bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring for Adult Patients With Autism in the Critical Care Setting
Authors: Quiban Carlota , Brooks Raelene , Armstrong Dometrives
Published: November 2019

Many adults with autism spectrum disorders (ASDs) are admitted as an inpatient, and much has been reported on their ASD-related characteristics and aggressive behaviors that complicate their care during hospitalizations. A variety of surgical and medical clinical conditions have required their admissions in the critical care unit. A limited number of case studies are present for hospitalized adults with ASD; most literature about young children was on how to provide care for them. An interdisciplinary approach with a focus on determining information specific to adult patients with ASD, medical problems or common causes of challenging behaviors, and medication history, as well as nutritional needs, is essential in meeting the care needs of autistic adults. Suggestions informed by multiple sources of evidence are presented to assist critical care nurses on how to provide support to care needs of adult patients with ASD during their hospital stay and transition to home.
Burnout, Compassion Fatigue, and Secondary Trauma in Nurses
Authors: Kelly Lesly
Published: November 2019

Burnout and compassion fatigue describe the state of health care professionals' extended stress, emotional states, and prolonged duress after events. In the past few decades, burnout and compassion fatigue have received increased focus and attention. This article summarizes the evolution in moving from viewing burnout as an individual's problem to understanding burnout as an occupational phenomenon, additionally recognizing the powerful role secondary trauma contributes to compassion fatigue. As such, the causes and addressing the solutions of burnout are multifaceted and complex. Causes of burnout stem from external pressure of caring for patients and pressure from organizational policy and practices, including unhealthy work environments, poor communication, stigma, and more. The harm from burnout and secondary trauma in health care professionals can be profound, impacting a significant portion of the workforce and manifesting in real suffering, including depression, emotional trauma, and suicide. As health care professionals are daily at risk, the need to recognize, address, and treat burnout is a priority. Both personal resilience building activities for effective stress reduction in clinicians and system-level solutions to address root causes must be utilized to address burnout.
Music Therapy for Surgical Patients
Authors: Bojorquez Genesis R. , Jackson Kimmeth E. , Andrews Amy K.
Published: November 2019

Music therapy (MT) in the inpatient setting has demonstrated positive outcomes worldwide. There was no protocol to utilize MT at this organization. The purpose of this project was to incorporate and evaluate MT as an adjunct intervention to address pain and anxiety in adult surgical step-down patients. Evidence-based practice change using the 8A's method integrated individualized MT provided by a board-certified music therapist to hospitalized patients over a 3-month period. Training was provided to 35 nurses and unit-assigned social worker on the utilization of MT for patients exhibiting pain or anxiety symptoms. The clinical social worker and staff nurses provided referrals for MT directly to the music therapist. Evaluation of MT included paired t-test and Wilcoxon signed-rank score comparisons of the numerical pain rating scale and the DSM-5 Patient Reported Outcome Measurement Information System Anxiety short form before and after the MT encounter. Among patients who received MT (n = 42), there was a statistically significant reduction in both pain (pre

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= 6.07, post

JOURNAL/ccnqu/04.03/00002727-202001000-00010/10FSM1/v/2023-09-02T061800Z/r/image-gif

= 3.45, t = 7.046, P = < .001) and anxiety (pre

JOURNAL/ccnqu/04.03/00002727-202001000-00010/10FSM1/v/2023-09-02T061800Z/r/image-gif

= 56.47, post

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= 46.52, t = 7.787, P ≤ .001). The reduction in pain (moderate to mild) and anxiety (mild to none) was also clinically significant.
Therapeutic Hypothermia
Authors: Alne Thomas
Published: November 2019

Background

Therapeutic hypothermia (TH) has shown promise for increasing survival and neurological recovery for post–cardiac arrest patients who are not responding neurologically initially after return of spontaneous circulation.

Objective

The aim of this study was to explore the differences between surface and intravascular cooling methods of TH related to survival and neurological outcomes in post–cardiac arrest patients.

Method

A literature search was conducted from 2008 to 2018 using 4 databases, including PubMed, CINAHL, Web of Science, and Scopus.

Results

Six articles were identified that compared surface and intravascular cooling for TH in post–cardiac arrest patients, with the outcomes being mortality and neurological outcome. The articles included observational retrospective studies, a systematic analysis, and randomized controlled studies. The articles had between 167 and 934 participants from multiple locations, including Europe, Australia, France, Norway, the Netherlands, and South Korea. The analyzed literature did not highlight differences in mortality or neurological outcome when surface cooling or intravascular cooling was used in post–cardiac arrest patients. One study did find that intravascular cooling was superior to surface cooling in mortality and neurological outcome. Three studies showed better survival rates after intravascular cooling even if not statistically significant. Clinically, using either cooling method is acceptable.

Discussion

This review found no difference between intravascular and surface cooling and effects on survival and neurological outcome. More research needs to be performed on the best type of cooling method as well as the best product within each category.
Visualization of the “Intradermal Plexus” Using Ultrasonography in the Dermis Flap: A Step beyond Perforator Flaps
Authors: Yoshimatsu Hidehiko , Hayashi Akitatsu , Yamamoto Takumi , Visconti Giuseppe , Karakawa Ryo , Fuse Yuma , Iida Takuya
Published: November 2019

Background:

Free flaps have evolved from musculocutaneous flaps to perforator-based cutaneous flaps. The subdermal plexus is now thought to play a significant role in skin paddle perfusion. We propose a new concept, the “intradermal plexus,” allowing survival of dermis flaps, according to our study.

Methods:

A dermis flap was used in 6 cases to reconstruct small defects. The superficial branch of the superficial circumflex iliac artery was traced distally using an ultrasound device with a 70-MHz linear array transducer until the artery’s branch entered the dermis. The location of the dermis entry site was marked and the vessels running inside the dermis were observed and video-recorded. A flap was elevated above the superficial fascia, and the adipose tissue was removed using scissors after confirmation of the vessels’ dermis entry point.

Results:

The use of 70-MHz ultrasonography permitted observation in all patients of small arteries entering the dermis layer. The artery was observed to give off branches after entering the dermis, in effect constituting an “intradermal plexus.” Small veins entering the dermis were similarly visualized using 70 MHz ultrasonography. All flaps survived completely.

Conclusions:

Small arteries and veins entering and running inside the dermis were visualized for the first time with 70 MHz real-time ultrasonography. Knowledge of the existence of this “intradermal plexus” made it possible to discard nearly all subdermal adipose tissue quickly and safely, without resorting to the elaborate measures described in previous reports.
The Use of Hydrodissection in Nipple- and Skin-sparing Mastectomy: A Retrospective Cohort Study
Authors: Tasoulis Marios-Konstantinos , Agusti Ana , Karakatsanis Andreas , Montgomery Catherine , Marshall Chris , Gui Gerald
Published: November 2019

Background:

Hydrodissection (HD) is a method to create a subcutaneous and prepectoral plane during mastectomy using a mixture of crystalloid solution with local anesthetic and epinephrine. The aim of this study was to evaluate postoperative complications and surgical outcomes of this technique compared with standard mastectomy.

Methods:

This is a retrospective cohort study of patients who underwent bilateral risk-reducing, nipple-sparing mastectomy and immediate implant-based reconstruction through an inframammary crease incision either with standard electrocautery (control group) or HD (HD group) between January 2013 and January 2017. Patient demographics, procedural details, surgical outcomes, and complications were compared using nonparametric statistical tests and logistic regression analysis.

Results:

Forty-one patients (82 nipple-sparing mastectomies) were analyzed (23 patients in the HD group and 18 in the control group). Patients' demographics were similar for both groups. Surgical time was shorter with HD compared with standard mastectomy (median 168 versus 207.5 minutes, P = 0.016) with shorter median hospital stay (2 versus 2.5 days, P = 0.033). Complication rates were similar in both groups, and fewer patients in the HD group required Coleman fat transfer to improve cosmesis (12 versus 3, P = 0.003).

Conclusions:

HD mastectomy is a safe alternative to standard technique in selected patients. Further surgical research to explore the role of HD in a wider clinical setting is warranted.
Automatic Anterior Chamber Angle Measurement for Ultrasound Biomicroscopy Using Deep Learning
Authors: Li Wanyue , Chen Qian , Jiang Zhenying , Deng Guohua , Zong Yuan , Shi Guohua , Jiang Chunhui , Sun Xinghuai
Published: November 2019

Purpose:

To develop a software package for automated measuring of the trabecular-iris angle (TIA) using ultrasound biomicroscopy.

Methods:

Ultrasound biomicroscopy images were collected and the TIA was manually measured by specialists. Different models were used as the convolutional neural network for the automatic TIA measurement. The root-mean-squared error, explained variance, and mean absolute percentage error were used to evaluate the performance of these models. The interobserver reproducibility, coefficient of variation, and intraclass correlation coefficient were calculated to evaluate the consistency between the manual measured and the model predicted values.

Results:

ResNet-18 had the best performance in root-mean-squared error, explained variance, and mean absolute percentage error among all 5 models. The average difference between the angles measured manually and by the model is −0.46±3.97 degrees for all eyes, −1.67±5.19 degrees for open angles, and 0.75±1.43 degrees for narrow angles. The coefficient of variation, intraclass correlation coefficient, and reproducibility of the total TIA measurements are 6.8%, 0.95, and 6.1 degrees for all angles; 6.4%, 0.99, and 7.7 degrees for open angles; and 8.8%, 0.93, and 4 degrees for narrow angles, respectively.

Conclusions:

Preliminary results show that this fully automated anterior chamber angle measurement method can achieve high accuracy and have good consistency with the manual measurement results, this has great significance for future clinical practice.
Evaluation of Iridocorneal Angle, Choroidal Thickness, and Retinal Nerve Fiber Layer Thickness in Children With a History of Retinopathy of Prematurity
Authors: Ulusoy Mahmut Oğuz , Kivanç Sertaç Argun , Kal Ali
Published: November 2019

Purpose:

Retinopathy of prematurity (ROP) is proliferative retinopathy affecting premature infants associated with abnormal maturation of the retinal vasculature. We sought to evaluate iridocorneal angle, choroidal thickness, and retinal nerve fiber layer thickness (RNFLT) of the children that have a history of ROP using spectral-domain optical coherence tomography.

Patients and Methods:

Fifty eyes of 28 children with a history of ROP and 46 eyes of 23 healthy school-aged children were included in this study. RNFLT, choroidal thickness, and iridocorneal angle parameters [trabecular iris angle, angle opening distance (AOD500), and trabecular iris space area (TISA500) 500 μm from the scleral spur] were evaluated using spectral-domain optical coherence tomography. Student t test was used to compare the mean of the parameters. Correlations between the variables were investigated based on the Pearson or Spearman correlation coefficient.

Results:

Subfoveal (ROP: 253.98±42.5; control: 286.2±71.9; P=0.045), 500 µm (ROP: 242.04±41.8; control: 276.7±45.3; P=0.003), 1000 µm (ROP: 237±39.7; control: 270.15±55.93; P=0.007), and 1500 µm (ROP: 224.16±37.5; control: 259.75±55.2; P=0.003) temporal choroidal thicknesses were significantly thinner in ROP history children. None of the RNFLT parameters and ganglion cell complex thickness were different between groups. Iridocorneal angle parameters were significantly lower in children with ROP history. (trabecular iris angle: ROP=31.35±3.9 degrees, control=35.4±4.5 degrees, P<0.001; TISA500: ROP=0.167±0.05 mm2, control=0.21±0.05 mm2, P=0.003; AOD500: ROP=480.96±160.4 µm, control=542.95±161.2 µm, P=0.035).

Conclusions:

ROP is associated with differences in the iridocorneal angle. Possible iridocorneal angle pathology should be a consideration in children with a history of ROP.
Crowdsourcing Morphology Assessments in Oculoplastic Surgery: Reliability and Validity of Lay People Relative to Professional Image Analysts and Experts
Authors: Rootman Daniel B. , Bokman Christine L. , Katsev Blake , Rafaelof Michael , Ip Michael , Manoukian Narek , Esfandiari Mahtash , Webb Noreen M.
Published: November 2019

Purpose:

To determine if crowdsourced ratings of oculoplastic surgical outcomes provide reliable information compared to professional graders and oculoplastic experts.

Methods:

In this prospective psychometric evaluation, a scale for the rating of postoperative eyelid swelling was constructed using randomly selected images and topic experts. This scale was presented adjacent to 205 test images, including 10% duplicates. Graders were instructed to match the test image to the reference image it most closely resembles. Three sets of graders were solicited: crowdsourced lay people from Amazon Mechanical Turk marketplace, professional graders from the Doheny Image Reading Center (DIRC), and American Society of Ophthalmic Plastic and Reconstructive Surgery surgeons. Performance was assessed by classical correlational analysis and generalizability theory.

Results:

The correlation between scores on the first rating and the second rating for the 19 repeated occurrences was 0.60 for lay observers, 0.80 for DIRC graders and 0.84 for oculoplastic experts. In terms of inter-group rating reliability for all photos, the scores provided by lay observers were correlated with DIRC graders at a level of r = 0.88 and to experts at r = 0.79. The pictures themselves accounted for the greatest amount of variation among all groups. The amount of variation in the scores due to the rater was highest in the lay group at 25%, and was 20% and 21% for DIRC graders and experts, respectively.

Conclusions:

Crowdsourced observers are insufficiently precise to replicate the results of experts in grading postoperative eyelid swelling. DIRC graders performed similarly to experts and present a less resource-intensive option.
Usefulness of High Resolution T2-Weighted Images in the Evaluation and Surveillance of Vestibular Schwannomas? Is Gadolinium Needed?
Authors: Pizzini Francesca B. , Sarno Alessandro , Galazzo Ilaria Boscolo , Fiorino Francesco , Aragno Anna M. R. , Ciceri Elisa , Ghimenton Claudio , Mansueto Giancarlo
Published: November 2019

Objectives:

First aim of study was to compare the diagnostic accuracy of high resolution T2-WI (HRT2-WI) and gadolinium-enhanced T1-weighted image (Gd T1-WI) sequences in quantitative evaluation of vestibular schwannomas (VS). The second one was to determine through qualitative evaluation when Gd-injection should be recommended.

Methods:

Two observers in consensus retrospectively reviewed 137 magnetic resonance imaging (MRI) scans of patients with histological diagnosis of VS (33 women, 26 men), 116 with both HRT2-WI and Gd T1-WI. The examinations were subdivided in: surveillance (10), pretreatment (30), posttreatment (43), and posttreatment follow-up (33) studies. Quantitative evaluation was based on size measurement of the lesion. Structural details of the lesion, facial nerve course, and involvement of the fundus of the internal auditory canal were assessed for the qualitative evaluation in both sequences.

Results:

No statistically significant changes were demonstrated between size measurement in the HRT2-WI and Gd T1-WI (p = 0.329). Sensitivity, specificity, and accuracy of HRT2-WI in the detection of lesional size were 90.4, 98.9, 92.5%, respectively. HRT2-WI was worse for characterization of structural details in pretreatment, posttreatment, and posttreatment follow-up examinations. HRT2-WI showed better or equal capability for all the groups in the demonstration of the facial nerve course. In the evaluation of the involvement of the fundus of the internal auditory canal, HRT2-WI showed worse results or had a complementary role for the posttreatment and posttreatment follow-up groups, while in the other groups was considered mainly equal or complementary. Only in the surveillance group, HRT2-WI was never worse for all the criteria.

Conclusion:

Results for quantitative evaluation were similar in both the sequences. Gadolinium injection can be avoided only in surveillance studies.
Anatomical and Functional Consequences of Microneedle Perforation of Round Window Membrane
Authors: Yu Michelle , Arteaga Daniel N. , Aksit Aykut , Chiang Harry , Olson Elizabeth S. , Kysar Jeffrey W. , Lalwani Anil K.
Published: November 2019

Hypothesis:

Microneedles can create microperforations in the round window membrane (RWM) without causing anatomic or physiologic damage.

Background:

Reliable delivery of agents into the inner ear for therapeutic and diagnostic purposes remains a challenge. Our novel approach employs microneedles to facilitate intracochlear access via the RWM. This study investigates the anatomical and functional consequences of microneedle perforations in guinea pig RWMs in vivo.

Methods:

Single three-dimensional-printed, 100 μm diameter microneedles were used to perforate the guinea pig RWM via the postauricular sulcus. Hearing was assessed both before and after microneedle perforation using compound action potential and distortion product otoacoustic emissions. Confocal microscopy was used ex vivo to examine harvested RWMs, measuring the size, shape, and location of perforations and documenting healing at 0 hours (n = 7), 24 hours (n = 6), 48 hours (n = 6), and 1 week (n = 6).

Results:

Microneedles create precise and accurate perforations measuring 93.1 ± 29.0 μm by 34.5 ± 16.8 μm and produce a high-frequency threshold shift that disappears after 24 hours. Examination of perforations over time demonstrates healing progression over 24 to 48 hours and complete perforation closure by 1 week.

Conclusion:

Microneedles can create a temporary microperforation in the RWM without causing significant anatomic or physiologic dysfunction. Microneedles have the potential to mediate safe and effective intracochlear access for diagnosis and treatment of inner ear disease.
Clinico-hematological and thromboelastographic profiles in glanzmann's thrombasthenia
Authors: Ahammad Javed , Kamath Asha , Shastry Shamee , Chitlur Meera , Kurien Annamma
Published: November 2019

Glanzmann's thrombasthenia is a rare inherited bleeding disorder characterized by the quantitative or qualitative defect of glycoprotein IIb/IIIa receptor on platelets which leads to ineffective aggregation. Light transmittance aggregometry is considered as the gold standard for diagnosis of Glanzmann's thrombasthenia. Thromboelastography (TEG) is a global hemostatic assay which measures clot formation, clot strengthening and fibrinolysis. This study evaluates the clinical, laboratory and TEG profiles in patients with Glanzmann's thrombasthenia. Bleeding score by (International Society on Thrombosis and Haemostasis) ISTH-bleeding assessment tool (bleeding score), laboratory tests to diagnose Glanzmann's thrombasthenia, and TEG parameters were correlated in 11 Glanzmann's thrombasthenia patients. Seventeen participants with normal bleeding score were included as controls. Bleeding score was increased in all patients. The highest bleeding score was in an adult female (26), whereas the lowest score (4) was in two children of less than 1 year. Majority of TEG parameters (except R-time) showed a statistically significant difference between Glanzmann's thrombasthenia patients and controls (K-time: P < 0.001, angle: P < 0.001, maximum amplitude: P < 0.001). The average time required to record the maximum amplitude was 23 min. Maximum amplitude was markedly reduced in all Glanzmann's thrombasthenia patients with an average of 20.9 mm (reference range 44–68 mm) having 100% sensitivity. The thromboelastographic profile of Glanzmann's thrombasthenia showed a consistently reduced maximum amplitude. Hence reduced maximum amplitude with a normal platelet count, significant bleeding score and prolonged bleeding time could potentially be used as a preliminary algorithm for the diagnosis of Glanzmann's thrombasthenia.
Adrenoleukodystrophy in the era of newborn screening
Authors: Eng Liane , Regelmann Molly O.
Published: November 2019

Purpose of review

Adrenoleukodystrophy (ALD) is a peroxisomal disorder with varying clinical presentations, including adrenal insufficiency, neurologic disease, and testicular dysfunction. The present review is intended to describe the current knowledge of the pathophysiology of ALD and provide an update regarding newborn screening, diagnosis, monitoring, and treatment.

Recent findings

New York State initiated newborn screening for ALD on December 30, 2013. Successful ALD newborn screening has led to its addition on other state newborn screens and recommendations for universal screening. Initial incidence reports, based on newborn screening, suggest ALD may be more common than previously described. The Pediatric Endocrine Society has published guidance for monitoring newborn males with ALD and case reports suggest biochemical adrenal insufficiency can be present during early infancy. Allogeneic hematopoietic stem cell transplant and gene therapy have been effective at halting the progression of cerebral ALD.

Early diagnosis and monitoring for progression of ALD can prevent adrenal crisis and treat the cerebral form of the disease. Initial guidelines for surveillance are likely to evolve as newborn screening not only aids in early detection and therapeutic interventions for ALD, but also expands our knowledge of the natural history of ALD.
Update on pediatric hyperthyroidism
Authors: Kaplowitz Paul B. , Vaidyanathan Priya
Published: November 2019

Purpose of review

This review is intended to highlight recent studies which provide new data on the epidemiology and management of children with hyperthyroidism, including neonates.

Recent findings

A French study demonstrates differences in age-related trends in incidence of hyperthyroidism in males versus females and suggests the overall incidence may be increasing. New studies confirm the effectiveness and safety of long-term medical therapy (up to 10 years), including from the first randomized trial of short-term versus long-term therapy. Radioiodine ablation (RAI) is the main alternative therapy, though surgery may have some advantages if done in a high-volume center; using higher weight-based doses of I-131 (250 μCI/g thyroid tissue) could increase proportion of patients achieving hypothyroidism and decrease repeat ablations. Maternal or neonatal thyroid-stimulating hormone (TSH) receptor antibodies in children of mothers with Graves’ disease, and TSH at 3–7 days of age are good predictors of which neonates will have problems.

More research is needed on the epidemiology of Graves’ disease. Long-term medical therapy well past two years should be considered an option in compliant patients to decrease the number who need definitive therapy. For those receiving RAI, a dose of about 250 μCI/g thyroid tissue should result in fewer cases of persistent hyperthyroidism than lower doses.
Resurgence of measles in the United States: how did we get here?
Authors: Feemster Kristen A. , Szipszky Claire
Published: November 2019

Purpose of review

In September 2019, the United States was at risk of losing measles elimination status due to several large-scale outbreaks resulting in more than 1200 confirmed cases across 31 states. This resurgence caps approximately 10 years of increasing incidence, marked by a highly publicized outbreak in 2015 associated with Disneyland when an infected traveler from the Philippines unknowingly spread the virus to susceptible park visitors and the recently ended large outbreak in undervaccinated Orthodox Jewish communities in New York City and Rockland counties. This review highlights current literature elucidating factors associated with current trends in measles epidemiology in the United States, the public health implications of current measles outbreaks and a path forward for addressing challenges contributing to the resurgence of measles in the United States and globally.

Recent findings and summary

As the most highly transmissible vaccine preventable disease, measles is especially sensitive to changes in herd immunity, the impact of vaccine refusal and globalization. Results highlight the confluence of these factors in current outbreaks, provide tools to predict outbreak risk, demonstrate the growing impact of misinformation and evaluate the impact of policy approaches for outbreak control and prevention.
Follicular T-cell regulation of alloantibody formation
Authors: Mohammed Mostafa T. , Sage Peter T.
Published: November 2019

Purpose of review

To summarize recent studies elucidating the roles of follicular T cells in controlling allospecific antibody responses and antibody-mediated rejection (AbMR).

Recent findings

The field of antibody regulation has provided an in depth identification of the T-cell subsets involved in regulation of antibody responses. In addition, tools have been developed to study these cells during disease. Over the past few years, these strategies have been implemented in the field of transplantation to study the roles of T cells in mediating pathogenic antibody responses.

AbMR is largely responsible for long-term graft failure after solid organ transplantation and is induced by allospecific antibodies. In vaccination and infection, antiboody responses are controlled by humoral immunoregulation in which T follicular helper (Tfh) cells promote, and T follicular regulatory (Tfr) cells inhibit, antibody responses. Recent studies have suggested multifaceted roles for follicular T-cell subsets in regulating allospecific antibody responses and AbMR during organ transplantation. In addition, we discuss research priorities for the field to help elucidate mechanisms used by these cells so that new targeted therapeutics can be developed to prevent AbMR in human organ transplantation.
Three Consecutive Cases of Familial Hemophagocytic Lymphohistiocytosis, Including a Case Due to Maternal Uniparental Disomy
Authors: Sato Hiroko , Kawasaki Naomi , Kawasaki Motoi , Abiko Yu , Meguro Toru , Takahashi Noriyuki , Izumino Hiroko , Kanno Miyako , Numakura Chikahiko , Sasaki Ayako , Imamura Toshihiko , Taki Tomohiko , Mitsui Tetsuo
Published: November 2019

We have experienced 3 consecutive cases of familial hemophagocytic lymphohistiocytosis (FHL). All affected infants had mutations in exon 3 of the perforin gene. The first had a homozygous mutation, c.1168C>T (p.R390*), caused by maternal uniparental isodisomy. The second and third had compound heterozygous mutations: c.781G>A (p.E261K) and c.1491T>A (p.C497*); c.1724G>T (p.C242G) and p.R390*, respectively. FHL is very rare in Northern Japan but should be suspected if infants exhibit prolonged fever. This is the first report of a relationship of p.R390* with FHL caused by uniparental isodisomy, and the second reported case of FHL type 2 with this form of inheritance.
Reversible Cerebral Vasoconstriction Syndrome and Sickle Cell Disease: A Case Report
Authors: Regling Katherine , Pomerantz Daniel , Narayanan Sandra , Altinok Deniz , Sivaswamy Lalitha , Marupudi Neena I. , Callaghan Michael U. , Martin Alissa
Published: November 2019

Reversible cerebral vasoconstriction syndrome (RCVS), is rare in the pediatric population and is characterized by severe headaches and other neurologic symptoms. We present a case of RCVS occurring concomitantly with posterior reversible encephalopathy syndrome in an 8-year-old African American child with sickle cell disease (HbSS). Imaging studies including computed tomography, magnetic resonance imaging and cerebral angiography of the brain showed acute hemorrhagic stroke and a beaded appearance of peripheral cerebral vessels. In this report, we focus on the typical features of RCVS and discuss the underlying risk factors that may increase the risk in patients with HbSS disease.
Teenagers Who Coexist With Cancer
Authors: Yang Hui-Chuan , Mu Pei-Fan , Chang Te-Kau , Curia Marianne
Published: November 2019

Background

The experiences of teenagers with cancer are related to falling ill, receiving treatment, and the way they exist in the world. The understanding of the meaning of teenagers coexisting with cancer must be placed in the social context with the teenagers at the core.

Objective

By using an interpretive ethnographic research method, this study applied the body perception view of Merleau-Ponty to how teenagers with cancer understand self through the body in a social and cultural context.

Methods

Participant observation and individual semistructured interviews of 18 teenagers diagnosed with cancer were conducted over a 20-month period.

Results

The illness experience of teenagers undergoing chemotherapy was described as self-integration. Five themes emerged: boundary ambiguity of body, medical equipment as part of the body, confined body space, from self-dissociation toward self-integration, and healing power formed by self and others.

Conclusion

In the face of the adjustments of body disorder, the teenagers with cancer initiated motility of the body, self-displacement, and integration in order to regain control of the body.

Implications for Practice

The provision of correct disease knowledge to strengthen teenagers’ understanding and their sense of mastery of their bodies throughout the participation in their cancer treatment is essential. Discussions on making decisions, self-management, and social identification are related to the relationship between body and self as well as between healthcare and otherness. Providing culture and social sensitivity support systems and resources to teenagers and families can strengthen them to face the disease and promote positive healing.
Predictors of Disagreement Between Diagnoses From Consult Requesters and Consultation-Liaison Psychiatry
Authors: Otani Victor , Otani Thaís , Freirias Andrea , Calfat Elie , Aoki Patricia , Cross Sean , Sumskis Susan , Kanaan Richard , Cordeiro Quirino , Uchida Ricardo
Published: November 2019

We evaluated disagreement between reported symptoms and a final diagnosis of depression, anxiety, withdrawal, psychosis, or delirium through regression models assessing individual and combined diagnoses. Highest disagreement rates were reported for services classified as others (88.2%), general surgery (78.5%), and bone marrow transplant (77.7%). Disagreement rates varied widely across different diagnoses, with anxiety having the highest disagreement rate (63.3%), whereas psychosis had the lowest disagreement rate (10.6%). When evaluating kappa coefficients, the highest agreement occurred with diagnoses of withdrawal and psychosis (0.66% and 0.51%, respectively), whereas anxiety and depression presented the lowest values (0.31% and 0.11%, respectively). The best-performing predictive model for most outcomes was random forest, with the most important predictors being specialties other than the ones focused on single systems, older age, lack of social support, and the requester being a resident. Monitoring disagreement rates and their predictors provides information that could lead to quality improvement and safety programs.
Avoiding Misdiagnosis When Auditory Verbal Hallucinations Are Present in Borderline Personality Disorder
Authors: Beatson Josephine A. , Broadbear Jillian H. , Duncan Charlotte , Bourton David , Rao Sathya
Published: November 2019

Misdiagnosis is common for patients with a primary diagnosis of borderline personality disorder (BPD) who experience auditory verbal hallucinations (AVHs). AVHs in BPD are associated with severe BPD and high levels of suicidality. Wrongly treating these patients as though they are suffering from schizophrenia or other primary psychotic disorder and not treating BPD can cause significant iatrogenic damage. We outline a specific pattern of symptoms and phenomenology that will assist diagnostic accuracy in these cases. A focused review identified the following characteristic pattern: AVHs in BPD cannot be distinguished phenomenologically from AVH in schizophrenia, often meet the criteria for First-Rank Symptoms (FRSs), are highly stress related, and are strongly associated with dissociative experiences and childhood trauma. Formal thought disorder is uncommon, negative symptoms are usually absent, bizarre delusions are absent, affect remains reactive, and sociability is usually retained. Diagnostic accuracy can be improved by examining the overall clinical presentation and is essential to improving the prognosis for these patients.
Corn, Niacin, and the History of Pellagra
Authors: Berdanier Carolyn D.
Published: November 2019

The recognition that certain diseases were caused by a lack of a specific nutrient occurred as nutrition science evolved. In some instances, many centuries elapsed before a connection was made. In others, only a few hundred years elapsed between the description of a disease and its nutrient cause. This is the situation for the disease, pellagra, which was only recognized as impoverished people began to depend on corn as their major food source. This article describes the history of pellagra and its relationship to poverty and the consumption of corn.
High-Quality Carbohydrates
Authors: Kanter Mitchell M.
Published: November 2019

The terms “high- and low-quality carbohydrate” are often ascribed to individual foods as a means of describing the healthfulness of the food in question, without any empirical definition of what constitutes high or low quality. This article summarizes the views of experts on the concept of carbohydrate quality and the numerous factors that should be considered when assessing the quality of a carbohydrate-containing food or meal.
Faculty and Student Perspectives of a Graduate Online Delivery Model Supported by On-Campus Immersion
Authors: Hardin-Pierce Melanie , Hampton Debra , Melander Sheila , Wheeler Kathy , Scott Leslie , Inman Dianna , Parrish Evelyn , Mudd-Martin Gia
Published: November 2019

Purpose

The purpose of this article is to describe an immersion model implemented in a doctor of nursing practice program with the goal of engaging students and optimizing learning.

Description of the Project

The immersion model was designed to support learners in an online doctor of nursing practice program to promote self-direction and active involvement in diagnosing, planning, implementing, and evaluating their own learning. The Community of Inquiry framework, based on learning and teaching theory, was used in developing this immersion model.

Outcome

Students expressed positive opinions about immersion. Students valued simulation and skills practice, peer interaction, engagement with faculty, and the leadership colloquium. Faculty reported value in having group advising meetings and in collaborating across specialty tracks for skills laboratory experiences.

Conclusion

The immersion model has enhanced student engagement and helped optimize learning outcomes. Students and faculty found the use of the immersion model to be beneficial for practicing skills, use of simulated learning experiences, and student advising.
Involvement of CHP2 in the Development of Non–Small Cell Lung Cancer and Patients’ Poor Prognosis
Authors: Xu Liqin , Qin Yanmei , Sun Baier , Wang Haiying , Gu Jun , Tang Zhiyuan , Zhang Weishuai , Feng Jian
Published: November 2019

The present study aimed to investigate the expression levels and clinical significance of the calcineurin B homologous protein 2 (CHP2) in non–small cell lung cancer (NSCLC), and to study its effects on biological characteristics of NSCLC cells. Tumor and adjacent samples were collected from 196 NSCLC patients. Western blot analysis was used to detect the expression levels of the CHP2 in 8 pairs of NSCLC fresh tissues and 4 NSCLC cell lines. Immunohistochemical analysis was used to detect the expression of the CHP2 in 188 additional pairs of NSCLC wax block tissues. The data indicated that the expression levels of the CHP2 in the paraffin and fresh tissues of NSCLC were significantly higher than those of the adjacent tissues. According to the histo-score, univariate and multivariate analysis indicated that a high expression level of CHP2 was an important factor affecting the 5-year survival rate of NSCLC patients. After knocking down the expression of CHP2 in NSCLC cell lines, the proliferative, migratory, and invasive activities of NSCLC-CHP2 cells were decreased which were assessed by Western blotting, Cell Counting Kit-8, and transwell and wound-healing assays. In conclusion, the data demonstrated that CHP2 was highly expressed in NSCLC and that it could promote the development of NSCLC, suggesting its potential application for the therapy of NSCLC.
High-grade Pelvic Serous Carcinoma Within the Fallopian Tube Lumen: Real or Artifact?
Authors: Seidman Jeffrey D. , Krishnan Jayashree
Published: November 2019

Tumor cells are occasionally observed in the lumen in histologic sections of the fallopian tube from women with gynecologic cancer. There is some evidence that this finding may be important in endometrial cancer, but its significance is unknown in women with extrauterine pelvic serous carcinomas (tubo-ovarian high-grade serous carcinoma). Fallopian tube sections from 213 women with extrauterine pelvic serous carcinoma were reviewed, and luminal tumor cells were correlated with clinical and pathologic features. Intraluminal tumor cells were found in 84 patients (39%). The presence or absence of luminal tumor cells correlated significantly with serous tubal intraepithelial carcinoma (52% and 33%, respectively, P=0.004), tubal lymphatic invasion (32% and 12%, respectively, P=0.0002), and number of tube sections reviewed (6.6 and 4.9 for lumen-positive and lumen-negative cases, respectively, P=0.0056). There was no correlation with the presence of ascites, peritoneal cytopathologic findings, lymph node metastases, or FIGO stage. In the setting of pelvic serous carcinoma, a substantial portion of fallopian tube tissue is often distorted, fibrotic, and difficult to identify. Since the identification of luminal tumor cells, serous tubal intraepithelial carcinoma and tubal lymphatic invasion all depend on identification of fallopian tube tissue, these correlates with luminal tumor cells could be a result of a higher likelihood of their observation when tubal tissue can be more readily identified and may not necessarily reflect a biologically important phenomenon. It remains unclear whether and in what proportion this finding reflects an artifact of specimen handling.
Breathing Easier: Decreasing Tracheal Intubation-associated Adverse Events in the Pediatric ED and Urgent Care
Authors: Neubrand Tara L. , Alletag Michelle , Woods Jason , Mendenhall Marcela , Leonard Jan , Schmidt Sarah K.
Published: November 2019

Introduction:

Tracheal intubation is a high-risk procedure in the pediatric emergency department (PED) and pediatric urgent care (PUC) settings. We aimed to develop an airway safety intervention to decrease severe tracheal intubation-associated adverse events (TIAEs) by decreasing process variation.

Methods:

After gathering baseline data on TIAE, an interdisciplinary team underwent a mini-Delphi process to identify key drivers for decreasing severe TIAE rates. We launched a 4-part airway safety bundle that included: (1) color-coded weight-based equipment chart, (2) visual schematic of airway equipment, (3) recommended medication dosing, and (4) safety checklist across a single, tertiary PED and 5 satellite community PUCs/PEDs. Multiple plan–do–study–act cycles were undertaken, and results were monitored using statistical process control charts. Charts were restaged when special cause variation was achieved. This study aimed to decrease the severe TIAE rate from a baseline of 23% in the tertiary site and 25% in the community sites to <15% within 12 months and to sustain these outcomes for 6 months.

Results:

During the study period, we noted decreased rates of severe TIAE in both the PED and PUC setting during the intervention period, and we have sustained this improvement for more than 6 months in all sites with no associated change in balancing measures.

Conclusions:

Implementation of an airway safety bundle over a wide geographic area and among personnel with variable levels of training is possible and has the potential to decrease severe TIAE across multiple clinical settings.
Preschool Vision Screening Collaborative: Successful Uptake of Guidelines in Primary Care
Authors: Anzeljc Samantha , Ziemnik Lisa , Koscher Stephanie , Klein Wendy , Bridge Christine , Van Horn Allyson
Published: November 2019

Introduction:

Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment.

Methods:

Thirty-nine Ohio primary care providers interested in preschool vision screening self-selected to participate in an Institute for Healthcare Improvement Breakthrough Series learning collaborative that spanned 18 months. Charts of patients attending 3-, 4-, and 5-year well-child visits were randomly selected and reviewed for documentation of vision screening attempts, referrals, and need for rescreening.

Results:

Practitioners improved evidenced-based screening attempts for distance visual acuity and stereopsis of 3–5-year-old patients from 18% at baseline to 87% (P < 0.001) at 6 months; improved screening rates were sustained through completion of the collaborative. Baseline referral rates (26%) of abnormal vision screens improved by 59% (P < 0.001) during the first 6 months and were maintained through month 18. Rates for children with incomplete screens that were scheduled for a repeated screening increased during the first 6 months. However, changes in this metric did not reach statistical significance (P = 0.265), nor did it change during the remainder of the collaborative.

Conclusions:

Rapid integration and maintenance of preschool vision screening guidelines are feasible across primary care settings utilizing a structured learning collaborative. Challenges with the rescreening processes for children with incomplete vision screens remain, with the 3-year age group having the greatest room for improvement.
Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up
Authors: Alster Tina S. , Li Monica Ka Yi
Published: November 2019

Background:

In recent years, microneedling has been increasingly used to treat a number of dermatologic conditions, including scars. Although initial studies demonstrated improvement of (mostly) atrophic scars with microneedling, the number of patients evaluated was relatively small, and the devices and treatment protocols used and posttreatment follow-up varied widely. Through this prospective observational study, the results of microneedling on 20 patients with a variety of scars are described.

Methods:

One hundred twenty consecutive patients (skin phototypes I through VI) with facial and nonfacial scars from a variety of etiologic sources (acne, trauma, surgery) were treated using a mechanical microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of scars 1, 3, 6, and 12 months after treatment on a five-point scale. Side effects were monitored and tabulated.

Results:

Patients received one to six consecutive monthly microneedling treatments. All scars improved at least 50 percent after an average of 2.5 treatments. Over 80 percent of patients had 50 to 75 percent improvement, and 65 percent of patients demonstrated over 75 percent improvement. No significant clinical differences were observed in treatment responses of facial scars versus nonfacial scars nor between responses of atrophic acne scars and traumatic or surgical scars.

Conclusions:

This study supports the use of microneedling for various facial and nonfacial scars across a broad range of skin phototypes with minimal risk of adverse effects. Further studies will help to establish standardized protocols to optimize treatment outcomes for different scar types.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Impact of a Nurse-Driven Diabetic Ketoacidosis Insulin Infusion Calculator on the Rate of Hypoglycemia
Authors: Lee Cynthia , Szwak Jennifer Austin , Bastow Samantha , McCarthy Sarah
Published: November 2019

Objective

The aim of the study was to evaluate the impact of an insulin infusion calculator incorporated into electronic health record system in reducing the rate of hypoglycemia in diabetic ketoacidosis (DKA) management.

Methods

Retrospective chart review of patients with primary admission diagnosis of DKA was conducted in a university-affiliated academic medical center. End points including the rate of hypoglycemia, time to DKA resolution, rate of hypokalemia, time on insulin drip, and length of stay were measure before and after implementation of DKA calculator.

Results

Of 181 adult patients admitted for primary diagnosis of DKA, 103 were managed using the calculator. After implementation of the calculator, incidence of hypoglycemia and severe hypoglycemia were significantly reduced by 70% and 87%, respectively (P < 0.01). No difference was observed for time to DKA resolution, time on insulin drip, and length of stay.

Conclusions

Implementation of DKA insulin infusion calculator significantly reduced the rate of hypoglycemia. Future improvements should focus on reducing time to DKA resolution and length of stay.