lumbar pain radiating to the left lower limb. She complained of neurologic claudication with more than 100 m ambulation.

Diagnosis:

Plain standing view on spine radiography revealed L4–5 spondylolisthesis and disc-space narrowing. Magnetic resonance imaging (MRI) revealed severe L4–5 bilateral foraminal stenosis. After the first surgery, simple rib cage radiography was performed to examine the source of her right-sided flank pain and it revealed acute fracture of the right ninth and tenth ribs.

Interventions:

The patient was laterally positioned on the table in an extreme bending position. The intervertebral cage was inserted in the L4–5 disc space and disc height was restored. With respect to the rib fracture, treatment was conservative.

Outcomes:

The patient's radiating pain was immediately relieved and her lower back pain disappeared at 3 months after surgery. The patient reported right-sided flank pain after the first surgery. Simple rib cage radiography was performed and revealed fracture of the right ninth and tenth ribs. Follow-up assessments conducted 2 months later revealed complete bony union.

Lessons:

DLIF avoids many access-related complications. However, it is associated with other intraoperative complications, including injury to the lumbar nerve root and plexus. In addition, there are preoperative complications associated with improper patient placement on the table. In this case, the patient's obesity and strict positional requirements resulted in rib fracture. We suggest that surgeons consider this complication and exercise care in preoperative positioning.
Atypical incomplete femoral neck fracture in patients taking long-term bisphosphonate
Authors: Suh You-Sung , Jang Byung-Woong , Nho Jae-Hwi , Won Sung-Hun , Lee Won-Seok
Published: February 2019

Rationale:

We present 2 cases of lateral incomplete impending fracture of the femoral neck without trauma in elderly patients taking long-term bisphosphonate (BP) treatment, and we defined it as atypical femoral neck fracture (AFNF). To the best of our knowledge, this is the first report on the follow-up results of AFNF.

Patient concerns:

Patients in both cases had been taking BP drugs for a long time with osteoporosis. The duration of BP treatment was 6 years, and there was no history of repeated stresses.

Diagnoses:

All fractures were linear at the lateral aspect of the mid portion of the femoral neck, and the BMD of the femoral neck was −0.9, and −1.8, respectively.

Interventions:

Internal fixation was performed in both cases (73 years, 68 years) using cannulated screws.

Outcomes:

In both patients who underwent screw fixation, the fracture line started to extend distally at 4 weeks and 2 weeks following surgery. In the 3-month follow-up image, the length of the fracture increased by 20.1 mm and 9.9 mm, respectively. There was a problem with active rehabilitation, and the possibility of revision was also found to be a burden in terms of mortality and cost in older patients.

Lessons:

In the case of AFNF, guidelines for treatment should be set in consideration of the decreased bone healing, even when the fracture pattern is simple. Arthroplasty based on a wider indication may be worth considering.
The effect of remote health intervention based on internet or mobile communication network on hypertension patients
Authors: Wu Yong , Zhao Pei , Li Wei , Cao Ming-Qiang , Du Lin , Chen Jian-Chang
Published: February 2019

Background:

To systematically review the impact of remote health interventions based on an internet or mobile communication network on patients with hypertension and to provide a theoretical basis for hypertension patients with the implementation of remote health interventions.

Methods:

Data were retrieved from a total of 4 Chinese databases and 3 foreign databases. The Chinese databases included: China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Biomedical Database (SinoMed), and Chongqing Chinese Science and Technology Journey database (VIP). The foreign language databases included PubMed, The Cochrane Library, and EMbase, and the date range for the search was from the date the database became active to December 1st, 2018. After screening and extracting the materials and evaluating the risk of bias in each study (conducted by 2 researchers), the quality of the selected literature was evaluated by Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014, and the statistical analysis was applied by Stata 12.0 software.

Result:

This study will provide high-quality evidence-based medicine research evidence for remote health interventions on hypertensive patients based on the Internet and mobile communication network using systematic evaluation and meta-analysis methods.

Conclusion:

This systematic review will provide a scientific conclusion as to whether the remote health intervention model based on an internet or mobile communication network can better control blood pressure and improve patient compliance than the traditional nursing intervention model for hypertensive patients.

Ethics and dissemination:

This protocol for a systematic review and meta-analysis of randomized controlled trials does not require ethical approval and the results of this paper will be published in an open form in internationally influential academic journals.

Protocol and registration:

A protocol had been registered in PROSPERO CRD42019122404.
The efficacy of extracorporeal membrane oxygenation in liver transplantation from non-heart-beating donors
Authors: Peng Jiang-Chen , Ding Jia , He Zheng-Yu , Deng Yu-Xiao , Xing Shun-Peng , Zhao Xian-Yuan , Li Zhe , Dai Yi-Li , Gao Yuan
Published: February 2019

Background:

A systematic review and meta-analysis was made to see whether extracorporeal membrane oxygenation (ECMO) in liver transplantation could improve non-heart-beating donors (NHBDs) recipients’ outcomes compared with donors after brain death (DBDs) recipients.

Methods:

We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for eligible studies. The study eligible criteria are cohort or case–control studies using ECMO in all NHBDs; studies involved a comparison group of DBDs; and studies evaluated 1-year graft and patient survival rate in NHBDs and DBDs groups.

Results:

Four studies with 704 patients fulfilled the inclusion criteria. The pooled odds ratio (OR) of 1-year patient survival rate in NHBDs recipients compared with DBDs recipients was 0.8 (95% confidence interval [CI], 0.41–1.55). The pooled OR of 1-year graft survival rate in NHBDs recipients compared with DBDs recipients was 0.46 (95% CI, 0.26–0.81). NHBDs recipients were at greater risks to the occurrence of primary nonfunction (PNF) (OR = 7.12, 95% CI, 1.84–27.52) and ischemic cholangiopathy (IC) (OR = 9.46, 95% CI, 2.76–32.4) than DBDs recipients.

Conclusions:

ECMO makes 1-year patient survival acceptable in NHBDs recipients. One-year graft survival rate was lower in NHBDs recipients than in DBDs recipients. Compared with DBDs recipients, the risks to develop PNF and IC were increased among NHBDs recipients.
Meta-analysis of the effectiveness of laparoscopic adjustable gastric banding versus laparoscopic sleeve gastrectomy for obesity
Authors: Li Laiyuan , Yu Huichuan , Liang Jinglin , Guo Yinyin , Peng Shaoyong , Luo Yanxin , Wang Jianping
Published: February 2019

Background:

Laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are common weight loss procedures. Our meta-analysis compared these procedures for the treatment of morbid obesity and related diseases.

Methods:

We systematically searched the PubMed, Embase, and the Cochrane Library through January 2018. The percentage of excess weight loss (%EWL), improvement or remission of type 2 diabetes mellitus (T2DM) and hypertension were analyzed and compared.

Results:

Thirty-three studies with 4109 patients were included. Greater decreases in excess weight were found in patients who received LSG at 6 months (weighted mean difference (WMD) −9.29, 95% confidence interval (CI): −15.19 to −3.40, P = .002), 12 months (WMD −16.67 95% CI: −24.30 to −9.05, P < .0001), 24 months (WMD −19.63, 95% CI: −29.00 to −10.26, P < .0001), and 36 months (WMD −19.28, 95% CI: −27.09 to −11.47, P < .0001) than in patients who received LAGB. However, there were no significant differences in the 3-month outcomes between the 2 groups (WMD −1.61, 95% CI: −9.96 to 6.73, P = .70). T2DM patients after LSG experience more significant improvement or remission of diabetes (odds ratio (OR): 0.22, 95% CI: 0.06–0.87, P = .03). The 2 groups did not significantly differ regarding improvement or remission of hypertension (OR 0.80, 95% CI: 0.46–1.38, P = .42).

Conclusion:

LSG is a more effective procedure than LAGB for morbidly obese patients, contributing to a higher %EWL and greater improvement in T2DM.
Systematic Review of Probiotics for Cystic Fibrosis Patients
Authors: Neri Lenycia de Cassya Lopes , Taminato Monica , Silva Filho Luiz Vicente Ribeiro Ferreira da
Published: February 2019

Background:

Cystic fibrosis (CF) is associated with chronic respiratory disease and pancreatic insufficiency and results in the malabsorption of nutrients and intestinal inflammation. There is evidence that probiotic supplementation may impact the gastrointestinal and respiratory microbiota. This study aimed to categorize current evidence regarding the effects of supplementing with probiotics in CF patients on gastrointestinal and respiratory outcomes according to the type of intervention.

Methods:

The initial database search included all identified studies according to the recommendations of the Cochrane Collaboration, regardless of language, publication date or design. Studies were categorized by probiotic strain (Lactobacillus reuteri; Lactobacillus rhamnosus GG or a mix of strains); dosage (low dosage if <109 CFU [colony forming units] or high dosage if >109 CFU); and duration of intervention (1, 3, 6, or 12 months). Assessment of quality was performed based on the Cochrane risk of bias criteria and the Downs & Black checklist.

Results:

A total of 205 studies were identified; however, only 9 met the criteria for inclusion. The studies were considered to have a high risk of bias, hampering the possibility of performing a meta‐analysis. Eighty percent of the studies (4 of 5) reported a positive result for intestinal inflammation, and another 4 studies (4 of 5) reported a positive result for pulmonary exacerbation frequency, regardless of the treatment approach.

Conclusions:

The present data indicate a promising future for probiotic use in cystic fibrosis, which has an impact on exacerbations and intestinal inflammation; however, further studies of standardized therapeutic interventions are required.
Effects of the Gluten‐free Diet on Body Mass Indexes in Pediatric Celiac Patients
Authors: Amirikian Karine , Sansotta Naire , Guandalini Stefano , Jericho Hilary
Published: February 2019

Objective:

The aim of the study was to determine the effects of the gluten‐free diet (GFD) on body mass indexes (BMIs) in children with celiac disease at University of Chicago before and after 2011, when processed gluten‐free foods became readily available on the market.

Methods:

We conducted a retrospective chart review of children seen at University of Chicago Celiac Center from January 2002 to May 2016. BMI was recorded upon GFD initiation in addition to at least 1 other timepoint: 6 months, 1 year, 2 years, 3 years, and 4+ years. We compared the rate of BMI increase in children who were diagnosed before versus after 2011.

Results:

A total of 147 children (66% girls) with biopsy‐confirmed celiac disease were included in the study. The mean BMI at diagnosis was 17.8 (standard deviation 3.9) for those diagnosed before 2011 and 17.1 (standard deviation 2.7) for those diagnosed after 2011. Based on a mixed‐effects random‐intercept random‐slope regression model, there was no evidence for significant difference in BMI change over time between the 2 groups (P value = 0.36). BMI values overall were noted to increase after starting the GFD, even at the first appointment. Serologies were monitored after patients started the GFD and approached normal values, allowing us to conclude that patients were adherent to the GFD.

Conclusions:

Although overall we observed no significant changes in BMI before and after 2011, we did notice that in adolescent celiac patients there was a trend toward a higher postdiagnosis BMI in the years after 2011. We speculate that teenagers may be especially vulnerable to choosing quick and easy processed gluten‐free options over more healthy, natural alternatives leading to a rise in their BMIs after the 2011 surge in production of processed gluten‐free foods on the market. Therefore, special attention must be paid to this population to insure ongoing healthy food choices even after many years on the GFD.
The Infusion Nurse's Role in Antibiotic Stewardship
Authors: Morgan Sharon A.
Published: February 2019

Since the introduction of the first antibiotic, the quick development of resistance has threatened the efficacy of such medications. Improving antibiotic use is, above all, a patient safety issue. As frontline health care providers, nurses can become more engaged and take a leadership role to enhance antibiotic stewardship programs. The unrecognized role of nurses in antibiotic stewardship efforts is just beginning to be explored. From hospital to home settings, the breadth of infusion nurse practice positions them to take principal roles in antibiotic stewardship program development across the continuum of care.
Exploring the Experiences of People Treated With Immunotherapies for Advanced Melanoma and Those Caring for Them: “Real-World” Data
Authors: Milne Donna , Hyatt Amelia , Billett Alex , Gough Karla , Krishnasamy Mei
Published: February 2019

Background

Recent advances in the development of immunotherapy drugs have resulted in durable responses and improved overall survival for a proportion of patients with advanced melanoma; however, toxicities can be potentially life-threatening. The patients' family and friends (carers) are relied upon to support patients at home post treatment; however, we know little about their experiences.

Objectives

This study aimed to understand the experiences of patients with advanced melanoma who received immunotherapy and their carers; and to explore the impact of immunotherapy treatment on patients' and carers' quality of life (QoL).

Methods

A cross-sectional, exploratory design was employed. Semi-structured interviews were conducted with patients: diagnosed with stage IV melanoma, attending an Australian public cancer hospital, had completed or were receiving treatment with immunotherapies; and the people caring for them at home.

Results

Patients (n = 22) described how immunotherapy impacted emotional health, functional ability; and had damaging economic consequences. Fatigue was reported consistently as having a considerable negative influence across all domains of QoL. Carers (n = 9) were anxious about their ability to correctly identify, report and manage side effects at home.

Conclusions

Results demonstrate how immunotherapy can impact the QoL of both patients and carers, either directly through toxicities or indirectly through mechanisms such as stress, financial toxicity, or fatigue that limits participation in life activities.

Implications for Practice

Supportive care resources and interventions are needed for those receiving immunotherapy to minimise negative impacts on QoL. Carers likewise require better preparation and information to assist in identifying potential treatment toxicities and ensure patient safety.
The Fainting Assessment Inventory
Authors: Heyer Geoffrey L.
Published: February 2019

The conversion disorder that appears like syncope is common but poorly recognized. The study aimed to develop and validate a brief, clinician-administered screening tool to discriminate psychogenic nonsyncopal collapse (PNSC) among young patients referred for fainting. Consecutive patients with PNSC and with syncope (15.4 ± 2.2 years) completed a 92-item inventory highlighting features typical of PNSC and neurally mediated syncope (n= 35, each cohort). Fourteen items were retained and revised and then administered to new cohorts ultimately diagnosed with PNSC or syncope (n= 40, each cohort). Further revision led to a 10-item Fainting Assessment Inventory (FAI-10). Scoring the syncope ratings positively and the PNSC ratings negatively, median scores differed between cohorts with PNSC and with syncope (−6vs. 7;p< 0.001). Diagnostic sensitivity (0.95), specificity (0.875), positive predictive value (0.889), negative predictive value (0.93), and area under the curve (0.973) were calculated. The FAI-10 furthers clinicians' ability to distinguish various forms of transient loss of consciousness.
Transitions in Care Model for a Senior-Level Clinical Immersion Experience
Authors: Fleming Louise , Lorenzen Rachael , Stanek Joan , Williams Megan , Mendel Hilary
Published: February 2019

Background

RN precepted clinical immersion experiences have become a mainstay of prelicensure nursing education, as they increase autonomy and confidence as students prepare to graduate and enter the workforce.

Problem

Nursing students are often assigned a hospital unit that neither enables them to work with their preferred patient population nor appreciates the patient care continuum.

Approach

A clinical immersion experience was developed using an innovative model focused on specific patient populations across the care continuum.

Outcomes

Five clinically immersive experiences were developed. More than 50 students transitioned through varied areas across the care continuum, based on their chosen focus.

Conclusion

Senior-level nursing students were able to care for patients along the care continuum in both acute and community settings through a new model.
“Learning How to Teach” in Nursing: Perspectives of Clinicians After a Formal Academy
Authors: Jarosinski Judith M. , Seldomridge Lisa A. , Reid Tina P. , Hinderer Katherine A.
Published: February 2019

Background

The nursing faculty shortage is expected to persist throughout the next decade. Understanding what influences transition from clinician to educator and retention can improve approaches used in nursing programs for those aspiring to careers in nursing education.

Purpose

This qualitative study elicited the experiences of participants who completed a structured program to prepare clinicians to become clinical faculty for prelicensure students.

Methods

Focus groups uncovered participant perspectives on “learning how to teach.”

Results

Using interpretive phenomenological analysis, the themes (1) I'm not sure I can do this, (2) changing perspectives-learning to teach, and (3) instilling confidence emerged.

Conclusions

Novice educators reported benefitting most from exposure to multiple teaching methods, simulated teaching encounters, and group debriefing as they learned to become educators.
What is the Role of Tumor-treating Fields in Newly Diagnosed Glioblastoma?
Authors: Ornelas Abbie S. , Porter Alyx B. , Sharma Akanksha , Knox Molly G. , Marks Lisa A. , Wingerchuk Dean M. , O’Carroll Cumara B.
Published: February 2019

Alternating electrical fields can disrupt mitosis leading to apoptosis of rapidly dividing cancer cells. The device that utilizes this mechanism is known as tumor-treating fields (TTFields). TTFields can be applied by ceramic transducer arrays on a shaved scalp to deliver the alternating electric activity to patients with glioblastoma (GBM). It has FDA approval for use in both recurrent and newly diagnosed GBM. The objective is to critically appraise the current evidence for the use of TTFields as adjunctive treatment to newly diagnosed GBM. The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, evidence summary, clinical bottom lines, and expert discussion. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of neurooncology. A randomized controlled trial was selected for critical appraisal. Patients with newly diagnosed GBM completing standard radiation and chemotherapy with temozolomide (TMZ) were subsequently randomized to receive maintenance TMZ with TTFields, or TMZ alone. With the addition of TTFields, median progression-free survival was 6.7 months compared with 4 months without the addition of TTFields (95% confidence interval, 0.52-0.76; P<0.001) and overall survival was 20.9 months compared with 16.0 months without the addition of TTFields (95% confidence interval, 0.53-0.76; P<0.001). TTFields may increase both progression-free and overall survival in patients receiving standard chemoradiation therapy for GBM.
Cardioembolic Sources in Patients With Small Single Subcortical Infarcts
Authors: Celaj Stela , Prabhakaran Shyam
Published: February 2019

Transthoracic echocardiogram (TTE) is widely used as part of the work-up for ischemic stroke. However, the added utility of TTE in the management of small single subcortical infarcts (SSSI) has not been extensively evaluated. Therefore, we aimed to determine the frequency of high-risk and medium-risk cardioembolic sources diagnosed by TTE in SSSI patients, and whether the findings altered clinical management. We performed a retrospective analysis of a prospective cohort of patients with confirmed acute ischemic stroke enrolled in a single-center observational registry between August 2012 and July 2014. We assessed infarct topography on brain magnetic resonance imaging, blinded to final stroke subtype and treatment, to identify patients with SSSI. We defined SSSI as lesions in the corona radiata, basal ganglia, thalamus, or brainstem measuring <1.5 cm in maximal diameter. We excluded patients with atrial fibrillation and large artery stenosis >50%, and assessed the frequency of cardioembolic sources found by TTE in the remaining patients. Among 908 patients, 75 (8.3%) had SSSI, of which 4 (5.3%) had atrial fibrillation and 6 (8%) had symptomatic large artery stenosis. TTE revealed cardiac abnormalities in 46% of the remaining patients (mean age: 65.1 y, 52% female, 58% white). The most common findings were dilated left atrium (29%), patent foramen ovale (14%), and atrial septal aneurysm (7.7%). Anticoagulants were prescribed in 3 (4.6%) patients on the basis of TTE results. TTE identified potential cardioembolic sources in almost half of the patients, but altered antithrombotic management in only 5% of patients with SSSI.
Prevalence of Myopia and Associated Risk Factors in Schoolchildren in North India
Authors: Singh Neeraj Kumar , James Ritika M. , Yadav Avdhesh , Kumar Rishikesh , Asthana Smita , Labani Satyanarayana
Published: February 2019

SIGNIFICANCE

Studies reporting the prevalence and associated risk factors of myopia among schoolchildren in India are limited. Knowledge about the prevalence and the modifiable risk factors associated with myopia development will help in planning cost-effective strategies to prevent its progression in India.

PURPOSE

The purpose of this study was to assess the prevalence and associated behavioral risk factors of myopia in schoolchildren in Gurugram, Haryana, in north India.

METHODS

This cross-sectional study was conducted on schoolchildren (aged 5 to 15 years) from two private schools in Gurugram. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study chart. Myopia was defined as the spherical equivalent refractive error of at least −0.50 D in the better eye. Information on the child's habits and lifestyle, study hours, hours of playing video games, and outdoor playtime were obtained using a questionnaire. Association of behavioral risk factors was analyzed for children with and without myopia, and adjusted odds ratio (OR) for each factor was estimated.

RESULTS

A total of 1234 children (mean ± SD age, 10.5 ± 3 years; 59% boys) were screened. Myopia prevalence was found to be 21.1% (n = 261; mean ± SD age, 11 ± 2 years; 52% boys). The mean ± SD myopic spherical error was −1.94 ± 0.92 D. The prevalence of myopia was found to be higher (27%; 95% confidence interval, 23 to 30.6; OR, 3.19 [2.13 to 4.76]) among older children (9 to 12 years). Prevalence of myopia was more in boys (25%; 95% confidence interval, 21.1 to 28.8) compared with girls (P< .01). A positive association of presence of myopia was observed with children studying more than 4 hours per day (P< .008) and with children playing computer/video/mobile games more than 2 hours per day (P< .001). A protective effect was observed in children with outdoor activities/play for more than 1.5 hours per day (OR, 0.01 [0.00 to 0.06]).

CONCLUSIONS

Myopia is a major public health concern, and its prevalence is increasing rapidly among schoolchildren in India. There is a pressing need to develop cost-effective strategies to prevent this cause of vision impairment, which can be easily treated with optical interventions.
Serous Retinal Detachment Causes a Transient Reduction on Spectral Domain OCT Estimates of Ganglion Cell Layer Thickness
Authors: Nam Ki Yup , Kim Jung Yeul
Published: February 2019

SIGNIFICANCE

During the acute stage of central serous chorioretinopathy (CSC) with retinal elevation, the spectral domain optical coherence tomography (SD-OCT) estimate of ganglion cell layer complex thickness is reduced. Thickness returns to normal after resolution of the event. Measurement error is at least partially responsible for this effect. The reduction in ganglion cell layer complex thickness does not represent atrophy and is not predictive of a poor outcome.

PURPOSE

We investigated the effects of serous retinal detachment on the ganglion cell layer complex analysis (GCA) by SD-OCT in CSC patients during the acute episodes and after resolution of fluid.

METHODS

We retrospectively reviewed medical records of 30 patients who visited the hospital with a first episode of CSC. We analyzed GCA maps using SD-OCT (Cirrus; Carl Zeiss Meditec, Dublin, CA) at the initial visit with serous retinal elevation and after the absorption of subretinal fluid. For repeatability analysis, we used the intraclass correlation and repeatability coefficient from two consecutive measurements 5 minutes apart in 12 patients.

RESULTS

At the initial visit, an average thickness of ganglion cell layer complex was thinner than that measured in the fellow eye (67.4 ± 27.4 μm), but after the absorption of subretinal fluid, it normalized to 87.0 ± 6.7 μm; the difference was statistically significant. The intraclass correlation and repeatability coefficient were low during the period of serous elevation but normalized after fluid resorption. Abnormalities of GCA resulted from the segmentation error of ganglion cell layer and inner plexiform layer during the acute phase of CSC.

CONCLUSIONS

Serous retinal detachment can affect the GCA and repeatability measurements of the GCA. Clinicians should consider this finding when using the GCA measurement in the diagnosis and management of the patients with retinal contour changes such as retinal elevation including CSC.
Optometric Applications for Three-dimensional Printing: A Technical Report from Low Vision Rehabilitation Practice
Authors: Hopkins Gregory Robert , Irvin Brett C.
Published: February 2019

SIGNIFICANCE

Delivering personalized three-dimensional (3D)–printed solutions for our patients is easier now than it has ever been. This technological revolution makes things possible that it would be extremely challenging to achieve using traditional approaches.

PURPOSE

The purpose of this study was to increase awareness among the optometric and vision science community of opportunities to apply 3D printing to enhance clinical practice and research.

METHODS

A widely available fused deposition modeling 3D printing approach was used to fabricate several plastic items for use in optometric practice and low vision rehabilitation.

RESULTS

The authors will share nine optometric extensions of 3D printing: (1) an attachment for glare-acuity testing, (2) a disposable cover paddle to limit infection spread for red-eye visits, (3) ophthalmic equipment repair/modification, (4) ophthalmic lens thickness calipers, (5) NoIR lens filter flipper, (6) Optivisor faceplate, (7) EasyPocket lanyard card holder, (8) dome magnifier handle, and (9) a phoropter near card holder.

CONCLUSIONS

Designing customized solutions and problem-solving for our patients and offices are becoming easier to do using 3D printing every year. The possible applications for this technology are constantly being expanded. This technology allows for cost-effective production of solutions, some of which would not be feasible otherwise.
Using Small Samples to Evaluate Normative Reference Ranges for Retinal Imaging Measures
Authors: Swanson William H. , King Brett J. , Horner Douglas G.
Published: February 2019

SIGNIFICANCE

Retinal nerve fiber layer (RNFL) deviation maps often incorrectly score healthy eyes as having wedge defects. This study shows how to identify such problems early in the development of normative databases.

PURPOSE

After reference values are embedded in devices, clinicians and researchers often learn about issues that cause false-positive rates in healthy eyes. Here we show a way to detect and address such issues early on.

METHODS

The thickness of the RNFL was measured for both eyes of 60 healthy younger adults aged 20 to 31 years and one eye each of 30 healthy older adults aged 54 to 82 years. Deviation maps were developed from the left eyes of the first 30 younger adults, and between-subject variability in the shape of the RNFL was assessed. This was repeated in their right eyes, in the second group of younger adults and in the older adults.

RESULTS

For the first group of 30 healthy young adults, between-subject variability in the location of the region of greatest thickness meant that 58% of the pixels below the fifth percentile in the left eyes were from four people whose deviation maps had wedge-shaped patterns, as did the deviation maps for the nine right eyes with 87% of the pixels below the fifth percentile. Wedge patterns were also seen in deviation maps for 8 left eyes and 11 right eyes of the second group of young adults and for 9 eyes of the older adults.

CONCLUSIONS

Evaluation of RNFL thickness maps from 30 young adults was sufficient to determine that between-subject variability in the shape of the RNFL can cause wedge patterns in RNFL deviation maps in many healthy eyes.
Could the Clinical Effectiveness Be Improved Under the Integration of Orthotic Intervention and Scoliosis-Specific Exercise in Managing Adolescent Idiopathic Scoliosis?
Authors: Gao Chengfei , Zheng Yu , Fan Chunjiang , Yang Yan , He Chengqi , Wong Mansang
Published: February 2019

Objective

The aim of the study was to compare the effectiveness of the integration of orthotic intervention and scoliosis-specific exercise with orthotic intervention only via assessing the spinal deformity, back muscle endurance, and pulmonary function of the patients with adolescent idiopathic scoliosis.

Design

It is a prospective randomized controlled study. Patients who fulfilled the SRS criteria for orthotic intervention were randomly assigned to the orthosis combined with exercise group (combined orthotic and exercise intervention) or the orthotic intervention group (orthotic intervention only). All the subjects were prescribed with a rigid thoracolumbosacral orthosis and scoliosis-specific exercise program was provided to the subjects in the orthosis combined with exercise group. Cobb angle, back muscle endurance, and pulmonary function of subjects were measured at baseline, 1-mo, and 6-mo follow-up visits.

Results

After 6 mos of intervention, the subjects in the orthosis combined with exercise group showed better Cobb angle correction than those in the orthotic intervention group. The back muscle endurance and pulmonary function decreased in the subjects of the orthotic intervention group, whereas some improvement happened in the subjects of the orthosis combined with exercise group. Between-group statistical significance was detected at the 6-mo follow-up among back muscle endurance time and parameters of pulmonary function.

Conclusions

In this study, orthotic intervention combined with scoliosis-specific exercise offered better Cobb angle correction and improvement of the respiratory parameters and back muscle endurance of the patients with adolescent idiopathic scoliosis as compared with orthotic intervention only.
Improved Mobility, Cognition, and Disease Severity in Corticobasal Degeneration of an African American Man After 12 Weeks of Adapted Tango
Authors: Silverstein Hayley A. , Hart Ariel R. , Bozorg Ariyana , Hackney Madeleine E.
Published: February 2019

Corticobasal degeneration (CBD) has no available treatment to slow disease progression and generally resists drug therapy. Corticobasal degeneration has symptoms and decreased quality of life similar to Parkinson disease. Adapted Tango, a successful rehabilitation for Parkinson, may address CBD. A 63-yr-old African American man with CBD (alias: YD; CBD duration = 2 yrs) was evaluated for motor, cognitive, and psychosocial function before, immediately after, 1 mo after, and 6 mos after 12 wks of 20, biweekly 90-min adapted-tango lessons. After intervention, disease-related motor symptoms improved and YD reported fewer problems in nonmotor experiences of daily living, which include mood, cognition, pain, fatigue, etc. Motor symptoms remained above baseline at 6-mo posttest. YD's balance confidence improved after intervention but declined below baseline at 6-mo posttest. Quality of life was maintained despite worsened depression. YD improved or maintained executive function, and visuospatial function and attention at posttest and 1-mo posttest. At posttest, YD maintained mobility and improved on dynamic balance. At 1-mo posttest, most mobility measures had improved relative to baseline. However, YD showed executive function and overall motor decline 6 mos after intervention. Adapted tango may have temporarily slowed disease progression and improved or maintained mobility and cognition. Gains were poorly maintained after 6 mos. Further study is warranted.
Barriers of Access to Breast Reconstruction: A Systematic Review
Authors: Retrouvey Helene , Solaja Ogi , Gagliardi Anna R. , Webster Fiona , Zhong Toni
Published: February 2019

Background:

The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care.

Methods:

The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included.

Results:

The authors’ search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction.

Conclusions:

Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors’ systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
Hip Asymmetry: Implications in Body Contouring Surgery
Authors: Maia Munique , Shikowitz-Behr Lauren , Matarasso Alan
Published: February 2019

Background:

Asymmetry of the hips and its implication in body contouring procedures has not yet been reported. Hip asymmetry is common in the general population and may account for uneven abdominoplasty scar and the apparent discrepancies in volume following liposuction of the hips and flanks. The goal of this study was to determine the presence of hip asymmetry in women presenting for abdominal contouring surgery.

Methods:

Analysis of preoperative photographs of 100 female patients was performed by three independent plastic surgeons. They were asked to evaluate for hip asymmetry and, when present, determine which side was higher. Adobe Photoshop was also used to objectively measure hip asymmetry. Patients were women with no known history of hip abnormalities; age ranged from 17 to 64 years and the body mass index ranged from 16 to 47 kg/m2.

Results:

All three plastic surgeon reviewers found that the majority of patients had hip asymmetry, with raters 1, 2, and 3 documenting discrepancies in hip height in 88, 60, and 76 percent of patients, respectively. The interrater reliability was 0.713. Chi-square statistical analysis suggested that the raters were not statistically different from one another (p = 0.086). The objective analysis found asymmetry in 82 percent of patients.

Conclusions:

The results showed that the majority of patients who present for abdominal contouring surgery have asymmetric hips. Patients are usually unaware of the unevenness of their own hips; however, they often notice postoperative discrepancies in scar height after abdominoplasty or volume differences after liposuction.