bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey Development
Authors: Mensik Jennifer , Leebov Wendy , Steinbinder Amy
Published: February 2019

OBJECTIVE

The aim of this study was to develop an instrument that measures all healthcare staff's perceptions of a culture of caring.

BACKGROUND

Healthcare organizations have increased their focus on cultures of caring within their staff to improve staff satisfaction and patient satisfaction. Nurses and physicians traditionally have been the focus in understanding caring cultures excluding non–direct care staff who do impact organizational culture.

METHODS

An exploratory and partial confirmatory factor analysis was completed on 2 instruments that measure the perception of a caring culture in both direct care and non–direct care staff.

RESULTS

Results demonstrate that both the direct and non–direct care instruments are valid and reliable measures for assessing a caring culture.

CONCLUSIONS

The new 14-item clinical and new 10-item nonclinical staff caring assessment instruments will provide healthcare and nursing leaders with the ability to assess their culture through a direct and non–direct care perspective.
Dose–Response Relationship in a Healthy Habits Study for Head Start Preschoolers
Authors: Ling Jiying , Zahry Nagwan R. , Robbins Lorraine B.
Published: February 2019

Background

Understanding the dose–response relationship in behavioral interventions is critical to guide future research efforts. However, only few studies have fully examined the dose–response relationship especially among children.

Objective

The aim of the study was to examine the relationships between level of participation and intervention effects.

Methods

The study used data from 39 Head Start parent–preschooler dyads participating in a 10-week lifestyle intervention. The intervention included daily center-based preschooler program, preschooler weekly letters to parents, parent meetings, and weekly Facebook-based program. Height, weight, waist circumference (WC), moderate-to-vigorous physical activity (MVPA), screen time, and fruit/vegetable intake were assessed.

Results

Preschooler program average daily attendance was 79%, and Facebook-based program average completion rate was 80%. About 49% attended all three parent meetings. Parent meeting attendance was significantly and positively related to preschoolers’ vegetable intake (p = .023) and MVPA (p < .001) and parents’ MVPA (p = .016). Preschooler letters were significantly and negatively related to preschoolers’ screen time (p = .002) and parents’ WC (p = .027) and positively correlated with parents’ MVPA (p = .01). Preschooler program attendance was not significantly correlated with their body mass index (ρ = −.31) or WC (ρ = −.16).

Discussion

The study provides important information for designing effective interventions among low-income families. The findings imply that (a) parent-only interventions and parent–child interventions may result in similar effects, (b) future behavioral interventions should focus on the bidirectional parent–child relationship, and (c) it is important to include face-to-face contacts in lifestyle interventions. In addition, it highlights the need to examine the dose–response relationship in multicomponent lifestyle interventions.
A Population Health Approach to America's Opioid Epidemic
Authors: Salmond Susan , Allread Virginia
Published: February 2019

The United States is in the midst of a nationwide public health emergency: an epidemic of opioid misuse and abuse that has been called the deadliest drug crisis in American history. This article reviews the current status of the opioid epidemic, the trends over the last 30-40 years that may have contributed to the epidemic, and a population health approach to addressing the epidemic. The epidemic is conceptualized from a population health perspective—an upstream and midstream perspective focusing on prevention and a downstream perspective targeting access to evidence-based interventions and maximizing health whether using or abstaining. Within the context of acute care, this approach will include patient screening for opioid use and other risk factors for addiction, use of opioid-sparing analgesics, and follow-up care that addresses pain and pain relief without opioids. For individuals who need addiction treatment, a gradualism philosophy is put forward. Gradualism recognizes the incremental nature of behavior change and recommends strategies to maximize health and functioning—through harm reduction—at all points along the journey to overcome addiction. Working within communities to address the broad factors that contribute to opioid-related substance use disorder is also essential.
Management of Opioid Use Disorder Treatment
Authors: Salmond Susan , Allread Virginia , Marsh Robert
Published: February 2019

It is important for nurses not working in the area of addictions to be informed of the diagnosis and treatment of opioid use disorder so that they may serve as a resource, educate others, and influence and refer individuals to seek treatment on the basis of best evidence. In this article, we provide an overview of the postscreening diagnosis and treatment of opioid use disorders with an emphasis on medication-assisted treatment, starting with the definition of substance use disorder, tolerance, dependence, and addiction.
Intranasal Fentanyl and Midazolam for Procedural Analgesia and Anxiolysis in Pediatric Urgent Care Centers
Authors: Williams John Matthew , Schuman Sarah , Regen Rebecca , Berg Allyson , Stuart Lindsay , Raju Jampana , Mabry William , Kink Rudy John
Published: February 2019

Objectives

Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers.

Methods

This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions.

Results

Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2–17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99–4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07–0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6–4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03–0.45) mg/kg. There were no serious adverse drug reactions reported.

Conclusions

Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.
Molecular Classification and Emerging Targeted Therapy in Endometrial Cancer
Authors: Yen Ting-Tai , Wang Tian-Li , Fader Amanda N. , Shih Ie-Ming , Gaillard Stéphanie
Published: February 2019

Recent advances in molecular studies, especially genome-wide analyses, have revealed the landscape of genomic alterations present in endometrial carcinomas, and have provided valuable insight into the pathogenesis of this disease. The current challenges are in developing a molecular-morphologic classification system to enhance traditional pathologic diagnosis and in determining the optimal approach to using this new information to guide clinical management. Molecular assays may be particularly beneficial in allowing the earlier detection of endometrial cancer or precursor lesions and in guiding personalized treatment approaches. In this review, we describe the current molecular landscape of endometrial cancers, efforts underway to incorporate molecular alterations into the current classification systems, and the development of diagnostic tools for the early detection of endometrial cancer. Finally, we present opportunities for using these data to tailor therapeutic strategies. A comprehensive understanding of the molecular alterations responsible for the origination, relapse, and resistance patterns of this disease will ultimately improve outcomes for patients with endometrial cancer.
Primary Ovarian Tumors With Lymphogenic and Hematogenic Metastasis Express High MMP-14, Which Colocalizes With Highly Sulfated Chondroitin Sulfate in the Stroma
Authors: Vos Maria Caroline , Hollemans Eva , van der Steen Sophieke C.H.A. , van Kuppevelt Toin H. , van der Wurff Anneke A.M. , Massuger Leon F.A.G.
Published: February 2019

Lymphogenic and hematogenic metastases are uncommon in ovarian cancer, especially at presentation. We hypothesized that MMP-14 and MMP-2, CD44, and highly sulfated chondroitin sulfate (CS-E) may be overexpressed in tumors with these metastatic patterns. These molecules are all present in the ovarian tumor microenvironment, wherein they may interact. In an ovarian cancer cohort of 44 patients with metastases in lymph nodes, spleen, and/or liver, the presence of MMP-14, MMP-2, CD44, and CS-E in both the primary tumor and the metastases was determined with immunohistochemistry and related to clinical characteristics. Immunohistochemical expression was found for MMP-14 in all primary tumors as well as in all metastases and for MMP-2 expression in most of the samples. Most primary tumors with synchronous metastases were positive for CS-E, as well as most primary tumors with metachronous lymphogenic metastases. The expression of the MMPs and CS-E in the stroma seemed to colocalize. For CD44 immunohistochemical expression, this relationship was not found. Epithelial MMP-14 on the one hand and stromal CS-E on the other hand seem to be essential players in ovarian cancer with lymphogenic and hematogenic metastases. CD44 expression is not correlated with the other markers. More research on the interaction of these molecules and their role in the process of dissimination of disease is warranted.
Distinct Histologic, Immunohistochemical and Clinical Features Associated With Serous Endometrial Intraepithelial Carcinoma Involving Polyps
Authors: Trinh Vincent Q.-H. , Pelletier Mathieu P. , Echelard Philippe , Warkus Thomas , Sauthier Philippe , Gougeon François , Mès-Masson Anne-Marie , Provencher Diane M. , Rahimi Kurosh
Published: February 2019

The origin of serous endometrial intraepithelial carcinoma (SEIC) is debated, due to its premalignant and independently malignant nature. It often arises next to endometrial serous carcinoma (ESC), with a propensity for polypoid growth. We aimed to better characterize this discrepancy by analyzing the clinical, histologic, and immunohistochemical features of polypoid carcinoma associated with SEIC (P-SEIC), and compared them with usual endometrial serous carcinoma without SEIC (UESC). Consecutive patients with P-SEIC were recruited and compared with UESC controls from our institutional research center. Clinical, histologic, and immunohistochemical (IHC, ER, PR, P53, Napsin-A, WT1, P16) were analyzed. BRCA testing results and familial history were also extracted from clinical databases. Welch T test, Pearson χ2, and Fisher exact test were performed in SPSS version 23. A total of 37 P-SEIC and 25 UESC were the basis of a case-control study. P-SEIC was associated with more bilateral ovarian involvement (P=0.026), yet showed lower rates of myometrial invasion (P=0.002). P-SEIC showed a statistically different IHC profile: p53+, p16+, ER+, PR+, and WT-1+, and high rates of Napsin-A, while UESC was p53+, p16+, WT-1−, Napsin-A−, with lower rates of ER and PR. We also identified 2 patients who received prophylactic salpingo-oophorectomy for BRCA mutations and who subsequently developed P-SEIC with its unique IHC pattern. Our results suggest different underlying expression profiles and possibly diverging molecular signatures between both P-SEIC and UESC. If confirmed in further molecular studies, it could lead to a distinct molecular subclass.
Leadership Disparities in State Governmental Public Health Workforce: Examining the Influence of Gender
Authors: Chapple-McGruder Theresa , Mendoza Zipatly V. , Miles Gandarvaka , Hilson Renata , Wiltshire Jacqueline , Wilder Jocelyn , Heidari Leila , Castrucci Brian C. , Gould Elizabeth
Published: February 2019

Objective:

To determine the extent to which gender disparities exist in either obtaining a leadership position or pay equity among those with leadership positions in state governmental public health agencies.

Design:

Utilizing the 2014 Public Health Workforce Interests and Needs Survey, a nationally representative cross-sectional study of state governmental public health agency employees, the characteristics of the state governmental public health agency leadership were described. We estimated the odds of being a manager or an executive leader and the odds of leaders earning greater than $95 000 annually for women compared with men using polytomous multinomial regression and logistic regression models, respectively.

Setting and Participants:

The Public Health Workforce Interests and Needs Survey was conducted via electronic survey at 37 state health departments. This study utilized only those respondents who listed their current position as a supervisory position (n = 3237).

Main Outcome Measures:

Leadership position and high-earning leadership were the 2 main outcome measures explored. Leadership position was defined as a 3-level ordinal variable: supervisor, manager, or executive leader. High-earning leadership was defined as a member of leadership earning $95 000 or greater.

Results:

Women accounted for 72.0% of the overall state governmental public health agency workforce and 67.1% of leadership positions. Women experienced lower odds (odds ratio = 0.55, 95% confidence interval: 0.39-0.78) of holding executive leadership positions than men and lower odds (odds ratio = 0.64, 95% confidence interval: 0.50-0.81) of earning an annual salary greater than $95 000.

Conclusion:

While women were represented in similar proportions in the general workforce as in leadership positions, gender disparities still existed within leadership positions. Increased effort is needed to ensure that opportunities exist for women in executive leadership positions and in pay equity. With public health's commitment to social justice and the benefits of diversity to an agency's policies and programs, it is important to ensure that women's voices are equally represented at all levels of leadership.
The Planning, Implementation, and Evaluation of California's Inaugural Food Waste Prevention Week
Authors: Gosliner Wendi , Delaney Tracy , Caldwell Stephanie , Lee Joyce M. , Billups Naomi , Floor Sara
Published: February 2019

Preventing food waste can divert food from landfills to feed people, combat climate change, preserve natural resources, and save money. In February 2017, the Nutrition Policy Institute and the Public Health Alliance of Southern California initiated a multisector collaboration among California state agencies to raise awareness about food waste. After development and distribution of a Communications Guide, Food Waste Prevention Week was launched successfully in March 2018, with official support from California's Governor, Secretary of Agriculture, Superintendent of Public Instruction, and other leaders. The multiagency shared messaging campaign was estimated to reach millions, based on unique page views via social and traditional media. In a follow-up survey, partners expressed satisfaction with Food Waste Prevention Week and interest in participating in future efforts. Organizing leaders across multiple sectors to raise awareness about food waste is possible; such efforts can contribute to driving behavioral and structural changes to reduce food waste.
Community Benefit Spending Among North Carolina's Tax-Exempt Hospitals After Performing Community Health Needs Assessments
Authors: Fos Elmer B. , Thompson Michael E. , Elnitsky Christine A. , Platonova Elena A.
Published: February 2019

Context:

As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities.

Objective:

To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA.

Design:

Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics.

Setting:

Fifty-three private, nonprofit hospitals across North Carolina.

Main Outcome Measure:

Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs.

Results:

Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94).

Conclusions:

The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.
Local Health Departments' Spending on the Foundational Capabilities
Authors: Singh Simone R. , Bekemeier Betty , Leider Jonathon P.
Published: February 2019

Improving our nation's public health system requires a detailed understanding of public health expenditures and related revenue sources, yet no comprehensive data source exists that contains such information for governmental health agencies at all levels. Using pilot study data of a standardized financial accounting framework for public health agencies—in the form of a uniform chart of accounts crosswalk—this article presents local health departments' (LHDs') expenditures on the foundational capabilities, that is, crosscutting skills and capacities needed to support all of an LHD's programs and activities. Among 16 sample LHDs from 4 states, per capita foundational capabilities spending ranged from $1.10 to $26.19, with a median of $7.67. Larger LHDs and LHDs with greater financial resources spent more per capita, as did accredited LHDs. Future work using data from a larger sample of LHDs is needed to examine agency and community-level characteristics associated with adequate funding for the foundational capabilities.
CDC Guidance for Use of a Third Dose of MMR Vaccine During Mumps Outbreaks
Authors: Marlow Mariel A. , Marin Mona , Moore Kelly , Patel Manisha
Published: February 2019

Context:

In response to numerous mumps outbreaks reported throughout the United States in 2016 and 2017, the Advisory Committee on Immunization Practices (ACIP) recommended a third dose of measles, mumps, and rubella (MMR) vaccine for groups of persons determined by public health authorities to be at increased risk for acquiring mumps because of an outbreak.

Objective:

To provide guidance for health departments when implementing the ACIP recommendation.

Design:

Draft guidance was developed by Centers for Disease Control and Prevention subject matter experts based on technical consultations with health departments and review of published and unpublished data regarding mumps outbreaks. The guidance was finalized based on input from experts from the ACIP Mumps Work Group and local and state epidemiologists through the Council of State and Territorial Epidemiologists and the National Association of County and City Health Officials.

Results:

We developed guidance to assist public health authorities when determining which groups are at increased risk for acquiring mumps and should receive a third dose of MMR vaccine. During outbreaks, public health authorities identify groups of persons with known or likely close contact exposure to a mumps patient. Then, evidence of transmission and likelihood of transmission in a group's setting can be used to determine whether these groups are at increased risk. Additional epidemiologic and implementation factors may also be considered. All persons in the group at increased risk for acquiring mumps should receive a dose of MMR vaccine, including those with unknown vaccination status or those who have evidence of presumptive immunity other than documented 2 doses of MMR vaccine; no additional dose is recommended for persons who had received 3 or more doses before the outbreak.

Conclusion:

This guidance provides a framework for public health authorities to use when considering a third dose of MMR in response to mumps outbreaks while maintaining flexibility to incorporate local factors related to individual outbreaks.
Systems Integration: The Next Frontier in Newborn-Screening Timeliness
Authors: Simon Norma-Jean , Atkins Anne , Yusuf Careema , Tarini Beth A.
Published: February 2019

Context:

In 2015, the United States Federal Advisory Committee on Heritable Disorders in Newborns and Children issued recommendations for state-based newborn screening programs to benchmark improvements in newborn-screening timeliness. Newborn screening (NBS) timeliness encompasses the efficient collection, transportation, testing, and reporting of results. Nearly all state programs fail to achieve recommended timeliness benchmarks.

Objectives:

Our study explored the processes and procedures that accelerate or hamper progress toward improving NBS timeliness from a public health laboratory program perspective.

Design:

We conducted semistructured interviews to elicit public health laboratory perspectives on NBS specimen delivery, laboratory testing and processing, communication of results to birthing providers, program staffing, and quality measures and data sharing. A content analysis explored practices, processes, and procedures related to NBS timeliness. A secondary analysis examined interorganizational strategies to enhance timeliness outcomes among NBS stakeholders.

Participants:

Ten laboratories participated in the study (n = 21 personnel). Participants included public health laboratory directors, NBS program managers, and NBS follow-up program staff.

Results:

Efforts to improve NBS timeliness included engaging birthing providers, expanding courier services, extending operating hours, modifying staffing schedules, and implementing cross-training schedules to facilitate prompt collection, transport, and processing of NBS specimens. Sustained improvements will require implementing robust data systems, integrating laboratory and follow-up processes, and improving communication among all NBS stakeholders. Programs expressed a desire to refine timeliness metric definitions to ensure useful comparisons across states.

Conclusions:

Efforts to improve timeliness have accelerated in recent years; sustained progress will require increased coordination and integration among stakeholders in the NBS delivery system.
Detecting Drop-offs in Electronic Laboratory Reporting for Communicable Diseases in New York City
Authors: Greene Sharon K. , Andrews Erin M. , Evans Lloyd Pamela , Baumgartner Jennifer , Peterson Eric R.
Published: February 2019

Context:

The Bureau of Communicable Disease at the New York City Department of Health and Mental Hygiene receives an average of more than 1000 reports daily via electronic laboratory reporting. Rapid recognition of any laboratory reporting drop-off of test results for 1 or more diseases is necessary to avoid delays in case investigation and outbreak detection.

Program:

We modified our outbreak detection approach using the prospective space-time permutation scan statistic in SaTScan. Instead of searching for spatiotemporal clusters of high case counts, we reconceptualized “space” as “laboratory” and instead searched for clusters of recent low reporting, overall and for each of 52 diseases and 10 hepatitis test types, within individual laboratories. Each analysis controlled for purely temporal trends affecting all laboratories and accounted for multiple testing.

Implementation:

A SAS program automatically created input files, invoked SaTScan, and further processed SaTScan analysis results and output summaries to a secure folder. Analysts reviewed output weekly and reported concerning drop-offs to coordinators, who liaised with reporting laboratory staff to investigate and resolve issues.

Evaluation:

During a 42-week evaluation period, October 2017 to July 2018, we detected 62 unique signals of reporting drop-offs. Of these, 39 (63%) were verified as true drop-offs, including failures to generate or transmit files and programming errors. For example, a hospital laboratory stopped reporting influenza after changing a multiplex panel result from “positive” to “detected.” Six drop-offs were detected despite low numbers of expected reports missing (<10 per drop-off).

Discussion:

Our novel application of SaTScan identified a manageable number of possible electronic laboratory reporting drop-offs for investigation. Ongoing maintenance requirements are minimal but include accounting for laboratory mergers and referrals. Automated analyses facilitated rapid identification and correction of electronic laboratory reporting errors, even with small numbers of expected reports missing, suggesting that our approach might be generalizable to smaller jurisdictions.
Complication Profiles by Mastectomy Indication in Tissue Expander Breast Reconstruction
Authors: Chouairi Fouad , Gabrick Kyle S. , Avraham Tomer , Markov Nickolay P. , Alperovich Michael
Published: February 2019

Background:

Two-stage implant breast reconstruction is the most commonly performed breast reconstruction procedure. Limited data exist regarding reconstruction complication rates examined by mastectomy indication.

Methods:

Patients who underwent two-stage implant breast reconstruction at Yale New Haven Hospital from 2011 to 2017 were included in the study. Perioperative complications were compared. Chi-square analysis, t tests, and Fisher’s exact tests were used to determine significant associations. A binary logistic regression was used to determine variables with a significant impact on the likelihood of mastectomy flap necrosis.

Results:

Between 2011 and 2017, complete perioperative records were available for 141 patients who underwent 226 mastectomies followed by two-stage tissue expander/permanent implant reconstruction. Of the 226 mastectomies, 134 were therapeutic and 92 were prophylactic. On regression analysis, there were no significant differences in demographics, comorbidities, or mastectomy and reconstructive details between the two breast groups except for there being more modified radical mastectomies in therapeutic breasts (p = 0.003). When comparing complications, there was a significantly higher risk of mastectomy flap necrosis in the therapeutic group (p = 0.017). Therapeutic mastectomies had a 9.5 times higher risk of mastectomy flap necrosis than prophylactic mastectomies when adjusted for confounding variables. There were no significant differences in other reconstructive complications between the two groups.

Conclusions:

Patients undergoing therapeutic mastectomies have a significantly higher risk of mastectomy flap necrosis than those undergoing prophylactic mastectomies. Although the underlying cause still needs to be determined, differences in technique may be related to mastectomy flap necrosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Assessment of Health-Related Quality of Life in Robin Sequence: A Comparison of Mandibular Distraction Osteogenesis and Tongue-Lip Adhesion
Authors: Logjes Robrecht J. H. , Mermans Joline F. , Paes Emma C. , Muradin Marvick S. M. , Don Griot J. Peter , Breugem Corstiaan C.
Published: February 2019

Background:

Numerous studies have proven the efficacy of mandibular distraction osteogenesis or tongue-lip adhesion in Robin sequence infants with upper airway obstruction. However, none has compared health-related quality of life outcomes.

Methods:

In the present retrospective study, Robin sequence infants younger than 1 year, who underwent mandibular distraction osteogenesis or tongue-lip adhesion, were included (2006 to 2016). The infants’ caregivers were asked to complete a questionnaire based on the Glasgow Children’s Benefit Inventory.

Results:

The response rate was 71 percent (22 of the 31 questionnaires; mandibular distraction osteogenesis, 12 of 15; and tongue-lip adhesion, 10 of 16) and median age at surgery was 24 days (range, 5 to 131 days). Median total Glasgow Children’s Benefit Inventory scores after mandibular distraction osteogenesis and after tongue-lip adhesion were 21.9 (interquartile range, 9.4) and 26.0 (interquartile range, 37.5), respectively (p = 0.716), indicating an overall benefit from both procedures. Positive changes were observed in all subgroups emotion, physical health, learning, and vitality. In syndromic Robin sequence, both procedures demonstrated a lower positive change in health-related quality of life compared with isolated Robin sequence (p = 0.303).

Conclusions:

Both surgical procedures demonstrated an overall benefit in health-related quality-of-life outcomes, with no significant differences. The authors’ findings contribute to the debate regarding the use of mandibular distraction osteogenesis versus tongue-lip adhesion in the surgical treatment of Robin sequence; however, studies evaluating health-related quality of life in larger Robin sequence cohorts are necessary to identify which procedure is likely to be best in each individual Robin sequence infant.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis
Authors: Daar David A. , Shah Ajul , Mirrer Joshua T. , Thanik Vishal , Hacquebord Jacques
Published: February 2019

Background:

Two mainstay surgical options for salvage in scapholunate advanced collapse and scaphoid nonunion advanced collapse are proximal row carpectomy and four-corner arthrodesis. This study evaluates the cost-utility of proximal row carpectomy versus three methods of four-corner arthrodesis for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist.

Methods:

A cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analogue scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed.

Results:

Forty studies yielding 1730 scapholunate advanced collapse/scaphoid nonunion advanced collapse wrists were identified. Decision tree analysis determined that both four-corner arthrodesis with screw fixation and proximal row carpectomy were cost-effective options, but four-corner arthrodesis with screw was the optimal treatment strategy. Four-corner arthrodesis with Kirschner-wire fixation and four-corner arthrodesis with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analysis demonstrated that when the quality-adjusted life-years for a successful four-corner arthrodesis with screw fixation are lower than 26.36, proximal row carpectomy becomes the optimal strategy. However, multivariate probabilistic sensitivity analysis confirmed the results of our model.

Conclusions:

Four-corner arthrodesis with screw fixation and proximal row carpectomy are both cost-effective treatment options for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist because of their lower complication profile and high efficacy, with four-corner arthrodesis with screw as the most cost-effective treatment. Four-corner arthrodesis with plate and Kirschner-wire fixation should be avoided from a cost-effectiveness standpoint.
Brief Report: Onward Transmission of Multiple HIV-1 Unique Recombinant Forms Among Men Who Have Sex With Men in Beijing, China
Authors: Liu Yongjian , Su Bin , Zhang Yu , Jia Lei , Li Hanping , Li Zhen , Han Jingwan , Zhang Tong , Li Tianyi , Wu Hao , Wang Xiaolin , Li Jingyun , Li Lin
Published: February 2019

Background:

Unique recombinant forms (URFs) were generated in dually infected or multiply infected individuals, and some of URFs can be transmitted to many people resulting in the emergence of circulating recombinant forms (CRFs). We examined whether there was evidence for onward transmission of multiple URFs among men who have sex with men (MSM) in Beijing.

Methods:

A total of 146 MSM subjects with acute/early HIV-1 infection were recruited from the Beijing PRIMO clinical cohort between September 2010 and July 2012. HIV-1 full-length gag and partial pol, env genes were amplified and sequenced separately. Phylogenetic analysis and recombination analysis were performed to determine the viral genotypes. Single genome amplification and direct sequencing were used to confirm onward transmission of URFs.

Results:

CRF01_AE was the most common genotype (51.9%), followed by CRF07_BC (23.0%), subtype B (14.8%), URFs (7.4%), CRF65_cpx (2.2%), and CRF55_01B (0.7%). Multiple forms of URFs were identified, including CRF01_AE/BC, CRF01_AE/B, and CRF01_AE/C. Nine of the 10 individuals harboring URFs were infected by onward transmission of URFs. The remaining one individual was coinfected with CRF01_AE and CRF07_BC variants.

Conclusions:

We introduced a new method to provide evidence for onward transmission of URF strains by examining the absence of intersubtype coinfection among early infected individuals. Onward transmission of multiple URFs was found among MSM in Beijing, China. Our findings call for a program of continuous molecular surveillance and have implications to prevention programs among MSM in China.
Safety and Efficacy of Combined Peptide Receptor Radionuclide Therapy and Liver Selective Internal Radiation Therapy in a Patient With Metastatic Neuroendocrine Tumor
Authors: Maccauro Marco , Follacchio Giulia Anna , Spreafico Carlo , Coppa Jorgelina , Seregni Ettore
Published: February 2019

Nuclear medicine treatments of well-differentiated neuroendocrine tumors (NETs) are gaining increasing acceptance among clinicians. Peptide receptor radionuclide therapy (PRRT) is an effective systemic treatment, providing a significant survival benefit and improving patients' quality of life. Locoregional selective internal radiation therapy (SIRT) is a safe and effective treatment for unresectable NET liver metastases, providing good local tumor control and symptomatic relief. Few reports in literature examine the sequential use of PRRT and SIRT in metastatic NET. We report the case of a metastatic NET patient treated with sequential PRRT-SIRT achieving a long disease control interval without cumulative toxicity issues.
High-Resolution Brain 18F-FDG Images Provided by Fully Digital PET
Authors: Salvadori Julien , Perrin Mathieu , Marie Pierre-Yves , Imbert Laëtitia , Verger Antoine
Published: February 2019

Normal brain 18F-FDG PET images, consecutively recorded on analog and fully digital PET cameras in an 85-year-old woman, are depicted herein with the reconstruction methods recommended for a 2-mm voxel size on each camera and with a high-resolution reconstruction additionally developed for digital PET with a 1-mm voxel size. An enhanced gray-to-white matter contrast was consistently documented for digital PET when compared with analog PET, and was associated with a further enhancement in spatial resolution at 1-mm voxel size, as evidenced by a much clearer delineation of cortical gyri. These high-resolution images could favor the identification of brain abnormalities.
A Case of Radioactive Iodine Uptake Found in Artificial Eye
Authors: Kim Il-Hyun , Yoon Joon-Kee , Lee Su Jin , Jeong Eugene , An Young-Sil
Published: February 2019

Radioactive iodine (RAI) therapy is widely used as an adjunctive treatment in patients with differentiated thyroid cancer. Although 131I has high avidity in the functioning thyroid, and in differentiated thyroid cancer lesions, physiological and nonspecific uptake of 131I in healthy or benign tissue may contribute to false-positive findings on an 131I scan. Here, we present an interesting image of RAI uptake in the eye region post-RAI treatment, which has been identified as tear contamination in the artificial eye.
18F-FDG PET/CT of Lung Adenocarcinoma With Ovarian Metastases
Authors: García-Talavera Paloma , Colinas Daniel , Tamayo Pilar , Fra Joaquin , Montes Arnold
Published: February 2019

Patient was a 52-year-old woman with medical history of lung adenocarcinoma operated in 2009 (stage I, T2 N0 M0), showing increasing levels of tumor markers and a doubtful retrocrural adenopathy by means of CT scan with intravenous contrast. An 18F-FDG PET/CT was performed, which showed 2 hypermetabolic foci in both annexes. The anatomopathological study detected bilateral ovarian adenocarcinoma compatible with metastases of pulmonary origin.
Focally Increased Iodine Activity in a Small Thymic Cyst
Authors: Liu Yao , Bai Xia , Mu Da , Wang Jian , Lou Cen
Published: February 2019

A 40-year-old man with biopsy-proven papillary thyroid cancer received 131I radiotherapy. Posttherapy scan showed not only multiple foci of intense activity in the neck but also a small focal activity in the region of right upper mediastinum, confirmed by SPECT/CT images. This activity was suspected as mediastinal lymph node metastasis. However, pathology examination after the resection showed thymic cyst.
Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome–Associated Renal Cell Carcinoma Showing High FDG Uptake
Authors: Xiao Zhengguang , Dong Aisheng , Wang Yang
Published: February 2019

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is a rare autosomal-dominant disease, characterized by the development of cutaneous and uterine leiomyomas and renal cell carcinoma (RCC). Approximately 20% to 30% of patients with HLRCC syndrome develop RCC resembling sporadic type 2 papillary RCC, which is aggressive and associated with a poor prognosis. Information on the clinical usefulness of FDG PET/CT in HLRCC syndrome-associated RCC is limited. We present a case of HLRCC syndrome-associated RCC showing high FDG uptake in both the primary RCC and retroperitoneal lymph node metastases. In addition, the patient had 2 hypermetabolic uterine leiomyomas.
Management of Vocal Fold Scars by Concurrent Nanofat and Microfat Grafting
Authors: Cantarella Giovanna , Mazzola Riccardo F.
Published: February 2019

Vocal fold scarring is the cause of severe dysphonia and represents a therapeutic challenge; dysphagia can also be present in case of soft tissue defect due to previous oncological surgery. The ideal surgical solution should concurrently provide vocal fold augmentation and re-establishment of tissue elasticity. Nanofat technique has given so far promising results in remodeling skin scars and improving tissue pliability. The present paper describes for the first time the use of nanofat injected into the vocal fold cover for pliability restoration, combined with traditional microfat for vocal fold augmentation. Seven patients (aged 23–77 years) affected by severe dysphonia, related to extensive vocal fold scarring (3 of them were also affected by dysphagia for liquid consistencies), underwent a single procedure of concurrent microfat and nanofat vocal fold injection under direct microlaryngoscopy in general anesthesia. Results were evaluated by objective outcome measures and auto evaluation performed by questionnaires concerning the phonatory and swallowing efficiency. The voice quality and the perceived swallowing capability of all patients improved after surgery and are stable at follow-up (4–8 months). The reported preliminary data show that nanofat, due to its regenerative potential related to adipose-derived stem cells and growth factors, can be a promising adjunct to traditional fat augmentation to improve elasticity of the delicate multilayered structure of the vocal fold and to enhance its vibratory capabilities. Further experience on a wider number of patients and long-term follow-up are necessary to confirm the validity of this technique.
Assessment of Occlusal Appliance for the Reposition of Temporomandibular Joint Anterior Disc Displacement With Reduction
Authors: Shen Pei , Chen Xinwei , Xie Qianyang , Zhang Shanyong , Yang Chi
Published: February 2019

The aim of our study was to evaluate the success rates and prognoses of patients treated with occlusal appliances used to reposition the temporomandibular joint anterior disc displacement with reduction (ADDWR). A sample of 144 consecutive patients (210 joints) diagnosed with ADDWR based on MRI were included in our study. Disc recapture was confirmed in a mandible-anterior position to eliminate joint clicking based on magnetic resonance imaging (MRI). Anterior repositioning appliance (ARS) was applied to keep the mandible in this position. The occlusal surface of the ARS was ground down by 1 mm approximately every 4 weeks for bite reconstruction. MRI was carried out before treatment, 6 months after the start of treatment, at the end of the treatment, and at their last follow-up visit. A Cox regression model was used to estimate the risk of failure of the treatment. The mean treatment duration was 9.5±2.6 months. A total of 177 joints (84.3%) were successfully repositioned at the end of splint treatment according to MRI. Regular follow-up indicated that almost 53% of the patients had normal disc–condyle relationships after 2 years. Sex, age, treatment duration, and orthodontics used were included in the final Cox regression model, with hazard ratios of 1.375, 1.141, 0.396, and 0.364, respectively. ARS is inferior for recapturing ADDWR in the long-term. It is thus better to explore other more effective methods to reposition the displaced disc in patients with ADDWR.
Effect of Electrohydraulic Extracorporeal Shockwave Therapy on the Repair of Bone Defects Grafted With Particulate Allografts
Authors: Özkan Enes , Bereket Mehmet Cihan , Şenel Erman , Önger Mehmet Emin
Published: February 2019

This study determined the effect of electrohydraulic extracorporeal shockwave therapy (ESWT) on the healing of mandible defects repaired using particulate allogenic bone grafts. This study included 20 male Wistar rats aged 12 weeks. In all the animals, a critical-sized defect of 4-mm diameter was created in the mandible and the defect area was filled with particulate allograft. Next, the rats were divided into 2 groups, allograft (G) (n = 10) and allograft + ESWT (GE) (n = 10). On days 3, 5, and 7 after the grafting, rats in the GE group received ESWT involving 200 pulses with an energy flux density of 0.19 mJ/mm2. Five rats in each group were sacrificed at the end of week 4 and at the end of week 8. Defect areas were examined radiologically by performing high-resolution computed tomography and stereologically by using the Cavalieri method. Obtained data were compared by performing statistical analysis. Radiological evaluation showed that bone density was higher in rats in the G group than in those in the GE group at week 4. In contrast, bone density was higher in rats in the GE group than in those in the G group at week 8. Stereological examination showed that new bone, connective tissue, and capillary volumes were higher in rats in the GE group than in those in the G group at both weeks 4 and 8. The authors’ results indicate that repeated doses of ESWT accelerate the healing of bone defects repaired using allogenic bone grafts.
Anthropometric Facial Changes After Orthognathic Surgery and Their Relation With Oral Health Related Quality of Life
Authors: Geramy Allahyar , Sheikhzadeh Sedigheh , Jalali Yasamin Farajzadeh , Nazarifar Arezoo Mazaheri
Published: February 2019

Purpose:

The aim of the present study was to determine the impacts of orthognathic surgery on soft tissue on frontal and profile views and their relation with patient's quality of life.

Methods:

Twenty-nine patients with severe skeletal class III malocclusion who were candidate for bimaxillary orthognathic surgery consisted of 1-piece Lefort I surgery with bilateral sagittal split osteotomy were selected. Oral health was assessed by short from of Oral Health Impact Profile-14 questionnaire. Facial anthropometric measurements were conducted before starting any treatment and 6 months after orthognathic surgery according to Farkas anthropometric study. The correlation between facial changes due to treatment and oral health were tested by Pearson correlation analysis.

Results:

No significant differences were observed in Oral Health Impact Profile-14 scores with regard to genders. Decreased vermilion total upper lip height index correlates positively with feeling difficult to relax. Increasing in medial-lateral cutaneous upper lip height index correlates negatively with dissatisfaction with diet. Increased upper face–face height index correlates positively with feeling uncomfortable to eat any foods and feeling a bit irritable with other people.

Conclusion:

Oral health-related quality of life can be affected not only by the objective aesthetic criterion but also by different factors like their attitude toward aesthetic, surgery side effects.
Change of Cerebral Blood Flow After a Successful Pharmacological Treatment of Phantom Bite Syndrome: A Case Report
Authors: Umezaki Yojiro , Tu Trang T. H. , Toriihara Akira , Sato Yusuke , Naito Toru , Toyofuku Akira
Published: February 2019

Background

“Phantom bite syndrome,” a persistent complaint of an uncomfortable bite sensation with no obvious occlusal abnormal finding, recently was suggested to be related with central nervous system dysfunction. Here, we report a case of phantom bite syndrome in which the occlusal discomfort was improved with mirtazapine and aripiprazole combination parallel with regional cerebral blood flow change.

Case report

A 60-year-old-female patient came to our clinic with the chief complaint of a “loosely bite” after dental treatment and various uncomfortable sensations of body sites. One year after the medication therapy, the prosthodontic retreatment was carried out successfully, and a good outcome was obtained for over 24 months so far. In addition, a subsequent change of regional cerebral blood flow was observed in single-photon emission computed tomography: the right and left asymmetry of cerebral blood flow in the frontal lobe has disappeared along with the improvement to the symptoms improvement.

Conclusions

This case suggests that some central nervous system dysfunction involving dopaminergic system might be related to the pathophysiology of phantom bite syndrome.