bluuebunny/crossref_metadata_2025 huggingface dataset:
“Is My Heart Healing?” A Meta-synthesis of Patients' Experiences After Acute Myocardial Infarction
Authors: Dreyer Rachel P. , Pavlo Anthony J. , Hersey Denise , Horne Anna , Dunn Robert , Norris Colleen M. , Davidson Larry
Published: August 2020

Background

Recovery from acute myocardial infarction (AMI) has been primarily understood in a narrow medical sense. For patients who survive, secondary prevention focuses largely on enhancing clinical outcomes. As a result, there is a lack of descriptive accounts of patients' experiences after AMI and little is known about how people go about the challenge of recovering from such an event.

Objective

We conducted a meta-synthesis of the available literature on qualitative accounts of patients' experiences after AMI.

Methods

We searched for relevant papers that were descriptive, qualitative accounts of participants' experiences after AMI across 4 electronic databases (April 2016). Using an adapted meta-ethnography approach, we analyzed the findings by translating studies into one another and synthesizing the findings from the studies.

Results

After a review of titles/abstracts, reading each article twice in full, and cross-referencing articles, this process resulted in 17 studies with 224 participants (48% women) aged 23 to 90 years. All participants provided a first-person account of an AMI within the 3-day to 25-year time frame. Two major themes emerged that characterized patients' experiences: navigating lifestyle changes and navigating the emotional reaction to the event—consisting of various subthemes.

Conclusion

Although AMI tends to be seen as a discrete event, participants are left with little professional guidance as to how to negotiate significant, and often discordant, psychosocial changes that have long-lasting effects on their lives, similar to persons with chronic illnesses but without research in place to figure out how to best support them.
Vitamin D Mediates the Relationship Between Depressive Symptoms and Quality of Life Among Patients With Heart Failure
Authors: Ruz Mohannad Eid Abu , Momani Aaliyah , Shajrawi Abed Almajeed
Published: August 2020

Background

Depressive symptoms are common among patients with heart failure and are associated with poor quality of life. Vitamin D plays a role in the regulation of mood and depressive symptoms levels. Patients with heart failure can have lower levels of vitamin D.

Objective

The aim of this study was to explore the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure in Jordan.

Methods

A cross-sectional correlational comparative design was used in this study. Depressive symptoms were measured by the Arabic subscale of the Hospital Anxiety and Depression Scale, quality of life was measured by the 36-item Short Form Health Survey questionnaire, and vitamin D was measured in plasma. Data were analyzed by independent-sample t test and multiple regression.

Results

A total of 220 patients participated in this study, 70.5% of whom were men, and 57.3% had vitamin D deficiency (<30 ng/mL). Patients with vitamin D deficiency had higher levels of depressive symptoms compared with those with normal levels (mean [SD], 16.2 [4.3] vs 6.3 [2.3]; P ≤ .001). In multiple regression, according to the Baron and Kenny approach, depressive symptoms predicted quality of life and vitamin D levels. Vitamin D deficiency and higher levels of depressive symptoms were associated with poor quality of life.

Conclusions

Vitamin D levels partially mediated the relationship between depressive symptoms and quality of life. Therefore, further research is needed to better understand the nature of the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure.
Prognostic Value of Braden Scale in Patients With Acute Myocardial Infarction
Authors: Jia Yu , Li Hong , Li Dongze , Li Fanghui , Li Qin , Jiang Ying , Gao Yongli , Wan Zhi , Cao Yu , Zeng Zhi , Zeng Rui
Published: August 2020

Background

The Braden Scale (BS) is a routine nursing measure used to predict pressure ulcer events; it is recommended as a frailty identification instrument.

Objective

We aimed to evaluate the predictive utility of the BS in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention.

Methods

We enrolled 2285 patients with AMI from the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain. The patients were divided into 3 groups (B1, B2, and B3) according to their BS score (≤12 vs 13–14 vs ≥15). The primary endpoint was all-cause death.

Results

There were 264 (12.0%) all-cause deaths during the median follow-up period of 10.5 (7.9–14.2) months. In-hospital and midterm mortality and other adverse outcomes increased with decreases in the BS score. The Kaplan-Meier survival analysis showed that patients with a lower BS score had a lower cumulative survival rate (P < .001). The multivariate Cox regression analysis showed that a decreased BS score was an independent predictor for all-cause mortality (B2 vs B1: hazard ratio, 0.610; 95% confidence interval, 0.440–0.846; P = .003; B3 vs B1: hazard ratio, 0.345; 95% confidence interval, 0.241–0.493; P < .001).

Conclusions

The BS at admission may be a useful routine nursing measure to evaluate the prognosis of patients with AMI. The BS may be used to stratify risk at early stages and to identify those who may benefit from further assessment and intervention due to frailty syndrome.
Exercise Training in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Bean Glenn , Mou Jin , Pflugeisen Bethann , Olsen Lindsay , Hoag Stephanie , Silva Angela , Ball Andrea L. , Lee Tobias
Published: August 2020

Background

Patients with heart failure with preserved ejection fraction (HFpEF) experience poor exercise tolerance and quality of life. Little is known about the feasibility or effects of HFpEF exercise training (ET) in a community hospital setting.

Objective

The aim of this study was to examine the feasibility and pilot data of a community-based HFpEF ET intervention.

Methods

This was a single-group (n = 16), pretest-posttest, 9-week ET intervention. The Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, cardiopulmonary exercise test (peak VO2), and 6-minute walk test were used for evaluation.

Results

Participants (n = 16) attended 88% of prescribed ET sessions and 94% completed all pretest-posttest assessments. Significant improvements in Minnesota Living With Heart Failure Questionnaire (P = .01), Patient Health Questionnaire-9 (P ≤ .01), exercise test time (P = .01) and 6-minute walk test (P = .001), but not in peak VO2 (P = .16), were found.

Conclusions

The ET intervention was feasible and safe, and findings support improved quality of life, depressive symptoms, and exercise tolerance. Larger controlled trials are warranted.
COVID-19 Is a Catalyst for Future Changes in Stroke Nursing Care
Authors: Paletz Laurie
Published: August 2020

INTRODUCTION: During the COVID-19 pandemic, hospitals still have to meet external regulations while delivering compassionate patient care. This reflections article provides a solution for certified stroke programs to continue to meet stroke certification requirements. One area of focus, in this article, is stroke education. Because of “shelter-in-place orders,” there were no visitors permitted at the bedside, yet we know that high-quality poststroke education is important to improve outcomes. The purpose of this reflections article is to share what has worked at my institution. INNOVATIONS: We found that calling family members to engage them in stroke education was a great option. They seemed engaged, took notes, and asked questions. Nurses document details from these phone encounters in the patient's medical record. Many people placed the call on speaker so other family members could listen to the education session. While family members were at home, telehealth nursing has its own set of challenges. Although telehealth is not a perfect solution, it was one we found most reasonable and found it to work well through this unprecedented time. SUMMARY: These strategies are being shared to promote dissemination of innovative nursing interventions that will help to continue providing loved ones with the information and education they deserve to receive even during the COVID-19 pandemic.
Hearing Outcomes of Treatment for Acute Noise-induced Hearing Loss: A Systematic Review and Meta-analysis
Authors: Koochakzadeh Sina , Gupta Avigeet , Nguyen Shaun A. , McRackan Theodore R. , Kil Jonathan , Bhenswala Prashant N. , Lambert Paul R.
Published: August 2020

Objective:

To determine the efficacy of various treatment modalities used for acute noise-induced hearing loss (aNIHL) from acute acoustic trauma (AAT) via a systematic review and meta-analysis.

Data Sources:

PubMed, Cochrane, and Scopus databases.

Study Selection:

The scientific literature was searched up to October 2018 for articles evaluating hearing outcomes after treatment of aNIHL.

Data Extraction:

The following were extracted: Oxford level of evidence, number of patients, mean age, time to presentation, source of noise exposure, method of treatment/intervention, baseline hearing threshold, posttreatment hearing threshold, hearing gain, proportion of patients with no recovery, partial recovery, or complete recovery, and treatment complications.

Data Synthesis:

Sixteen studies with 932 patients met inclusion criteria for systematic review and four studies with 187 patients were included in the meta-analysis.

Conclusions:

Treatment modalities identified were steroids, vascular agents, nootropics, antioxidants, vitamins, cell apoptosis inhibitors, and hyperbaric oxygen therapy. Meta-analysis demonstrated significant improvement in mean hearing threshold for patients with high-frequency hearing loss, those treated within 48 hours, and those receiving treatment with a nootropic agent. Significant heterogeneity was present in experimental design among included studies and many were of lower levels of evidence. More prospective, large scale, randomized, double-blinded, placebo-controlled clinical trials are required to determine optimal treatment regimens for patients suffering from aNIHL caused by AAT.
Endoscopic Stapedectomy: Collective Experience From a Large Australian Center
Authors: Vaughan Casey , Fox Richard , Jufas Nicholas , Kong Jonathan H. K. , Patel Nirmal P. , Saxby Alexander J.
Published: August 2020

Introduction:

Endoscopic stapes surgery is a technically demanding procedure that is increasing in popularity. Surgical outcomes and complication rates have been demonstrated to be comparable to traditional microscopic techniques. The surgical outcomes for patients undergoing stapes surgery performed by the Sydney Endoscopic Ear Surgery Research Group are presented.

Study Design:

Retrospective review from prospectively gathered database.

Setting:

Tertiary referral centers.

Patients:

A retrospective case review of patients undergoing endoscopic stapes surgery performed by four surgeons between February 2015 and July 2019 was carried out. Sixty nine patients were identified, and assessed for demographics, functional results, and postoperative complications.

Intervention:

Endoscopic stapedotomy.

Main Outcome Measure:

Postoperative hearing results.

Results:

Sixty eight of 69 patients (98.6%) achieved an air-bone gap (ABG) closure of less than 20 dB. Sixty of 69 patients (87%) achieved and ABG closure of less than 10 dB. The average improvement of the ABG over four frequencies achieved was 26.5 dB (range, 0–61). Postoperative complications were infrequent and self-limiting. Six patients experienced dysgeusia without obvious chorda tympani injury, four patients developed short lived vertigo, and two patients experienced tinnitus.

Conclusions:

Endoscopically assisted stapes surgery represents a safe alternative to traditional microscopic techniques, with similar morbidity and audiological outcomes.
Immune Response of Macrophage Population to Cochlear Implantation: Cochlea Immune Cells
Authors: Noonan Kathryn Y. , Lopez Ivan A. , Ishiyama Gail , Ishiyama Akira
Published: August 2020

Hypothesis:

The presence and distribution of ionized calcium binding adaptor 1 and CD68 macrophages in the human cochlea is altered in cochlear implantation (CI) compared with the normative or nonimplanted cochlea.

Background:

It has been hypothesized that CI induces an immunological response in macrophages leading to implant failure or reduced hearing. Macrophages are resident immune cells in human cochlea and have been shown to phagocytize implant material. In animal models, macrophage populations increase with surgical stress and with the introduction of a foreign body. However, the function and response of inner ear macrophages to CI are only beginning to be understood. This study seeks to investigate the inflammatory response to CI by comparing cochlear macrophages in implanted and nonimplanted human temporal bones.

Methods:

Nineteen temporal bones from nine implanted ears, seven contralateral controls, and three normal control ears were evaluated for the presence and distribution of CD68 and Iba1 expressing positive macrophages.

Results:

Three types of macrophage populations were detected 1) CD68 positive macrophages, 2) Iba1 positive macrophages, and 3) CD68 and Iba1 colocalizing macrophages. Macrophage distribution was ubiquitous: the stria vascularis, Rosenthal canal, and the mid-modiolus intermingled in the spiral ganglia. Iba1 and CD68 macrophages were found in the CI and non-CI contralateral and normal human cochlea. Most ionized calcium binding adaptor 1 expressing macrophages were ramified/amoeboid cells, while CD68 expressing macrophages were round shaped with foamy appearance in some areas. In the CI cochlea, both types of macrophages were detected in the fibrous sheath surrounding the CI path and within fibrotic areas within the scala tympani and the scala vestibuli in the case of CI translocation. In four cases, the density of macrophages was unchanged in the CI compared with the contralateral nonimplanted side, and in three cases, there was an increased number of macrophages in the implanted CI side compared with the nonimplanted side.

Conclusion:

Multiple populations of macrophages exist within the cochlea which are present at baseline and in response to trauma from CI. These results further support evidence for a macrophage response to cochlear implantation. Further studies are indicated to evaluate whether these macrophages have a beneficial, detrimental, or a mixed effect in CI patients.
Are There Real-world Benefits to Bimodal Listening?
Authors: Nyirjesy Sarah , Rodman Cole , Tamati Terrin N. , Moberly Aaron C.
Published: August 2020

Objective:

To assess the benefits of bimodal listening (i.e., addition of contralateral hearing aid) for cochlear implant (CI) users on real-world tasks involving high-talker variability speech materials, environmental sounds, and self-reported quality of life (quality of hearing) in listeners’ own best-aided conditions.

Study Design:

Cross-sectional study between groups.

Setting:

Outpatient hearing clinic.

Patients:

Fifty experienced adult CI users divided into groups based on normal daily listening conditions (i.e., best-aided conditions): unilateral CI (CI), unilateral CI with contralateral HA (bimodal listening; CIHA), or bilateral CI (CICI).

Intervention:

Task-specific measures of speech recognition with low (Harvard Standard Sentences) and high (Perceptually Robust English Sentence Test Open-set corpus) talker variability, environmental sound recognition (Familiar Environmental Sounds Test-Identification), and hearing-related quality of life (Nijmegen Cochlear Implant Questionnaire).

Main Outcome Measures:

Test group differences among CI, CIHA, and CICI conditions.

Results:

No group effect was observed for speech recognition with low or high-talker variability, or hearing-related quality of life. Bimodal listeners demonstrated a benefit in environmental sound recognition compared with unilateral CI listeners, with a trend of greater benefit than the bilateral CI group. There was also a visual trend for benefit on high-talker variability speech recognition.

Conclusions:

Findings provide evidence that bimodal listeners demonstrate stronger environmental sound recognition compared with unilateral CI listeners, and support the idea that there are additional advantages to bimodal listening after implantation other than speech recognition measures, which are at risk of being lost if considering bilateral implantation.
A 3D-printed Lateral Skull Base Implant for Repair of Tegmen Defects: A Case Series
Authors: VanKoevering Kyle Keith , Gao Rebecca Weiwei , Ahmed Sameer , Green Glenn Edward , Arts Henry Alexander
Published: August 2020

Objective:

To determine the feasibility of a patient-specific, three-dimensionally (3D)-printed reconstruction plate for repair of lateral skull base defects.

Study Design:

Prospective case series and cadaveric study.

Setting:

A university-based, tertiary care hospital.

Patients:

Three patients with lateral skull base defects and five cadavers.

Main Outcome Measure(s):

Caliper gauge fit testing was performed in the cadaver temporal bones to determine the fit of the tegmen plate in engaging the tegmen defect. Additionally, three patients underwent standard of care reconstruction of their middle fossa floor using autografts or allografts. Temporary plate insertion during standard operative repair was performed to gauge feasibility and fit. Operative time required for standard grafting compared with placement of the tegmen plate was examined.

Results:

Real-time, intraoperative placement of the tegmen plate in our patients under 1 minute compared with nearly 60 minutes for standard surgical repair. Tegmen plates covered the defects and locked into place from contour matching without impinging on critical structures. Fit testing revealed flush-fitting plates to the cadaveric temporal bone surface with all gaps less than 500 μm.

Conclusions:

Computer modeling and 3D printing can design custom fitted tegmen reconstruction plates for temporal bone defects. Versatility in prefabrication and 3D modeling shows potential in allowing the construct to avoid critical structures and adequately cover defects with high precision to the tegmen surface.
Comparing Cochlear Duct Lengths Between CT and MR Images Using an Otological Surgical Planning Software
Authors: George-Jones Nicholas A. , Tolisano Anthony M. , Kutz J. Walter , Isaacson Brandon , Hunter Jacob B.
Published: August 2020

Objective:

We sought to examine the intra- and interobserver variability in measuring the cochlear duct length (CDL) from magnetic resonance imaging (MRI) images versus computed tomography (CT) images using an otological surgical planning software that uses measurements of the basal turn diameter and cochlear width to estimate the CDL.

Patients:

Twenty-one adult cochlear implant patients with preoperative MRI and CT images.

Intervention:

Three fellowship-trained neurotologists served as the raters in the study. One rater measured the CDL using preoperative CT scans to serve as the benchmark. Two of the raters measured the CDL on preoperative MRI scans. One rater also remeasured the scans using MRI images after a period of 1 week to assess intraobserver variability.

Main Outcome Measure:

Intraclass correlational coefficients were calculated to assess for intra- and interobserver agreement.

Results:

The mean CDL measured from the CT scans was 32.7 ± 2.0 mm (range 29.4 – 37.6 mm). The mean difference between the raters when measuring the CDL using MRI scans was −0.15 ± 2.1 mm (range −3.2 to 4.3 mm). The intraclass correlational coefficients for inter-rater reliability of CDL determination using MRI scans was judged as fair to excellent (0.68; 95% CI 0.41–0.84). The intrarater reliability of CDL determination using MRI scans was judged at fair to excellent (0.73; 95% CI 0.491–0.866).

Conclusion:

We demonstrate that a validated otological surgical planning software for estimating the CDL preoperatively had comparable performance using MRI scans versus the gold-standard CT scans.
Congenital Hearing Loss Is Associated With a High Incidence of Central Nervous System Abnormalities
Authors: Sayyid Zahra N. , Boldt Brian , Mokhtari Tara E. , Schoppy Krista , Yeom Kristen W. , Cheng Alan G.
Published: August 2020

Objective(s):

To assess the incidence of central nervous system abnormalities in pediatric subjects with sensorineural hearing loss (SNHL).

Methods:

One hundred forty-three pediatric subjects evaluated for SNHL at a single academic center from 2007 to 2014 were included and divided into eight diagnosis groups based on etiology of SNHL. One hundred forty-three age- and gender-matched control subjects with no known brain-related pathology or history of hearing loss were included as healthy controls for comparison. Two neuroradiologists independently evaluated magnetic resonance imaging (MRI) and computed tomography (CT) scans for each subject. Comparison of abnormal cerebral development was performed using an ordinal logistic regression model. Concordance between CT and MRI of the temporal bone was assessed using the kappa statistic.

Results:

The etiologies of hearing loss in our cohort were 37.8% genetic, 12.6% infectious, 1.4% ototoxin-induced, and 48.3% idiopathic. Brain MRI revealed cerebral developmental abnormalities in defined regions in >30% of the SNHL cohort, significantly more than in normal-hearing pediatric controls. The Sylvian fissure, Virchow-Robin spaces, and lateral ventricles were most commonly affected. In the temporal bone, the percentage of subjects with concordant findings on CT and MRI was ≥92% across all anatomical structures.

Conclusion:

MRI revealed a high incidence of intracranial abnormalities, suggestive of aberrant development of auditory and nonauditory neural structures associated with SNHL. CT and MRI share a high degree of concordance in detecting temporal bone anomalies. Inclusion of MRI as part of the workup of congenital SNHL may facilitate the detection of developmental anomalies of the brain associated with SNHL.
When Opposites Attract: Pediatric Cochlear Implantation in the Setting of Cerebrospinal Fluid Shunts
Authors: Selleck Anne Morgan , Park Lisa R. , Brown Kevin D.
Published: August 2020

Objective:

The Food and Drug Administration (FDA) has recently raised concern regarding the safety of cochlear implantation in the setting of programmable cerebrospinal fluid shunts. The purpose of this study was to evaluate the outcomes and complications of cochlear implantation in children who have a cerebrospinal fluid shunt.

Study Design:

Retrospective chart review.

Setting:

Tertiary academic referral center.

Patients:

Twenty pediatric subjects with a cerebrospinal fluid shunt and cochlear implant (CI).

Intervention:

Cochlear implantation in the setting of a cerebrospinal fluid shunt.

Main Outcome Measures:

Primary outcome measures included descriptive data regarding age at implantation, etiology of hearing loss, medical management, complications, and speech perception outcomes.

Results:

The average age of CI candidacy was 30 months with an average 21.5 months delay to implantation. In 45% of cases the laterality of the shunt determined the ear to be implanted. Three of the subjects required a surgical intervention on the shunt before cochlear implantation. Three subjects had a concurrently programmable shunt and activated CI. Two of the three subjects had no complications as a result of the two devices; however, the third subject had significant interactions requiring multiple revision surgeries. For those with the cognitive ability to perform open set, recoded speech perception, the average postoperative Consonant Nucleus Consonant word score in the best aided condition was 65.2% (n = 5).

Conclusions:

Children with a cerebrospinal fluid shunt are viable candidates for cochlear implantation, although they often require additional procedures and considerations before and after implantation.
Pentoxifylline and Tocopherol in the Management of Temporal Bone Osteoradionecrosis: A Case Series
Authors: Lovin Benjamin D. , Choi Jonathan S. , Lindquist Nathan R. , Phan Jack , Gidley Paul W. , Nader Marc-Elie
Published: August 2020

Objective:

Temporal bone osteoradionecrosis (TBORN) is a rare, chronic complication of head and neck radiation. Initial treatment consists of conservative management, with surgical resection of necrotic bone indicated for cases of severe, symptomatic, or progressive disease. Pentoxifylline-tocopherol (PENTO) has demonstrated usefulness for osteoradionecrosis of other head and neck subsites. Herein, we report five TBORN cases utilizing this protocol.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

This case series describes five TBORN cases in which the PENTO protocol was used in conjunction with conservative management. All patients were women and average age was 61 ± 8 years.

Intervention:

All patients received a daily dose of 800 mg of pentoxifylline and 1 g of tocopherol. Four of the five patients received systemic and/or ototopical antibiotics as an antimicrobial regimen before and/or during the PENTO protocol.

Main Outcome Measures:

Details regarding the total duration of protocol, improvement in symptoms, exposed bone and radiographic changes, and duration until first improvement of exposed bone were collected retrospectively.

Results:

The average duration of PENTO protocol was 302 ± 166 days. Four of the five (80%) patients demonstrated a decrease in exposed ear canal bone. Three of the five (60%) patients had stable or improvement in otologic symptoms of TBORN. One patient progressed to diffuse TBORN. The average duration until first improvement in exposed bone was 193 ± 137 days.

Conclusions:

The PENTO protocol may be a useful adjunct to conservative measures in the management of localized TBORN. We recommend trialing the protocol for at least 12 months.
A Case of Incus Necrosis Following Oral and Intratympanic Steroid Administration for Sensorineural Hearing Loss
Authors: Kapoor Elina , Sabetrasekh Parisa , Monfared Ashkan
Published: August 2020

Objective:

Intratympanic (IT) steroid injections are often used for the treatment of inner ear pathologies, including sudden sensorineural hearing loss. IT steroids are also commonly used in conjunction with or in case of systemic steroid therapy failure. They are viable options for patients who cannot endure side effects or are at high risk of complications from systemic therapy. The duration of treatment, strength, and type of steroid, and number of IT injections are important factors that impact possible treatment complications. Reported complications, though uncommon, include tympanic membrane perforation, otalgia, vertigo, otitis media, and acne. In this report, we explore a novel case of incus necrosis associated with oral and/or IT steroid administration.

Study Design:

Clinical Capsule Report.

Setting:

Tertiary Academic Center.

Patient:

We present a case of a 70-year-old male with sudden sensorineural hearing loss who developed incus necrosis and conductive hearing loss following treatment with oral and intratympanic steroids.

Intervention:

The patient underwent a left tympanoplasty with ossicular chain reconstruction to treat the conductive component of his hearing loss.

Results:

The left tympanoplasty almost fully-resolved the conductive component of his hearing loss. However, intraoperative and CT assessment of the temporal bone revealed resorption of the long process of the incus, with otherwise normal-appearing ossicles.

Conclusion:

We report the first case of possible steroid-induced necrosis of the long process of the incus. Owing to its tenuous blood supply, the incus may be predisposed to steroid-induced osteonecrosis similar to that of the femoral head.
The Clinical Spectrum of Dizziness in Sleep Apnea
Authors: Foster Carol A. , Machala Maria
Published: August 2020

Objective:

Sleep apnea has been associated with dizziness, but the clinical characteristics of this dizziness have not been fully described. This study evaluated clinical descriptions of dizziness, vestibular diagnoses, and the response to treatment of dizzy patients with sleep apnea.

Patients:

All subjects had a new diagnosis of sleep apnea with a confirmatory pulse oximetry or polysomnogram and received treatment for sleep apnea through our center. Fifty-two patients met these criteria, with a mean age of 55 years and a mean BMI of 31.

Intervention:

Continuous positive airway pressure or uvulopalatopharyngoplasty.

Main Outcome Measures:

Reported symptoms of dizziness and vestibular diagnoses were collected retrospectively in all patients. Nineteen patients with a complete resolution of dizziness with treatment of sleep apnea on mean follow-up of 4 years were used to define the clinical syndrome and their symptoms were compared with the remainder of the group.

Results:

Repeated spells of sudden momentary vertigo were common. Vestibular migraine, Menière's disease, and sudden sensorineural hearing loss occurred in a much higher frequency than in the general population.

Conclusions:

Brief spells of nonpositional vertigo that recur throughout the day, phenotypically similar to vestibular paroxysmia, responded to treatment of sleep apnea, and could represent a new vestibular entity. The greatly elevated risk of migraine, Menière's disease and sudden sensorineural hearing loss are likely due to enhanced vascular risks associated with sleep apnea. A history of snoring should be sought in all dizzy patients.
Characterization of Sensorineural Hearing Loss in Adult Patients With Sickle Cell Disease: A Systematic Review and Meta-analysis
Authors: Kapoor Elina , Strum David , Shim Timothy , Kim Sunny , Sabetrasekh Parisa , Monfared Ashkan
Published: August 2020

Objectives and Main Outcome Measures:

To determine the prevalence of sensorineural hearing loss (SNHL) attributable to sickle cell disease (SCD) in the global adult population and to identify factors contributing to its severity.

Study Design:

Systematic Review and Meta-analysis.

Methods:

We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations over 18 years of age with SCD.

Results:

We identified 138 studies from the initial search, 12 of which met inclusion criteria and were utilized for data analysis. A total of 636 SCD patients and 360 controls were included in the Cochrane Review Manager 5.3 meta-analysis. There was a statistically significant increase in the prevalence of SNHL in adults with SCD compared with the general population with a cumulative risk ratio (RR) of 6.03.

Conclusions:

This is the first systematic investigation of the relationship between SCD and SNHL in adult patients across the globe. SNHL is more prevalent in patients with SCD, specifically those of the HbSS genotype, than the general population likely due to the pathophysiology of the disease and its effects on labyrinthine microvasculature. The increased prevalence of SNHL in the adult SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of adult SCD patients.
A novel concept: cardiovascular assessment of hypertensive patients in pharmacies
Authors: O’Brien Eoin
Published: August 2020

A range of cardiovascular investigations is required for the effective management of hypertension. To obtain these investigations my require the patient having to attend many facilities. A scheme for performing basic cardiovascular investigations in pharmacies is proposed.
Association between long-term pulse pressure trajectories and risk of end-stage renal diseases in incident malignant hypertensive nephropathy: a cohort study
Authors: Zhuang Yi , Ding Caiyan , Xu Yajing , Ding Zhongqin , Yu Dahai
Published: August 2020

Objective

The trajectories of pulse pressure (PP) might affect the prognosis of malignant hypertensive nephropathy (MHN). We aimed to describe the association between PP trajectories and the future risk of end-stage renal disease and to identify and compare the associated patient characteristics of any distinct trajectory patterns in MHN patients.

Methods

Patients with newly diagnosed biopsy-proven MHN 2010–2015 were included. Latent class growth analysis was applied to the PP measured over 3 years prior to biopsy to identify distinct trajectories. Concurrent systolic blood pressure, diastolic blood pressure, plasma creatinine, and 24-h urine protein measurements for each trajectory group were modelled using generalized estimating equations. The risk of end-stage renal disease (with kidney replacement therapy as a proxy) was estimated using Logistic regression.

Results

Two hundred three patients were included (median-age 34 years, and 19.7% female). A two-group cubic model was optimal, with trajectories distinguished by the rate of PP and absolute level at final measurement. Trajectory Group-1 (n = 84) was characterized by ‘first-increased-then-decreased’ PP and trajectory Group-2 (n = 119) was characterized by ‘first-decreased-then-increased’ PP over 3 years prior to biopsy. Systolic and diastolic blood pressures, plasma creatinine, and 24-h urine protein were differed by the trajectory group. Baseline characteristics differed substantially between trajectory groups. Compared with Group-1, Group-2 had a 66% greater risk of developing into end-stage renal disease in the subsequent 3 years.

Conclusions

Two distinct 3-year trajectories for PP exist with MHN. Early introduction of intensive antihypertensive treatment might delay the development of end-stage renal disease among patients with malignant hypertension.
National Trends and Outcomes of Nonautoimmune Hemolytic Anemia in Alcoholic Liver Disease
Authors: Tariq Tooba , Karabon Patrick , Irfan Furqan B. , Sieloff Eric M. , Patterson Rachel , Desai Archita P.
Published: August 2020

Goal:

The aim of this study was to determine the burden of nonautoimmune hemolytic anemia (NAHA) in hospitalized patients with coexisting alcoholic liver disease (ALD), identify risk factors for NAHA in ALD and describe the hospitalization outcomes.

Background:

ALD can result in structural and metabolic alterations in the red-blood cell membrane leading to premature destruction of erythrocytes and hemolytic anemia of varying severity.

Study:

Hospitalized ALD patients with concomitant NAHA were identified in the Nationwide Inpatient Sample database using International Classification of Diseases-9 codes from 2009 to 2014. The primary outcome was to determine the nationwide prevalence and risk factors of NAHA in patients hospitalized with ALD.

Results:

The prevalence of NAHA was 0.17% (n=3585) among all ALD patients (n=2,125,311) that were hospitalized. Multivariate analysis indicated higher odds of NAHA in ALD patients in the following groups: female gender [adjusted odds ratio (AOR) AOR 1.80, P<0.0001]; highest quartile of median household income (AOR 1.88, P<0.0001); increasing Charlson-Deyo Comorbidity Index (3 to 4 vs. 0, AOR 2.16, P=0.0042) and cirrhosis (AOR 2.74, P<0.0001). Discharges of ALD with anemia had a significantly longer average length of stay (8.8 vs. 6.0 d, P<0.0001), increased hospital charges ($38,961 vs. $25,244, P<0.0001) and higher mortality (9.0% vs. 5.6%, P<0.0001) when compared with ALD with no anemia.

Conclusion:

NAHA in patients with ALD is an important prognostic marker, predicting a longer, costlier hospitalization and increased inpatient mortality in ALD.
Therapeutic Drug Monitoring for Current and Investigational Inflammatory Bowel Disease Treatments
Authors: Lee Scott D. , Shivashankar Raina , Quirk Daniel , Zhang Haiying , Telliez Jean-Baptiste , Andrews John , Marren Amy , Mukherjee Arnab , Loftus Edward V.
Published: August 2020

This article reviews therapeutic drug monitoring (TDM) use for current inflammatory bowel disease (IBD) treatments. IBD comprises Crohn’s disease and ulcerative colitis-chronic gastrointestinal inflammatory disorders. Treatment options for moderate to severe IBD include thiopurines; methotrexate; biologic agents targeting tumor necrosis factor, α4β7 integrin or interleukins 12 and 23; and Janus kinase inhibitors. TDM is recommended to guide treatment decisions for some of these agents. Published literature concerning TDM for IBD treatments was reviewed. S.D.L., R.S., and E.V.L. drew on their clinical experiences. Polymorphisms resulting in altered enzymatic activity inactivating thiopurine metabolites can lead to myelotoxicity and hepatotoxicity. Increased elimination of biologic agents can result from immunogenicity or higher disease activity, leading to low drug concentration and consequent nonresponse or loss of response. TDM may aid treatment and dose decisions for individual patients, based on monitoring metabolite levels for thiopurines, or serum drug trough concentration and antidrug antibody levels for biologic agents. Challenges remain around TDM implementation in IBD, including the lack of uniform assay methods and guidance for interpreting results. The Janus kinase inhibitor tofacitinib is not impacted by enzyme polymorphisms or disease activity, and is not expected to stimulate the formation of neutralizing antidrug antibodies. TDM is associated with implementation challenges, despite the recommendation of its use for guiding many IBD treatments. Newer small molecules with less susceptibility to patient variability factors may fulfill the unmet need of treatment options that do not require TDM, although further study is required to confirm this.
Endoscopic Ultrasound Guided Gastroenterostomy
Authors: Tyberg Amy , Kats Daniel , Choi Anthony , Gaidhane Monica , Nieto Jose , Kahaleh Michel
Published: August 2020

Introduction:

Endoscopic ultrasound guided gastroenterostomy (EUS-GE) is a minimally invasive option for gastric outlet obstruction. It requires skills in endoscopic ultrasound, fluoroscopy, and lumen-apposing metal stent deployment. The aim of this study was to determine the learning curve for EUS-GE.

Methods:

Consecutive patients undergoing EUS-GE by a single operator were included from a prospective registry over 3 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum analyses were conducted for the learning curve. Clinical success was defined as tolerating a diet postprocedure.

Results:

Twenty-three patients were included (39% male, mean age 65.8 y). Technical success was achieved in 22 (96%) patients. Clinical success was achieved in 21/22 (95%) patients. Average follow-up time 10.8 months (9.1 SD). Five patients had minor postprocedure complications; 1 patient had a periprocedural esophageal tear treated with clips. Four patients required repeat intervention for stent revision or removal if no longer needed.

Median procedure time was 88 minutes (range: 45 to 140 min). Cumulative sum chart shows 88-minute procedure time was achieved at the seventh procedure indicating efficiency. Even with bridging of a misdeployed lumen-apposing metal stent, the procedure duration further reduced with consequent procedures indicating continued improvement with experience (nonlinear regression P<0.0001).

Conclusions:

Endoscopists experienced in EUS-GE achieve a reduction in procedure time over successive cases, with efficiency reached at 88 minutes and a learning rate of 7 cases. Misdeployed stents that require bridging add to the procedure time even after competency is achieved but do not affect the overall learning curve trend.
The 6 Ps of post-ICU recovery: application of a shared conceptual model
Authors: Jones Jennifer R.A. , Griffith David M.
Published: August 2020

Purpose of review

We aimed to explore, through a conceptual model, how we can maximize the post-ICU recovery of patients with ICU-acquired weakness (ICU-AW). The ‘6 Ps’ were used to structure our research questions, what are the Predisposing (pre-ICU patient characteristics), Precipitating (ICU exposures) and Perpetuating (hinder recovery) risk factors for ICU-AW (Problem) and what Protective strategies and Proactive treatment can we adopt to improve muscle mass, strength and function of these patients?

Recent findings

Examination of the relationship between pre-ICU patient characteristics with ICU-AW and post-ICU factors that prolong recovery are limited. Our understanding of the pathophysiology of the condition is improving, however, much of the biological mechanisms of ICU-AW and persistent weakness remain unknown. Investigation into the ICU-AW phenotype and prediction tools would be of great clinical utility. Further research on ICU-AW muscle biology and recovery may permit the application of precision and personalized medicine to therapeutic interventions.

A structured approach to clinical practice and future research to better understand the mechanism (Problem), and identify Predisposing, Precipitating and Perpetuating risk factors will advance the field in better managing ICU-AW through implementation of Protective strategies and Proactive multimodal treatments.
Maze test score time adjustments when using nondominant hand in fitness-to-drive assessments
Authors: Unsworth Carolyn A. , Hext Gemma , Baker Anne M. , Ratzon Navah Z. , Browne Matthew
Published: August 2020

Drivers with medical conditions may need to demonstrate their fitness by participating in clinical and on-road assessments. Scores from the clinic-based occupational therapy-drive home maze test (OT-DHMT) can contribute to fitness-to-drive recommendations. The OT-DHMT is a short, timed test that has previously been shown to be valid and reliable, and norms are available for completion with a driver’s dominant hand. Following stroke or trauma, many drivers need to complete assessments and resume driving using their nondominant hand. The validity of a person’s OT-DHMT score when completed with a nondominant hand is unknown. This study investigated if a person’s OT-DHMT score time requires adjustment when completed with a nondominant hand. The OT-DHMT was administered with a convenience sample of 148 community-dwelling participants, aged 21–81 years (M = 48.6, SD = 19.38) using both their dominant and nondominant hands, in a random order. OT-DHMT score times were significantly faster when using dominant (M = 15.73) compared with nondominant (M = 17.64) hand, d = 1.91 [confidence interval (CI) 1.13, 2.69], t = 4.84, P < 0.01. Employing a generalized weighted least squares regression model indicated that multiplying a driver’s nondominant hand time by 0.833 s for drivers aged ≤60, and by 0.929 s for drivers aged 61+ can approximate dominant hand completion times. The OT-DHMT has been validated for use with people using their nondominant hand. Time adjustments are required for people using their nondominant hand when completing the OT-DHMT, and a larger adjustment is required for people aged ≤60 reinforcing previous findings that younger people have faster OT-DHMT completion times.
Coping Strategies of Adolescent and Young Adult Survivors of Childhood Cancer
Authors: Belpame Nathalie , Kars Marijke C. , Deslypere Eva , Rober Peter , Van Hecke Ann , Verhaeghe Sofie
Published: August 2020

Background

Many adolescent and young adult (AYA) survivors of childhood cancer are dealing with late effects of the cancer and its treatment.

Objective

The aim of this study was to explore how AYA survivors cope with their childhood cancer experience and its long-term consequences.

Methods

This is a descriptive qualitative study in which 21 semistructured interviews with AYA survivors of childhood cancer were conducted. A thematic analysis was conducted by a multidisciplinary research team and supported by NVivo 10.

Results

Five coping strategies, which facilitated in living a normal life, of which some were developed during their cancer experience, were identified: (1) focusing on the “here and now,” (2) refraining from discussing the cancer experience, (3) recalling and preserving positive memories, (4) redefining the impact positively, and (5) consolidating and preserving a sense of togetherness.

Conclusions

Even long after completing treatment, the cancer experience remained deeply ingrained in AYA survivors' lives. Although they did not perceive their survivorship as a large problem in their current lives, coping with being a childhood cancer survivor did take effort. The deployment of specific coping strategies helped them to remain focused on the positive outlook in life and to deal with the long-term physical and psychosocial consequences of the cancer experience aimed at ultimately leading a normal life.

Implications for Practice

This study emphasizes the current individual frame of reference of the AYA survivor as the point of departure for psychosocial support. Healthcare professionals are advised to acknowledge and respect the value and function of the AYA survivors' coping strategies used.
Perceptions of Older Adult Care Among Ambulatory Oncology Nurses
Authors: Capezuti Elizabeth , Davis Mary Elizabeth , Wahlberg Lara , Lundy Theresa , McEvoy Lorraine K.
Published: August 2020

Background

Most cancer treatment is provided in the ambulatory setting; thus, it is important to know what issues ambulatory oncology nurses identify in their practice with older cancer patients as well as resources that are helpful or are needed.

Objective

The aim of this study was to capture ambulatory oncology nurses’ perceptions of the unique aspects of caring for older patients and to present the development process, content validity testing, and psychometric evaluation of a survey designed to denote nurse perceptions of older adult care.

Methods

An expert panel and 2 focus groups informed the development of a 34-item survey scored on a 5-point Likert-type agreement scale and 2 open-ended questions. Psychometric testing and descriptive statistics summarized the quantitative responses. Using thematic analysis, we identified the themes from the open-ended responses.

Results

The survey demonstrated good psychometric qualities. A total of 401 participants, mostly staff from large, academic cancer centers, reported an average total score of 3.76, indicating generally positive perceptions of older adult care. The 269 (67%) open-ended responses were categorized into 4 main themes: concerns over medical issues, the need for specialized services, adequate support systems, and appropriate communication.

Conclusions

Although most perceived their geriatric practice environment favorably, nurses recognized the complexity of caring for older adults with cancer. They identified gaps in care, such as the need for geriatric specialists and better community resources, paid by insurance.

Implications for Practice

Nurses need more time in the clinic to address complex advanced care planning, symptom burden and home services of older adults with cancer. Each institution should seek feedback from nurses to guide resource allocation.