bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparisons of Stroke Knowledge and Health Behaviors in Patients With Hypertensive Stroke at Different Recurrence Risk Strata
Authors: Li Jing-Jing , Tan Ju-Xiang , Zhu Fen-Yan , Wu Zhen , Ruan Heng-Fang , Li Zhuo-Ran , Wan Li-Hong
Published: February 2021

Background

Risk factor management via behavioral change contributes substantially to secondary stroke prevention. The health belief model identified self-perceived risk as a significant factor in behavior change. In previous studies, people have tended to incorrectly estimate their risk of stroke. Little is known about the differences in stroke knowledge and health behaviors in patients who have had a stroke with different risks of stroke recurrence in China.

Objective

The aims of this study were to determine the accuracy of self-perceived risk of stroke recurrence and to compare stroke knowledge and health behaviors in patients with hypertensive stroke at different recurrence risk strata.

Methods

Baseline data from 174 patients in the Comprehensive Reminder System based on the Health Belief Model (CRS-HBM) study were used. Self-perceived risk was assessed via the susceptibility subcategory of the Short-Form Health Belief Model Scale, and actual risk was stratified using the Essen Stroke Risk Score.

Results

Only 27.0% of the patients estimated their risks of stroke recurrence accurately. Patients who perceived themselves to be at higher risk had better knowledge of warning signs. Compared with patients who underestimated their risk of stroke recurrence, those who accurately estimated or overestimated their risk less likely to smoke.

Conclusions

Most patients incorrectly estimated their risk of stroke recurrence. Communicating with patients about their future risk of recurrent stroke may help improve their stroke knowledge and health behaviors. Implementation of the Comprehensive Reminder System based on the Health Belief Model focusing on risk education aimed at prevention of stroke recurrence is warranted in China.
Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model
Authors: D'Angelo Alexa B. , Davis Ewart Leah N. , Koken Juline , Bimbi David , Brown Justin T. , Grov Christian
Published: February 2021

Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included low perceived risk and concerns about PrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population.
A Review of Recent HIV Prevention Interventions and Future Considerations for Nursing Science
Authors: Threats Megan , Brawner Bridgette M. , Montgomery Tiffany M. , Abrams Jasmine , Jemmott Loretta Sweet , Crouch Pierre-Cedric , Freeborn Kellie , Kamitani Emiko , Enah Comfort
Published: February 2021

As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.
Use of the Tongue Tip Flap for Lower Lip Reconstruction in Involuted Hemangioma
Authors: Goldenberg Dov C. , Ferreira Marina V. C. , Moura Tatiana , Gemperli Rolf
Published: February 2021

Two young female patients underwent lower lip reconstruction after the loss of tissue secondary to the involution of infantile hemangiomas. A proximally based dorsal tongue flap was raised from the tip of the tongue, including a layer of intrinsic muscle. The second stage of the flap division was performed after 3 weeks. Lip contour was improved in both patients, and oral competence was obtained. The papillary appearance of the tongue mucosa smoothened in approximately 2 weeks. Tongue mobility was not compromised. When the defect involves only the vermilion, reconstruction options must be considered on an individual basis. The dorsal portion of the tongue is thicker than the ventral surface and provides better fullness for the lower lip, with a good color match. The 2-staged tongue tip flap (TTF) surgery is an effective alternative to reconstruct vermilion defects after sequelae from infantile hemangioma.
Holistic Admissions and Underrepresented Minorities in Physician Assistant Programs
Authors: Coplan Bettie , Todd Michael , Stoehr James , Lamb Gerri
Published: February 2021

Purpose

The purpose of this study was to assess holistic review use in physician assistant (PA) programs and determine whether a relationship between holistic review and underrepresented minority (URM) matriculation exists.

Methods

Using data from the 2016–2017 Physician Assistant Education Association annual survey of PA programs, we examined the frequency of holistic review use across PA programs. Bivariate correlation analyses and binary logistic regression were used to examine relationships between holistic review practices and program percentages of first-year underrepresented racial and ethnic minority students.

Results

Most PA programs (169/219 [77.2%]) reported using holistic review, and its use modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.16, 95% confidence interval [CI] = 0.02–0.30) or Hispanic (rho = 0.20, 95% CI = 0.06–0.33). Using several holistic review elements related to program commitment to diversity modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.25, 95% CI = 0.10–0.39) or African American (rho = 0.20, 95% CI = 0.04–0.34). Additionally, the odds of a first-year student being an underrepresented racial or ethnic minority were slightly higher in PA programs using holistic review (OR = 1.56, 95% CI = 1.23–1.99 and OR 1.33, 95% CI = 1.09–1.62, respectively).

Conclusions

PA program use of holistic review practices was modestly associated with percentage of URM students. Further research is needed to identify elements that are most effective.
Using Data Mining for the Early Identification of Struggling Learners in Physician Assistant Education
Authors: Black Erik W. , Buchs Shalon R. , Garbas Breann
Published: February 2021

Purpose

Despite the importance of early intervention and remediation, the relatively short duration of physician assistant education programs necessitates the importance of early identification of at-risk learners. This study sought to ascertain whether machine learning was more effective than logistic regression in predicting remediation status among students, using the limited set of data available before or immediately following the first semester of study as predictor variables and academic remediation as an outcome variable.

Methods

The analysis included one institution and student data from 177 graduates between 2017 and 2019. We employed one data mining model, random forest trees, and compared it to a traditional predictive analysis method, logistic regression. Due to the small sample size, we employed leave-one-out cross-validation and bootstrap aggregation.

Results

Data provided evidence that the random forest algorithm correctly identified individuals who would later experience academic intervention with a 63.3% positive predictive value, whereas logistic regression exhibited a positive predictive value of 16.6%.

Conclusions

This single-institution study indicates that predictive modeling, employing machine learning, may be a more effective means than traditional statistical methods of identifying and providing assistance to learners who may experience academic challenges.
Uncovering Ethical Dilemmas in International Service-Learning: A Grounded Theory
Authors: Dholakia Kripa , Willgens Annette , Rubertone Patricia P. , Ebaugh David
Published: February 2021

Introduction.

International Service-Learning (ISL) is a model of experiential learning offered by Doctor of Physical Therapy (DPT) programs in the United States. Over the past several years, the number of these experiences has grown rapidly.

Review of Literature.

Recent evidence has uncovered detrimental impacts of short-term health-related experiences, such as ISL, on the host community; however, to date, ethical situations arising in ISL in DPT education have not been explored. From the perspective of the American Physical Therapy Association (APTA's) Code of Ethics and the Realm-Individual Process-Situation (RIPS) model of ethical decision making, the aims of this study were to (1) explore the experiences, perceptions, and insights of faculty, students, and alumni, who attended an ISL experience and (2) analyze their ethical nature.

Subjects.

Ten students, 6 faculty members, and 5 alumni from 4 DPT programs participated. All participants, except one alumnus, traveled to the same Central American country and partnered with the same host organization for the ISL experience.

Method.

This study used a constructivist grounded theory approach.

Results.

Data analyses indicated that ISL as experienced by participants in this study did not align with APTA's ethical principles 2A, 3B, and 8B. Furthermore, the RIPS situational analysis indicated that the primary themes arising from this study reflected ethical issues/problems and an ethical temptation, with an overarching ethical silence.

Discussion and Conclusion.

In their desire to be altruistic and provide global experiential opportunities to students, educators may overlook ethical situations arising from ISL. Research demonstrating the benefit of ISL to patients and the host community, and to establish best practice standards to minimize detrimental impacts to the host should be undertaken.
Responsiveness of Health-Related Quality of Life Patient-Reported Outcome Measures in Women Receiving Conservative Treatment for Urinary Incontinence: A Systematic Review
Authors: Bernard Stéphanie , Pellichero Alice , McLean Linda , Moffet Hélène
Published: February 2021

Background:

Responsive patient-reported outcome measures (PROMs) are able to detect change induced by a treatment. It is unknown whether PROMs on urinary incontinence (UI) are responsive in a conservative management setting.

Objective:

To systematically review the responsiveness of recommended PROMs (grade A) for the assessment of health-related quality of life in women receiving conservative treatment for UI.

Study Design:

Systematic review.

Methods:

A literature search was conducted on MEDLINE, EMBASE, and CINAHL. Selection criteria included women with UI undergoing conservative treatment, grade A-recommended PROM measuring the impact of UI on health-related quality of life, at least 1 responsiveness index, and original results. Two reviewers independently performed screening, data extraction, and methodological quality assessment using COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). A descriptive analysis was conducted.

Results:

Five studies, including 5 PROMs, were retained (n = 672 participants). Participants had mixed UI (n = 3 studies) or stress UI (n = 2 studies). Flaws in methodological quality were identified (n = 1 study) for the assessment of responsiveness (COSMIN Box I) and (n = 3 studies) for interpretability (Box J). Highest internal responsiveness was found for the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ-UI SF) (standardized response mean: 2.07, effect size = 2.12) and highest external responsiveness was found for the Protection Amount Frequency Adjustment Body Image Questionnaire (PRAFAB-Q) (area under the curve: 0.96).

Conclusion:

Four questionnaires presented at least 1 high responsiveness index (Urinary Incontinence Specific Quality of Life Instrument [I-QOL], PRAFAB-Q, ICIQ-UI SF, and International Consultation on Incontinence Questionnaire—Lower Urinary Tract Symptoms Quality of Life Modules [ICIQ-LUTSqol]). While the ICIQ-UI presented the highest overall responsiveness index, the PRAFAB-Q, an informative and brief questionnaire for clinical use, had the highest index with the highest methodological quality. There is a need to further confirm responsiveness of PROMs in this population and context.
Case-based learning: Facilitating nurse practitioner clinical learning with virtual patient cases
Authors: Moore Jeanne , Montejo Leigh
Published: February 2021

Through unfolding patient case studies, case-based learning has the potential to facilitate nurse practitioner (NP) student application of didactic knowledge to clinical practice, thus narrowing the theory–practice gap. The purpose of this study was to investigate NP student experience using virtual patient cases to supplement clinical learning. Bloom's cognitive taxonomy served as the framework. Seven students enrolled in the final semester of a distance family NP program completed 45 virtual patient cases over an 8-week period. Case topics covered a variety of primary care problems. Usability of the virtual learning platform was measured by the System Usability Scale. Clinical learning value was measured by the Student Satisfaction and Self-Confidence in Learning Scale. Students rated their perceived ability to manage common primary care problems at the start and end of the 8-week period. Students found the virtual learning platform highly usable and were satisfied and self-confident with their learning. Student perceived ability to manage common primary care problems increased for all virtual case topics from start to end of course. This study provides further evidence that well-designed virtual patient cases have the potential to effectively supplement NP student clinical learning. These results are important as NP faculty look for alternative forms of clinical learning to supplement direct care clinical experiences.
Measuring the contribution of clinical rotations to skills confidence in primary care nurse practitioner students
Authors: MacDonald Brent , Floyd Olivia , Dowd-Green Caitlin , Bertram Amanda , Fingerhood Marianne , Sharps Phyllis , Stewart Rosalyn W.
Published: February 2021

Primary care providers (PCPs) are essential components of a health care system, but there are shortages of PCPs. Nurse practitioners (NPs) are essential in meeting the needs of an increased demand for primary care, but there is a wide variety in the training offered to NP students. The purpose of this analysis is to determine student self-reported comfort in a variety of care delivery, covering primary care topics, including knowledge and skills. We conducted a preclinical and postclinical survey. Surveys were obtained before and at the conclusion of two clinical rotations in Baltimore, MD. Students were a part of a Health Resources and Services Administration–funded program to prepare NP students to practice in urban, underserved settings. Seventeen NP students NP students responded to both our pre- and postsurveys. Overall, student comfort increased in many focus areas, but no change was seen in important domains, including interpreting imaging studies, filling out common forms, and interpreting certain diagnostic tests. Further study of student skills and confidence at the conclusion of their study would be beneficial in determining if these gaps persist at entry into NP practice. Given wide variation in NP student training programs, it would be additionally beneficial to understand how these differences impact student skills and confidence during their clinical rotations and on entry to practice. Well rounded, broad-based education is necessary for the development of highly trained PCPs; greater understanding of student confidence, knowledge, and skills can assist educators in assuring that all NPs enter practice as safe and competent providers.
Development of the novice nurse practitioner role transition scale: An exploratory factor analysis
Authors: Barnes Hilary , Faraz Covelli Asefeh , Rubright Jonathan D.
Published: February 2021

Background:

Novice nurse practitioner role transition (NNPRT) can be described as stressful and turbulent, leading to decreased job satisfaction and increased intent to leave. No published instrument exists to measure NNPRT. Thus, researchers, educators, and administrators are limited in their ability to measure the concept and therefore understand the factors that lead to a successful, or unsuccessful, role transition experience. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT.

Purpose:

The purpose of this study was to develop and examine the initial factor structure of a novel instrument that measures NNPRT.

Methods:

Initial item development was guided by concept analysis, literature review, and qualitative data. Face and content validity were established from expert review. Using pilot data from 89 novice nurse practitioners (NPs), an exploratory factor analysis (EFA) was conducted to examine the instrument's internal factor structure.

Results:

The NNPRT Scale includes 40 items that measure an individual's perception of their role transition experience. The EFA revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation.

Implications for practice:

In an evolving health care system, provider well-being is at the center of workforce, educational, and organizational conversations. Understanding how to optimize the workforce and prepare NPs for health care delivery is increasingly important. The NNPRT Scale will allow for large-scale examinations of the factors that influence NP role transition, as well as assess interventions to prepare and support novice NPs' transitions.
Assessment for sexually transmitted infections in men who have sex with men attending a nurse-run HIV preexposure prophylaxis clinic
Authors: Stockton Janice M.
Published: February 2021

Background:

Male-to-male sexual contact remains the primary mode of transmission for HIV and other sexually transmitted infections (STIs) in the United States. Reported STI rates in men who have sex with men (MSM) taking HIV preexposure prophylaxis (PrEP) are higher than expected, possibly due to decreased condom use while on PrEP or more frequent STI screening with routine PrEP care.

Local problem:

Hamilton County, located in southwestern Ohio, consistently has the highest rates of gonorrhea and syphilis and second highest rate of chlamydia in the state. The purpose of this project was to incorporate Centers for Disease Control and Prevention (CDC)–recommended comprehensive STI evaluations for MSM attending a nurse-run PrEP clinic in southwestern Ohio.

Methods:

Seventy-five MSM seen for PrEP between January 1, 2017, and May 15, 2019, were included in the STI testing program. Of these, 59 were included in outcome evaluation.

Intervention:

Sexually transmitted infection testing was performed every three months, including HIV and syphilis, with chlamydia/gonorrhea testing performed at all potentially exposed sites.

Results:

During the evaluation period, 43 STIs occurred in 18 patients (30.5%). Affected sites for gonorrhea included 10 oropharynx, eight anorectal, and two genitourinary; for chlamydia, it included one oropharynx, 12 anorectal, and one genitourinary. All extragenital infections were asymptomatic.

Conclusions:

Sexually transmitted infection results in this population are consistent with those reported in other PrEP centers and reinforce importance of three-point chlamydia/gonorrhea testing as part of comprehensive STI evaluation. Implementing CDC screening recommendations in PrEP programs has been effective in identifying and treating STIs. Incorporating sexual history and comprehensive testing may help providers in other settings identify patients who need more frequent HIV/STI screening and prevention services.
Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty
Authors: Ranguis Sebastian C. , Leonard Colin G. , James Adrian L.
Published: February 2021

Objective:

To compare outcomes and complications of endoscopic lateral graft (LGT) and interlay (IT) tympanoplasty.

Study Design:

Prospective observational cohort study of totally endoscopic ear surgery (TEES) tympanoplasty.

Setting:

Pediatric tertiary referral center.

Patients:

One hundred fourteen surgeries for children with tympanic membrane perforation without cholesteatoma.

Intervention:

Porcine-derived collagen graft tympanoplasty using either LGT or IT.

Main Outcome Measures:

Closure rates of perforation, hearing outcomes (four-tone average air conduction [AC] and air bone gap), and complications that required further surgery were assessed 12 months postoperatively.

Results:

Perforation closure rates did not differ between LGT (52/59 (88%)) and IT (45/51 (88%)), (Fisher's exact p = 1.00) (four ears lost to follow-up). AC thresholds (p = 0.32) and air bone gap (p = 0.88) improved similarly after surgery with LGT (median 8.8 dB) and IT (median 7.5 dB). The proportion of ears with serviceably normal hearing (AC ≤ 30 dB HL) postoperatively was similar (LGT 40/49 (82%), IT 36/46 (78%), Fisher's exact p = 0.80). Following IT, three (6%) ears developed inclusion cholesteatoma requiring revision surgery. One (2%) LGT ear developed blunting after myringitis.

Conclusions:

IT and LGT provide similar perforation closure rates and hearing outcomes. When choosing between these two techniques to repair pediatric tympanic membrane perforations, LGT would seem to be preferable than IT due to the risk of inclusion cholesteatoma after IT. There is a small risk of anterior blunting after LGT.
Comparison of Speech Recognition With an Organ of Corti Versus Spiral Ganglion Frequency-to-Place Function in Place-Based Mapping of Cochlear Implant and Electric-Acoustic Stimulation Devices
Authors: Dillon Margaret T. , Canfarotta Michael W. , Buss Emily , O’Connell Brendan P.
Published: February 2021

Objective:

To compare acute speech recognition with a cochlear implant (CI) alone or electric-acoustic stimulation (EAS) device for place-based maps calculated with an organ of Corti (OC) versus a spiral ganglion (SG) frequency-to-place function.

Patients:

Eleven adult CI recipients of a lateral wall electrode array.

Intervention:

Postoperative imaging was used to derive place-based maps calculated with an OC versus SG function.

Main Outcome Measure:

Phoneme recognition was evaluated at initial activation with consonant-nucleus-consonant (CNC) words presented using an OC versus a SG place-based map.

Results:

For the 9 CI-alone users, there was a nonsignificant trend for better acute phoneme recognition with the SG map (mean 18 RAUs) than the OC map (mean 9 RAUs; p = 0.071, 95% CI [≤−1.2]). When including the 2 EAS users in the analysis, performance was significantly better with the SG map (mean 21 RAUs) than the OC map (mean 7 RAUs; p = 0.019, 95% CI [≤−6.2]).

Conclusions:

Better phoneme recognition with the SG frequency-to-place function could indicate more natural tonotopic alignment of information compared with the OC place-based map.

A prospective, randomized investigation is currently underway to assess longitudinal outcomes with place-based mapping in CI-alone and EAS devices using the SG frequency-to-place function.
Preoperative Sudden Hearing Loss May Predict Hearing Preservation After Retrosigmoid Resection of Vestibular Schwannoma
Authors: Tawfik Kareem O. , Alexander Thomas H. , Saliba Joe , Ren Yin , Mastrodimos Bill , Cueva Roberto A.
Published: February 2021

Objectives:

Describe the effect of preoperative sudden hearing loss (SHL) on likelihood of hearing preservation (HP) after surgical resection of vestibular schwannoma (VS).

Study Design:

Retrospective chart review.

Setting:

Tertiary referral center.

Patients:

Adult patients (≥18 years) who underwent retrosigmoid VS resection for HP between February 2008 and December 2018 were reviewed. All patients had preoperative word recognition score (WRS) of at least 50%. Similarly, HP was defined as postoperative WRS of more than or equal to 50%. Regression analysis was used to describe the effect of SHL on HP, accounting for tumor size, and preoperative hearing quality.

Interventions:

All patients underwent retrosigmoid VS resection for HP.

Main Outcome Measures:

WRS of at least 50%.

Results:

Of 160 patients who underwent retrosigmoid VS resection during the study period, 153 met inclusion criteria. Mean tumor size was 14.0 (±6) mm. Hearing was preserved in 41.8% (n = 64). Forty patients (26.1%) had a history of preoperative SHL. Among 138 patients (90.2%) in whom the cochlear nerve was anatomically preserved during surgery, HP was achieved in 61.8% of those with SHL (21 of 34) and 41.3% of those without SHL (43 of 104) (p = 0.0480). On univariate and multivariate analysis (accounting for tumor size and preoperative hearing quality), SHL was a significant positive predictor of HP (odds ratio 2.292, p = 0.0407 and odds ratio 2.778, p = 0.0032, respectively).

Conclusion:

In patients with VS and retained serviceable hearing, SHL is an independent predictor of HP after retrosigmoid microsurgical resection when the cochlear nerve is preserved.
Imaging Characteristics of Sigmoid Sinus Wall Anomalies, Idiopathic Intracranial Hypertension, and Spontaneous CSF Leaks
Authors: Bhatnagar Kavita , Patel Lakir , Gourishetti Saikrishna , Raghavan Prashant , Eisenman David J.
Published: February 2021

Objective:

To assess the frequency of radiographic features of elevated intracranial pressure (ICP) in patients with sigmoid sinus wall anomalies (SSWA) and compare to those in idiopathic intracranial hypertension (IIH) and spontaneous CSF (sCSF) leaks.

Study Design:

Retrospective review.

Setting:

Tertiary care center.

Patients:

110 patients - 62 SSWAs, 19 IIH, 29 sCSF leaks.

Main Outcome Measures:

Demographics, comorbidities and radiographic features by diagnosis.

Results:

Imaging findings indicative of elevated ICP were similar across all three groups, as were body mass index, hyperlipidemia and diabetes. On univariate analysis, sCSF leak patients were significantly older than SSWA (60 vs. 41 years, p < 0.001) and IIH (60 vs. 40 years, p < 0.001) patients. They had a greater prevalence of arachnoid granulations than SSWA (75.8% vs. 37.1%, p < 0.01) and tegmen dehiscence than both SSWA and IIH (93.1% vs. 75.8% vs. 57.8%, p = 0.01), though a lower prevalence of empty sella than SSWA (44.8% vs. 72.5%, p < 0.001). SSWAs were present in roughly 44.3% of IIH and sCSF leak patients, and IIH in roughly 15.8% of SSWA and sCSF leak patients. Age (OR = 1.1, p = 0.001), hypertension (OR = 8.3, p = 0.01) and empty sella (OR = 0.1, p = 0.01) were predictive of sCSF leaks compared to SSWAs on multivariate analysis.

Conclusions:

Many radiographic and clinical features of elevated ICP are found at similar rates among patients with SSWA, IIH and sCSF leaks, suggesting a common underlying process. SSWAs seem to present earlier along this spectrum of phenotypes, while sCSF leaks present later. Differences in age, metabolic syndrome and ICP may influence a patient's clinical presentation.
Sudden Brief Unilateral Tapering Tinnitus (SBUTT) Is Closely Related to the Lateral Pterygoid Muscle
Authors: Levine Robert Aaron , Lerner Ynon
Published: February 2021

Objective(s):

To determine the cause of sudden brief unilateral tapering tinnitus (SBUTTs).

Patients:

Five adults evaluated at a tertiary tinnitus referral center.

Intervention:

Dry needling of lateral pterygoid muscle of one patient; jaw maneuvers in two patients.

Main Outcome Measure(s):

Halting of SBUTTs.

Results:

Trauma to the region of the lateral pterygoid muscle is associated with ipsilateral SBUTTs. Dry needling of the lateral pterygoid muscles abolishes SBUTTs. Some SBUTTs can be heard by others.

Conclusions:

Some, if not all, SBUTTs appear to be closely related to trigger points within the lateral pterygoid muscle. SBUTTs may be generated by a local twitch response from trigger points within the lateral pterygoid muscle.
Can a Self-report Measure Be Used to Assess Cognitive Skills in Adults With Hearing Loss?
Authors: Khandalavala Rohan , Vasil Kara , Castellanos Irina , Moberly Aaron C.
Published: February 2021

Hypotheses:

Adult cochlear implant candidates would self-report their executive functioning abilities as poorer than normal-hearing peers. These executive function abilities would correlate with laboratory-based cognitive tests. Lastly, executive functioning (EF) abilities would be associated with hearing-related quality of life.

Background:

Executive function refers to cognitive abilities involved in behavioral regulation during goal-directed activity. Pediatric and adult users have demonstrated delays and deficits in executive function skills compared with normal-hearing peers. This study aimed to compare self-report executive function in adult cochlear implant candidates and normal-hearing peers and to relate executive function skills to laboratory-based cognitive testing and hearing-related quality of life.

Methods:

Twenty-four postlingually deaf adult cochlear implant candidates were enrolled, along with 42 normal-hearing age-matched peers. Participants completed self-reports of executive function using the Behavior Rating Inventory of Executive Function- Adult (BRIEF-A). Participants were also tested using laboratory-based cognitive measures, as well as assessment of hearing-related quality of life on the Nijmegen Cochlear Implant Questionnaire. Groups were compared on BRIEF-A scores, and relations between BRIEF-A and lab-based cognitive measures as well as Nijmegen Cochlear Implant Questionnaire scores were examined.

Results:

Self-report executive function on the BRIEF-A was not significantly different between groups. Consistent relations of self-report executive function and nonverbal reasoning were identified. Strong relations were not found between self-report executive function and hearing-related quality of life.

Conclusions:

Executive function as measured by BRIEF-A demonstrates some relation with a laboratory-based metric of nonverbal reasoning, but not other cognitive measures. Hearing-impaired individuals did not report poorer EF than normal-hearing controls. EF additionally did not correlate with quality of life. Our findings provide preliminary, partial validation of the BRIEF-A instrument in the preoperative evaluation of adult cochlear implant candidates.
Cost-utility Analysis of Cochlear Implantation in Adults With Single-sided Deafness: Austrian and German Perspective
Authors: Seebacher Josef , Muigg Franz , Kühn Heike , Weichbold Viktor , Galvan Oliver , Zorowka Patrick , Schmutzhard Joachim
Published: February 2021

Background:

Single-sided deafness (SSD) is associated with a loss of binaural hearing. Major limitations of such patients are poor speech understanding in noisy environments and a lack of spatial hearing. To date, cochlear implantation is the most promising approach to overcome these deficits in this group of patients.

Objective:

Cost-effectiveness analyses of cochlear implantation in patients with unilateral deafness. The model targets Austrian and German SSD patients who can either opt for treatment with a cochlear implant (CI) or decide against a CI and stay without any treatment.

Methods:

A Markov model analyzed as microsimulation was developed using TreeAge Pro 2019 software. Pre- and postoperative utility values generated with HUI-3 were used to populate the model. Costs covered by the national insurance were considered. Costs and utilities were discounted by 3%. A model time horizon of 20 years was set.

Results:

According to Austrian base-case analysis, the incremental cost-utility ratio (ICUR) was €34845.2 per quality-adjusted life year gained when comparing the “CI strategy” to the “no treatment strategy.” The ICUR is marginally lower when adapting a German cost perspective—it was €31601.25 per quality-adjusted life year gained. Sensitivity analyses showed that the cost-effectiveness results are stable. Analyses also showed that the longer the time horizon is set, the more favorable the cost-effectiveness result is.

Conclusions:

Based on currently available data, the Markov microsimulation model suggests that cochlear implantation is cost-effective in Austrian and German patients with SSD if no other treatment option is considered within the model.
Platelet, Red Cell, and Endothelial Activation and Injury During Extracorporeal Membrane Oxygenation
Authors: Chandler Wayne L.
Published: February 2021

Extracorporeal membrane oxygenation (ECMO) can be lifesaving but suffers from high rates of bleeding and repeated transfusions. Current monitoring of blood cell damage during ECMO is limited to platelet counts, hematocrit, and plasma hemoglobin levels. Extracelluar vesicles (EV) are small cell fragments released when cells are activated/injured. The objective was to evaluate flow cytometric measurements of EV during ECMO as an indication of platelet, red cell, and endothelial activation/injury. Samples were collected from 55 patients (1 day to 19 years) during 58 ECMO runs. ECMO activated or injured blood cells, but the extent was highly variable and patient dependent. On average platelet activation was increased sevenfold during ECMO with up to 60-fold increased activation during the first 24 hours in some patients. EV associated with platelet and red-cell injury were increased eightfold on average but up to 200-fold in patients with disseminated intravascular coagulation, severe hemolysis, or massive transfusion. Approximately 9% of ECMO patients showed a red-cell and endothelial activation pattern that was associated with poor prognosis. Extracellular vesicles with autofluorescence similar to bilirubin appeared to come from monocytes processing hemoglobin. ECMO is associated with a highly variable, sustained increase in platelet, red-cell, and endothelial activation and injury that is a combination of circuit and transfusion related events, the patients underlying condition and possibly genetic influences on blood cell activation and injury. Extracellular vesicle measurements may improve our understanding of cellular activation and injury during ECMO as we work to improve the biocompatibility of these systems.
Extracorporeal Cardiopulmonary Resuscitation and Survival After Refractory Cardiac Arrest: Is ECPR Beneficial?
Authors: Daubin Cedric , Brunet Jennifer , Huet Justine , Valette Xavier , Charbonnier Charlotte , Sabatier Remi , Joret Aurélie , Dupeyrat Julien , Saplacan Vladimir , Courtois Serge , Goursaud Suzanne , Fischer Marc-Olivier , Babatasi Gérard , Morello Remy , Du Cheyron Damien
Published: February 2021

The level of evidence of expert recommendations for starting extracorporeal cardiopulmonary resuscitation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) is low. Therefore, we reported our experience in the field to identify factors associated with hospital mortality. We conducted a retrospective cohort study of all consecutive patients treated with ECPR for refractory cardiac arrest without return to spontaneous circulation, regardless of cause, at the Caen University Hospital. Factors associated with hospital mortality were analyzed. Eighty-six patients (
i.e.
, 35 OHCA and 51 IHCA) were included. The overall hospital mortality rate was 81% (
i.e.
, 91% and 75% in the OHCA and IHCA groups, respectively). Factors independently associated with mortality were: sex, age > 44 years, and time from collapse until extracorporeal life support (ECLS) initiation. Interestingly, no-shockable rhythm was not associated with mortality. The receiver operating characteristic-area under the curve values of pH value (0.75 [0.60–0.90]) and time from collapse until ECLS initiation over 61 minutes (0.87 [0.76–0.98]) or 74 minutes (0.90 [0.80–1.00]) for predicting hospital mortality showed good discrimination performance. No-shockable rhythm should not be considered a formal exclusion criterion for ECPR. Time from collapse until ECPR initiation is the cornerstone of success of an ECPR strategy in refractory cardiac arrest.
A Review of Endoscopic Full-thickness Resection, Submucosal Tunneling Endoscopic Resection, and Endoscopic Submucosal Dissection for Resection of Subepithelial Lesions
Authors: Bhagat Vicky H. , Kim Marina , Kahaleh Michel
Published: February 2021

Gastrointestinal subepithelial tumors (SETs) are often found while performing routine endoscopy. Recently, there has been the development of new endoscopic techniques such as endoscopic submucosal dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection, all minimally invasive approaches which have made it possible to resect SETs that were previously resected with surgery. This review discusses the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, procedure-related complications, and advantages and disadvantages of these endoscopic techniques.
The role of dietary supplements that modulate one-carbon metabolism on stroke outcome
Authors: Yahn Gyllian B. , Leoncio Jeannine , Jadavji Nafisa M.
Published: February 2021

Purpose of review

Ischemic stroke results in disability and mortality worldwide. Nutrition is a modifiable risk factor for stroke. For example, deficiencies in one-carbon metabolism have been linked to increased risk of stroke through elevated levels of homocysteine. Some countries world-wide fortify their diets with folates to prevent neural tube defects, but deficiencies in other one-carbon metabolites, such as vitamin B12 and choline are still present in many populations. The aim of this review is to understand the current evidence on how dietary supplementation by nutrients which modulate one-carbon metabolism impact stroke outcome.

Recent findings

The results from clinical studies evaluating lowering homocysteine through B-vitamin supplementation on stroke risk remain unclear. Other clinical and preclinical studies have shown increasing dietary intake of one-carbon metabolism has some benefit on stroke outcome. Preclinical studies have shown that increased levels of nutrients which modulate one-carbon metabolism help facilitate recovery in damage models of the central nervous system. One the mechanisms driving these changes is neuroplasticity.

The data suggest that increasing dietary nutrients that modulate one-carbon metabolites in patients that are at a higher risk for and suffer from central nervous system diseases, such as stroke, could benefit in addition to other therapies.
Host-directed therapies for COVID-19
Authors: Maeurer Markus , Ramalho Renata , Wang Fu-Sheng , Zumla Alimuddin
Published: February 2021

Purpose of review

Severe acute respiratory syndrome coronavirus-2-induced hyperinflammation is a major cause of death or end-organ dysfunction in COVID-19 patients. We review adjunct host-directed therapies (HDTs) for COVID-19 management.

Recent findings

The use of umbilical cord-derived mesenchymal stem cells as HDT for COVID-19 has been shown to be safe in phase 1 and 2 trials. Trials of anti-interleukin-6 receptor antibodies show promising mortality benefit in hospitalized COVID-19 patients. Repurposed drugs and monoclonal antibodies targeting specific cytokines acting on different aspects of the pro- and anti-inflammatory cascades are under evaluation.

A range of HDTs shows promise for reducing mortality and improving long term disability in patients with severe COVID-19, and require evaluation in randomized, controlled trials
Retrospective analysis of safety of ultrasound-guided percutaneous liver biopsy in the 21st century
Authors: Mulazzani Lorenzo , Terzi Eleonora , Casadei Giacomo , Pasquali Valentina , Felicani Cristina , Stefanini Federico , Granito Alessandro , Serra Carla , Piscaglia Fabio
Published: February 2021

Background

Ultrasound-guided percutaneous liver biopsy is a standard procedure, but it might be burdened with serious adverse events, mainly hemorrhagic. Literature lacks recent studies taking into account new ultrasound machines, more sensitive to tiny vessels and the evolution of the bioptic technique, including ultrasound guidance in all instances. Hence, the primary aim of this study was to evaluate complication rates of ultrasound-guided percutaneous liver biopsy in a recent population. Secondary aims were to evaluate if the experience of operator is a determinant of risk of complication and to identify other potential risk factors.

Methods

We evaluated 800 procedures carried out in one hospital in the period 2010–2018.

Results

Complication rate resulted in 4%, with the occurrence of moderate hemorrhagic complications in 0.75%. No cases of severe events or death were registered. A higher risk of bleeding was found to be associated with less experienced operators, while the need to perform multiple needle insertions increased the probability of adverse events.

Conclusion

The present findings confirmed ultrasound-guided percutaneous liver biopsy to be a substantially safe procedure with a low risk of overall adverse events and bleeding in particular, especially when performed by expert operators.
Screening-detected positive serology for celiac disease: a real clinical challenge
Authors: Donat Ester , Roca Maria , Masip Etna , Polo Begoña , Ramos David , Ribes-Koninckx Carmen
Published: February 2021

According to European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2020 criteria for celiac disease diagnosis, the small bowel biopsy (SBB) can be omitted in selected circumstances, even in asymptomatic patients. Hence, we have conducted a retrospective study to identify the histological findings of the asymptomatic patients with antitransglutaminase IgA antibodies 10 times above the upper limit of normal and positive antiendomisium antibodies; 5/24 patients fulfilling these criteria had, however, a nonconclusive SBB and were diagnosed with potential celiac disease. The nonbiopsy approach in these cases needs to be carefully evaluated and the risk of overdiagnosis pondered as the management and evolution of potential celiac disease cases is still a matter of study.
Elective Surgical Delays Due to COVID-19
Authors: Byrnes Mary E. , Brown Craig S. , De Roo Ana C. , Corriere Matthew A. , Romano Matthew A. , Fukuhara Shinichi , Kim Karen M. , Osborne Nicholas H.
Published: February 2021

Background:

This qualitative research explored the lived experiences of patients who experienced postponement of elective cardiac and vascular surgery due to coronavirus disease 2019 (COVID-19). We know very little about patients during the novel coronavirus pandemic. Understanding the patient voice may play an important role in prioritization of postponed cases and triage moving forward.

Methods:

Utilizing a hermeneutical phenomenological qualitative design, we interviewed 47 individuals who experienced a postponement of cardiac or vascular surgery due to the COVID-19 pandemic. Data were analyzed and informed by phenomenological research methods.

Results:

Patients in our study described 3 key issues around their postponement of elective surgery. Patients described robust narratives about the meanings of their elective surgeries as the chance to “return to normal” and alleviate symptoms that impacted everyday life. Second, because of the meanings most of our patients ascribed to their surgeries, postponement often took a toll on how patients managed physical health and emotional well-being. Finally, paradoxically, many patients in our study were demonstrative that they would “rather die from a heart attack” than be exposed to the coronavirus.

Conclusions:

We identified several components of the patient experience, encompassing quality of life and other desired benefits of surgery, the risks of COVID, and difficulty reconciling the 2. Our study provides significant qualitative evidence to inform providers of important considerations when rescheduling the backlog of patients. The emotional and psychological distress that patients experienced due to postponement may also require additional considerations in postoperative recovery.
Extrahepatic metastases from hepatocellular carcinoma: multimodality image evaluation
Authors: Abouzied Moheieldin M. , Alhinti Nayef , AlMuhaideb Ahmad , Al Sugair Abdulaziz S. , Al Qahtani Mohammed
Published: February 2021

The most prevalent primary malignancy of the liver is hepatocellular carcinoma (HCC); its poor prognosis is mainly related to intrahepatic recurrence and extrahepatic metastases. However, survival from HCC has improved due to better control of the primary tumor, the development of newer treatment modalities, including liver transplant, together with advances in imaging techniques. Therefore, the significance of patient management as corresponds with distant metastases has increased; since the proper evaluation and detection of extrahepatic metastases is crucial to optimize potential therapy for patients. Conventional imaging like CT, MRI play crucial rule in patient’s diagnosis and qualifying for a certain type of therapy. More recently, a molecular imaging tool with radiolabeled deoxyglucose and fluorocholine has proved its promising value as a complementary tool to conventional studies. In this review, the frequent sites of metastases and HCC spread are discussed as well as the imaging findings as seen by both conventional imaging techniques and by molecular imaging tools, namely 18F-Choline PET/CT, and FDG PET. The implications of guiding treatment planning have also been discussed.