bluuebunny/crossref_metadata_2025 huggingface dataset:
The spectrum of disorders associated with adult rheumatic and musculoskeletal diseases
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

The Oxford Handbook of Rheumatology, 4th edition, takes the reader through a pragmatic and realistic way of assessing musculoskeletal and rheumatological disease presentation in its first four chapters. The text reflects real life, with differential diagnoses suggested as information becomes available through the details from history, then examination, then investigations. The chapters focus on patterns of, and focal regional, symptoms in adults and children. In this chapter, the book considers musculoskeletal and rheumatic conditions which occur in, or are closely associated with, other conditions of the skin, eye, heart, lung, kidney, and in hormonal, neurological, and gastrointestinal systems. Such an approach should help general practitioners and rheumatology trainees caring for their patients across their medical comorbidities and in general medicine. There is also a section on musculoskeletal–rheumatological features in patients with neoplasia. The chapter focuses primarily on adult disease.
Rheumatoid arthritis
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter describes the presenting features, clinical manifestations, and management of rheumatoid arthritis. Commonly used investigations, their indication and interpretation, as well as the holistic treatment of rheumatoid arthritis are outlined. A summary of the commonly used drugs for the treatment of rheumatoid arthritis, their mechanism of action, and key points for starting and monitoring their use is included. Special circumstances including the management of rheumatoid arthritis in pregnancy, surgery, vaccinations, and during infections are also discussed.
The spondyloarthritides including psoriatic arthritis
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

The Oxford Handbook of Rheumatology, 4th edition, includes a chapter on spondyloarthritis (SpA) conditions. These conditions are axial spondyloarthritis, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and inflammatory bowel disease-related arthritis. It summarizes evidence for pathogenetic mechanisms either common to all conditions, or specific for each condition, highlights current disease classifications, and emphasizes clinical features common to all SpAs, such as inflammatory back pain and enthesitis. There is an expanded section on treatments including biologic disease-modifying antirheumatic drugs (bDMARDs; ‘biologics’) such as anti-tumour necrosis factor-α‎, ustekinumab, and secukinumab, and new to this edition of the Handbook, an expanded section on juvenile spondyloarthritis.
Antiphospholipid syndrome
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter describes the clinical and laboratory classification criteria for antiphospholipid syndrome. It highlights the complexity and diagnostic challenges of antiphospholipid syndrome and discusses potential mimics of the disease that need to be excluded. Current therapeutic targets as well as novel therapeutic avenues are explored. The chapter finishes with a section on catastrophic antiphospholipid syndrome, which constitutes a rheumatological emergency. The clinical presentation, laboratory features, treatment, and outcomes of this life-threatening presentation of antiphospholipid syndrome are also discussed.
Sjögren’s syndrome
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter focuses on Sjögren’s syndrome and covers epidemiological, pathophysiological, and clinical aspects of disease. It discusses classification criteria and disease-specific features, along with potential differential diagnoses. The chapter also includes a section on the extra-glandular (systemic) manifestations of disease, illustrating its potential for multiorgan involvement. The chapter provides a guide to the reader regarding how to best approach a patient presenting with related symptoms and signs. Furthermore, it discusses relevant investigations for the key manifestations of disease, the sicca symptoms, and describes common biopsy findings. The chapter closes with the treatment of Sjögren’s syndrome and a note on prognosis.
Primary vasculitides
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter describes large, medium, and small vessel primary vasculitides. The 2012 Chapel Hill Consensus Conference nomenclature of vasculitis is introduced, and acts as a framework for more detailed descriptions of polymyalgia rheumatic and giant cell arteritis, polyarteritis nodosa (systemic and cutaneous), granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, Takayasu arteritis, childhood-onset vasculitis, Kawasaki disease, Henoch–Schönlein purpura, and leucocytoclastic vasculitis. Other antineutrophil cytoplasmic antibody-associated vasculitides and primary angiitis of central nervous system in children are also covered. The epidemiology, aetiopathogenesis, classification criteria, presenting features, clinical manifestations, and management of these diseases are presented. In particular, diagnostic criteria for and mimics of polymyalgia rheumatic and giant cell arteritis are discussed in detail to permit rheumatologists and non-rheumatologists to confidently manage them.
Common upper limb musculoskeletal lesions
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter introduces readers to some common upper limb musculoskeletal lesions, including subacromial (shoulder) impingement syndrome, adhesive capsulitis, and lateral epicondylitis (tennis elbow). The epidemiology, aetiopathogenesis, clinical presentation, and management of these conditions are presented. Algorithms for their management are provided. Other disorders presenting with a subacromial impingement pattern of pain are detailed and optimal diagnostic imaging methods proposed. These include supraspinatus/cuff tendonitis, subacromial bursitis, rotator cuff tear, long head of biceps tendonitis, osteophyte impingement on the rotator cuff tendon, glenohumeral instability due to labral trauma (e.g. SLAP lesion), arthritis of the glenohumeral joint, enthesitis related to spondyloarthritis, and lesions at the suprascapular notch.
Drugs used in rheumatology practice
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

The Oxford Handbook of Rheumatology, 4th edition, emphasizes the importance of evidence-based therapeutics and therefore devotes a whole chapter to medications used to treat rheumatological and bone disease (‘Drugs used in rheumatological disease’). Details about treatments are cross-referenced to specific use of medications for specific diseases and conditions elsewhere in the book. There are chapter sections on analgesics including opiate-based medications, NSAIDs, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, intravenous immunoglobulin, and other immunosuppressants. There is a specific focus in the chapter on drugs used for Raynaud’s disease, osteoporosis (e.g. bisphosphonates), pulmonary hypertension, gout, and hyperuricaemia. Overall there is reference to both adult and paediatric disease treatments in the chapter.
Rheumatological emergencies
Authors: Clunie Gavin , Wilkinson Nick , Nikiphorou Elena , Jadon Deepak R.
Published: August 2018

This chapter covers commonly encountered rheumatological emergencies, including septic arthritis (for both adults and paediatrics), infections in patients taking biologic therapy, acute systemic lupus erythematosus (SLE), systemic vasculitis, systemic sclerosis-related crises, methotrexate-induced pneumonitis, macrophage activation syndrome (MAS), and paediatric osteomyelitis. Malignancies presenting with musculoskeletal symptoms in children are also covered. Several of these topics are covered in more detail in other chapters of this handbook, with links provided from this chapter as appropriate.
Exercise and sport in the management of cardiovascular diseases (ischaemic heart disease, heart failure, and hypertension)
Authors: Piepoli Massimo Francesco
Published: August 2018

Physical activity promotion is a key component of all preventive interventions in the management of cardiovascular diseases: many of the multi-risk factor benefits are mediated through its implementation. In cardiovascular diseases, physical exercise increases fibrinolysis and decreases coagulability, exerts anti-inflammatory effects, improves autonomic function, and prevents and restores age-related declines in endothelium-dependent vasodilatation, which may also help to explain the improvement in hyperaemic myocardial blood flow (flow reserve). Regular physical activity slows coronary artery disease progression, and improves functional independence by improving fitness and reducing signs and symptoms of exercise intolerance. In addition, peak oxygen uptake is an important predictor of both cardiac and all-cause death: even a small gain in aerobic power may improve not only functional capacity but also survival prospects. In this chapter, key points concerning implementation of exercise in ischaemic heart disease, heart failure (including cardiac transplantation), and hypertension are discussed.
Medico-legal aspects of surgical practice
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Medical law is a branch of law concerned with the responsibilities of healthcare professionals and the rights of patients. Civil cases (litigation) are heard in the County and High Court in England and Wales, and Sheriff Courts and Court of Session in Scotland. If a trial takes place, then the claimant has to provide enough evidence, and judgment would be based on the balance of probabilities. Both parties can appeal the judgment. Criminal cases (proceedings) are dealt with by the Crown Prosecution Service (CPS) in most cases. The CPS engages barristers to conduct the prosecution in the higher court. The burden of proof is placed on the prosecution. They must call supporting evidences to prove that the defendant is guilty. The defendant then needs to prove that the evidence is unreliable and that the evidence does not prove guilt to the required standards. i.e. beyond reasonable doubt. Doctors should always be aware of certain aspects of medicolegal principles in their practice, such as rules for appearing in court for doctors, writing a statement, mental health act, brain stem death, and confidentiality.
Principles of wound care
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

It’s important to be aware of healing process, associated comorbidities, and the role of nutrition in wound care management. Assessment of the amount and type of wound exudate plays an important role in deciding the type of dressing used. Infection or underlying osteomyelitis needs careful assessment, further investigation, and administration of systemic/oral anti-microbial therapy. Early use of non-surgical or surgical debridement is necessary to speed up the healing process. Diagnostic criteria of surgical site infection are increasingly used in postoperative wounds in hospitals for audit of infection control measures. No one type of dressing appears superior over other. Dressings should be cost effective, acceptable to the patients, and easy to use. In addition, in recent decades newer non-surgical debriding method, e.g. larvae therapy and negative pressure wound therapy, are increasingly being used and supported by recent NICE guidelines, especially in diabetic foot care.
Principles of blood transfusion
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Blood transfusion allows an increase in the oxygen-carrying capacity of blood, with a resultant more efficient delivery of oxygen to vital and non-vital organs. Transfusion should always be taken cautiously, weighing the expected benefits against possible risks. Clear valid justification for blood transfusion should always be available and documented in the patient’s notes. The chapter discusses different indications, contraindications, and special particulars related to blood transfusion services.
Principles of pain management
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Post-operative pain is related to surgical trauma and pre-operative assessment plays a vital part in post-operative pain management. Both pharmacological and non-pharmacological options should be discussed with the patient and do help in quick recovery. The ABCDE approach should be followed whilst assessing the pain postoperatively. WHO analgesic ladder is recommended for pain management. Effective management of side-effects of analgesia and re-evaluation of pain management are also important. The same principle is applied for cancer pain and neuropathic pain.
Diverticular disease
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Diverticular disease prevalence increases with age with up to 70% in octogenarians. Diverticulitis can be uncomplicated or complicated. The Hinchey classification is used to categorize complicated diverticulitis and guides urgent treatment, which may range from antibiotics to laparotomy. Recommended investigations are outlined, as well as conservative treatment. Management of diverticular bleeding may be problematic and guidelines in this area are outlined including urgent colonoscopy, CT angiography, and therapeutic superselective mesenteric angiography.
Anal fissures
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Anal fissure is a common painful condition with a lifetime incidence of 11%. Most occur posteriorly and most are associated with sphincter hypertonia. Therapies centre around conservative measures, topical smooth muscle relaxants, and botulinum toxin therapy. Lateral sphincterotomy still has a place in treatment for refractory cases, as does advancement flap.
Colorectal cancer
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Colorectal cancer may present with anaemia, bleeding, bowel habit change, or as an emergency with obstruction/perforation. Diagnosis is most commonly on endoscopy and biopsy. CT staging is a universal assessment, and MRI is used for local staging of rectal cancer. Treatment is according to stage, but primary cancer is most often resected, and principles of resection in the colon and rectum are discussed. Neo-adjuvant radiotherapy is given in moderate or high risk rectal cancer. Adjuvant chemotherapy is recommended for Dukes C tumours and for selected Dukes B.
Acute pancreatitis
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Acute pancreatitis presents with severe abdominal pain and systemic inflammation. Raised amylase is still the cornerstone of diagnosis along with CT scanning where diagnosis is uncertain. Causes include gallstones, alcohol abuse, and hypertriglyceridaemia. Therapy centres on supportive therapy and managing systemic inflammatory response/organ failure. Scoring systems are described which help predict severity of the attack, as well as nutritional support and treatment of complications (necrosis, pseudocyst).
Hepatocellular carcinoma (HCC) and hepatic hydatid disease (HHD)
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Hepatocellular carcinoma (HCC) is strongly associated with cirrhosis. High-risk groups include those with hepatitis due to hepatitis B (HBV) or C (HCV) virus. This chapter provides an algorithm for investigating liver nodules in order to diagnose hepatocellular carcinoma. It explores surgical options including resection, liver transplantation, and minimally invasive options, such as radiofrequency ablation. Palliative options are described and an algorithm for the treatment of HCC is presented. The chapter also discusses hepatic hydatid disease, caused by the metacestode stages of Echinococcus granulosus and E. multilocularis.
Prevention of post-splenectomy sepsis (PSS)
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Post-splenectomy sepsis is a potentially lethal yet preventable complication. It’s common in children and most cases occur within 2 years of splenectomy. This chapter highlights the risk factors for developing this complication and potential pathogens. It explores recommended investigations and provides an algorithm for its prevention. Prevention involves antibiotics, immunization, and patient education.
Carotid artery stenosis
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Carotid disease is often asymptomatic but can lead to strokes, transient ischaemic attacks (TIA), or amaurosis fugax. This chapter explores the pathogenesis of the disease and examines the investigations often used to diagnose the severity of the carotid stenosis. It details the ABCD scoring system for TIA evaluation and the features in the carotid ultrasound scan that are used to establish the degree of stenosis. A recommended approach to managing symptomatic and asymptomatic carotid disease is described.
Surgery for hyperparathyroidism
Authors: Jibawi Abdullah , Baguneid Mohamed , Bhowmick Arnab
Published: August 2018

Hyperparathyroidism (HPT) is abnormal excessive production of parathyroid hormone (PTH) from the parathyroid gland(s), often with resultant hypercalcaemia. HPT affects 1% of adult population. Incidence increases after the age of 55. Over 80% of primary hyperparathyroidism (PHP) cases in Western countries are found incidentally by routine biochemical tests or on investigation of aetiology of resultant end-organ damage (osteoporosis and renal stones). Diagnosis can be established by demonstrating persistent hypercalcaemia (or serum calcium at the high normal levels) in the presence of elevated (or inappropriately normal) PTH concentrations and elevated urinary calcium excretion. Surgical resection is the treatment of choice for all symptomatic and asymptomatic patients with overactive parathyroid gland who are ﬁt for surgery.
A Practical Guide to Using Qualitative Research with Randomized Controlled Trials
Authors: O'Cathain Alicia
Published: August 2018

A Practical Guide to Using Qualitative Research with Randomized Controlled Trials focuses on qualitative research, emphasizing subjectivity, flexibility, open data collection, depth, and context, and randomized controlled trials (RCTs), emphasizing objectivity, standardization, measurement, and a key goal of bias reduction. The differences between the two methodologies make their combination an interesting ‘extreme case’ of mixed methods research. The book is about how to use qualitative research when preparing for, undertaking, or implementing the results of an RCT. The focus is on a range of designs, including pilot and pragmatic RCTs. The book focuses on health research because the majority of RCTs are undertaken in this field. It is written for researchers who are undertaking or planning to undertake qualitative research with RCTs. The book may also be useful to researchers leading RCTs and graduate students. It does not explain how to do qualitative research or how to do RCTs. The book focuses on how to undertake qualitative research in the specific context of RCTs. The book is divided into three parts. Part 2 offers the practical guidance promised within the title of the book. Each chapter focuses on key steps when undertaking qualitative research in the context of RCTs: writing a proposal, selecting research questions, collecting data, analysing data, integrating qualitative and quantitative components, and publishing. Part 1 sets the scene for the practical aspects. Part 3 focuses on the human beings we work closely with during research and offers practical advice to ensure these interactions are positive and fruitful.
Assessing the quality of qualitative research undertaken with RCTs
Authors: O'Cathain Alicia
Published: August 2018

In this chapter the focus is on how researchers can attend to quality when undertaking qualitative research with RCTs, including the steps involved in achieving methodological rigour. The assessment of the quality of published qualitative research is considered, and the range of guidance available presented.
Neuroradiology
Authors: Manji Hadi , Connolly Seán , Kitchen Neil , Lambery Christian , Mehta Amrish , Sheikh Faraz Tariq
Published: August 2018

Abstracts and keywords to be supplied.
Lymphoma
Authors: Provan Drew , Baglin Trevor , Dokal Inderjeet , de Vos Johannes , Al-Sader Hassan
Published: August 2018

Non-Hodgkin lymphoma (NHL) - International Prognostic Index - Indolent lymphoma - Treatment of indolent lymphoma - Aggressive lymphomas - Initial treatment of aggressive lymphomas - Salvage therapy in aggressive lymphomas - Response criteria for lymphoma - Role of FDG-PET scanning in NHL diagnosis and treatment - CNS lymphoma - Hodgkin lymphoma (HL) - Treatment of HL
Myeloproliferative neoplasms
Authors: Provan Drew , Baglin Trevor , Dokal Inderjeet , de Vos Johannes , Kaur Mammit
Published: August 2018

Myeloproliferative neoplasms (MPNs) - Pathogenesis of the MPNs - Polycythaemia vera (PV) - Natural history of PV - Management of PV - Secondary erythrocytosis - Relative erythrocytosis - Idiopathic erythrocytosis - Essential thrombocythaemia - Reactive thrombocytosis - Primary myelofibrosis - Chronic neutrophilic leukaemia - Eosinophilic syndromes and neoplasms - Mastocytosis (mast cell disease) - Systemic mastocytosis - MPN—unclassifiable
Blood transfusion
Authors: Provan Drew , Baglin Trevor , Dokal Inderjeet , de Vos Johannes , Allard Shubha , Kaur Mammit
Published: August 2018

Introduction - Using the blood transfusion laboratory - Transfusion of red blood cells - Platelet transfusion - Fresh frozen plasma - Intravenous immunoglobulin - Transfusion transmitted infections - Irradiated blood products - Strategies for reducing blood transfusion in surgery - Maximum surgical blood ordering schedule (MSBOS) - Patients refusing blood transfusion for religious reasons, i.e. Jehovah’s Witnesses
Treatment: head and neck
Authors: Johnson Chris , Dallimore Jon , Cobb Alistair R. M. , Cooper Paul , Morris Daniel S. , Nickol Annabel H. , Geddes David , Hearns Stephen
Published: August 2018

Anatomy - Facial injuries - Minor injuries to head and neck - Fractured facial bones - Head injury - Blackouts, syncope, and epilepsy - Migraine - Sleep disturbances - The eye - Ear problems - Nasal problems - Upper respiratory tract
Treatment: dental
Authors: Johnson Chris , Cobb Alistair R. M. , Granger Penelope B. , Langdana Burjor K. , Geddes David , Drew Rose
Published: August 2018

Dental terminology - Pre-departure preparations - Dental work in the field - Toothache and dental swellings - Fillings - Dislodged crowns and bridges - Dental injuries - Dental local anaesthesia - Extractions - Medevac for dental problems
Treatment: chest
Authors: Nickol Annabel H. , Ferguson Jonathan , Leach Jonathan , Thompson Julian , Thurgood Andrew , Warrell David A.
Published: August 2018

Introduction - Chest pain - Myocardial infarction - Rib fractures - Spontaneous pneumothorax - Acute chest infections - Asthma
Risks from animals
Authors: Warrell David A. , Bond Jim , Conway Robert , Davies John , Figgins Lloyd , Fox Simon , Healey Beth , Whitton Lucy
Published: August 2018

Animals that can cause severe trauma - Treatment of trauma caused by animals - Venomous land animals - Venomous marine animals - Poisonous fish and shellfish
Anaesthesia in remote locations
Authors: Craven Rachael , Silsby Joe
Published: August 2018

Introduction to field anaesthesia - When to give an anaesthetic - Know your limits - Local infiltration anaesthesia - Peripheral nerve blocks - Spinal anaesthesia - Ketamine anaesthesia - Sedation - Suggested minimum equipment and drugs for field anaesthesia
Mountains and high altitude
Authors: Imray Chris , Johnson Chris , Dallimore Jon , Nickol Annabel H. , Pollard Andrew J. , Roberts Barry , Rodway George W. , Windsor Jeremy , Clarke Charles , Moxon Christopher
Published: August 2018

The high-altitude environment - Avalanches - Preparing to travel to altitude - Humans at altitude - High-altitude physiology - High-altitude illness - Children at altitude - Chronic mountain sickness
Inland and coastal waters
Authors: Johnson Chris , Morgan Paddy , Watt Andy
Published: August 2018

Aquatic environments - Rescue - Humans in aquatic environments - Immersion and drowning - Canoeing and kayaking - White-water rafting - Medical problems in small craft
Offshore
Authors: Johnson Chris , Briggs Spike , MacKenzie Campbell
Published: August 2018

The environment - Risk assessment - Environmental impact of sailors - Preparations for voyage - Offshore medical kits - Offshore medical problems - Emergency procedures
Underwater
Authors: Johnson Chris , Conway Robert , Thomson Lesley F. , Pitkin Andy , Drew Rose
Published: August 2018

The underwater environment - Preparations before travel - Diving medicine - Effects of high-pressure gases - Decompression sickness - Barotrauma - Other problems
The short orbital period binary star at the heart of the planetary nebula M 3-1
Authors: Jones David , Boffin Henri M J , Sowicka Paulina , Miszalski Brent , Rodríguez-Gil Pablo , Santander-García Miguel , Corradi Romano L M
Published: August 2018

We present the discovery of a 3h5m orbital-period binary star at the heart of the planetary nebula M 3-1 – the shortest period photometrically variable central star known and second only to V458 Vul, in general. Combined modelling of light and radial velocity curves reveals both components to be close to Roche lobe filling, strongly indicating that the central star will rapidly evolve to become a cataclysmic variable, perhaps experiencing a similar evolution to V458 Vul resulting in a nova eruption before the planetary nebula has fully dissipated. While the short orbital period and near Roche lobe filling natures of both components make the central binary of M 3-1 an important test case with which to constrain the formation processes of cataclysmic variables, novae, and perhaps even supernovae type Ia.
Implementing a small media intervention to increase colorectal cancer screening in primary care clinics
Authors: Melvin Cathy L , Vines Anissa I , Deal Allison M , Pierce Holly O , Carpenter William R , Godley Paul A
Published: August 2018

Colorectal cancer (CRC) is one of the most common cancers in the USA. In 2017, an estimated 135,420 people were diagnosed with CRC and 50,260 people died from CRC. Several screening modalities are recommended by the United States Preventive Services Task Force (USPSTF), including annual stool tests that are usually completed at home and under-used compared with colonoscopy despite stated patient preferences for an alternative to colonoscopy. The Community Preventive Services Task Force recommends use of small media interventions (SMIs) to increase CRC screening and calls for a greater understanding of its independent impact on screening participation. This study tested whether a SMI increased the likelihood of participant return of a USPSTF recommended Fecal Immunochemical Test (FIT). In total, 804 individuals participated in a two-group, prospective randomized controlled trial. Descriptive statistics with chi-square tests compared differences in participant characteristics and return rates. Multivariable log-binomial modeling estimated combined effects of patient characteristics with FIT return rates. No differences in return rates were observed overall or by participant characteristics other than the year of enrollment. A multivariable model controlling for all covariates, found gender, insurance type, and regular place for healthcare to be significantly associated with return rates. Receipt of the SMI did not independently increase overall return rates but it may have improved the ease of completing the FIT by some participants, particularly women, those with insurance, and those with a regular place for healthcare.
A Perspective on the Baltimore Freddie Gray Riots: Turning Tragedy Into Civic Engagement and Culture Change in an Academic Department of Medicine
Authors: Golden Sherita Hill , Cudjoe Thomas K.M. , Galiatsatos Panagis , Brownlee Darren , Flanagan Eleni , Crews Deidra C. , Maruthur Nisa , Brown Megan , Ashby Anthony , Hellmann David B. , Knox Tamala , Anderson Mark E.
Published: August 2018

Problem

The Johns Hopkins University School of Medicine Department of Medicine (DOM) sought ways of enhancing community engagement after the death of Freddie Gray and consequent unrest in Baltimore City.

Approach

The DOM launched a five-part noon lecture series in May 2015—“Journeys in Medicine”—to facilitate discussion among DOM faculty, staff, trainees, and community residents regarding the city’s unrest. This evolved into a department-wide civic engagement initiative in July 2016 to enhance employee and community engagement. The civic engagement committee is composed of two collaborative steering committees: Staff Engagement and Community Engagement.

Outcomes

The DOM has sponsored and/or participated in programs to address major concerns raised during the Journeys in Medicine series—improving the strained relationship between police and the community, mentoring young people, involving more DOM employees in community activities, sharing research results with the community, and addressing cultural differences to enhance relationships and communication. To enhance staff engagement, a Nursing Diversity Council, complementing the Faculty Diversity Council, has been established. DOM faculty and staff have participated in and championed several disease-focused physical activity endeavors (e.g., walks) that, collectively, have raised over $40,000. Community service projects include supporting registration and screenings at a local health fair, a professional clothing drive, and DOM Days of Service.

Next Steps

The Johns Hopkins University School of Medicine DOM is developing an administrator leadership program and continuing to participate in meaningful activities, leading to tangible outcomes designed to strengthen connections to the surrounding neighborhood and enhance engagement among all DOM employees.
Posttraumatic Subfibular Ossicle Formation in Children: Experience in a Single Primary Care Unit
Authors: Lee Dong Yeon , Lee Doo Jae , Kim Dong Han , Shin Hyuck Soo , Jung Whan Ik
Published: August 2018

Background:

Although subfibular ossicles have been linked to various clinical problems, whether its origin is congenital or traumatic remains unclear. The objectives of this study were to determine the incidence of subfibular ossicle formation after ankle inversion in children.

Methods:

Among 896 pediatric patients who visited a single primary care unit after foot and ankle trauma, 593 patients sustaining ankle inversion injury were included in this study. For each pediatric patient, physical examination and radiographic examination were performed. The incidence of subfibular ossicle was evaluated based on initial radiographic examination. To analyze the incidence of unprecedented subfibular ossicle formation after ankle inversion injury, radiographs of 188 patients who were followed up for >6 months were evaluated according to the grade of initial injury.

Results:

At initial visit, 1.0% of examined ankles (12 from 1186 ankles) showed well-corticated subfibular ossicle not related to initial injuries. Overall incidence of subfibular ossicle at final follow-up after ankle inversion injury was 39.4% (74/188). Incidence of subfibular ossicle at final follow-up was associated with initial injury grade. As for the morphology of ossicle, 93.2% (55/59) of cases with wafer bone fragment at the time of initial injury became oval or round-shaped subfibular ossicle at final radiograph.

Conclusions:

The chance of ossicle formation after ankle inversion injury was substantially high in pediatric population. On the basis of the findings of our study, we carefully suggest that majority, if not all, of subfibular ossicles would be posttraumatic in pediatric period.

Level of Evidence:

Level IV—case series.
Basic Science Behind the Development of Posttraumatic Osteoarthritis of the Ankle
Authors: Liles Jordan L. , Steele John R. , Chen Fengyu , Nettles Dana L. , Adams Samuel B.
Published: August 2018

As the diagnosis of ankle osteoarthritis (OA) increases over time due to the use of new imaging modalities, including both direct visualization through arthroscopy and indirect imaging modalities such as magnetic resonance imaging and computed tomography, our understanding of the cause and progression of this disease is also growing. Unlike many other causes of end-stage OA in the body (knee, hip, shoulder), a majority of the causes of end-stage OA in the ankle is related to trauma. This unique difference between these major joints offers clinicians the ability to not only identify a specific timepoint which serves as the starting point for development of posttraumatic osteoarthritis (PTOA) in the ankle, but also serves as a possible initial timepoint for intervention to prevent further progression of the disease. In this article, we will review the biomechanical differences between the ankle and other weight-bearing joints, as well as changes in the cartilaginous cellular composition between the ankle joint and other weight-bearing joints at baseline and following trauma. In addition, the development of PTOA in the ankle is commonly explained using 2 different models of arthritis development: a mechanical model and an inflammatory model. This article outlines the basic science behind the mechanical and inflammatory model of development of PTOA of the ankle. The purpose of this article is to review the state of literature and understanding of ankle PTOA and serve as a foundation for future research aimed at reducing severity and progression of PTOA.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
From Death to Health in 30 Days
Authors: Becker Susan E. , Nickloy Diane
Published: August 2018

Background

Heredity hemochromatosis (HH) is an underdiagnosed genetic disease that can lead to life-threatening multisystem organ failure. Identifying and treating HH early can prevent the progression of the disease.

Case Presentation

For a 60-year-old white patient without obvious symptoms, it was a revelation to discover that he had HH. This patient, although receiving evidence-based care, ultimately required a liver transplant. As his condition deteriorated, the plan for this patient and his family involved working within an interdisciplinary team that included nurse practitioners and intensive care unit nurses.

Discussion

The uniqueness of this case illustrates the crucial role of a health care team that persisted in differentiating the patient’s diagnosis and continued to sustain both physical and emotional care throughout his hospitalization despite a poor prognosis. The patient felt support from this team during the course of his illness, from requiring life-supporting care in intensive care unit to returning home and resuming his normal activities of daily living.
Serum Perfluorooctanoic Acid and Birthweight
Authors: Steenland Kyle , Barry Vaughn , Savitz David
Published: August 2018

Background:

A recent meta-analysis of 15 studies found a change in birthweight of −12.8 g (95% CI = −23.1, −2.38) per ng/ml PFOA in maternal or cord blood and −27.1 g (−50.6, −3.6) per log ng/ml PFOA. Almost all studies were done in low-exposed populations. There are nine new studies, adding 6,019 births to the previous 6,937 births.

Methods:

We conducted a meta-analysis of 24 studies. To combine all results, we approximated results for untransformed PFOA from nine studies using log-transformed PFOA. We also included another large study, excluded from previous analyses, in a sensitivity analysis.

Results:

We found a change of birthweight of −10.5 g (−16.7, −4.4) for every ng/ml PFOA in maternal or cord blood. After adding one previously excluded large study, we found little evidence of an association (−1.0 g; 95% CI = −2.4, 0.4). Restricting to studies where blood was sampled from mothers early in the pregnancy or shortly before conception (5,393 births), we found little association of PFOA with birthweight (−3.3 g [−9.6, 3.0]). In studies where blood was sampled late in the pregnancy (7563 pregnancies), lower birthweight was associated with higher PFOA (−17.8 [−25.0, −10.6]).

Conclusion:

Present human evidence provides only modest support for decreased birthweight with increasing PFOA. Studies with a wide range of exposure, and studies with blood sampled early in pregnancy, showed little or no association of PFOA with birthweight. These are studies in which confounding and reverse causality would be of less concern.
Corneal Cross-Linking: Current USA Status: Report From the Cornea Society
Authors: Belin Michael W. , Lim Li , Rajpal Rajesh K. , Hafezi Farhad , Gomes Jose A. P. , Cochener Beatrice
Published: August 2018

The initial published clinical report on riboflavin/ultraviolet A corneal cross-linking (CXL) for treatment of progressive keratoconus dates back to 2003. CXL has since then been widely used outside the United States for treatment of progressive keratoconus and post-laser in situ keratomileusis ectasia. The Food and Drug Administration (FDA) approved Avedro Inc.'s corneal cross-linking system (KXL) for treatment of patients with progressive keratoconus and post-laser in situ keratomileusis ectasia in April 2016. The procedure is not currently approved for stable keratoconus. There are 2 FDA-approved topical ophthalmic solutions for use in CXL. Riboflavin 5′-phosphate in 20% dextran ophthalmic solution 0.146% (Photrexa Viscous) and Riboflavin 5′-phosphate ophthalmic solution 0.146% (Photrexa) are intended for use with the KXL system. Photrexa Viscous is used in all CXL procedures, whereas Photrexa is indicated for use when the corneal stroma is thinner than 400 µm after completion of the Photrexa Viscous induction period. The FDA-approved procedure using the Dresden protocol (UV-A, 3 mW/cm2 for 30 min) induces cytologic and morphologic changes in the anterior 250 to 300 µm of the corneal stroma. It has been believed that a minimum thickness of 400 μm was necessary to protect the corneal endothelium from potential damage. The CXL procedure using the standard Dresden protocol is established as the gold standard for treatment of progressive keratoconus. CXL treatment is indicated for a list of conditions ranging from corneal ectasia to infectious keratitis. Newer protocols, treatment regimens, and expanded indications will require further refinements, investigations, and long-term studies.
What Should We Do When HIV-positive Children Fail First-line Combination Antiretroviral Therapy? A Comparison of 4 ART Management Strategies
Authors: Patten Gabriela , Schomaker Michael , Davies Mary-Ann , Rabie Helena , van Zyl Gert , Technau Karl , Eley Brian , Boulle Andrew , Van Dyke Russell B. , Patel Kunjal , Sipambo Nosisa , Wood Robin , Tanser Frank , Giddy Janet , Cotton Mark , Nuttall James , Essack Gadija , Karalius Brad , Seage George , Sawry Shobna , Egger Matthias , Fairlie Lee
Published: August 2018

Background:

Managing virologic failure (VF) in HIV-infected children is especially difficult in resource-limited settings, given limited availability of alternative drugs, concerns around adherence, and the development of HIV resistance mutations. We aimed to evaluate 4 management strategies for children following their first episode of VF by comparing their immunologic and virologic outcomes.

Methods:

We included children (< 16 years of age) with VF from 8 International Epidemiologic Database to Evaluate AIDS Southern Africa cohorts, initiating combination antiretroviral therapy (cART) between 2004 and 2010, who followed one of the 4 management strategies: continuing on their failing regimen; switching to a second-line regimen; switching to a holding regimen (either lamivudine monotherapy or other non-cART regimen); discontinuing all ART. We compared the effect of management strategy on the 52-week change in CD4% and log10VL from VF, using inverse probability weighting of marginal structural linear models.

Results:

Nine hundred eighty-two patients were followed over 54,168 weeks. Relative to remaining on a failing regimen, switching to second-line showed improved immunologic and virologic responses 52 weeks after VF with gains in CD4% of 1.5% (95% confidence interval [CI], 0.2–2.8) and declines in log10VL of -1.4 copies/mL (95% CI, -2.0, -0.8), while switching to holding regimens or discontinuing treatment had worse immunologic (-5.4% (95% CI, -12.1, 1.3) and -5.6% (95% CI, -15.4, 4.1) and virologic outcomes (0.2 (95% CI, -3.6, 4.1) and 0.8 (95% CI, -0.6, 2.1), respectively.

Conclusions:

The results provide useful guidance for managing children with VF. Consideration should be given to switching children failing first-line cART to second-line, given the improved virologic and immune responses when compared with other strategies.
Factors Influencing Self-Care Competence in Korean Women With Rheumatoid Arthritis
Authors: SOK Sohyune R. , RYU Ji Sun , PARK Sun Hee , SEONG Mi Hueon
Published: August 2018

Background:

The incidence of many chronic diseases is increasing rapidly in South Korea. Rheumatoid arthritis is a chronic disease for which treatment by both doctors and long-term self-care by patients is deemed very important for successful disease management.

Purpose:

This study is designed to examine and identify the factors influencing self-care competence in Korean women with rheumatoid arthritis.

Methods:

A cross-sectional descriptive design was employed. Participants included 132 women aged 20 years or older who were visiting rheumatoid arthritis outpatient clinics at hospitals in Seoul and Gyeonggi-do, South Korea. Measures included a demographics form, Self-as-Carer Inventory, Korean Activities of Daily Living scale, Visual Analogue Scale, Mishel Uncertainty in Illness Scale–Community Form, and Self-esteem Scale.

Results:

The analyses illustrated the significance of the prediction model (F = 21.744, p < .001). The value of the adjusted R
2 was set at .401, corresponding to 40.1% explanatory power. Uncertainty (β = −.43) and self-esteem (β = .26) were identified as having the most influence on self-care competence in Korean women with rheumatoid arthritis.

Conclusions/Implications for Practice:

This cross-sectional study yielded preliminary evidence that nursing interventions that reduce uncertainty and improve self-esteem in Korean women with rheumatoid arthritis are necessary to promote the self-care competence of this vulnerable population. Healthcare professionals should recognize uncertainty and self-esteem as factors that influence self-care competence in Korean women with rheumatoid arthritis.
The Impact of Racial, Geographic, and Socioeconomic Risk Factors on the Development of Advanced-Stage Cervical Cancer
Authors: Powell T. Clark , Dilley Sarah E. , Bae Sejong , Straughn J. Michael , Kim Kenneth H. , Leath Charles A.
Published: August 2018

Objectives

Despite screening, disparities exist in cervical cancer incidence and outcomes. Demographic factors are associated with diagnosis at advanced stage (AS), but less is known about geographic factors. We sought to investigate risk factors for developing AS cervical cancer in Alabama.

Materials and Methods

We identified women treated for cervical cancer from 2005 to 2015 at our institution. Stages II–IV were considered AS. ZIP codes were categorized by federal Rural-Urban Commuting Area Codes, and 16 historically underserved counties were categorized as Black Belt rural. Using data from the American College of Obstetricians and Gynecologists, we identified women's health provider locations. We explored associations between stage and multiple factors using logistic regression.

Results

Of 934 patients, 29.2% were black, 52.7% had AS cancer, and 63.4% lived in urban areas. Average distance to nearest American College of Obstetricians and Gynecologists Fellow in urban, rural, and Black Belt rural areas was 5.0, 10.6, and 13.7 miles, respectively. Black race, public insurance and age of older than 65 years were associated with increased risk of AS cancer. Living in a rural area trended toward higher risk but was not significant. When stratified by race, insurance status and age were associated with AS cancer in white women only.

Conclusions

Living further from a women's health provider or in a rural area was not associated with a higher risk of AS cervical cancer. Black women had a higher risk of AS than white women regardless of age, insurance status, and geography. Disparities in cervical cancer are multifactorial and necessitate further research into socioeconomic, biologic, and systems causes.
Sudden Sensorineural Hearing Loss in Children: A Report of 75 Cases
Authors: Qian Yi , Zhong Shixun , Hu Guohua , Kang Houyong , Wang Ling , Lei Yan
Published: August 2018

Objective:

To investigate the characteristics, treatment, and prognostic factors of sudden sensorineural hearing loss (SSNHL) in children.

Methods:

Seventy-five cases (78 ears) of SSNHL in children from February 2011 to June 2016 were retrospectively analyzed. We scrutinized the clinical manifestations, audiological assessments, and serologic examinations of these pediatric cases by univariate and multivariate logistic analysis methods. The patients were divided into four groups according to their audiometric curve type: ascending, descending, flat, and profound.

Results:

Of the 75 patients (78 ears), 25 patients were in the ascending group (32.00%), 9 patients were in the descending group (12.00%), 17 patients were in the flat group (22.67%), and 24 patients were in the profound group (32.32%). The overall recovery rates (complete + partial + slight) of the different groups were as follows: ascending group, 96.00%; flat group, 76.47%; profound group, 50.00%; and descending group, 44.44%. The overall recovery rate of all patients was 70.67%. The multivariate logistic analysis showed that the type of audiometric curve and the interval from onset to intervention were two independent risk factors that correlated with the prognosis of SSNHL in children. Some children had positive cytomegaoviyns, rubella virus, and herpes simplex virus immunoglobulin G antibodies. Twenty-one children were treated with additional intratympanic methylprednisolone as salvage therapy and 13 of these children showed improved (complete + partial + slight) recoveries. Three children had postauricular compound betamethasone injections, but none of them showed improvement. One of three children recovered slightly after treatment with intratympanic methylprednisolone combined with postauricular betamethasone injection.

Conclusions:

The prognosis of SSNHL in children is closely related to the type of audiometric curve and the onset of treatment. Intratympanic methylprednisolone and compound betamethasone injected postauricularly could be effective for SSNHL in children.