bluuebunny/crossref_metadata_2025 huggingface dataset:
An Emerging Human Right to Protection against Unjustified Dismissal
Authors: Collins Hugh
Published: January 2020

Although a right to protection against unjustified dismissal is not widely recognised in human rights law, the European Court of Human Rights has begun to use Article 8 of the European Convention of Human Rights to develop a general right based on the adverse consequences to ordinary private life caused by an unjustified dismissal. Instead of requiring the employer’s reason for the dismissal to be connected to an aspect of an employee’s private and family life in order to engage Article 8, the Court’s new, broader approach focuses on major adverse effects or consequences caused by dismissals to an employee’s family life, personal and professional relationships, to self-respect, and to their chosen way of life and career. The consequence-based approach permits the application of Article 8 whatever reason the employer puts forward for the dismissal. The article assesses the extent and limits of the protection against unjustified dismissal under the Convention as a result primarily of this extension from a reason-based approach to a consequence-based approach to Article 8, an approach that was confirmed by the Grand Chamber in Denisov v Ukraine.
Improving paediatric antimicrobial stewardship in hospital-based settings: why, where and how?
Authors: Tanner E , Munro A P S , Gray J , Green H , Rutter M , Jones C E , Faust S N , Alderton M , Patel S V
Published: January 2020

Background

Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues.

Objectives

A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children’s Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections.

Methods

All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September–October 2016) and then prospectively after its introduction (September–October 2018).

Results

A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018.

Conclusions

Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.
Non-linear interacting cosmological models after Planck 2018 legacy release and the H0 tension
Authors: Pan Supriya , Yang Weiqiang , Paliathanasis Andronikos
Published: January 2020

Interacting dark energy models are widely renowned for giving an explanation to the cosmic coincidence problem as well as several observational issues. According to the recent observational data, and so far we are concerned with the literature, the choice of the interaction function between dark matter and dark energy is always questionable since there is no such underlying theory that could derive it. Thus, in this work we have raised this issue by proposing two new non-linear interaction functions and constrain them using cosmic microwave background (CMB) from Planck 2018, baryon acoustic oscillations (BAOs), dark energy survey and a measurement of the Hubble constant H0 from Hubble Space Telescope (HST) 2019. The dark energy equation of state is considered to be constant throughout the work and the geometry of the universe is assumed to be homogeneous and isotropic with zero spatial curvature. Our analyses report that a non-zero interaction is always allowed by the observational data and the dark energy equation of state is bent towards the phantom regime. In particular, when H0 from HST is added to Planck 2018+BAO, we find an evidence for a non-zero coupling at more than 2σ confidence level. Our analyses also report that for both the models, H0 is close to its local measurements and thus alleviating the H0 tension. In particular, one of the interacting models perfectly solves the H0 tension.
From the Deeming Rule to JUUL—US News Coverage of Electronic Cigarettes, 2015–2018
Authors: Wackowski Olivia A , Sontag Jennah M , Singh Binu , King Jessica , Lewis M Jane , Steinberg Michael B , Delnevo Cristine D
Published: January 2020

Introduction

News media may influence public perceptions and attitudes about electronic cigarettes (e-cigarettes), which may influence product use and attitudes about their regulation. The purpose of this study is to describe trends in US news coverage of e-cigarettes during a period of evolving regulation, science, and trends in the use of e-cigarettes.

Methods

We conducted a content analysis of e-cigarette topics and themes covered in US news articles from 2015 to 2018. Online news databases (Access World News, Factiva) were used to obtain US news articles from the top 34 circulating newspapers, four national wire services, and five leading online news sources.

Results

The number of articles increased by 75.4% between 2015 and 2018 (n = 1609). Most articles focused on policy/regulation (43.5%) as a main topic, followed by health effects (22.3%) and prevalence/trends (17.9%). Discussion about flavor bans quadrupled (6.1% to 24.6%) and discussion of youth e-cigarette use was most prevalent (58.4%) in 2018, coinciding with an increase in coverage about JUUL. JUUL was mentioned in 50.8% of 2018 articles. Across years, articles more frequently mentioned e-cigarette risks (70%) than potential benefits (37.3%).

Conclusions

E-cigarettes continue to be a newsworthy topic, with coverage both reflecting numerous changes and events over time, and providing repeated opportunities for informing the public and policymakers about these novel products. Future research should continue to track how discourse changes over time and assess its potential influence on e-cigarette perceptions and policy changes.

Implications

E-cigarette news coverage in the United States increased between 2015 and 2018 and predominantly focused on policy and regulation. Notable spikes in volume were associated with some but not all major e-cigarette events, including the FDA’s deeming rule, Surgeon General’s report, and release of the National Youth Tobacco Survey data in 2018. Coverage of the 2018 National Academy of Medicine, Engineering, and Sciences report on the Public Health Consequences of E-cigarettes received minimal news coverage. The high volume in 2018 was driven in large part by coverage of the e-cigarette brand JUUL; over half of news articles in 2018 referenced JUUL specifically.
How Can EU Law Respond to Populism?
Authors: Dawson Mark
Published: January 2020

The rise in Europe of populist movements has created severe anxiety about the stability of the EU legal order. This article argues that, while populist ideas challenge numerous elements of the EU’s constitutional settlement, there exists no fundamental incompatibility between populism and EU law. By comparing its response to populism with attempts by EU law to stabilise its legal order in the face of political contestation arising from other political cleavages, the article discusses three different ways to understand the interaction between EU law and populism. EU law may seek to ‘survive’ the growth of populism by (i) bracketing or insulating its institutions from populist contestation, (ii) accommodating populist ideas or (iii) confronting the constitutional strategies populists utilise domestically. In examining the constitutional foundations of populism and its relation to emerging doctrines of EU law, the article seeks to build a road map of how populist movements might utilise or resist EU law in their development.
Clinical and sonographic discrimination between fibromyalgia and spondyloarthopathy in inflammatory bowel disease with musculoskeletal pain
Authors: Martinis Federica , Tinazzi Ilaria , Bertolini Elena , Citriniti Giorgia , Variola Angela , Geccherle Andrea , Marchetta Antonio , McGonagle Dennis , Macchioni Pierluigi
Published: January 2020

Objectives

Joint pain is common in subjects with IBD and is linked to several factors including SpA, drug therapy, concomitant OA or FM. The primary aim of this study was to estimate the prevalence of primary FM and concomitant FM and SpA in a cohort of patients with IBD utilizing clinical and US assessment.

Methods

A total of 301 consecutive cases with IBD attending two IBD Units were assessed by a rheumatologist for Assessment of SpondyloArthritis International Society criteria fulfilment for SpA or the 2010 ACR criteria for FM. Some 158 cases also had US entheseal examination on large insertions in the upper and lower limbs.

Results

Thirty-seven IBD patients (12%) met the ACR criteria for primary FM with 9% presenting with primary FM and 3.3% presenting with concomitant FM and SpA. Meeting FM criteria was not related to smoking, sedentary job, BMI or the presence of psoriasis. FM patients presented higher Leeds Enthesitis Index, BASDAI and BASFI scores than SpA patients. At US examination, patients who satisfied the Assessment of SpondyloArthritis International Society criteria for SpA had significantly higher mean enthesis or patient power Doppler positive as compared with the IBD and FM group (P < 0.001)

Conclusion

We found that FM occurred in 12% of SpA patients and in this setting SpA disease activity indices performed poorly. US examination in a large patient subgroup showed a promising discriminating capacity between FM and SpA in IBD patients.
Workplace Violence Outside the Hospital Setting
Authors: Schmidt Joanne
Published: January 2020

Efforts to protect nurses are promising but need to expand their focus.
Descovy Approved for HIV Prexposure Prophylaxis
Authors: Aschenbrenner Diane S.
Published: January 2020

Descovy (a combination of emtricitabine 200 mg and tenofovir alafenamide 25 mg) has been approved for HIV preexposure prophylaxis (PrEP). The drug was previously approved to treat HIV in combination with other antiretroviral drugs.

Descovy carries a boxed warning that patients who also have hepatitis B virus (HBV) can experience exacerbations of HBV upon discontinuing Descovy.
What Nurses Need to Know About Health Care–Reform Proposals
Authors: Myers Carole R.
Published: January 2020

The 2020 elections are approaching, and nurses have a lot of clout.
RN to BSN Programs: The Social Media Perspective
Authors: Abbott Miriam R. B. , Nininger Jami
Published: January 2020

AIM

This article assesses and addresses common perceptions regarding RN to BSN programs.

BACKGROUND

Public online forums can provide educators with alternative perspectives on nursing education. Although such perspectives may, at times, be ill informed, they reflect views that shape choices regarding nursing education. Understanding diverse views equips educators with strategies that can promote degree relevance for learners.

METHOD

Using opportunistic sampling, a post on an anonymous, open forum for nurses with over 88,000 subscribers was retrospectively reviewed in an exploratory qualitative study to identify perceptual themes about RN to BSN programs.

RESULTS

Users expressed largely negative sentiments regarding the quality and value of RN to BSN coursework.

CONCLUSION

Evidence-based models for communication to promote the relevance of RN to BSN coursework are introduced. Such models permit nurse educators to proactively address negative perceptions of RN to BSN programs.
Multiple sclerosis
Authors: Varner Christine A.
Published: January 2020

To effectively assist your patients with managing their disease, a thorough understanding of how it affects them is essential.
Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy
Authors: Vilkins Annmarie L. , Sahara Michael , Till Sara R. , Ceci Christina , Howard Ryan , Griffith Kendall C. , Waljee Jennifer F. , Lim Courtney S. , Skinner Bethany D. , Clauw Daniel J. , Brummett Chad M. , As-Sanie Sawsan
Published: January 2020

(Abstracted from Obstet Gynecol 2019;134:823–833)

Opioid use disorder is an epidemic. In the United States, more than 11 million people abused prescription opioids in 2016.
Hearing Loss With Congenital Cytomegalovirus Infection
Authors: Foulon Ina , De Brucker Yannick , Buyl Ronald , Lichtert Elke , Verbruggen Katia , Piérard Denis , Camfferman Fleur Anne , Gucciardo Léonardo , Gordts Frans
Published: January 2020

(Abstracted from Pediatrics 2019;144(2):e20183095)

Congenital cytomegalovirus (cCMV) infection is the most common fetal viral infection and is the leading cause of nonhereditary sensorineural hearing loss (SNHL) in the developed world. This prospective study aimed to determine the incidence of SNHL in 157 children with proven cCMV infection, along with searching for risk determinants for developing hearing loss and proposing recommendations for screening and follow-up with the newborn.
Neonatal Developmental and Behavioral Outcomes of Immediate Delivery Versus Expectant Monitoring in Mild Hypertensive Disorders of Pregnancy: 2-Year Outcomes of the HYPITAT-II Trial
Authors: Zwertbroek Eva F. , Franssen Maureen T. M. , Broekhuijsen Kim , Langenveld Josje , Bremer Henk , Ganzevoort Wessel , van Loon Aren J. , van Pampus Maria G. , Rijnders Robbert J. P. , Sikkema Marko J. , Scherjon Sicco A. , Woiski Mallory D. , Mol Ben W. J. , van Baar Anneloes L. , Groen Henk
Published: January 2020

(Abstracted from Am J Obstet Gynecol 2019;221:154.e1–154.e11)

Hypertensive pregnancy disorders complicate up to 10% of pregnancies worldwide, resulting in significant maternal and neonatal morbidity. The only definitive treatment for hypertensive disorders is delivery.
Food protein-induced enterocolitis syndrome: epidemiology and comorbidities
Authors: Baker Mary Grace , Nowak-Wegrzyn Anna
Published: January 2020

Purpose of review

First described in the mid 20th century, it was just in the last decade that diagnostic and treatment guidelines for food protein-induced enterocolitis syndrome (FPIES) were established. Awareness of the diagnosis is improving, and epidemiologic data are emerging.

Recent findings

Recent studies suggest that FPIES may affect as many as 0.5% of children worldwide. FPIES in adults is usually triggered by seafood and may be more common than previously thought. Many patients with FPIES have other allergic disorders.

With refined diagnostic criteria and improved awareness, FPIES is now diagnosed with increasing frequency, and epidemiologic data are emerging. FPIES appears to be increasing in prevalence, and the frequent association with other allergic disorders suggests a shared predisposition or immune mechanism that remains to be elucidated.
Implicit Bias in Health Professions: From Recognition to Transformation
Authors: Sukhera Javeed , Watling Christopher J. , Gonzalez Cristina M.
Published: January 2020

Implicit bias recognition and management curricula are offered as an increasingly popular solution to address health disparities and advance equity. Despite growth in the field, approaches to implicit bias instruction are varied and have mixed results. The concept of implicit bias recognition and management is relatively nascent, and discussions related to implicit bias have also evoked critique and controversy. In addition, challenges related to assessment, faculty development, and resistant learners are emerging in the literature. In this context, the authors have reframed implicit bias recognition and management curricula as unique forms of transformative learning that raise critical consciousness in both individuals and clinical learning environments. The authors have proposed transformative learning theory (TLT) as a guide for implementing educational strategies related to implicit bias in health professions. When viewed through the lens of TLT, curricula to recognize and manage implicit biases are positioned as a tool to advance social justice.
Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools
Authors: Hojat Mohammadreza , Shannon Stephen C. , DeSantis Jennifer , Speicher Mark R. , Bragan Lynn , Calabrese Leonard H.
Published: January 2020

Purpose

To examine differences in students’ empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools.

Method

Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017–2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring “good impression” response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of “good impression” response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools.

Results

A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students.

Conclusions

Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.
The Interplay of Parent and Child Coping Responses in Understanding Child Functioning in the Context of Living With a Parent With or Without Chronic Pain
Authors: Van Lierde Elke , Goubert Liesbet , Lammens Tim , Ben Brahim Lamia , Van den Bussche Eva , Vervoort Tine
Published: January 2020

Objectives:

Pain disorders tend to run in families, and children of individuals with chronic pain have been found to report lower functioning. Drawing upon a social learning perspective, the current study examined how diverse maternal pain coping responses (ie, pain catastrophizing and distraction) may, via corresponding child pain coping responses, act as a vulnerability or protective factor for child functioning in the context of parental chronic pain (CP).

Methods:

A cross-sectional study was conducted in mothers with CP and their pain-free child (N=100) and mothers without CP and their pain-free child (N=74). Moderated mediation analyses were performed to test whether associations between maternal coping responses and child functioning (ie, somatic symptoms, physical functioning, and psychosocial health) were mediated by corresponding child coping responses and whether these associations were moderated by the presence or absence of maternal CP.

Results:

Maternal pain catastrophizing was indirectly related to more somatic symptoms, lower physical functioning, and lower psychosocial health in their child via child pain catastrophizing. Relationships were moderated by the presence or absence of maternal CP, such that mediated relationships were only found in mothers without CP and their child. No (in)direct relationships between maternal distraction, child distraction, and child functioning were observed.

Discussion:

The current findings demonstrated that child functioning was associated with maternal and child pain catastrophizing, but only in children of mothers without CP. No evidence was found in support of maternal pain coping responses as vulnerability or protective factors in the context of parental CP.
Age Affects Speech Understanding and Multitask Costs
Authors: Devesse Annelies , Wouters Jan , van Wieringen Astrid
Published: January 2020

Objectives:

We examined the effect of age on speech understanding and multitask costs in the ecologically relevant “Audiovisual True-to-Life Assessment of Auditory Rehabilitation”-paradigm (AVATAR).

Design:

Twenty-nine normal-hearing middle-aged adults completed AVATAR, which combines an auditory-visual speech-in-noise task with three secondary tasks on auditory localization or visual short-term memory in different dual-, triple-, and quadruple-task combinations. Performance decrements on the secondary tasks were considered to reflect the cognitive resources allocated during listening. Self-reported hearing difficulties were administered via a questionnaire. Results were compared with scores of 35 young normal-hearing adults.

Results:

Middle-aged adults performed consistently worse than young adults on speech understanding and, in the triple- and quadruple-task combinations only, on secondary task performance. Furthermore, middle-agers reported higher levels of daily listening concentration and more difficulties with speech understanding.

Conclusions:

This study demonstrated the adverse effect of age on speech-in-noise understanding and the amount of allocated cognitive resources during challenging listening situations realized in AVATAR.
More Than 10-year Follow-up After Laminoplasty and Pedicle Screw Fixation for Cervical Myelopathy Associated With Athetoid Cerebral Palsy
Authors: Demura Satoru , Kato Satoshi , Shinmura Kazuya , Yokogawa Noriaki , Yonezawa Noritaka , Shimizu Takaki , Oku Norihiro , Kitagawa Ryo , Handa Makoto , Annen Ryohei , Murakami Hideki , Kawahara Norio , Tsuchiya Hiroyuki
Published: January 2020

Study Design.

Retrospective case series.

Objective.

The aim of this study was to investigate the clinical outcomes >10 years following laminoplasty and pedicle screw fixation for cervical myelopathy associated with athetoid cerebral palsy (CP).

Summary of Background Data.

Surgery for cervical myelopathy associated with CP remains a challenge because of perioperative instrumentation failure and adjacent segment problems due to patients’ repetitive involuntary neck movements with deformity of the cervical spine.

Methods.

A single-center series of 14 patients were reviewed. The patients comprised seven women and seven men with a mean age of 52 years at the time of surgery. The mean follow-up period was 12.5 years. The Barthel index (BI), which shows independence in activities of daily life, and Japanese Orthopaedic Association (JOA) score were assessed. Radiographic evaluation included changes of the C2–C7 angle in the sagittal plane, fusion rate, adjacent segment degeneration, and instrument failure.

Results.

The 10-year BI and JOA score significantly improved at 36% and 31%, respectively. The preoperative Cobb angle of the sagittal plane from C2–C7 measured 11.9° of kyphosis, which improved to 0.8° of lordosis. In the radiographic analysis, 35% (proximal) and 21% (distal) of the adjacent segment showed progression in degeneration of more than one grade after 10 years. More than 90% of the patients who underwent magnetic resonance imaging showed progressive disc degeneration on either side after 10 years. Autofusion inside the disc or anterior vertebral bony bridging was observed in 86% of intervertebral levels without anterior procedures.

Conclusion.

The procedure showed favorable initial stability and maintained favorable clinical outcomes in patients with CP. More than 90% of the patients showed disc degeneration on either side. The rate of proximal adjacent segment degeneration was higher than that of distal segments with or without symptoms at the >10-year follow-up.

Level of Evidence: 4
Role of serum cystatin C in the prediction of contrast-induced nephropathy after intra-arterial interventions
Authors: Wang Zheng-Yu , Wang Yong-Li , Wei Jian , Jin Long , Wang Zhen-Chang
Published: January 2020

Background

The diagnosis of contrast-induced nephropathy (CIN) is usually based on changes in serum creatinine (sCr). However, sCr has poor sensitivity as a biomarker of kidney injury. The aim of this study was to investigate the usefulness of serum cystatin C (sCysC) to predict CIN after intra-arterial interventions.

Methods

A total of 360 consecutive patients underwent intra-arterial procedures using digital subtraction angiography. SCr, sCysC, and estimated glomerular filtration rate were measured at 1 to 2 days before and at 48, 72 h, and 7 days after the procedure.

Results

Thirty-one patients (8.61%) developed CIN. Receiver operating characteristic (ROC) curve analysis showed that pre-operative sCysC levels had good discriminatory power (area under the curve [AUC] = 0.634; 95% confidence interval [CI] = 0.526–0.743) for evaluating the risk of CIN after an endovascular procedure, with a sensitivity of 53.33% and specificity of 73.70%. ROC analysis showed that sCysC at 48 h after contrast medium administration was predictive of CIN after an endovascular procedure (AUC = 0.735; 95% CI = 0.647–0.822) with satisfactory sensitivity of 74.20% and specificity of 63.90%. Diabetes mellitus was an independent risk factor for CIN (odds ratio = 2.778; 95% CI = 1.045–7.382; P = 0.040).

Conclusions

SCysC is an appropriate biomarker to predict the occurrence of CIN. Baseline sCysC before an intervention is useful to obtain a preliminary estimate of the risk of CIN. A 48-h cut-off value of sCysC of 0.99 mg/L after an endovascular procedure may help to rule out patients at lower risk of CIN.
Effectiveness and safety of different doses of pioglitazone in psoriasis: a meta-analysis of randomized controlled trials
Authors: Zhang Jing-Zhan , Ding Yuan , Xiang Fang , Yu Shi-Rong , Zhang De-Zhi , Guan Meng-Meng , Kang Xiao-Jing
Published: January 2020

Background:

Pioglitazone may be beneficial in the treatment of psoriasis. However, based on the effectiveness and safety considerations, it has not been widely used. To fully evaluate the strength of evidence supporting psoriasis treatment with pioglitazone, we conducted a meta-analysis of existing published studies.

Methods:

PubMed, Ovid, Cochrane Library, Google Scholar, and Web of Science databases were systematically searched before February 2019. Randomized controlled trials (RCTs) of pioglitazone administration compared with placebo, administered to patients with psoriasis for at least 10 weeks, and published in English were included. Quality of the included RCTs was identified by the modified Jadad scale. The quality of evidence for each outcome was evaluated using the GRADEpro Guideline Development Tool online software. Primary outcomes were proportion of patients showing psoriasis area and severity index (PASI) score improvement (>75%) and the mean percent change in PASI score from baseline to the end of treatment. Dichotomous data were analyzed using odds ratios (ORs) corresponding to the 95% confidence interval (CI), whereas continuous variables, expressed as mean and standard deviation, were analyzed using the mean differences (MD) with the 95% CI.

Results:

Six RCTs were analyzed. Meta-analysis showed that pioglitazone reduced the PASI scores in patients with psoriasis compared with the control group when administered at 30 mg per day (P < 0.001, MD = –3.82, 95% CI = –5.70, –1.93) and at 15 mg per day (P = 0.04, MD = –3.53, 95% CI = –6.86, –0.20). The PASI-75 of the pioglitazone group was significantly higher than that of the control group at 30 mg per day (P < 0.001, OR = 8.30, 95% CI = 3.99, 17.27) and at 15 mg per day (P = 0.03, OR = 2.96, 95% CI = 1.08, 8.06). No statistically significant differences in total adverse events were observed between the groups. There were no significant differences in common adverse reactions such as weight gain and elevated liver enzymes between the two pioglitazone groups.

Conclusions:

Use of pioglitazone in the current treatment of psoriasis is beneficial. The therapeutic effect of the daily 30 mg dose may be greater than that of the 15 mg dose per day with no significant change in the frequency of adverse reactions.
Data-science-based subgroup analysis of persistent pain during 3 years after breast cancer surgery
Authors: Lötsch Jörn , Ultsch Alfred , Kalso Eija
Published: January 2020

BACKGROUND

Persistent pain extending beyond 6 months after breast cancer surgery when adjuvant therapies have ended is a recognised phenomenon. The evolution of postsurgery pain is therefore of interest for future patient management in terms of possible prognoses for distinct groups of patients to enable better patient information.

OBJECTIVE(S)

An analysis aimed to identify subgroups of patients who share similar time courses of postoperative persistent pain.

DESIGN

Prospective cohort study.

SETTING

Helsinki University Hospital, Finland, between 2006 and 2010.

PATIENTS

A total of 763 women treated for breast cancer at the Helsinki University Hospital.

INTERVENTIONS

Employing a data science approach in a nonredundant reanalysis of data published previously, pain ratings acquired at 6, 12, 24 and 36 months after breast cancer surgery, were analysed for a group structure of the temporal courses of pain. Unsupervised automated evolutionary (genetic) algorithms were used for patient cluster detection in the pain ratings and for Gaussian mixture modelling of the slopes of the linear relationship between pain ratings and acquisition times.

MAIN OUTCOME MEASURES

Clusters or groups of patients sharing patterns in the time courses of pain between 6 and 36 months after breast cancer surgery.

RESULTS

Three groups of patients with distinct time courses of pain were identified as the best solutions for both clustering of the pain ratings and multimodal modelling of the slopes of their temporal trends. In two clusters/groups, pain decreased or remained stable and the two approaches suggested/identified similar subgroups representing 80/763 and 86/763 of the patients, respectively, in whom rather high pain levels tended to further increase over time.

CONCLUSION

In the majority of patients, pain after breast cancer surgery decreased rapidly and disappeared or the intensity decreased over 3 years. However, in about a tenth of patients, moderate-to-severe pain tended to increase during the 3-year follow-up.
Frailty predicts 30-day mortality in intensive care patients
Authors: De Geer Lina , Fredrikson Mats , Tibblin Anna O.
Published: January 2020

BACKGROUND

Frailty is a multidimensional syndrome characterised by a loss of reserve and an increased risk of adverse outcomes.

OBJECTIVE

To study the impact of frailty on mortality in unselected intensive care patients, and to compare its discriminatory ability to an established model for outcome prediction in intensive care.

DESIGN

A prospective study with a comparison of two prediction models.

SETTING

A tertiary mixed ICU, from January 2017 to June 2018.

PATIENTS AND MAIN OUTCOME MEASURES

Data on premorbid frailty (clinical frailty scale; CFS), severity of illness (the simplified acute physiology score, third version; SAPS3), therapeutic procedures, limitations of care and outcome were collected in 872 adult ICU patients. A cut-off level of CFS for predicting death within 30 days was identified and unadjusted and adjusted analyses were used to evaluate the association of frailty to outcome.

RESULTS

The receiver operating curve, area under the curve of CFS [0.74 (95% confidence interval, 0.69 to 0.79)] did not differ significantly from that of SAPS3 [0.79 (0.75 to 0.83), P = 0.53], whereas combining the two resulted in an improved discriminatory ability [area under the curve = 0.82 (0.79 to 0.86), CFS + SAPS3 vs. SAPS3 alone, P = 0.02]. The correlation of CFS to SAPS3 was moderate (r = 0.4). A cut-off level was identified at CFS at least 5, defining 43% (n=375) of the patients as frail. Frail patients were older with higher SAPS3 and more comorbidities. Treatment in the ICU was more often withheld or withdrawn in frail patients, and mortality was higher. After adjustment for SAPS3, comorbidities, limitations of treatment, age and sex, frailty remained a strong predictor of death within 30 days [hazard ratio 2.12 (95% confidence interval, 1.44 to 3.14), P < 0.001].

CONCLUSION

Premorbid frailty was common in general ICU patients and was an independent predictor of death. Our study suggests that frailty could be a valuable addition in outcome prediction in intensive care.
What Are the Predictors for Achieving Therapeutic Levetiracetam Serum Concentrations in Adult Neurological Patients?
Authors: Cotta Menino O. , Abdul-Aziz Mohd H. , Frey Otto R. , Sime Fekade B. , Roberts Jason A. , Roehr Anka C.
Published: January 2020

Background:

Emerging studies suggest that levetiracetam pharmacokinetics can be difficult to predict in certain special patient populations, including the elderly, critically ill patients, and pregnant women.

Objective:

To determine clinical characteristics that predict the attainment of target serum concentrations in a heterogeneous group of patients prescribed levetiracetam.

Methods:

A retrospective observational study was conducted in adult neurological patients prescribed levetiracetam for the treatment or prophylaxis of seizures. Serum samples were collected after steady-state was reached, with a trough/steady-state serum concentration between 6 and 20 mg/L considered therapeutic. Logistic regression was used to identify significant predictors associated with the attainment of therapeutic concentrations.

Results:

One-hundred thirty patients (63 male) were included. The median (interquartile ranges) serum trough/steady-state concentration (Cmin/ss) was 16.2 (9.8–26.1) mg/L. The dose-normalized median (interquartile range) Cmin/ss was 11.5 (7.0–16.5) mg/L. The coefficient of variation of Cmin/ss and dose-normalized Cmin/ss were 69.4% and 64.2%, respectively. A weak correlation was observed between levetiracetam Cmin/ss and patient age (r = 0.21; P = 0.020), creatinine clearance (r = −0.26; P = 0.004), and daily dose (r = 0.42; P < 0.001). Logistic regression analysis identified age and daily levetiracetam dose as significant factors predicting target Cmin/ss attainment. The influence of concomitant antiepileptic therapy was not determined.

Conclusions:

Age and daily dose were the most significant predictors of levetiracetam target-concentration attainment and should be considered in further investigations to develop a dosing algorithm for optimal levetiracetam therapy.
Role of Axial Split Osteotomy of Free Fibula Flap in Mandibular Reconstruction and Dental Rehabilitation
Authors: Bolzoni Alessandro Remigio , Baj Alessandro , Sweed Ahmed Hassan , Giannì Aldo Bruno , Montrasio Edoardo Francesco , Beltramini Giada Anna
Published: January 2020

The fibula free flap (FFF) is regarded as the gold standard in mandibular reconstruction. Dental rehabilitation is important to improve the health-related quality of life of patients undergoing mandibular reconstruction. FFF provides adequate cortical bone osseous tissue for use in dental implantation. The application of “axial split osteotomy” via a double-barrel fibula graft may enable discrepancies between the native mandible and FFF to be avoided, thereby improving the likelihood of early and successful dental rehabilitation.
Gene expression and growth factor analysis in early nerve regeneration following segmental nerve defect reconstruction with a mesenchymal stromal cell-enhanced decellularized nerve allograft
Authors: Rbia Nadia , Bulstra Liselotte F. , Friedrich Patricia F. , Bishop Allen T. , Nijhuis Tim H.J. , Shin Alexander Y.
Published: January 2020

Background:

The purpose of this study was to evaluate the molecular mechanisms underlying nerve repair by a decellularized nerve allograft seeded with adipose-derived mesenchymal stromal cells (MSCs) and compare it to the unseeded allograft and autograft nerve.

Methods:

Undifferentiated MSCs were seeded onto decellularized nerve allografts and used to reconstruct a 10 mm gap in a rat sciatic nerve model. Gene expression profiles of genes essential for nerve regeneration and immunohistochemical staining (IHC) for PGP9.5, NGF, RECA-1, and S100 were obtained 2 weeks postoperatively.

Results:

Semi-quantitative RT-PCR analysis showed that the angiogenic molecule VEGFA was significantly increased in seeded allografts, and transcription factor SOX2 was downregulated in seeded allografts. Seeded grafts showed a significant increase in immunohistochemical markers NGF and RECA-1, when compared with unseeded allografts.

Conclusions:

MSCs contributed to the secretion of trophic factors. A beneficial effect of the MSCs on angiogenesis was found when compared with the unseeded nerve allograft, but implanted MSCs did not show evidence of differentiation into Schwann cell-like cells.
The effects of antihypertensive class on gout in older adults: secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Authors: Juraschek Stephen P. , Simpson Lara M. , Davis Barry R. , Shmerling Robert H. , Beach Jennifer L. , Ishak Anthony , Mukamal Kenneth J.
Published: January 2020

Objectives:

Gout is a common complication of blood pressure management and a frequently cited cause of medication nonadherence. Little trial evidence exists to inform antihypertensive selection with regard to gout risk.

Methods:

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized clinical trial on the effects of first-step hypertension therapy with amlodipine, chlorthalidone, or lisinopril on fatal coronary heart disease or nonfatal myocardial infarction (1994–2002). Trial participants were linked to CMS and VA gout claims (ICD9 274.XX). We determined the effect of drug assignment on gout with Cox regression models. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) with gout.

Results:

Claims were linked to 23 964 participants (mean age 69.8 ± 6.8 years, 45% women, 31% black). Atenolol use was reported by 928 participants at the 1-month visit. Over a mean follow-up of 4.9 years, we documented 597 gout claims. Amlodipine reduced the risk of gout by 37% (hazard ratio 0.63; 95% CI 0.51--0.78) compared with chlorthalidone and by 26% (hazard ratio 0.74; 95% CI 0.58--0.94) compared with lisinopril. Lisinopril nonsignificantly lowered gout risk compared with chlorthalidone (hazard ratio 0.85; 95% CI 0.70--1.03). Atenolol use was not associated with gout risk (adjusted hazard ratio 1.18; 95% CI 0.78--1.80). Gout risk reduction was primarily observed after 1 year of follow-up.

Conclusion:

Amlodipine lowered long-term gout risk compared with lisinopril or chlorthalidone. This finding may be useful in cases where gout risk is a principal concern among patients being treated for hypertension.

This trial is registered at clinicaltrials.gov, number: NCT00000542.
Eckardt Forceps Tip Widening for the Removal of Posterior Intraocular Foreign Bodies Bigger Than 1 mm
Authors: Vastarella Paola , Bratu Adriana , Sinisi Fabrizio
Published: January 2020

Purpose:

To propose a new technique with an “old” tool to allow for better intraocular foreign body (IOFB) grasping and manipulation during mininvasive vitreoretinal surgery.

Methods:

The authors report herein their technique on seven eyes, diagnosed with posterior IOFBs, in which the surgery consisted of a 23-gauge vitrectomy, using, for IOFB grasping, a Grieshaber DSP 23-gauge Eckardt forceps, properly modified intraoperatively. Such result was achieved by enlarging the forceps opening bite, according to the IOFB size.

Results:

In all patients, IOFBs were removed using the modified 23-gauge Grieshaber Eckardt forceps. In 6 cases, a combined phacovitrectomy was performed, and the IOFB expressed through the corneal phacoincision; in one phakic patient, the removal was performed through the sclerotomy, extended just as needed.

Conclusion:

The Grieshaber Eckardt forceps commonly used in MIVS can be used in IOFB surgery for a scleral or corneal removal. In case of IOFB bigger than 1 mm, enlarging the forceps bite according the IOFB size provides a firm and safe grip, allowing the surgeon to complete the surgery without switching to bigger and more traumatic instrumentation, reducing collateral damage and shortening the surgery time.
Antimicrobial Stewardship Metrics that Matter
Authors: Wagner Jamie L. , Carreno Joseph J. , Kenney Rachel M. , Kilgore Paul E. , Davis Susan L.
Published: January 2020

Background

Guidelines for antimicrobial stewardship programs (ASPs) highlight the need for measuring quality metrics as surrogate markers for outcome. The objective of this study was to determine the relationship between ASP quality metrics and patient outcomes at an institution with an established ASP.

Methods

Retrospective cohort study including 442 patients receiving intravenous antibiotics for 72 hours or more in 1 of 3 designated inpatient units were assessed for compliance with ASP metrics and associated outcomes. Clinical success was defined as discharged alive, without adverse drug reaction and not readmitted within 30 days of discharge.

Results

The mean (SD) age was 62 (17) years with 205 males (46%) enrolled. A total of 422 patients (96%) had documented indication for therapy, 365 (83%) had appropriate cultures obtained at baseline, 354 (80%) had appropriate empiric therapy at baseline, and 166 (83%) of 199 had appropriate deescalation performed. All metrics were met in 58% of patients. Sixty-two percent of patients achieved clinical success; while, 14% died, 13% had an adverse drug reaction, and 21% were readmitted within 30 days. Completion of all ASP metrics was not associated with clinical success (odds ratio, 0.862; P = 0.46). Documentation of indication for therapy was a significant indicator for clinical success (97.8% vs 91.7%; P = 0.003); this remained associated after adjusting for infection type and severity.

Conclusions

Documented indication showed strong association with clinical success, providing support for use of the Centers for Disease Control's Core Elements as a metric for quality of care.
Combined Descemet membrane endothelial keratoplasty and extracapsular cataract extraction: management of an intraoperative challenge
Authors: Hind Jennifer , Lyall Douglas
Published: January 2020

Endothelial corneal transplantation (Descemet membrane endothelial keratoplasty [DMEK]) combined with cataract surgery as a triple procedure has been demonstrated to be safe and cost-effective. Where the corneal opacity is more significant, this may preclude safe phacoemulsification. This may not be apparent during preoperative assessment. An 80-year-old man with corneal decompensation secondary to herpes simplex endotheliitis and cataract underwent combined cataract extraction and DMEK. Intraoperatively, the surgical view became too poor to continue with conventional phacoemulsification. The lens was extracted by conversion to extracapsular surgery (extracapsular cataract extraction [ECCE]). Descemet membrane endothelial keratoplasty surgery was then completed without complication. Postoperatively, the graft remained attached, and by 3 months, acuity improved to 20/32 (Snellen). A poor intraoperative view during the triple procedure does not preclude a successful outcome. Corneal opacity can be overcome, avoiding full-thickness penetrating keratoplasty or discarding healthy graft tissue. Conversion to ECCE combined with DMEK is a feasible option intraoperatively that can still provide good outcomes.
Herpetic endothelial dendrite
Authors: Ehrenhaus Michael Phillip , Guzman Sebastian
Published: January 2020

To our knowledge, we report the first case of a herpetic endothelial dendrite in a patient with known herpetic keratitis. The patient had been treated with topical antivirals for herpetic epithelial dendritic keratitis. When the epithelial dendrites had resolved, the new endothelial dendrite appeared. The adjacent cornea was not edematous; however, the apparent endotheliitis was treated with oral antivirals and topical steroids until resolution.
A case of inferior rhegmatogenous Descemet's membrane detachment after stromal hydration in cataract surgery
Authors: Bourke Liam , Mullaney Paul
Published: January 2020

We describe the uncommon case of an inferior rhegmatogenous Descemet's membrane detachment (DMD) from stromal hydration at the side port during cataract surgery that was successfully treated with pneumodescemetopexy and head posturing. A temporally located, transverse and inferior, DMD was noted during stromal hydration. An air bubble was inserted at the end of cataract surgery. This failed to appose the detached Descemet's membrane against the overlying stroma because of the inferior location of the detachment and the superior position of the bubble without appropriate head positioning. Corneal edema persisted with an associated visual acuity of counting fingers. Two weeks after initial cataract surgery, a further air bubble with appropriate head positioning (Trendelenburg, ie, feet up and head down) for 6 hours was performed. The patient's corneal edema and associated poor vision almost completely resolved within the 6 hours of air bubble reinsertion and appropriate head positioning. His corrected distance visual acuity remains at 6/6.
Evolution of visual acuity, flap thickness, and optical density after laser in situ keratomileusis performed with a femtosecond laser
Authors: Parafita-Fernandez Alberto , Garcia-Gonzalez Montserrat , Gros-Otero Juan , Alvarez-Rementería Capelo Laureano , Blázquez Sánchez Vanesa , Teus Miguel
Published: January 2020

Purpose:

To describe the postoperative evolution of visual acuity, flap morphology, and stromal optical density femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).

Setting:

Clínica Rementería, Madrid, Spain.

Design:

Prospective case series.

Methods:

The study comprised 44 consecutive eyes that had FS-LASIK performed with the WaveLight FS200 and the Allegretto excimer laser to correct myopia. Visual outcomes, flap thickness, and stromal optical density were assessed 1 day, 1 week, 1 month, and 3 months postoperatively.

Results:

A statistically significant improvement in the mean uncorrected distance visual acuity at 1 day (0.94 ± 0.2) and 1 week (0.93 ± 0.2) to 1 month (1.04 ± 0.2) and 3 months (1.11 ± 0.1) postoperatively (P < .05). At 3 months postoperatively, the femtosecond laser had good outcomes in efficacy (0.98 ± 0.1), safety (0.98 ± 0.1), and predictability (100% of eyes were within ± 0.5 D of emmetropia). The femtosecond-created flaps were slightly thicker than intended, the mean SD intraflap was 7.1 μm, the range between the thickest and thinnest points in each flap was 25.4 μm, and the mean flap thickness homogeneity was 7.6 μm at 3 months postoperatively. A progressive decrease in the optical density of the flap stroma and the residual stromal bed was detected during follow-up.

Conclusions:

The femtosecond laser study appears to be a safe, effective, and predictable platform to obtain LASIK flaps. The flaps were planar and homogeneous but slightly thicker than intended. The optical density of the flap stroma was slightly higher at early follow-up and decreased over time.