bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Pregnancy Diabetes Screening and Diagnosis
Authors: Mission John F. , Catov Janet , Deihl Tiffany E. , Feghali Maisa , Scifres Christina
Published: October 2017

OBJECTIVE:

To evaluate the prevalence of early diabetes screening in pregnancy, rates of abnormal diabetes test results before 24 weeks of gestation, and factors associated with early diabetes screening.

METHODS:

This was a retrospective cohort study of all singleton deliveries from 2012 to 2014 among diverse clinical practices at a large academic medical center. We assessed rates of early (less than 24 weeks of gestation) and routine (at or beyond 24 weeks of gestation) diabetes screening, with abnormal test results defined using the Carpenter-Coustan criteria, a 50-g glucose challenge test result greater than 200 mg/dL, or a hemoglobin A1C level greater than 6.5%. Univariate and multivariate analyses were used to evaluate clinical and demographic determinants of screening and diagnosis.

RESULTS:

Overall, 1,420 of 11,331 (12.5%) women underwent early screening. Increasing body mass index (BMI) category, race, public insurance, history of gestational diabetes mellitus, a family history of diabetes, and chronic hypertension were associated with early screening. Early screening rates rose with increasing BMI category, but only 268 of 551 (48.6%) of women with class III obesity underwent early screening. Among those screened early, 2.0% of normal-weight women, 4.0% of overweight women, 4.2% of class I obese women, 3.8% of class II obese women, and 9.0% of class III obese women had abnormal early test results (P<.001).

CONCLUSION:

Early diabetes screening is used inconsistently, and many women with risk factors do not undergo early screening. A significant proportion of women with class III obesity will test positive for gestational diabetes mellitus before 24 weeks of gestation, and studies are urgently needed to assess the effect of early diabetes screening and diagnosis on perinatal outcomes in high-risk women.
Pregnancy Outcomes Among Deaf Women in Washington State, 1987–2012
Authors: Schiff Melissa A. , Doody David R. , Crane Deborah A. , Mueller Beth A.
Published: October 2017

OBJECTIVE:

To evaluate pregnancy and neonatal outcomes among deaf women using population-based vital records data in Washington State from 1987 to 2012.

METHODS:

We performed a retrospective cohort study using the Washington State birth and fetal death records linked to state hospital discharge records to identify women with diagnosis codes for deafness indicated at their delivery hospitalization and compared them with randomly selected women without these codes. Pregnancy conditions and outcomes evaluated included gestational diabetes, preeclampsia, placental abruption, labor induction, and cesarean delivery. Neonatal outcomes evaluated included preterm gestational age (less than 28, 28 to less than 37 weeks) at delivery and low birth weight. We also assessed length of maternal and neonatal delivery hospitalization. We performed Poisson regression to estimate relative risks (RRs) and 95% CIs for each outcome, adjusting for birth year, maternal age, and parity.

RESULTS:

Most adverse pregnancy and neonatal outcomes were similar for deaf and comparison women. Among women who underwent vaginal delivery, deaf women were more than twofold (RR 2.15, 95% CI 1.43–3.22) more likely to have a delivery hospitalization of 4 or more days (6.0% compared with 2.8%). We found a modestly increased risk of cesarean delivery (RR 1.15, 95% CI 1.01–1.30), with 29.9% of deaf compared with 25.6% of nondeaf women having a cesarean delivery.

CONCLUSION:

Deaf women are not at increased risk of the majority of adverse pregnancy and neonatal outcomes. Obstetric care providers may use our findings in counseling this special population of prenatal patients.
Discontinuing Oxytocin Infusion in the Active Phase of Labor
Authors: Saccone Gabriele , Ciardulli Andrea , Baxter Jason K. , Quiñones Joanne N. , Diven Liany C. , Pinar Bor , Maruotti Giuseppe Maria , Martinelli Pasquale , Berghella Vincenzo
Published: October 2017

OBJECTIVE:

To evaluate the benefits and harms of discontinuation of oxytocin after the active phase of labor is reached.

DATA SOURCES:

Electronic databases (ie, MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, ScienceDirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) were searched from their inception until April 2017.

METHODS OF STUDY SELECTION:

We included all randomized controlled trials comparing discontinuation (ie, intervention group) and continuation (ie, control group) of oxytocin infusion after the active phase of labor is reached, either after induction or augmentation of labor. Discontinuation of oxytocin infusion was defined as discontinuing oxytocin infusion when the active phase of labor was achieved. Continuation of oxytocin infusion was defined as continuing oxytocin infusion until delivery. Only trials in singleton gestations with vertex presentation at term were included. The primary outcome was the incidence of cesarean delivery.

TABULATION, INTEGRATION, AND RESULTS:

Nine randomized controlled trials, including 1,538 singleton gestations, were identified as relevant and included in the meta-analysis. All nine trials included only women undergoing induction of labor. In the discontinuation group, if arrest of labor occurred, usually defined as no cervical dilation in 2 hours or inadequate uterine contractions for 2 hours or more, oxytocin infusion was restarted. Women in the control group had oxytocin continued until delivery usually at the same dose used at the time the active phase was reached. Women who were randomized to have discontinuation of oxytocin infusion after the active phase of labor was reached had a significantly lower risk of cesarean delivery (9.3% compared with 14.7%; relative risk 0.64, 95% CI 0.48–0.87) and of uterine tachysystole (6.2% compared with 13.1%; relative risk 0.53, 95% CI 0.33–0.84) compared with those who were randomized to have continuation of oxytocin infusion until delivery. Discontinuation of oxytocin infusion was associated with an increase in the duration of the active phase of labor (mean difference 27.65 minutes, 95% CI 3.94–51.36).

CONCLUSION:

In singleton gestations with cephalic presentation at term undergoing induction, discontinuation of oxytocin infusion after the active phase of labor at approximately 5 cm is reached reduces the risk of cesarean delivery and of uterine tachysystole compared with continuous oxytocin infusion. Given this evidence, discontinuation of oxytocin infusion once the active stage of labor is established in women being induced should be considered as an alternative management plan.
Nonreassuring Status
Authors: Winkel Abigail Ford , Hughes Francine , Blank Stephanie V.
Published: October 2017

Physician wellness directly affects patient and physician health and has broader implications for our health systems. A summary of what is known about physician wellness in medicine, and obstetrics and gynecology in particular, identifies several areas for future focus. To change our culture and the structure of our academic health centers in a way that promotes resilience, we suggest greater attention to preparedness for practice and attention to work–life integration as well as mentoring and professional development.
Current treatments in periprosthetic shoulder infections
Authors: Rahmi Hithem , Burkhead Wayne , Itamura John
Published: October 2017

Management of shoulder arthroplasty infections can be challenging. The most common organisms that are isolated from shoulder arthoplasty infections are Propionibacter acnes and Staphylococcus species. Treatment algorithms tend to be unclear, especially in the setting of unexpected positive cultures and in Propionibacter acnes infections, but they include antibiotic suppression, tissue debridement with retention of the prosthesis, one or two-stage prosthesis exchange, and resection arthroplasty. Prevention of infection is paramount, with the use of antibiotics and proper preoperative skin preparation. Our goal was to review the current literature in diagnosing and managing shoulder arthroplasty infections.
Comparison of Intended Lengthening of Magnetically Controlled Growing Rods: Ultrasound Versus X-Ray
Authors: Cobanoglu Mutlu , Shah Suken A. , Gabos Peter , Rogers Kenneth , Yorgova Petya , Neiss Geraldine , Grissom Leslie , Mackenzie William G.
Published: October 2017

Background:

In the treatment of early onset scoliosis (EOS), there has been a trend to use magnetically controlled growing rods (MCGR) in order to reduce the number of surgeries. To confirm the amount of lengthening, spine radiographs were required. Recently, ultrasound (US) has been added to monitor lengthening of MCGR to avoid radiation exposure. Our aim was to determine whether US is as accurate as plain radiography (x-ray) in determining the amount of length achieved at individual MCGR lengthening episodes.

Methods:

Retrospective study; inclusion criteria: EOS cases with dual MCGR with minimum 12 months follow-up. Intended lengthening IL (mm), lengthening on US (mm) and x-ray (mm) were documented from medical records for both right and left rods. Primary (no surgery before MCGR) and conversion (other types of instrumentation were replaced with MCGR) cases were reviewed separately. P-values determined with analysis of variance.

Results:

Sixteen cases with 100 lengthening episodes met the inclusion criteria. Eleven were primary MCGR cases with 67 episodes. Mean follow-up was 19±5 months. Significant differences were found between IL (3.4±1 mm), US (2.7±1.9 mm), and x-ray (4.1±2.2 mm) (P<0.001). The difference between IL and x-ray was minimal, but statistically significant (P=0.046). US showed statistically lower values than both IL (P=0.001) and x-ray (P<0.001). The mean ratio of x-ray/IL, US/IL, and US/x-ray were 1.1, 0.75, and 0.84, respectively. Five conversion cases had 33 episodes. Mean follow-up was 21±2 months. Significant differences were found between IL (3.4±0.8 mm), US (1.3±0.8 mm), and x-ray (1.7±0.9 mm) (P<0.001) but there was no significant difference between US and x-ray (P=0.283). IL was significantly higher than both US (P< 0.001) and x-ray (P<0.001). The mean ratio of x-ray/IL, US/IL, and US/x-ray were 0.64, 0.41, and 1.1, respectively.

Conclusions:

US can provide confirmatory information of noninvasive lengthening of MCGR. However, US tended to underestimate the achieved length as measured by x-ray in primary cases. Conversion cases demonstrate better concordance between US and x-ray but in these cases less overall length was achieved at each lengthening episode.

Level of Evidence:

Level III.
ONO-1301 Enhances in vitro Osteoblast Differentiation and in vivo Bone Formation Induced by Bone Morphogenetic Protein
Authors: Kanayama Sadaaki , Kaito Takashi , Kitaguchi Kazuma , Ishiguro Hiroyuki , Hashimoto Kunihiko , Chijimatsu Ryota , Otsuru Satoru , Takenaka Shota , Makino Takahiro , Sakai Yusuke , Myoui Akira , Yoshikawa Hideki
Published: October 2017

Study Design.

In vitro and in vivo assessment of osteogenic effect by prostacyclin agonist (ONO-1301).

Objective.

The aim of this study was to investigate the effects of ONO-1301 on in vitro osteoblastic differentiation and in vivo bone formation induced by bone morphogenetic protein (BMP).

Summary of Background Data.

Among prostaglandins (PGs), PGE2 is the most abundant in bone tissue and its effects on bone formation have been well studied. PGI2 (prostacyclin) is the second most abundant PG in bone tissue and plays important roles in hemodynamics. However, the effects of PGI2 on osteoblast differentiation and bone regeneration have not been elucidated.

Methods.

The effects of PGI2 agonist (ONO-1301), with and without recombinant human (rh) BMP-2, on osteoblastic differentiation and cell proliferation were investigated in vitro using alkaline phosphatase (ALP) and WST-1 assays. Murine primary osteoblasts and cell lines (ST2, MC3T3-E1, C2C12, and CH310T1/2) were used for the study. The effects of ONO-1301 on rhBMP-2 induced bone formation were investigated in a mouse model of muscle pouch transplantation (ectopic model) and in a rat model of spinal fusion (orthotopic model).

Results.

ONO-1301 significantly increased ALP activity in the primary osteoblasts and ST2 cells. In addition, cotreatment with ONO-1301 and rhBMP-2 significantly increased ALP activity in the primary osteoblasts, as well as in ST2 and MC3T3-E1 cells. Cell proliferation was not affected by both ONO-1301 and ONO-1301 as well as rhBMP-2. In the ectopic model, ONO-1301 significantly increased the volume of ectopic bone whose formation was induced by BMP. In addition, in the orthotopic model, ONO-1301 significantly increased bone volume and fusion rate.

Conclusion.

This study has demonstrated that the PG IP agonist ONO-1301 improves in vitro BMP-2 induced osteoblast differentiation and in vivo ectopic and orthotopic bone formation. The results suggest that ONO-1301 has a potential clinical application as an enhancer of BMP-induced bone formation.

Level of Evidence: N/A
Development and Validation of Taiwanese Version of the Neck Disability Index
Authors: Lue Yi-Jing , Chen Chung-Hwan , Chou Shih-Hsiang , Lin Chih-Lung , Cheng Kuang-I , Lu Yen-Mou
Published: October 2017

Study Design.

Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with neck pain.

Objective.

To translate and cross-culturally adapt the Neck Disability Index (NDI) into a Taiwanese version and to assess the psychometric properties.

Summary of Background Data.

The Taiwanese NDI has not been developed or validated.

Methods.

The NDI was first translated and culturally adapted to the Taiwanese version. The test–retest reliability within 1 week was examined (n = 32). The factor structure was assessed by confirmatory factor analysis (n = 137). The construct validity was assessed by examining the relationship between the NDI and other well-known measures (n = 137).

Results.

The Taiwanese version was successfully translated and cross-culturally adapted. The internal consistency was excellent, with Cronbach α = 0.89. High test–retest reliability was demonstrated with intraclass correlation coefficients of 0.87. The minimal detectable change was 8.74. The two-factor model (pain and function factors) was better than the one-factor model, with higher factor loadings and better goodness-of-fit statistics. The convergent validity was supported by moderate correlation of the pain factor with the Visual Analogue Scale (|rho| = 0.45), and high correlation of the function factor with the physical component summary of the Short-From 36 (SF-36) (|rho| = 0.60).

Conclusion.

The Taiwanese NDI is a reliable and valid disease-specific measure for assessment of pain and functional status in patients with neck pain.

Level of Evidence: 3
Intraoperative Mulitplanar Alignment System to Guide Triplanar Correction of Hallux Valgus Deformity
Authors: Smith W. Bret , Santrock Robert D. , Hatch Daniel J. , Dayton Paul
Published: October 2017

Hallux valgus surgery or “bunion surgery” is one of the most common surgical procedures for the foot and ankle surgeon. As we continue to gain understanding of this complex deformity, it has become clear that our understanding may be incomplete. The Lapidus procedure was described over 80 years ago and still offers many challenges. Often the choice of a Lapidus procedure is not considered due to the complexity or perceived complications. As the traditional Lapidus procedure relied on multiple freehand steps that can be fraught with error, it was often relegated to be used as a last resort. As our understanding of the hallux valgus deformity has grown it is becoming clear that the anatomic Center of Rotation of Angulation of the deformity may lie at the tarsometatarsal joint. There is also the component of the 3-dimensional nature of the deformity that may be best addressed at this anatomic Center of Rotation of Angulation. With those issues in mind, it was necessary to address the shortcomings of the traditional Lapidus procedure and progress toward more consistent, instrumented steps that could address the 3-dimensional nature of the deformity.

Level of Evidence: Level IV—Technique presentation.
Burnout and Psychological Distress Among Pediatric Critical Care Physicians in the United States*
Authors: Shenoi Asha N. , Kalyanaraman Meena , Pillai Aravind , Raghava Preethi S. , Day Scottie
Published: October 2017

Objectives:

To estimate the prevalence of physician burnout, psychological distress, and its association with selected personal and practice characteristics among pediatric critical care physicians and to evaluate the relationship between burnout and psychological distress.

Design:

Cross-sectional, online survey.

Setting:

Pediatric critical care practices in the United States.

Subjects:

Pediatric critical care physicians.

Interventions:

None.

Measurement and Main Results:

A nonrandom sample of 253 physicians completed an online survey consisting of personal and practice characteristics, the Maslach Burnout Inventory, and the General Health Questionnaire. Nearly half of the participants (49%; 95% CI, 43–55%; n = 124) scored high burnout in at least one of the three subscales of the Maslach Burnout Inventory and 21% reported severe burnout. The risk of any burnout was about two times more in women physicians (odds ratio, 1.97; 95% CI, 1.2–3.4). Association between other personal or practice characteristics and burnout was not evident in this study, while regular physical exercise appeared to be protective. One third of all participants (30.5%) and 69% of those who experienced severe burnout screened positive for psychological distress. About 90% of the physicians reporting severe burnout have considered leaving their practice.

Conclusions:

Burnout is high among pediatric critical care physicians in the United States. About two thirds of the physicians with severe burnout met the screening criteria for psychological distress that suggests possible common mental disorders. Significant percentages of physicians experiencing burnout and considering to leave the profession has major implications for the critical care workforce.
Primary malignant melanoma arising in an ovarian cystic teratoma
Authors: Shen Xuejie , Fan Yang , Cao Shui
Published: October 2017

Primary malignant melanoma arising in an ovarian cystic teratoma is exceedingly rare event with an estimated incidence of 0.2–0.8%. So far, there have been approximately only 47 relevant reports. We report a case of primary malignant melanoma of the ovary arising in a cystic teratoma here. Moreover, we review systematically the disease from the following aspects, that origin, clinical characteristics, accessory examination, pathological features, diagnosis, differential diagnosis, treatment, prognosis.
Lymphocyte-to-monocyte ratio is associated with survival in pembrolizumab-treated metastatic melanoma patients
Authors: Failing Jarrett J. , Yan Yiyi , Porrata Luis F. , Markovic Svetomir N.
Published: October 2017

The peripheral blood lymphocyte-to-monocyte ratio (LMR) has been associated with prognosis in many malignancies including metastatic melanoma. However, it has not been studied in patients treated with immune checkpoint inhibitors. In this study, we analyzed the baseline LMR with progression-free survival (PFS) and overall survival (OS) in metastatic melanoma patients treated with pembrolizumab. A total of 133 patients with metastatic melanoma treated with pembrolizumab were included in this retrospective study. LMR was calculated from pretherapy peripheral blood counts and the optimal cutoff value was determined by a receiver operator characteristic curve. PFS and OS were evaluated using the Kaplan–Meier method and multivariate Cox proportional hazard modeling. Patients with an LMR of at least 1.7 showed improved PFS (hazard ratio=0.55; 95% confidence interval: 0.34–0.92; P=0.024) and OS (hazard ratio=0.29; 95% confidence interval: 0.15–0.59; P=0.0007). The baseline LMR is associated with PFS and OS in metastatic melanoma patients treated with pembrolizumab, and could represent a convenient and cost-effective prognostic biomarker. Validation of these findings in an independent cohort is needed.
From Classical to Unusual: Report on 5 Cases of Transient Reactive Aquagenic Pseudokeratoderma and Review of the Literature
Authors: Peña-Romero Adriana Guadalupe , Toussaint-Caire Sonia , Charli-Joseph Yann , Dela Barreda-Becerril Fernando , Domínguez-Cherit Judith
Published: October 2017

Transient reactive aquagenic pseudokeratoderma is characterized by transient whitish and translucent papules after water exposure in palms and soles. We report 5 additional cases and their histopathologic features. Patient 5 showed a topography that had not been reported before; this demonstrates that it is not an exclusive condition of palms and soles. Patient 2 presents very subtle clinical findings, making difficult the diagnosis. And the other 3 patients have a typical presentation. Transient reactive aquagenic pseudokeratoderma has heterogeneous clinical features; in some cases, histopathologic findings, although subtle, help to confirm the diagnosis.
Long-Term Follow-Up Results of Topical Imiquimod Treatment in Basal Cell Carcinoma
Authors: Bostanci Seher , Kocyigit Pelin , Vural Seçil , Heper Aylin Okcu , Botsali Ayşenur
Published: October 2017

BACKGROUND

Imiquimod 5% topical cream is approved for treatment of superficial basal cell carcinoma (BCC). Data on the long-term efficacy and usage in other BCC subtypes are scarce.

OBJECTIVE

Evaluation of long-term safety and efficacy of topical imiquimod treatment in various BCC subtypes and locations, with individualized treatment duration.

MATERIALS AND METHODS

Histopathologically confirmed BCCs treated solely with topical imiquimod were identified retrospectively and included in this study. Clinical and histopathologic tumor clearances were the primary end point. After treatment was concluded, patients were examined every 3 to 6 months.

RESULTS

In total, 24 BCC samples from 22 patients (F:M = 9:13; mean age: 73.5 years, SD: 10.767) were evaluated. The majority of the lesions were located in the head and neck area (83%). Mean treatment duration until complete clearance was 15.7 ± 6.9 weeks (6–28 weeks). Imiquimod was discontinued in 3 lesions, due to either clinically or histopathologically insufficient response. During follow-up, 2 lesions recurred, at 42 and 50 months after treatment. During a mean follow-up time of 72.7 (SD = 9) months, 79.1% of the lesions were cured without local recurrence.

CONCLUSION

Although imiquimod is only approved for superficial BCC, treatment success was high among the study patients with various histological subtypes, with good long-term cosmetic results.
Investigation of the Efficacy and Safety of Topical Vibration Anesthesia to Reduce Pain From Cosmetic Botulinum Toxin A Injections in Chinese Patients: A Multicenter, Randomized, Self-Controlled Study
Authors: Li Yiming , Dong Weiwei , Wang Min , Xu Ning
Published: October 2017

BACKGROUND

Vibration has been proved to be effective to reduce pain during facial cosmetic injections, but it has not been studied in Chinese patients.

OBJECTIVE

To investigate the efficacy and safety of vibration for pain reduction associated with cosmetic botulinum toxin A (BTX-A) injections in Chinese patients.

MATERIALS AND METHODS

In this prospective, randomized, split-face and right-left, self-controlled study, 53 patients received BTX-A injections for rhytid reduction, lower face, shoulder, and leg reshaping. Injections were given in a split-face and right-left design randomly assigned. A vibration stimulus was coadministered with BTX-A injections on one side, whereas the other side received BTX-A injections only. Patients completed a questionnaire immediately after treatment and were followed up 2 weeks later. A visual analog scale of pain sensation was statistically analyzed.

RESULTS

The patients experienced both clinically and statistically significant pain reduction when a vibration was coadministered with injections. Patients reported less pain on the treated side compared with the control side. Overall, 75% of patients preferred to receive vibration with their next treatment. No adverse events were reported.

CONCLUSION

Vibration is an effective and safe way to reduce pain during cosmetic BTX-A injections and may have applications in other cosmetic procedures.
Outcomes Comparison for Microsurgical Breast Reconstruction in Specialty Surgery Hospitals Versus Tertiary Care Facilities
Authors: Vemula Rahul , Bartow Matthew J. , Freeman Matt , Callaghan Cameron , Matatov Tim , Jansen David , Allen Bob , Hilaire Hugo St. , Tessler Oren
Published: October 2017

Background:

Postoperative monitoring is crucial in the care of free flap breast reconstruction patients. Tertiary care facilities (TCFs) provide postoperative monitoring in an ICU after surgery. Specialty surgery hospitals (SSHs) do not have ICUs, but these facilities perform free flap breast reconstruction as well. Are outcomes comparable between the 2 facilities in terms of flap reexploration times and overall success?

Methods:

Retrospective study including 163 SSH and 157 TCF patients. Primary predictor was facility in which the procedure was performed. Secondary predictors included operative, demographic, and comorbidity data. Primary outcomes were flap take back rate and flap failures. Secondary outcomes were total time from adverse event noticed in the flap to returning to the operating room (OR) and total time from decision made to return to the OR to returning to the OR (decision made). Tertiary outcomes were length of stay, operative times, and blood loss.

Results:

Patients at the TCF were generally less healthy than SSH patients. Salvage rates and failure rates were similar between the 2 institutions. Adverse event noticed and decision made times did not differ between the 2 facilities. Overall flap success rate was 98.22% at SSH and 98.81% at TCF. No primary or secondary predictors had a significant correlation with increased odds for flap failure.

Conclusion:

SSHs can offer similar outcomes in free flap breast reconstruction with just as effective clinical response times to endangered flaps as found in a TCF. However, surgery at an SSH may best be reserved for healthier patients.
Oxidative Stress, Inflammation, and Neuroprogression in Chronic PTSD
Authors: Miller Mark W. , Lin Alex P. , Wolf Erika J. , Miller Danielle R.
Published: October 2017

Posttraumatic stress disorder is a serious and often disabling syndrome that develops in response to a traumatic event. Many individuals who initially develop the disorder go on to experience a chronic form of the condition that in some cases can last for many years. Among these patients, psychiatric and medical comorbidities are common, including early onset of age-related conditions such as chronic pain, cardiometabolic disease, neurocognitive disorders, and dementia. The hallmark symptoms of posttraumatic stress—recurrent sensory-memory reexperiencing of the trauma(s)—are associated with concomitant activations of threat- and stress-related neurobiological pathways that occur against a tonic backdrop of sleep disturbance and heightened physiological arousal. Emerging evidence suggests that the molecular consequences of this stress-perpetuating syndrome include elevated systemic levels of oxidative stress and inflammation. In this article we review evidence for the involvement of oxidative stress and inflammation in chronic PTSD and the neurobiological consequences of these processes, including accelerated cellular aging and neuroprogression. Our aim is to update and expand upon previous reviews of this rapidly developing literature and to discuss magnetic resonance spectroscopy as an imaging technology uniquely suited to measuring oxidative stress and inflammatory markers in vivo. Finally, we highlight future directions for research and avenues for the development of novel therapeutics targeting oxidative stress and inflammation in patients with PTSD.
NEW ULTRA–WIDE-FIELD ANGIOGRAPHIC GRADING SCHEME FOR RADIATION RETINOPATHY AFTER IODINE-125 BRACHYTHERAPY FOR UVEAL MELANOMA
Authors: McCannel Tara A. , Kim EunAh , Kamrava Mitchell , Lamb James , Caprioli Joseph , Yang Dong , McCannel Colin A.
Published: October 2017

Purpose:

Radiation retinopathy remains incompletely characterized and may cause severe vision loss. Ultra–wide-field fluorescein angiography provides a pan-fundus view of vascular alterations caused by radiation treatment and may predict visual and ocular outcomes. We have developed a grading scheme to describe pan-fundus severity and to predict the progression of radiation retinopathy in patients treated for uveal melanoma with iodine-125 brachytherapy.

Methods:

A retrospective review of patients treated with standard iodine-125 brachytherapy for uveal melanoma at the Ophthalmic Oncology Center at the University of California, Los Angeles, who had undergone both baseline and postbrachytherapy ultra–wide-field fluorescein angiography. A grading scheme was devised based on observations of vascular leakage, retinal perfusion status, and retinal proliferation. The correlation of grade severity with patient characteristics, tumor features, visual acuity, optical coherence tomography findings, and neovascular glaucoma was measured with chi-square and one-way analysis of variance analyses.

Results:

Sixty-seven patients were identified for review. Consistent wide-field angiographic patterns after brachytherapy were observed and graded as follows: Grade 0: normal; Grade 1: late foveal leakage; Grade 2: late peripheral leakage; Grade 3: presence of nonperfusion; and Grade 4: retinal neovascularization. Six eyes (8.9%) were Grade 0; 16 (23.8%) were Grade 1; 25 (37.3%) were Grade 2; 16 (23.4%) were Grade 3; and 4 (6.0%) were Grade 4. Higher grade radiation severity correlated significantly with duration of follow-up (P < 0.02); younger age (P = 0.035); worse visual acuity (P = 0.001); cystoid macular edema or atrophy on optical coherence tomography (P < 0.0001); and neovascular glaucoma (P = 0.003).

Conclusion:

Wide-field fluorescein angiography revealed distinct fundus-wide patterns of vascular damage, which were progressive in nature in eyes treated with iodine-125 brachytherapy for uveal melanoma and correlated with signs of progressive vascular injury. This grading scheme may have prognostic value to predict the progression of radiation retinopathy and to prognosticate visual outcomes in patients undergoing brachytherapy.
IN VITRO FLOW ANALYSIS OF NOVEL DOUBLE-CUTTING, OPEN-PORT, ULTRAHIGH-SPEED VITRECTOMY SYSTEMS
Authors: Zehetner Claus , Moelgg Marion , Bechrakis Emmanouil , Linhart Caroline , Bechrakis Nikolaos E.
Published: October 2017

Purpose:

To analyze the performance and flow characteristics of novel double-cutting, open-port, 23-, 25-, and 27-gauge ultrahigh-speed vitrectomy systems.

Methods:

In vitro fluidic measurements were performed to assess the volumetric aspiration profiles of several vitrectomy systems in basic salt solution and egg white.

Results:

Double-cutting open-port vitrectomy probes delivered stable aspiration flow rates that were less prone to flow variation affected by the cutting speed. Increase in cutting frequency to the maximum level resulted in flow reduction of less than 10% (0.0%–9.5%). Commercially available 23-, 25-, and 27-G double-cutting probes exhibited higher egg-white and basic salt solution flow rates at all evaluated cut rates, with aspirational efficiencies being 1.1 to 2.9 times the flow rates of standard single-blade vitrectomy probes of the same caliber at the maximum preset vacuum. The highest relative differences were observed at faster cut rates.

Conclusion:

The newly introduced double-cutting open-port vitrectomy probes delivered stable aspiration flow rates that were less prone to flow variation affected by the cutting speed. The fluidic principle of constant flow even at the highest cut rates and low vacuum levels might impact surgical strategies, especially when performing manipulations close to the retina.
REABSORPTION OF ACQUIRED VITELLIFORM LESIONS IN VITREOMACULAR DISORDERS AFTER VITRECTOMY
Authors: Bamonte Giulio , Appeltans Andrea , Cicinelli Maria Vittoria , Querques Giuseppe
Published: October 2017

Purpose:

To describe cases of reabsorption of subretinal acquired vitelliform material (acquired vitelliform lesion [AVL]) associated with vitreomacular disorders after 25-gauge pars plana vitrectomy and peeling of internal limiting membrane.

Methods:

Data of consecutive patients who underwent 25-gauge transconjunctival pars plana vitrectomy for vitreomacular disorders at the Department of Ophthalmology of the University Hospital of Brussels (Belgium) were collected. Patients featuring AVL on fundus examination or on spectral domain optical coherence tomography were recruited. Patients were followed up for 12 months after surgery.

Results:

Four eyes of three consecutive white patients presenting AVL were included. Three cases were affected by macular pucker, whereas one case featured vitreomacular traction syndrome. Progressive flattening of the AVL after surgery was observed in three eyes of three patients. One eye did not show any resorption of the submacular accumulation. In two eyes, atrophy of the retinal pigment epithelium and the outer retinal layers was observed along with resolution of the AVL, with significant worsening of visual acuity postoperatively.

Conclusion:

The outcome of surgery in cases of submacular AVL associated with vitreomacular interface syndromes could be heterogeneous and may depend on the duration of the disease and baseline optical coherence tomography characteristics of the lipofuscin accumulation.
The Development and Psychometric Testing on Psychiatric Nurses of a Nurse Case Management Competence Scale in Taiwan
Authors: Chen Shing-Chia , Lee Shih-Kai , Rong Jiin-Ru , Wu Chien-Chang , Liu Wen-I
Published: October 2017

Background:

Case management is a complex process involving multiple activities. It is vital that nurses are competent in all related tasks for case management. A competence scale is a valuable tool for assessing task-related competency.

Purpose:

The aims of this study were to examine the reliability and validity of an assessment scale for nurse case management competence and to use this scale to assess the current competency of nurses.

Methods:

A nurse case management competence scale was developed in three stages: (a) selection of assessment items according to standards of practice for case management and literature review, (b) determination of content validity using the Delphi technique with a panel of experts, and (c) psychometric testing of the developed competence scale using a cross-sectional design. Convenience sampling was used to recruit psychiatric nurses at seven psychiatric centers in Taiwan to complete the scale anonymously. An exploratory factor analysis was performed to analyze construct validity. Discriminant validity, internal consistency, and 2-week test–retest reliability were also examined.

Results:

Two hundred eighty-five psychiatric nurses completed an assessment scale comprising 18 items (originally 25 items). The content validity index reached 0.96 after the Delphi technique was applied twice in the expert panel. Seventy-eight percent of the total variance was explained by two dimension factors: coordination facilitation competence and direct care competence. Participants who had undertaken case management courses had superior case management ability compared with those who had not, indicating that the scale possesses excellent discriminant validity. Cronbach’s α and the test–retest results showed excellent reliability. Of the two competence factors, direct care competence (3.03) was better than coordination facilitation competence (2.81).

Conclusions/Implications for Practice:

There is a dearth of studies investigating the development and psychometric testing of case management competence scales. The results of this study provide evidence to support the reliability and validity of the developed case management competence scale among Taiwanese psychiatric nurses. It is a reliable and valid assessment instrument that may help identify educational needs and improve the case management competencies of nurses.
Relationship Between Lifestyles That Promote Health and Quality of Life in Patients With Chronic Schizophrenia: A Cross-Sectional Study
Authors: LIN Shih-Pi , LIU Chieh-Yu , YANG Chiu-Yueh
Published: October 2017

Background:

Over the last few decades, an increasing number of studies have examined quality of life in patients with chronic schizophrenia. However, little research has addressed the relationship between lifestyles that promote health and quality of life issues in these patients.

Purpose:

The aim of this study was to investigate the relationships between lifestyles that promote health and quality of life in patients with chronic schizophrenia.

Methods:

A cross-sectional study design was used. The study was conducted at 10 hospital-based psychiatric rehabilitation units in northern Taiwan. In total, 357 participants completed the World Health Organization Quality of Life–BREF and the Health-Promoting Lifestyle Profile. This study examined the relationships among the six domains of the Health-Promoting Lifestyle Profile and the four domains of the Quality of Life–BREF using canonical correlation analysis. Data collection occurred between April 2013 and April 2014.

Results:

The results of the canonical correlation analysis showed that the Health-Promoting Lifestyle Profile domains of nutrition, health responsibility, self-actualization, interpersonal support, exercise, and stress management were significantly related to the Quality of Life–BREF results, specifically in the physical, psychological, and social relationships and environment domains. Two canonical correlations were identified (the canonical correlation coefficients were .622 and .317), which showed that 38.6% of the variance in lifestyles that promote health and quality of life was shared.

Conclusions/Implications for Practice:

The results of this study may be useful to practitioners who are responsible for lifestyles that promote health and quality of life issues in patients with chronic schizophrenia.
Spleen and liver injuries: when to operate?
Authors: Gaarder Christine , Gaski Iver A. , Næss Pål A.
Published: October 2017

Purpose of review

Although nonoperative management (NOM) is the safest option in most patients with liver and splenic injuries or splenic injuries, some cases still need operative intervention. The aim of this review is to address the most recent literature and the evidence it provides for indications and timing of operative treatment for liver and spleen injuries.

Recent findings

There seems to be a decrease in publication rate on these topics over the last years, parallel to the acceptance of NOM as the ‘gold standard’, with little added to the existing body of evidence over the last 12–24 months. Most published studies are retrospective descriptions or comparisons with historical controls, some observational studies, but no randomized control trials (RCTs).

There is a striking lack of high-level evidence for the optimal treatment of solid organ injuries. The role of angiographic embolization as an adjunct to the treatment of liver and spleen injuries is still a matter of discussion.

Unstable patients with suspected ongoing bleeding from liver and spleen injuries or spleen injuries with inadequate effect of resuscitation should undergo immediate explorative laparotomy.

More RCTs are needed to further determine the role of angiographic embolization and who can be safely be treated nonoperatively and who needs surgical intervention.
Lumen Apposing Metal Stents (LAMSs) for Drainage of Pancreatic and Gallbladder Collections
Authors: Han Dennis , Inamdar Sumant , Lee Calvin W. , Miller Larry S. , Trindade Arvind J. , Sejpal Divyesh V.
Published: October 2017

Background and Aims:

Endoscopic ultrasound-guided transmural drainage using lumen apposing metal stents (LAMSs) is becoming a popular and promising therapeutic approach for drainage of intra-abdominal fluid collections. There has been an increasing number of studies evaluating LAMS for drainage of pancreatic pseudocysts (PP), walled-off pancreatic necrosis (WOPN), and gallbladder (GB) drainage. The aim of this meta-analysis is to analyze the literature to date regarding the clinical success, technical success, and adverse events of LAMS in treatment of pancreatic fluid collections and GB drainage.

Methods:

A comprehensive search of multiple literature databases through November 2016 was performed. Human studies with at least 10 subjects that examined the clinical success, technical success, and adverse events of LAMS in treating PP, WOPN, and GB drainage were included.

Results:

A total of 993 patients (608—WOPN; 204—PP; 181—GB drainage) underwent drainage from 20 trials. For drainage of WOPN, the pooled technical success was 98.9% [95% confidence interval (CI): 98.2% to 99.7%] and clinical success was 90% (95% CI: 87% to 93%) (τ2=0.001). For drainage of PP, the pooled technical success was 97% (95% CI: 95% to 99%) and clinical success was 98% (95% CI: 96% to 100%), (τ2=0.001). For GB drainage, the pooled technical success was 95% (95% CI: 91% to 99%) and clinical success was 93% (95% CI: 90% to 97%), (τ2=0.001). Total adverse events occurred in 11% of patients with higher complication rates observed in GB drainage. There was no evidence of publication bias in this meta-analysis.

Conclusions:

Endoscopic ultrasound-guided transmural drainage using LAMS is becoming a widely accepted therapeutic approach for the treatment of PP, WOPN, and GB drainage with high clinical and technical success rates and acceptable adverse events. Further prospective randomized trials reporting long-term clinical efficacy and cost-effectiveness are needed to validate LAMS as a therapeutic modality for pancreatic and GB collections.
State Variation in Quality Outcomes and Disparities in Outcomes in Community Health Centers
Authors: Cole Megan B. , Wilson Ira B. , Trivedi Amal N.
Published: October 2017

Background:

Prior studies have reported that community health centers perform as well as other sites of care, despite serving more vulnerable patient populations. However, there is little prior study of geographic variation in quality outcomes and disparities in outcomes in this setting. Quantifying geographic variation is important so as to target quality improvement efforts and funding and to learn from states where total quality is highest and racial/ethnic disparities are lowest.

Objectives:

To estimate between-state variation in hypertension, diabetes, and pregnancy outcomes and racial/ethnic disparities in these outcomes for health center patients.

Methods:

Using data on all US health centers from 2010 to 2014 (N=1047 health centers/year, or 21.2 million patients in 2014), we used linear regression models to estimate adjusted quality outcomes and racial/ethnic disparities in quality outcomes by state for hypertension control, diabetes control, and normal birthweight.

Results:

We found wide variation in both outcomes and racial/ethnic disparities in outcomes between states for patients seen at health centers. For instance, between states, the mean proportion of patients with hypertension control ranged from 58% to 70% for white patients, from 49% to 64% for black patients, and from 53% to 74% for Hispanic patients (P<0.001). Racial/ethnic disparities in outcomes ranged from negative or nonsignificant in some states to positive in others.

Conclusions:

Wide variation in health center patient outcomes and disparities in outcomes is observed between states. This variation suggests that policymakers should target funding and interventions to underperforming states, and identify determinants of high quality in higher performing states.
Femoral Vein Catheter is an Important Risk Factor for Catheter-related Thrombosis in (Near-)term Neonates
Authors: Dubbink-Verheij Gerdina H. , Pelsma Iris C.M. , van Ommen Cornelia H. , Smits-Wintjens Vivianne E.H.J. , Visser Remco , Steggerda Sylke J. , te Pas Arjan B. , Lopriore Enrico
Published: October 2017

Central venous catheters (CVCs) in neonates are associated with an increased risk of thrombosis. Most reports focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs), whereas data available on femoral venous catheters (FVCs) are limited. We performed a retrospective cohort study in all neonates (gestational age ≥34 wk) with CVCs. The primary outcome was the occurrence of thrombosis in CVCs. The secondary outcomes were possible risk factors for thrombosis, the thrombotic incidence in FVCs, UVCs, and PICCs, and clinical aspects of thrombosis in these groups. A total of 552 neonates received a total of 656 catheters, including 407 (62%) UVCs, 185 (28%) PICCs, and 64 (10%) FVCs. Thrombosis was detected in 14 cases, yielding an overall incidence of 2.1% or 3.6 events per 1000 catheter days. FVC was significantly associated with the occurrence of thrombosis when compared with UVC (P=0.02; odds ratio, 3.8; 95% confidence interval, 1.2-12.0) and PICC (P=0.01; odds ratio, 8.2; 95% confidence interval, 1.6-41.7). The incidence of thrombosis was higher in FVCs than in UVCs and PICCS, that is, 7.8% (5/64), 1.7% (7/407), and 1.1% (2/185), respectively (P<0.01). The number of thrombotic events per 1000 catheter days was 12.3 in FVCs, 3.2 in UVCs, and 1.5 in PICCs (P<0.05). We concluded that thrombosis occurs more frequently in FVCs than in other CVCs.
The New Age of Bullying and Violence in Health Care: Part 3
Authors: Fink-Samnick Ellen
Published: October 2017

Purpose/Objectives:

This article:

Primary Practice Setting(s):

Applicable to all health care sections where case management is practiced.

Findings/Conclusions:

This article is the third of a 4-part series on the topic of bullying in the health care workplace. Part 3 addresses the dimensions of the bullying boss and leadership, posing major implications for patient safety plus the mental health of staff members. The complex constructs and dynamics broached by the bullying boss and department leadership are explored. These include the underlying forces at play such as power, gender, leadership styles, plus weaves in assessment models. Strategic and proactive management of bullying by leadership is vital to workforce retention and well-being.

Implications for Case Management Practice:

The increasing incidence and impact of bullying across all sectors have made it a major workforce performance management challenge. Health care settings are especially tense environments, often making it difficult for individuals to distinguish between bullying behavior and high expectations for staff. Bullying impacts both direct targets and bystanders who witness the assaultive behaviors, with ethical implications as well.

Case management is poised to promote a safe health care workplace for patients and practitioners alike amid these intricate circumstances. Understanding types of bullying bosses and leadership styles is integral to a case manager's success in the workplace.