bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Endoscopic Facet Joint Denervation to the Percutaneous Technique Regarding Efficacy in Patients With Low Back Pain: A Randomized Controlled Trial
Authors: Woiciechowsky Christian
Published: July 2022

Study Design.

This was a single-center prospective randomized controlled study.

Objective.

The aim was to compare the efficacy of endoscopic facet joint denervation (FJD) with that of the percutaneous technique in terms of pain, functional disability, and quality of life in patients with low back pain (LBP).

Summary of Background Data.

Different controlled studies in patients with LBP have shown short-term benefits from percutaneous FJD. Observational studies have demonstrated that endoscopic FJD may be more effective. As the superiority of the endoscopic technique has not been clearly demonstrated in previous studies, a prospective randomized controlled study was conducted.

Materials and Methods.

For this study, 40 patients with LBP lasting more than 6 months duration and at least 50% pain reduction on the visual analog scale after medial branch block under fluoroscopy, were assigned randomly to receive percutaneous or endoscopic FJD. The primary outcome was pain, as indicated by visual analog scale. Secondary outcomes were functional disability, as assessed by the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and quality of life, as assessed by the Short Form Health Survey (SF-36).

Results.

After the intervention, the pain level decreased significantly in both groups (P<0.001); however, the effect was still significant in the endoscopic group (EG) and diminished to lower than the statistical significance in the percutaneous group (PG) after 12 months. The ODI and RDQ scores also improved significantly in both groups (P<0.001). However, the ODI and RDQ were significantly better (P<0.001) in the EG after 12 months. In the SF-36, we observed significant improvement in both groups three months after the intervention. The effect decreased after six months in the PG and was predominantly not demonstrable after 12 months, whereas in the EG there was still a strong significant improvement on all scales (P<0.001) after 12 months.

Conclusion.

Percutaneous and endoscopic FJD reduced pain and improved functionality and quality of life. However, the effects decreased or disappeared in the PG after 12 months, whereas there was still a strong significant improvement in the EG.
The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention
Authors: Passias Peter G. , Kummer Nicholas A. , Williamson Tyler K. , Ahmad Waleed , Lebovic Jordan , Lafage Virginie , Lafage Renaud , Kim Han Jo , Daniels Alan H. , Gum Jeffrey L. , Diebo Bassel G. , Gupta Munish C. , Soroceanu Alexandra , Scheer Justin K. , Hamilton D. Kojo , Klineberg Eric O. , Line Breton , Schoenfeld Andrew J. , Hart Robert A. , Burton Douglas C. , Eastlack Robert K. , Mundis Gregory M. , Mummaneni Praveen , Chou Dean , Park Paul , Schwab Frank J. , Shaffrey Christopher I. , Bess Shay , Ames Christopher P. , Smith Justin S. ,   on behalf of the International Spine Study Group
Published: July 2022

Summary of Background Data.

The influence of frailty on economic burden following corrective surgery for the adult cervical deformity (CD) is understudied and may provide valuable insights for preoperative planning.

Objective.

To assess the influence of baseline frailty status on the economic burden of CD surgery

Study Design.

Retrospective cohort.

Materials and Methods.

CD patients with frailty scores and baseline and two-year Neck Disability Index data were included. Frailty score was categorized patients by modified CD frailty index into not frail (NF) and frail (F). Analysis of covariance was used to estimate marginal means adjusting for age, sex, surgical approach, and baseline sacral slope, T1 slope minus cervical lordosis, C2–C7 angle, C2–C7 sagittal vertical axis. Costs were derived from PearlDiver registry data. Reimbursement consisted of a standardized estimate using regression analysis of Medicare payscales for services within a 30-day window including length of stay and death. This data is representative of the national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per quality-adjusted life-year (QALY) at two years was calculated for NF and F patients.

Results.

There were 126 patients included. There were 68 NF patients and 58 classified as F. Frailty groups did not differ by overall complications, instance of distal junctional kyphosis, or reoperations (all P>0.05). These groups had similar rates of radiographic and clinical improvement by two years. NF and F had similar overall cost ($36,731.03 vs. $37,356.75, P=0.793), resulting in equivocal costs per QALYs for both patients at two years ($90,113.79 vs. $80,866.66, P=0.097).

Conclusion.

F and NF patients experienced similar complication rates and upfront costs, with equivocal utility gained, leading to comparative cost-effectiveness with NF patients based on cost per QALYs at two years. Surgical correction for CD is an economical healthcare investment for F patients when accounting for anticipated utility gained and cost-effectiveness following the procedure.

Level of Evidence.

III.
Blockade of Osteoclast-Mediated Bone Resorption with a RANKL Inhibitor Enhances Bone Formation in a Rat Spinal Fusion Model
Authors: Payne Karin A. , Shaw Nichole M. , Erickson Christopher B. , Yarger Peter , Yu Yangyi , Baldini Todd , Kleck Christopher J. , Patel Vikas V. , Burger Evalina L.
Published: July 2022

Study Design.

Rat spine fusion model.

Objective.

The present study aimed to determine whether administration of osteoprotegerin in a rat model of spinal fusion increases bone volume, bone density, and decreases osteoclasts in the fusion mass.

Summary of Background Data.

Osteoprotegerin is a soluble RANK-ligand inhibitor that blocks osteoclast differentiation and activation. This makes it a potential agent to control the remodeling process and enhance bone mass during spinal fusion.

Methods.

Forty-eight male Sprague-Dawley rats received a one-level spinal fusion of L4-L5 with bone allograft. Rats were then divided into four groups according to initiation of treatment: (1) saline on Day 0 (Saline), (2) osteoprotegerin on Day 0 (OPG D0), (3) osteoprotegerin on Day 10 (OPG D10), and (4) osteoprotegerin on Day 21 (OPG D21) post-surgery. After their initial injection, rats received weekly subcutaneous injections of osteoprotegerin (10 mg/kg) and were euthanized six weeks post-surgery. MicroCT analysis of the fusion site and histological analysis of bone surface for quantification of osteoclast lining was performed.

Results.

Increased bone volume in the fusion site and around the spinous process was seen in OPG D0 and OPG D10 when compared to Saline. Mean trabecular thickness was greater in all groups receiving osteoprotegerin compared to saline, with OPG D0 and OPG D10 having significantly greater mean trabecular thickness than OPG D21. All osteoprotegerin groups had less bone surface lined with osteoclasts when compared to Saline, with OPG D0 and OPG D10 having fewer than OPG D21.

Conclusions.

This study indicates that osteoprotegerin inhibited osteoclast bone resorption, which led to greater bone at the fusion site. Future studies investigating osteoprotegerin on its own or in combination with an osteogenic factor to improve spinal fusion outcomes are warranted to further elucidate its potential therapeutic effect.
Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers: Results of the Multi-Ethnic Alignment Normative Study (MEANS)
Authors: Sardar Zeeshan M. , Cerpa Meghan , Kelly Michael , Bourret Stephane , Hasegawa Kazuhiro , Wong Hee-Kit , Liu Gabriel , Dennis Hey Hwee Weng , Riahi Hend , Le Huec Jean-Charles , Lenke Lawrence
Published: July 2022

Background.

Spinal alignment can have a significant impact on a patient’s overall quality of life. Predicting the ideal sagittal spinal alignment of a specific individual is still a difficult task. The Multi-Ethnic Alignment Normative Study (MEANS) investigated skeletal alignment, including the spine and lower extremities, of the largest multi-ethnic cohort of asymptomatic adult volunteers. In this analysis, the authors aim to assess normative values of spinopelvic parameters and the regional cervical, thoracic, and lumbar spinal alignment in asymptomatic volunteers stratified by age and sex.

Materials and Methods.

Asymptomatic volunteers between ages 18 and 80 years were enrolled prospectively from centers in France, Japan, Singapore, Tunisia, and the United States. Volunteers included reported no significant neck or back pain (Visual Analog Scale ≤2), nor any known spinal disorder(s). All volunteers underwent a standing full-body or full-spine low-dose stereoradiograph.

Results.

MEANS consisted of 468 volunteers with a mean age of 40.4±14.8 years. Mean cervical lordosis from C2 to C7 was −0.4±12.7°. The T1-slope averaged 23.0±7.9° and showed strong correlation (r=0.87) with the C7-slope mean of 19.8±8.6°. Thoracic kyphosis (TK) from T4 to T12 showed a mean of 37.4±10.9°. Average L1–S1 lumbar lordosis (LL) was −57.4±11.3°. The mean pelvic incidence (PI) measured 52.0±10.7° and pelvic tilt was 12.5±7.3°. Sacral slope averaged 39.5±8.2°. The average PI-LL was −5.4±10.7°. Approximately 60% of volunteers met the PI-LL criteria within ±10°, 8.3% were ≥10°, while 32.1% were ≤−10°. LL showed moderate correlation with PI (r=0.53) and TK (r=0.50), while there was no correlation between TK and PI. Multiple linear regression including PI, TK, and age resulted in the following equation LL=14.6+0.57 (PI)+0.57 (TK)−0.2 (age) (r=0.75).

Conclusions.

LL did not change with increasing age in asymptomatic volunteers. However, TK did increase with age leading to an increase in T1-slope and a compensatory increase in cervical lordosis. TK did not correlate with PI and was an independent variable in the prediction of LL.

Level of Evidence.

Level II—prospective cohort study.
Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review
Authors: Lee Kate E. , Shen Bo
Published: July 2022

BACKGROUND:

Patients with ulcerative colitis refractory to medication or familial adenomatous polyposis may require ileal pouch-anal anastomosis after a colectomy. IPAA is generally well tolerated. However, patients can experience posttreatment complications, including pouch strictures and leaks. Medical therapy has a limited role in mechanical fibrotic strictures, whereas surgery is invasive and costly. In the past few decades, endoscopic therapies have provided a less invasive and less costly intervention for pouch strictures and leaks.

OBJECTIVE:

This systematic literature review aimed to describe the status of advancements in endoscopic therapy for pouch leaks and strictures.

DATA SOURCES:

The sources used were PubMed and Cochrane databases.

STUDY SELECTION:

Studies between January 1990 and January 2022, in any language, were included. Articles regarding surgical management or pouches other than adult ileal pouch-anal anastomosis were excluded.

INTERVENTIONS:

Endoscopic management of acute and chronic leaks and strictures ileal pouch-anal anastomosis was included.

MAIN OUTCOME MEASURES:

Successful management (including persistent leak or stricture, pouch failure, subsequent endoscopy, or surgery) was measured.

RESULTS:

Sixty-one studies were included in this review, including 4 meta-analyses or systematic reviews, 11 reviews, 17 cohort studies, and 18 case series.

LIMITATIONS:

The limitations include qualitative review of all study types, with no randomized controlled studies available.

CONCLUSION:

Ileal pouch-anal anastomosis leaks are various in configuration, and endoscopic therapies have included clipping leaks at the tip of the “J” as well as endoscopic sinusotomy. Endoscopic therapies for pouch strictures have included endoscopic balloon dilation, endoscopic stricturotomy, and endoscopic stricturoplasty, which are now considered first-line therapies for pouch strictures. Endoscopic balloon dilation has shown safety and efficacy in single, short, and straight strictures and endoscopic stricturotomy for refractory long, fibrotic, anastomotic strictures. Endoscopic therapies can delay or prevent invasive surgeries. Key tenets of successful endoscopic therapy include patient and lesion candidacy, an experienced endoscopist, and adequate rescue surgery plans.
Breast Cancer Screening: An Overview of Risk-specific Screening and Risk Assessment
Authors: Scott Dana M.
Published: July 2022

Breast cancer screening decreases stage at diagnosis, treatment morbidity, and disease mortality. A comprehensive risk assessment is critical to determine an individual’s most appropriate screening regimen. Multiple guidelines exist for screening mammography in average-risk individuals, which differ on age and frequency of screening. Annual mammography starting at age 40 is associated with the greatest reduction in breast cancer mortality and greatest number of life-years saved. A formal risk calculator is helpful to assess one’s lifetime risk of breast cancer and assess eligibility for high-risk screening. Screening guidelines exist for genetic mutations that increase breast cancer risk.
Postnatal Unit Care and Safe Transition Home
Authors: HARRIS KANIKA A. , ETIENNE STEPHANIE , ARRINGTON LAUREN A.
Published: July 2022

The United States has the highest maternal mortality rate among developed nations with 60% of deaths occurring during the postpartum period. This chapter presents the case study of Maya Howard. Maya represents of composite of qualitative research studies that reveals missteps, gaps, and oversights of Black mothers and birthing people during birth and the postpartum period. Using a Black feminist framework, the chapter offers solutions to improve postnatal unit care and the transition home, a critical step in improving care and saving lives for all mothers and birthing people.
Relative Effectiveness of Cell-based Versus Egg-based Quadrivalent Influenza Vaccines in Children and Adolescents in the United States During the 2019–2020 Influenza Season
Authors: Imran Mahrukh , Ortiz Justin R. , McLean Huong Q , Fisher Lauren , O’Brien Dan , Bonafede Machaon , Mansi James A. , Boikos Constantina
Published: July 2022

Background:

Egg-based influenza vaccine production can lead to the accumulation of mutations that affect antigenicity. The mammalian cell-based inactivated quadrivalent influenza vaccine (IIV4c) may improve effectiveness compared with egg-based vaccines. This study estimated the relative vaccine effectiveness (rVE) of IIV4c versus egg-based inactivated quadrivalent influenza vaccine (IIV4e) in preventing influenza-related medical encounters (IRME) among children and adolescents during the 2019–2020 US influenza season.

Methods:

This retrospective cohort study used a dataset linking primary and specialty care electronic medical records with medical and pharmacy claims data from US residents 4 through 17 years of age vaccinated with IIV4c or IIV4e during the 2019–2020 influenza season. Odds ratios (ORs) were derived from a doubly robust inverse probability of treatment-weighted approach adjusting for age, sex, race, ethnicity, region, index week, health status and two proxy variables for healthcare accessibility and use. Adjusted rVE was estimated by (1-ORadjusted)*100, and an exploratory analysis evaluated IRMEs separately for outpatient and inpatient settings.

Results:

The final study cohort included 60,480 (IIV4c) and 1,240,990 (IIV4e) vaccine recipients. Fewer IRMEs were reported in subjects vaccinated with IIV4c than IIV4e. The rVE for IIV4c versus IIV4e was 12.2% [95% confidence interval (CI): 7.5–16.6] for any IRME and 14.3% (9.3–19.0) for outpatient IRMEs. Inpatient IRMEs were much less frequent, and effectiveness estimates were around the null.

Conclusions:

Fewer IRMEs occurred in pediatric subjects vaccinated with IIV4c versus IIV4e. These results support the greater effectiveness of IIV4c over IIV4e in this population during the 2019–2020 US influenza season.
Infections With Stenotrophomonas maltophilia in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study
Authors: Richert-Przygonska Monika , Czyzewski Krzysztof , Dziedzic Magdalena , Zalas-Wiecek Patrycja , Gryniewicz-Kwiatkowska Olga , Gietka Agnieszka , Malas Zofia , Semczuk Katarzyna , Chelmecka Liliana , Zak Iwona , Salamonowicz-Bodzioch Malgorzata , Fraczkiewicz Jowita , Zajac-Spychala Olga , Bien Ewa , Irga-Jaworska Ninela , Plonowski Marcin , Wawrykow Pawel , Bartnik Magdalena , Pierlejewski Filip , Gamrot Zuzanna , Badowska Wanda , Stolpa Weronika , Musial Jakub , Szmydki-Baran Anna , Hutnik Lukasz , Tomaszewska Renata , Urbanek-Dadela Agnieszka , Zaucha-Prazmo Agnieszka , Gozdzik Jolanta , Styczynski Jan ,   for the Polish Society of Pediatric Oncology and Hematology
Published: July 2022

Background:

Infections caused by Stenotrophomonas maltophilia (SM) have documented high mortality rate in immunocompromised patients.

Aim:

This nationwide multicenter study was performed to analyze the epidemiology of SM infections in children undergoing anticancer therapy (pediatric hematology and oncology [PHO]) or hematopoietic cell transplantation (HCT) over 2012–2019, including incidence and outcome of SM infections, as well as treatment regimens and multidrug resistance.

Methods:

Cumulative incidence of SM infections was calculated using the competing risk analysis from the day of diagnosis (PHO setting) or from the day of transplantation (HCT setting). The Kaplan-Meier method was used to determine survival from infection.

Results:

During the study period of 8 years, a total number of 1356 HCTs and 7337 children newly diagnosed for malignancy were analyzed. Diagnosis of acute leukemia was a predisposing factor for SM infection. The cumulative incidence of SM infections was comparable in HCT patients in comparison to PHO (0.81% vs. 0.76%). High rate of trimethoprim/sulfamethoxazole susceptibility among SM isolates was observed in both groups of patients (80.8%). Although this was the drug of choice, survival rates from SM infections were significantly lower in HCT than in PHO (45% vs. 85%, P = 0.001, log-rank test). We found the transplant procedure and lack of clinical resolution after 18 days of antibiotic therapy to be independent mortality risk factors.

Conclusions:

The risk of SM infections and the occurrence of resistant bacterial strains in allo-HCT patients were comparable to PHO patients. Irrespective of target antibiotic therapy, the outcome of SM infections was better in the PHO setting.
TandemHeart-Associated Fever
Authors: Nagarakanti Sandhya , Bishburg Eliahu , Hasan Mustafa , Okoh Alexis , Baran David A.
Published: July 2022

Percutaneous mechanical circulatory support devices such as TandemHearts have been increasingly used in the treatment of patients with refractory cardiogenic shock. Fever can develop as a consequence without the development of an infection. Infectious disease physicians are commonly consulted for the onset of fevers after device placement, and it is been a challenge to identify the cause of fevers and delineate infection as cause of fever. Fever and associated infections have not been well characterized after TandemHeart placement. The aim of the current study is to correlate the development of fever with infections and describe the infectious complications associated with TandemHearts. The study included patients who received TandemHearts between 2013 and 2016. Data on demographics, indication for insertion, fever course if noted within 72 hours after the device placement, infection type, and outcome were collected. Among the included 52 patients, fever was noted in 23 (44.2%) and infections in 15 (29%) patients, and both fever and infection in 5 patients. The median onset of fever was 26 hours, and the median onset of infection was 72 hours after insertion. Fever without any documented infection was noted in 18 of 23 (78%). The median duration of fever in patients without infection was 18.5 hours, and that in patients with infection was 96 hours (P = 0.12). Infections included pneumonia in 7 of 15 (46.6%) and central line–associated blood stream infection in 4 of 15 (25%).
Nurse-Sensitive Indicator Quality Improvement Toolkit
Authors: McVey Caitlin , von Wenckstern Toni , Mills Courtney , Yager Lauren , McCauley Christopher , Rivera Yvana , Reed Elizabeth
Published: July 2022

Background:

Existing best practices to monitor and prevent health care–associated infections (HAIs) were ineffective during the COVID-19 pandemic due to increased patient susceptibility toward infections, reduced resources, and increased use of agency nurses.

Problem:

A review of the US hospitals revealed a 60% increase in central line–associate bloodstream infections (CLABSIs) and a 43% increase in catheter-associated urinary tract infections (CAUTIs) in 2020. A large, academic, level 1 trauma center in Houston, Texas, experienced similar challenges at the start of the COVID-19 pandemic.

Approach:

An interdisciplinary team of nurses, infection preventionists, and hospital educators combined and adapted existing evidence-based practices in a novel way to create a nursing-led toolkit for quality improvement tracking, improving, and sustaining HAI improvements.

Outcomes:

CLABSI and CAUTI rates were reduced over time following the introduction of the Nurse-Sensitive Indicator Quality Improvement (NSIQI) Toolkit. The CLABSI standardized infection ratio (SIR) decreased by 19%, and the CAUTI SIR decreased by 19.4%.

Conclusions:

The novel NSIQI Toolkit is a scalable tool for improving and sustaining CLABSI and CAUTI rates, which may have the potential for other nurse-sensitive quality indicators.
A Systematic Review of the Consumer Emergency Care Satisfaction Scale (CECSS)
Authors: Hoonakker Peter L. T. , Carayon Pascale , Brown Roger L. , Werner Nicole E.
Published: July 2022

Background:

Patient experience is receiving increasing attention in the context of patient-centered care. However, there are relatively few instruments that measure patient experience that are valid and reliable.

Objective:

In this study, we systematically review the literature on the Consumer Emergency Care Satisfaction Scale (CECSS) and examine its psychometric properties.

Methods:

We conducted a systematic literature search in the Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Web of Science databases on articles that contain information on the CECSS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results:

Our systematic literature search resulted in 28 articles in which the CECSS was used.

Conclusions:

Results of our literature review show that from a psychometric perspective, the CECSS is a valid and reliable instrument. However, the results of our study also show that the CECSS has several weaknesses. We have made recommendations to improve the CECSS.
Findings From the 2021 Organizational Value of Nursing Professional Development Practice Study, Part 2
Authors: Harper Mary G. , Maloney Patsy , Aucoin Julia , MacDonald Ryan
Published: July 2022

A 2015 study exploring the relationship between nursing professional development (NPD) staffing and organizational outcomes was replicated in 2021. The background, including literature review, methods, and descriptive statistics, were presented in Part 1 of this report. Part 2 explores the relationships between NPD staffing and organizational outcomes. Evidence suggests that higher levels of NPD staffing are associated with many positive nursing and patient outcomes and provide financial benefit to the organization.
A Retrospective Study of the Adjunctive Use of Gabapentin With Benzodiazepines for the Treatment of Benzodiazepine Withdrawal
Authors: Leung Edison , Ngo Daniel H. , Espinoza Joe A. , Beal Lauren L. , Chang Catherine , Baris Dalsu A. , Lackey Blake N. , Lane Scott D. , Wu Hanjing E.
Published: July 2022

Benzodiazepine withdrawal is a widespread problem with potentially severe and deadly consequences. Currently, the only medications available for treating benzodiazepine withdrawal are short-acting and long-acting benzodiazepines. Identifying other drugs to help in treating benzodiazepine withdrawal is necessary. Gabapentin, an anxiolytic drug that is also used off-label to treat alcohol withdrawal, is a potential candidate for modulating benzodiazepine withdrawal. Using electronic records from a large inpatient psychiatric facility, a retrospective study of 172 patients presenting with benzodiazepine withdrawal was conducted to determine if the coincidental use of gabapentin for other medical conditions was associated with better outcomes of benzodiazepine withdrawal (N=57 gabapentin, N=115 no gabapentin). The primary outcomes were hospital length of stay and total amount of benzodiazepines given (lorazepam milligram equivalent). In this retrospective analysis of electronic medical record data, the patients experiencing benzodiazepine withdrawal who received gabapentin as an adjunct to the use of benzodiazepines were administered a smaller amount of benzodiazepines and had a shorter length of hospital stay relative to the comparison group who did not receive adjunctive gabapentin. These results suggest the potential use of gabapentin as an adjunct to the use of benzodiazepines for treating benzodiazepine withdrawal. The limitations of this study included a small sample size and variability in medication management strategies across the sample.
A Fatal Case of Factitious Aplastic Anemia
Authors: Bade-Boon Jordan , Dobson Hannah , Breadon Carolyn
Published: July 2022

We report the case of a 26-year-old female who intentionally ingested busulfan, an oral chemotherapy agent, to induce severe aplastic anemia. The patient was initially thought to be suffering from idiopathic aplastic anemia, before clues suggesting the diagnosis of a factitious disorder were identified. The patient underwent a bone marrow transplant and ultimately died 5 weeks later following a lengthy admission to the intensive care unit. It is unclear whether confrontation about a patient’s self-induction of physical illness is beneficial in the treatment of patients with factitious disorder. Cases such as this pose substantial diagnostic challenges, making early recognition of factitious disorder and initiation of treatment difficult. The patient described in this case report had risk factors for a factitious disorder, including age, gender, professional involvement in health care, recent loss and developmental trauma. Factitious disorder, while rare, can have lethal consequences for the patient. This diagnosis must be considered as part of a full diagnostic assessment.
Judging Personality Disorder: A Systematic Review of Clinician Attitudes and Responses to Borderline Personality Disorder
Authors: Baker James , Beazley Peter I.
Published: July 2022

Background:

It has been suggested that the diagnosis of borderline personality disorder (BPD) is associated with particularly stigmatizing connotations, particularly among mental health professionals. The goal of this study was to synthesize quantitative studies investigating the attitudes and responses of clinicians to BPD and to appraise the methodological quality of these studies.

Methods:

A systematic search was carried out using MEDLINE Complete, CINAHL Complete, PsychoINFO, PsychARTICLES, Scopus, Social Sciences Citation Index, and Academic Search Complete. Study quality was rated using an adapted tool.

Results:

This review included 37 papers involving an estimated 8196 participants: 21 cross-sectional survey studies, 5 studies assessing training workshops, 5 studies assessing countertransference, and 6 experimental studies. The methodological quality of the studies was mixed, with many differing measures with questionable validity used.

Conclusions:

Negative attitudes toward BPD continue to be a problem to differing degrees among clinical staff. Although this issue is most prominent among psychiatric nurses, the results of this review highlight evidence of negative attitudes across all mental health professions as well as potentially in professionals working in physical health settings. Various clinician-level factors may play a role in the development and maintenance of such attitudes. Greater exposure to patients with BPD and attendance at training programs have been found to be associated with improved attitudes. Professionals require regular training concerning BPD that is sufficiently evidence-based.
The Predictors of Somatic Symptoms in a Population Sample: The Lifelines Cohort Study
Authors: Creed Francis
Published: July 2022

Objective

Multiple bodily symptoms predict poor health status, high healthcare use, and onset of functional somatic syndromes. This study aimed to identify the predictors of somatic symptoms with special reference to mental disorders.

Methods

The prospective, population-based Lifelines cohort study included 80,888 adults who were followed up for a mean of 2.4 years. At baseline sociodemographic status, self-reported medical disorders, functional somatic syndromes, stress, neuroticism, mental disorders (assessed with Mini-International Neuropsychiatric Interview), health perception, and analgesic use were assessed. These variables were tested as predictors of number of somatic symptoms at follow-up using linear regression analysis, which adjusted for baseline somatic symptoms (n = 65,904). Logistic regression was used to identify the predictors of a persistently high number of somatic symptoms.

Results

The strongest predictors of somatic symptoms at follow-up were life events and difficulties score, and number of general medical illnesses/functional somatic syndromes. Neuroticism and mental disorders were also independent predictors in all analyses. Generalized anxiety, major depressive, and panic disorders were all independent predictors when entered individually into the regression analysis. A persistently high number of somatic symptoms were predicted most strongly by functional somatic syndromes, negative health perception, and paracetamol use.

Conclusions

Number of somatic symptoms should be regarded as a multifactorial measure with many predictors. Mental disorders form one predictor, but there are other stronger ones, including stress and general medical disorders. The bidirectional relationship between functional somatic syndromes and multiple somatic symptoms is compatible with the notion that perception of bodily symptoms is a key component of both.
Mechanical stress-induced Hippo signaling in respect to primordial follicle development and polycystic ovary syndrome pathogenesis
Authors: Xia Ling-Jin , Du Jing
Published: July 2022

Polycystic ovary syndrome (PCOS) is a heterogeneous reproductive disease that can cause infertility. The Hippo signaling pathway, a network highly conserved throughout evolution, maintains the balance between follicle proliferation and dormancy. Dynamic changes in primordial follicles cannot occur without the participation of biological signals and mechanical force; however, little is known about the mechanism by which biomechanical signaling triggers PCOS, especially in the context of primordial follicle development. To investigate the contribution of mechanical stress and the Hippo signaling pathway to the onset of PCOS, we searched the literature via the PubMed database, and inclusion and exclusion criteria were established to ensure the rigor of this research. We eventually included 54 publications in which Hippo signaling and mechanical force were suggested to play a vital role in the development of primordial follicles as well as elucidate the pathogenesis of PCOS. The Hippo pathway modulating follicle growth can be perturbed via extracellular mechanical stress caused by the stiff ovarian cortical environment in PCOS. Clinical intervention targeting the Hippo pathway can alter the activity of core Hippo members, such as the Yes-associated protein/transcriptional co-activator PDZ-binding motif complex. In some patients with PCOS, follicle overactivation can be attributed to the dysfunction of Hippo signal transduction. PCOS, a condition with various patterns, cannot be accurately explained by a single, specific mechanism. The present review identifies potential targets and therapeutic strategies for PCOS.
Embolic Events After Computed Tomography Contrast Injection in Patients With Interatrial Shunts
Authors: Schawkat Khoschy , Litmanovich Diana , Appel Elisabeth , Ghorishi Alex , Selim Magdy , Manning Warren J. , Nakhaei Masoud , Biglione Bianca , Camacho Andrés , Brook Olga R.
Published: July 2022

Background:

Patients with interatrial shunts (patient foramen ovale/atrial septal defect) are potentially at increased risk for paradoxical air embolism following computed tomography (CT) scans with intravenous (IV) contrast media injection. IV in-line filters aim to prevent such embolisms but are not compatible with power injection required for diagnostic CT.

Purpose:

The purpose of this study was to determine whether the incidence of paradoxical embolism to the heart and brain in patients with an interatrial shunt is higher compared with controls within 48 hours following injection of IV contrast media without IV in-line filter.

Methods:

This is a retrospective cohort study conducted at a large tertiary academic center, which included a total of 2929 consecutive patients who underwent 8983 CT scans with IV contrast media injection between July 1, 2000 and April 30, 2018. Diagnosis of an interatrial shunt was confirmed by transthoracic or transesophageal echocardiography. Incidence and risk of cardiac embolic events (new troponin elevation, >0.1 ng/mL) and neurological embolic events (new diagnosis of stroke/transient ischemic attacks) were evaluated.

Results:

Among the 2929 patients analyzed (mean±SD age, 61±14 y), 475/2929 (16.2%) patients had an interatrial shunt. After applying the exclusion criteria, new elevated troponin was found in 8/329 (2.4%; 95% confidence interval [CI]: 1.1-4.7) patients with an interatrial shunt compared with 25/1687 (1.5%; 95% CI: 0.9-2.2) patients without an interatrial shunt. New diagnosis of stroke occurred in 2/169 (1%; 95% CI: 0.3-4.2) of patients with an interatrial shunt compared with 7/870 (0.8%; 95% CI: 0.4-1.7) without interatrial shunt.

Conclusion:

Among patients with echocardiographic evidence of an interatrial shunt, IV CT contrast administration without an in-line filter does not increase the incidence of cardiac or neurological events.
Diagnosing Pulmonary Embolism With Computed Tomography Pulmonary Angiography
Authors: Schmid Johannes , Nagy Eszter , Kaufmann-Bühler Ann-Katrin , Steiner Jakob , Janisch Michael , Janek Elmar , Reiter Clemens , Eibisberger Martin , Softic Nina , Guss Helmuth , Fuchsjäger Michael , Adelsmayr Gabriel
Published: July 2022

Purpose:

Computed tomography pulmonary angiography (CT-PA) is frequently used in the diagnostic workup of pulmonary embolism (PE), even in highly radiosensitive patient populations. This study aims to assess CT-PA with reduced z-axis coverage (compared with a standard scan range covering the entire lung) for its sensitivity for detecting PE and its potential to reduce the radiation dose.

Materials and Methods:

We retrospectively analyzed 602 consecutive CT-PA scans with definite or possible PE reported. A reduced scan range was defined based on the topogram, where the cranial slice was set at the top of the aortic arch and the caudal slice at the top of the lower hemidiaphragm. Locations of emboli in relation to the reduced scan range were recorded.

Results:

We included 513 CT-PA scans with definite acute PE in statistical analysis. Patients’ median age was 66 (52 to 77) years, 46% were female. Median dose length product was 270.8 (111.3 to 503.9) mGy*cm. Comparing the original and reduced scan ranges, the mean scan length was significantly reduced by 48.0±8.6% (26.8±3.0 vs. 13.9±2.6 cm, P<0.001). Single emboli outside the reduced range in addition to emboli within were found in 15 scans (2.9%), while only 1 scan (0.2%) had an embolus outside the reduced range and none within it. The resulting sensitivity of CT-PA with reduced scan range was 99.81% (95% confidence interval: 98.74%-99.99%) for detecting any PE.

Conclusion:

A reduced scan length in CT-PA, as defined above, would substantially decrease radiation dose while maintaining diagnostic accuracy for detecting PE.
Serial Changes in Coronary Plaque Formation Using CT Angiography in Patients Undergoing PCSK9-Inhibitor Therapy With 1-year Follow-up
Authors: Baumann Stefan , Kettel Laura , Stach Ksenija , Özdemir Gökce H. , Renker Matthias , Tesche Christian , Becher Tobias , Hetjens Svetlana , Schoepf U. Joseph , Akin Ibrahim , Borggrefe Martin , Krämer Bernhard K. , Schoenberg Stefan O. , Janssen Sonja , Overhoff Daniel , Lossnitzer Dirk
Published: July 2022

Purpose:

Previous studies have shown positive effects of intensive low-density lipoprotein (LDL)-lowering therapy on atheroma volume using invasive intravascular ultrasound. This study describes the changes in coronary plaque composition on coronary computed tomography angiography in patients treated with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors.

Materials and Methods:

In this prospective study, coronary plaques were analyzed using third-generation dual-source computed tomography before and after 1 year of PCSK9-inhibitor treatment. Plaque markers included total plaque volume (TPV), calcified plaque volume (CPV), noncalcified plaque volume (NCPV), lumen volume and vessel volume (VV), minimal luminal area (MLA), minimal lumen diameter (MLD), corrected coronary opacification, eccentricity, remodeling index, and functional plaque parameters. Primary endpoint was defined as change in TPV; the secondary endpoint was TPV or CPV regression or nominal change in plaque parameters.

Results:

We analyzed 74 coronary plaques in 23 patients (60±9 y, 65% male). After 1 year of PCSK9-inhibitor treatment, LDL was reduced from 148 to 66 mg/dL (P<0.0001). Significant changes were found for VV (196 to 215 mm3, P=0.0340), MLA (3.1 to 2.6 mm2, P=0.0413), and MLD (1.7 to 1.4 mm, P=0.0048). TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly (P>0.05).

Conclusions:

Coronary artery plaque analysis by coronary computed tomography angiography highlights that LDL lowering therapy affects plaque composition. The primary endpoint of TPV change was not reached; however, VV, MLA, and MLD changed significantly.
STOPS
Authors: D’Angelo Jonathan D. , Lund Sarah , Woerster Malin , Sawatsky Adam P. , Kelley Scott R. , Dozois Eric J. , D’Angelo Anne-Lise D.
Published: July 2022

Objective:

To investigate the steps faculty surgeons take upon experiencing intraoperative error and synthesize these actions to offer a framework for coping with errors.

Background:

While intraoperative errors are inevitable, formal training in error recovery is insufficient and there are no established curricula that teach surgeons how to deal with the intraoperative error. This is problematic because insufficient error recovery is detrimental to both patient outcomes and surgeon psychological well-being.

Methods:

We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with faculty surgeons from 3 hospitals. Surgeons described recent experiences with intraoperative error. Interviews were transcribed and coded. Analysis allowed for development of themes regarding responses to errors and coping strategies.

Results:

Twenty-seven surgeons (30% female) participated. Upon completion of the analysis, themes emerged in 3 distinct areas: (1) Exigency, or a need for training surgical learners how to cope with intraoperative errors, (2) Learning, or how faculty surgeons themselves learned to cope with intraoperative errors, and (3) Responses, or how surgeons now handle intraoperative errors. The latter category was organized into the STOPS framework: Intraoperative errors could produce STOPS: Stop, Talk to your Team, Obtain Help, Plan, Succeed.

Conclusions and Relevance:

This study provides both novel insight into how surgeons cope with intraoperative errors and a framework that may be of great use to trainees and faculty alike.
Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them
Authors: Ferrari Linda , Mari Valentina , De Santi Gabriella , Parini Sara , Capelli Giulia , Tacconi Giovanna , Chessa Antonella , Verdi Daunia , Frigerio Isabella , Spolverato Gaya , Gumbs Andrew
Published: July 2022

Objective:

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles.

Background:

Visible and invisible impediments can hinder female doctors’ pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression.

Methods:

Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included.

Results:

Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition.

Conclusions:

Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.
Association Between American Board of Surgery Initial Certification and Medical Malpractice Payments
Authors: Jones Andrew T. , Ibáñez Beatriz , Barry Carol L. , Abashkin Yuri , Singh Harnam , Wilkinson Derek S. , Buyske Jo
Published: July 2022

Objective:

To measure associations between surgeons’ examination performance and obtaining American Board of Surgery certification with the likelihood of having medical malpractice payments.

Background:

Further research is needed to establish a broader understanding of the association of board certification and patient and practice outcomes.

Methods:

Retrospective analysis using propensity score–matched surgeons who attempted to obtain American Board of Surgery certification. Surgeons who completed residency between 2000 and 2019 (n=910) and attempted to become certified were categorized as certified or failing to obtain certification. In addition, groups were categorized as either passing or failing their first attempt on the qualifying and certifying examinations. Malpractice payment reports were dichotomized for surgeons who either had a payment report or not.

Results:

The hazard rate (HR) of malpractice payment reports was significantly greater for surgeons who attempted and failed to obtain certification [HR=1.87; 95% confidence interval (CI), 1.28–2.74] than for surgeons who were certified. Moreover, surgeons who failed either the qualifying (HR=1.64; 95% CI, 1.14–2.37) or certifying examination (HR=1.72; 95% CI, 1.14–2.60) had significantly higher malpractice payment HRs than those who passed the examinations on their first attempt.

Conclusions:

Failing to obtain board certification was associated with a higher rate of medical malpractice payments. In addition, failing examinations in the certification examination process on the first attempt was also associated with higher rates of medical malpractice payments. This study provides further evidence that board certification is linked to potential indicators for patient outcomes and practice quality.
TRIM7 restricts Coxsackievirus and norovirus infection by detecting the C-terminal glutamine generated by 3C protease processing
Authors: Luptak Jakub , Mallery Donna , Jahun Aminu S. , Albecka Anna , Clift Dean , Ather Osaid , Slodkowicz Greg , Goodfellow Ian , James Leo
Published: July 2022

TRIM7 catalyses the ubiquitination of multiple substrates with unrelated biological functions. This cross-reactivity is at odds with the specificity usually displayed by enzymes, including ubiquitin ligases. Here we show that TRIM7’s extreme substrate promiscuity is due to a highly unusual binding mechanism, in which the PRYSPRY domain captures any ligand with a C-terminal helix that terminates in a hydrophobic residue followed by a glutamine. Many of the non-structural proteins found in RNA viruses contain C-terminal glutamines as a result of polyprotein cleavage by 3C protease. This viral processing strategy generates novel substrates for TRIM7 and explains its ability to inhibit Coxsackie virus and norovirus replication. In addition to viral proteins, cellular proteins such as glycogenin have evolved C-termini that make them a TRIM7 substrate. The ‘helix-ΦQ’ degron motif recognised by TRIM7 is reminiscent of the N-end degron system and is found in ∼ 1% of cellular proteins. These features, together with TRIM7’s restricted tissue expression and lack of immune regulation suggest that viral restriction may not be its physiological function.
Chemical engineering of therapeutic siRNAs for allele-specific gene silencingin vivoin CNS
Authors: Conroy Faith , Miller Rachael , Alterman Julia F. , Hassler Matthew R. , Echeverria Dimas , Godinho Bruno M.D.C. , Knox Emily G. , Sapp Ellen , Sousa Jaquelyn , Yamada Ken , Mahmood Farah , Boudi Adel , Kegel-Gleason Kimberly , DiFiglia Marian , Aronin Neil , Khvorova Anastasia , Pfister Edith L.
Published: July 2022

Small interfering RNAs (siRNAs) are a new class of drugs, exhibiting sequence-driven, potent, and sustained silencing of gene expressionin vivo. We recently demonstrated that siRNA chemical architectures can be optimized to provide efficient delivery to the CNS. Many genetically-defined neurodegenerative disorders are autosomal dominant favoring selective silencing of the mutant allele. In some cases, successful targeting of the mutant allele requires targeting of a single nucleotide polymorphism (SNP) heterozygosity. Using Huntington’s disease as a model, we demonstrate allele-specific RNAi-based silencing of gene expressionin vivoand in neurons differentiated from HD patient-derived iPSCs. A series ofin vitroscreens, with chemical and thermodynamic optimization, identified compounds with >50-fold selectivity for the mutant HD-causing allele, based on a single nucleotide difference. The optimized compound exhibits selective silencing of mutant huntingtin (HTT) protein in patient derived cells and throughout the HD mouse brain, providing a demonstration of SNP-based allele-specific RNAi silencing of gene expressionin vivoin the CNS. The ability to target a disease-causing allele using RNAi-based therapies could be applied to a wide range of dominant CNS disorders, where maintenance of wild-type expression is essential.