bluuebunny/crossref_metadata_2025 huggingface dataset:
Wellbeing of Frontline Health Care Workers After the First SARS-CoV-2 Pandemic Surge at a Neuroscience Centre: A Cross-sectional Survey
Authors: Douglas Deborah R. , Choi David , Marcus Hani J. , Muirhead Will , Reddy Ugan , Stewart Trudy , Luoma Astri M.V.
Published: March 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic has affected people of all ages, races, and socioeconomic groups, and placed extraordinary stress on health care workers (HCWs). We measured the prevalence of burnout and assessed wellbeing and quality of life (QoL) in HCWs at a single UK neuroscience center after the first pandemic surge.

Methods:

A 38-item electronic questionnaire was disseminated through local team email lists between May 22 and June 7, 2020, to HCWs in a university neurosciences center. Burnout was measured using the single-item Emotional Exhaustion and Depersonalization scales, and wellbeing and QoL assessed using the Linear Analogue Self-Assessment Scale and the EuroQol-5 Dimension instrument.

Results:

The response rate was 57.4% (n=234); 58.2% of respondents were nurses, 69.4% were women and 40.1% were aged 25 to 34 years. Overall, 21.4% of respondents reported burnout assessed by the Emotional Exhaustion scale; burnout was higher for nurses (23.5%) and allied health care professionals (22.5%) compared with doctors (16.4%). HCWs from ethnic minority groups reported a higher rate of burnout (24.5%) compared with white HCWs (15.0%). There were no differences in reported wellbeing or QoL between professional groups, or HCW age, sex, or race. Nurses (36.8%) and staff from ethnic minority groups (34.6%) were more fearful for their health than others.

Conclusions:

Our findings highlight the prevalence of HCW burnout after the first surge of the pandemic, with an increased risk of burnout among nurses and staff from ethnic minority groups. Both nursing and staff from ethnic minority groups were also more fearful for their health. With ongoing pandemic surges, the impact on HCW wellbeing should be continuously assessed to ensure that local strategies to support staff wellbeing are diverse and inclusive.
Parental Participation in NICU-Based Occupational Therapy, Physiotherapy, and Speech and Language Therapy
Authors: Edney Sarah K. , McHugh Gretl
Published: March 2021

Background:

Parent involvement in neonatal care is beneficial to families and infant outcomes. Few studies have explored parental experiences of neonatal therapy participation.

Purpose:

This study had 2 purposes: (1) to explore parental attitudes and beliefs about participating in neonatal therapies and (2) to identify barriers and facilitators to parental involvement and suggest ways to optimize neonatal therapy services.

Methods:

The study design and data analysis were informed by constructivist grounded theory methods. Semistructured telephone interviews were conducted with 9 mothers of children who had received neonatal therapy.

Findings:

After an early period of fear and powerlessness, a transition point occurred where the survival of their infant became more certain and parents were able to consider the future. At this point, participation in therapies was perceived to be more relevant. Therapy participation was experienced as a means of regaining autonomy and control in a context of trauma, but parents encountered barriers related to accessing therapists and external demands on their time.

Implications for Practice:

Parental participation is best facilitated by frequent and flexible access to neonatal therapists and staffing levels should reflect this. On commencing therapy, parents should be given therapists' contact details to maximize opportunities for face-to-face encounters.

Implications for Research:

Future research is needed to explore parental readiness to participate in therapies in the neonatal intensive care unit. Research exploring the impact of parental involvement in therapies over a longer time frame would be beneficial. Finally, there is a need to determine efficacy and effectiveness of parent-delivered neonatal therapies.
Impact of a Care Bundle on Cost Saving for Noninvasive Respiratory Support for Neonates
Authors: Shetty Sandeep , Evans Katie , Kulkarni Anay , Greenough Anne
Published: March 2021

Background:

Neonates often receive noninvasive respiratory support via continuous positive airway pressure (CPAP) or high-flow nasal cannula oxygen (HHFNC). The decision to change from one mode to the other, however, is not evidence based, hence not standardized and does not consider cost implications.

Purpose:

To assess the introduction of a care bundle for the medical and nursing staff in a tertiary medical and surgical neonatal center with regard to any financial savings or adverse outcomes.

Methods:

An education package and written guidelines were used to increase the awareness of the durations for which CPAP and HHFNC Vapotherm (VT) circuits could be used and the costs of the circuits.

Results:

This resulted in a cost saving of £17,000 ($22,254) for the year without adverse outcomes.

Implications for Practice:

Introduction of a care bundle involving an education package and written guidelines to increase the awareness of the durations that circuits could be used and the costs of CPAP and HHFNC circuits among the medical and nursing staff can lead to cost savings when incorporated into clinical practice.

Implications for Research:

Strategies, particularly during weaning, which involve changing from one form of noninvasive respiratory support to another, need a greater evidence base. Future research should include awareness of the duration different circuits could be used and the cost implications of changes between modes and hence circuits.
Variability in Antibiotic Treatment of Pediatric Surgical Site Infection After Spinal Fusion at A Single Institution
Authors: Cohen Lara L. , Birch Craig M. , Cook Danielle L. , Hedequist Daniel J. , Karlin Lawrence I. , Emans John B. , Hresko Michael T. , Snyder Brian D. , Glotzbecker Michael P.
Published: March 2021

Background:

Recent focus on surgical site infections (SSIs) after posterior spine fusion (PSF) has lowered infection rates by standardizing perioperative antibiotic prophylaxis. However, efforts have neglected to detail antibiotic treatment of SSIs. Our aim was to document variability in antibiotic regimens prescribed for acute and latent SSIs following PSF in children with idiopathic, neuromuscular, and syndromic scoliosis.

Methods:

This study included patients who developed a SSI after PSF for scoliosis at a pediatric tertiary care hospital between 2004 and 2019. Patients had to be 21 years or younger at surgery. Exclusion criteria included growing rods, staged surgery, and revision or removal before SSI diagnosis. Infection was classified as acute (within 90 d) or latent. Clinical resolution of SSI was measured by return to normal lab values. Each antibiotic was categorized as empiric or tailored.

Results:

Eighty subjects were identified. The average age at fusion was 14.7 years and 40% of the cohort was male. Most diagnoses were neuromuscular (53%) or idiopathic (41%).

Sixty-three percent of patients had an acute infection and 88% had a deep infection. The majority (54%) of subjects began on tailored antibiotic therapy versus empiric (46%). Patients with a neuromuscular diagnosis had 4.0 times the odds of receiving initial empiric treatment compared with patients with an idiopathic diagnosis, controlling for infection type and time (P=0.01). Ninety-two percent of patients with acute SSI retained implants at the time of infection and 76% retained them as of August 2020. In the latent cohort, 27% retained implants at infection and 17% retained them as of August 2020.

Conclusions:

Patients with acute infections were on antibiotics longer than patients with latent infections. Those with retained implants were on antibiotics longer than those who underwent removal. By providing averages of antibiotic duration and lab normalization, we hope to standardize regimens moving forward and develop SSI-reducing pathways encompassing low-risk patients.

Level of Evidence:

Level III.
Analysis of Hidden Blood Loss and its Risk Factors in Oblique Lateral Interbody Fusion Surgery
Authors: Zhu Lei , Zhang Liang , Shan Yuzhou , Feng Xinmin , Zhang Wenjie
Published: March 2021

Study Design:

This was a retrospective study.

Objective:

The objective of this study was to evaluate the volume of hidden blood loss (HBL) and analyze its influential factors in single level oblique lateral interbody fusion (OLIF) surgery.

Summary of Background Data:

OLIF is a minimally invasive spine surgery and is increasingly used to treat lumbar degenerative disk diseases. It is generally believed that there is less bleeding during OLIF. However, HBL during the perioperative period is commonly ignored.

Materials and Methods:

From January 2018 to December 2019, a total of 70 patients underwent single level OLIF surgery were retrospectively reviewed. The values of preoperative and postoperative hematocrit (Hct) were recorded to reckon HBL in accordance with Gross formula. The influential factors included sex, age, height, weight, body mass index, hypertension, diabetes mellitus, American Society of Anesthesiologists classification, disease etiology, surgery type, operative time, surgical corridor distance, psoas cross-sectional area, thickness of abdominal wall soft tissue, coagulation panel value, platelet count, values of Hct and hemoglobin, and intraoperative blood loss. Independent sample t test, Pearson correlation, Spearman correlation, and multivariate linear regression analysis were performed to investigate the risk factors related to HBL.

Results:

The average volume of HBL was 809 mL and the average hemoglobin loss was 27.1 g/L in OLIF procedure. Multiple linear regression analysis revealed that thickness of abdominal wall soft tissue was the independent risk factor for HBL (P=0.008). Whereas age (P=0.414), activated partial thromboplastin time (P=0.314), preoperative value of Hct (P=0.854), disease etiology (P=0.362), operative time (P=0.389), and intraoperative blood loss (P=0.912) were not statistically associated with HBL.

Conclusions:

HBL was substantial and the average volume of HBL was 809 mL in single level OLIF surgery. The thickness of abdominal wall soft tissue was the risk factor of HBL. Accurate assessment of HBL can prevent perioperative complications and ensure patients’ safety.
eIF4E-eIF4G complex inhibition synergistically enhances the effect of sorafenib in hepatocellular carcinoma
Authors: Fang Chao , Xie Haishen , Zhao Jun , Wang Weichen , Hou Hui , Zhang Bin , Zhou Dachen , Geng Xiaoping
Published: March 2021

The clinical efficacy of sorafenib in hepatocellular carcinoma (HCC) is disappointing due to its low response rate and high rates of adverse effects. The eukaryotic translation initiation factor 4F (eIF4F) complex, mainly consisting of eIF4E-eukaryotic translation initiation factor 4G (eIF4G) interaction, is involved in the induction of drug resistance. Herein, we aimed to demonstrate that eIF4E-eIF4G complex inhibition enhanced the effect of sorafenib. The antiproliferation effect of combined treatment was evaluated by MTT assay and colony formation assay. Flow cytometry was used to detect the early cell apoptosis and cell cycle. The specific mechanism was demonstrated using western blot and lentivirus transfection. The combination of sorafenib with eIF4E-eIF4G inhibitors 4E1RCat (structural) or 4EGI-1 (competitive) synergistically inhibited the cell viability and colony formation ability of HCC cells. Moreover, the combined treatment induced more early apoptosis than sorafenib alone through downregulating the Bcl-2 expression. Besides, the coadministration of sorafenib and 4E1RCat or 4EGI-1 synergistically inhibited the expressions of eIF4E, eIF4G and phospho-4E-BP1 in HCC cells while blocking the phosphorylation of 4E-BP1 with lentiviral transfection failed to increase the sensitivity of HCC cells to sorafenib treatment. PI3K-AKT-mTOR signaling was also inhibited by the combined treatment. In a word, eIF4E-eIF4G complex inhibition synergistically enhances the effect of sorafenib in HCC treatment.
Feasibility of Using Blood Pressure Self-Monitoring and the Epic MyChart Blood Pressure Flowsheet to Monitor Blood Pressure After Preeclampsia
Authors: Burgess Adriane , Gartrell Kyungsook , Anderson Tiffany
Published: March 2021

Preeclampsia is associated with significant morbidity and mortality. Women who experienced preeclampsia require close blood pressure surveillance postpartum. Remote monitoring of blood pressure using a mobile health application may be a viable method of surveillance in this population. The purpose of this project was to assess the feasibility of using the MyWellSpan mobile application to engage postpartum women who experienced preeclampsia in blood pressure self-monitoring. Women who chose to participate were provided an automatic blood pressure cuff and educational materials and were enrolled in MyWellSpan. A survey created by the authors asked participants to rate by Likert scale their satisfaction with the program and ease of use of the blood pressure cuff and self-monitoring. The electronic health record was reviewed retrospectively to assess utilization of the MyWellSpan mobile application to document blood pressure. The majority of women who participated reported that operating the blood pressure cuff was very easy and felt that it would be very easy to monitor their blood pressure twice daily. Sixty-nine percent of those women in the program electronically submitted at least 1 blood pressure measurement, thus confirming the feasibility of self-monitoring and reporting using a mobile application.
Testing the Use of Natural Language Processing Software and Content Analysis to Analyze Nursing Hand-off Text Data
Authors: Galatzan Benjamin J. , Carrington Jane M. , Gephart Sheila
Published: March 2021

Natural language processing software programs are used primarily to mine both structured and unstructured data from the electronic health record and other healthcare databases. The mined data are used, for example, to identify vulnerable at-risk populations and predicting hospital associated infections and complications. Natural language processing programs are seldomly used in healthcare research to analyze the how providers are communicating essential patient information from one provider to another or how the language that is used impacts patient outcomes. In addition to analyzing how the message is being communicated, few studies have analyzed what is communicated during the exchange in terms of data, information, and knowledge. The analysis of the “how” and “what” of healthcare provider communication both written and verbal has the potential to decrease errors and improve patient outcomes. Here, we will discuss the feasibility of using an innovative within-methods triangulation data analysis to uncover the contextual and linguistic meaning of the nurse-to-nurse change-of-shift hand-off communication. The innovative within-methods triangulation data analysis uses a natural language processing software program and content analysis to analyze the nursing hand-off communication.
Impact of Radiation on Cardiovascular Outcomes in Older Resectable Esophageal Cancer Patients With Medicare
Authors: Sarkar Reith R. , Hatamipour Ahmadreza , Panjwani Neil , Courtney P. Travis , Cherry Daniel R. , Salans Mia A. , Yip Anthony T. , Rose Brent S. , Simpson Daniel R. , Banegas Matthew P. , Murphy James D.
Published: March 2021

Objectives:

Preoperative radiotherapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients.

Materials and Methods:

We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease.

Results:

Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late cardiovascular events among patients treated with preoperative chemotherapy (SDHR: 1.18; P=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy had a 68% decreased risk of having a late cardiovascular event compared with patients receiving conventional radiation (SDHR: 0.32; P=0.007).

Conclusions:

This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as intensity modulated radiotherapy.
Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps
Authors: Hanson-Viana Erik , Rojas-Ortiz Jorge , Rendón-Medina Marco A. , Pacheco-López Ricardo C. , Ríos-Lara López Luciano R. , Palacios-Juárez Julio
Published: March 2021

Background:

Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported.

Methods:

We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia.

Results:

The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps.

Conclusions:

A better understanding of the fat layers’ thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.
The 100 Most-cited Articles in Abdominoplasty: A Bibliometric Analysis
Authors: Khajuria Ankur , Charles Walton N. , Dutt Atul , Hoyos Alfredo
Published: March 2021

Background:

Abdominoplasty is one of the most common aesthetic procedures performed globally. Research in this field is evolving, with recent emphasis on evidence-based surgery optimizing informed consent. This bibliometric analysis aimed to characterize emerging research trends and to assess the methodological quality of the highest impact abdominoplasty research.

Methods:

The 100 most-cited articles in abdominoplasty were identified on Web of Science, across all available journals and years (1950–2019). Study details, including the citation count, main subject, and outcome measures, were extracted from each article by 2 independent reviewers. The level of evidence of each study was also assessed.

Results:

The 100 most-cited articles in abdominoplasty were cited by a total of 2545 articles. Citations per article ranged from 206 to 34 (mean 65). Overall, 50 articles were assessed to be level of evidence 3, which is representative of the large number of cohort studies (n = 59) on the list. Similar numbers achieved levels 2, 4, and 5 (n = 16, 20, and 14), though none reached level 1. The main subject was operative technique in 50 articles, followed by outcomes in 34 articles. Only 7 articles utilized objective cosmetic outcome measures. Patient-reported outcome measures were employed in 25 articles, though only 5 incorporated validated questionnaires.

Conclusions:

The most-cited research in abdominoplasty largely comprised low-to-moderate quality studies, with no article achieving the highest level of evidence. Contemporary high-quality evidence incorporating validated outcome measures is crucial to enhance shared decision-making, particularly in aesthetic procedures.
Surgical Management of Abdominal Anterior Cutaneous Nerve Entrapment Syndrome: Case Report, Surgical Technique, and Literature Review
Authors: Ramji Maleka , Alzahrani Saud , Cawthorn Thomas R. , Midha Rajiv , Elzinga Kate
Published: March 2021

Background:

Abdominal anterior cutaneous nerve entrapment syndrome (ACNES) is an emerging diagnosis, with estimated incidence of 13%–30% of the adult population. It is a syndrome characterized by chronic abdominal pain caused by entrapment of cutaneous branches of thoracoabdominal nerves at the lateral border of the rectus abdominis muscle. If conservative treatment with pain medication, botulinum toxin, or lidocaine injections is inadequate, surgical management is indicated.

Methods:

We present a case of a 40-year-old woman presenting with a 1-year history of daily right anterior abdominal wall pain, consistent with a diagnosis of ACNES. We describe our approach for an anterior neurectomy of the intercostal nerve with closure of its fascial foramen.

Results:

Three months after surgery, she remained pain free and was back to work full time. At a 13-month follow-up, the patient reported that her pain had resolved completely following surgery.

Conclusions:

Results are encouraging following anterior neurectomy for ACNES. Surgical descriptions in the literature are brief, with limited pictorial account. Our detailed surgical approach is provided along with a review of the existing literature on the management of ACNES.
INFECTIOUS ENDOPHTHALMITIS AFTER SCLERAL FIXATION OF AN INTRAOCULAR LENS
Authors: Kim Kyung Won , Park Un Chul , Ahn Jeeyun , Kim Jae Hui , Lee Sang Joon , Nam Ki Yup , Kim Min , Woo Se Joon
Published: March 2021

Purpose:

To determine the mechanism of infection, clinical features, and risk factors of endophthalmitis after scleral fixation of an intraocular lens.

Methods:

We included 15 patients with infectious endophthalmitis after scleral fixation of an intraocular lens between April 2004 and December 2017, as well as four patients found through a literature search. Thus, a total of 19 patients were analyzed.

Results:

Among 19 eyes, infectious endophthalmitis developed at a mean of 23 months (range: 1 day–10 years) after scleral fixation surgery. Nine eyes (47.4%) had early-onset endophthalmitis (≤6 weeks), and 10 eyes (52.6%) had delayed-onset endophthalmitis (>6 weeks). Eleven eyes (57.9%) had presumed microbial influx due to suture exposure. Those with delayed-onset endophthalmitis showed a higher rate of suture-related infection (80.0% vs. 33.3%) and culture of gram-negative bacteria (70.0% vs. 12.5%) than did those with early-onset endophthalmitis.

Conclusions:

Infectious endophthalmitis can develop late after scleral fixation of an intraocular lens, usually related to the exposed sutures, and the visual prognosis is poor. Eyes that have sutured scleral fixation should be monitored regularly, and preventive measures should be performed if an exposed suture is found.
Interface Drainage and Antimicrobial Irrigation Avoid Repeat Keratoplasty for Post-DSAEK Cold Interface Abscess
Authors: Yu Angeli Christy , Myerscough James , Socea Sergiu , Furiosi Luca , Spena Rossella , Bovone Cristina , Busin Massimo
Published: March 2021

Purpose:

To describe a surgical technique for the diagnosis and treatment of post–Descemet stripping automated endothelial keratoplasty (DSAEK) infectious interface keratitis presenting as a cold abscess.

Methods:

This study included 2 eyes of 2 patients that developed delayed-onset interface infections after DSAEK. Through an anterior keratotomy, diagnostic samples for microbial culture and histopathology examination were collected, and empiric antibiotic therapy was delivered directly to the site of the infection at the graft–host interface.

Results:

In both cases, microbiological examinations confirmed a fungal etiology consistent with Candida. Resolution of infection was achieved, and no signs of posterior segment involvement or recurrence of infection were observed. Both corneas remained clear with final visual acuity of 20/25 and 20/32. No case required additional surgical intervention or repeat keratoplasty after more than 15 months of follow-up.

Conclusions:

Interface drainage with antimicrobial irrigation may be considered for the management of post-DSAEK interface infections presenting as a peripheral cold abscess. By avoiding intraocular seeding of infectious pathogens, the anterior approach can achieve clinical resolution of infection, maintain visual function, and preserve the DSAEK graft, thereby obviating the need for a therapeutic keratoplasty.
Spheno-orbital Lesions—A Major Review of Nonmeningioma Causes
Authors: McNab Alan A. , Jones Randall S. , Hardy Thomas G.
Published: March 2021

Purpose:

To review the imaging features of the broad range of nonmeningioma lesions of the greater wing of the sphenoid (GWS) bone and adjacent orbit to assist clinicians in differentiating these lesions from each other and from the most common lesion of the GWS and adjacent orbit, meningioma.

Methods:

We reviewed 32 cases of spheno-orbital lesions involving the GWS from our own practice, as well as 109 published cases (total 141), with emphasis on available imaging features on computerized tomography (CT) and MRI. Features that might assist in differentiating meningioma from its mimics were analyzed for each lesion, including the presence of an osteoblastic or hyperostotic response, bone erosion or osteolysis, homogeneous hypo- or hyperintensity on T2-weighted MRI, leptomeningeal involvement, and the absence of a “dural tail” on contrast-enhanced MRI. The clinical and imaging features were also briefly summarized for each diagnostic group.

Results:

The largest diagnostic group was metastasis (67 cases, 47.5%). The most useful imaging features that helped differentiate meningioma from its mimics were the presence of bone erosion and the absence of a “dural tail.” Other features were helpful in a small minority of cases only. Metastatic prostate cancer was the largest single group (21 cases), and 18 (85.7%) of these were osteoblastic and most closely mimicked meningioma. Prostate cancer patients were generally older than males with GWS meningioma. Almost all other (44/46, or 95.7%) metastatic lesions showed evidence of bone erosion. Almost half (30 of 61, 49.2%) of patients with metastasis presented without a known diagnosis of malignancy. Among children 16 years of age and less, Langerhans cell histiocytosis (10 cases), dermoid cyst (5), and Ewing’s sarcoma (5) were the most common diagnoses.

Conclusions:

A combination of a careful history and both CT and MRI gives information, which can best guide the management of patients with spheno-orbital lesions. Metastatic prostate cancer to the GWS most closely mimics GWS meningioma but can in most cases be differentiated on clinical and imaging features. Older males with hyperostotic lesions of the GWS should be investigated for prostate cancer. Other metastatic lesions and primary tumors of the GWS, as well as benign and structural lesions can readily be differentiated from meningioma on clinical and imaging features.
Cost Analysis of a Dedicated Outpatient Clinic in Patients With Newly Diagnosed Atrial Fibrillation
Authors: Thrysoee Lars , Kidholm Kristian , Rasmussen Maja Kjær , Brandes Axel
Published: March 2021

Aims

The aim of this study was to assess healthcare utilization costs of a dedicated outpatient clinic for patients with atrial fibrillation (AF).

Methods

We conducted a registry-based retrospective study in patients with a first-time AF diagnosis from 2009 to 2011 (control group) and 2013 to 2015 (intervention group). The control group had physician-led usual care, and the intervention group received multidisciplinary care. The primary outcome was total costs of AF-related resource utilization. Exploratory outcomes were ischemic stroke, intracranial hemorrhage, and all-cause mortality. Multiple regression methods were used to control for confounders in the assessment of effects on outcomes.

Results

A total of 1552 patients were included, hereof 850 in the intervention group. Total AF-related costs were €2746 for the control group and €3154 for the intervention group, which was not statistically significant. Average outpatient costs were significantly higher in the control group than in the intervention group (€522 vs €344, respectively; P = .003). There was no difference in the number of AF-related hospital admissions and outpatient visits between the control group and the intervention group (incidence risk ratio, 1.03 vs 0.85; and 95% confidence interval, 0.92–1.16 vs 0.69–1.05, respectively). There was a trend toward reduced all-cause mortality (hazard ratio, 0.86; 95% confidence interval, 0.63–1.16) in the intervention group, which was not statistically significant.

Conclusion

Total expenses for AF-related hospital resource utilization in the intervention group were higher, but the expenses for AF-related outpatient visits were significantly lower. There was a trend toward lower all-cause mortality in the intervention group, although the differences were not statistically significant. More research is needed investigating whether a multidisciplinary AF clinic is cost-effective.
The Meaning and Perceptions of HIV-Related Stigma in African American Women Living With HIV in Rural Florida: A Qualitative Study
Authors: Williams Renessa S. , Stetten Nichole E. , Cook Christa , Cook Robert , Ezenwa Miriam O. , Lucero Robert
Published: March 2021

African Americans are disproportionally affected by HIV/AIDS compared with other races/ethnicities, yet few studies have examined the cultural and/or attitudinal precursors that can make African American women vulnerable to HIV-related stigma in the rural South. This study qualitatively explored the meaning and perceptions of HIV-related stigma among African American women in Florida. Thirteen semi-structured interviews were conducted using an empirical phenomenological approach. Five observer perspectives and 26 participant perspectives emerged. Participants described stigma through self-conceptualizations (e.g., ignorance), experiences (e.g., judgments), psychological dysfunction (e.g., mental health), intersectionality (e.g., race, disability), and overcoming stigma (e.g., advocacy). Our findings reveal that HIV-related stigma is unpleasant for African American women. However, over time, women in this study developed strategies to combat stigma. Elements of stigma reduction described in this study may be an important starting point for designing a culturally targeted intervention for African American women living with HIV.
Neurological Pupil Index as an Indicator of Irreversible Cerebral Edema: A Case Series
Authors: Cortes Michaela X. , Siaron Kathrina B. , Nadim Hend T. , Ahmed Khalid M. , Romito Jia W.
Published: March 2021

BACKGROUND: Assessing the pupillary light reflex is a core component of neurological assessments. Pupil size and reactivity can provide early warning about early neurological decline. Automated infrared pupillometry is noninvasive and easy to use and has greater reliability compared with manual assessments to obtain objective and consistent measurements of pupillary size and reactivity to light. METHODS: This is a case series of 3 patients who had poor baseline clinical neurological examinations. Because it would be more difficult to detect acute neurological deterioration, automated infrared pupillometry and the Neurological Pupil index (NPi) were used in addition to the clinical neurological examination. NPi values < 3.0 prompted further imaging. RESULTS: In each case, abnormal NPi values prompted emergent imaging that confirmed acute cerebral edema and resulted in a change in management and treatment plan. CONCLUSION: The automated infrared pupillometry is a noninvasive monitor that can provide additional objective data in patients with a poor baseline neurological examination in whom it may otherwise be difficult to detect neurological deterioration.
The Price of Otologic Procedures: Variation in Markup by Surgical Procedure and Geography in the United States
Authors: Bu Daniel D. , Schwam Zachary G. , Neifert Sean N. , Ferrandino Rocco , Kaul Vivian Z. , Perez Enrique , Wanna George B. , Cosetti Maura K.
Published: March 2021

Objective:

To characterize and analyze variation in price markup of seven common otologic surgeries by procedure and geographic region.

Study Design:

Retrospective Analysis of the Centers for Medicare and Medicaid Services database of 2017 Medicare Provider Utilization and Payment Public File.

Setting:

Inpatient and outpatient centers delivering Medicare-reimbursed services.

Patients:

Full sample of patients undergoing procedures with Medicare fee-for-service final action claims during 2017.

Interventions:

Seven procedures (myringotomy, tympanoplasty, mastoidectomy, tympanomastoidectomy stapedotomy/stapedectomy, cochlear implant, bone-anchored hearing aid).

Main Outcome Measures:

Markup ratio (MUR) is defined as the ratio of total charges to Medicare-allowable-costs; Variation in MUR was measured using coefficient of variation (CoV).

Results:

Among all providers, the median MUR was 2.4 (interquartile range: 1.9–3.1). MUR varied significantly by procedure, from 2.3 for myringotomy to 8.7 for mastoidectomy (p < 0.01). MUR also varied significantly within procedure, with the least variation found in myringotomy (CoV = 0.46), and the greatest in cochlear implants (CoV = 0.92). Using the national average as baseline, MUR varied 71% between states, ranging from 1.75 to 6.24. Within the same state, significant variation was also noted, varying by 4% (CoV = 0.04) in Montana compared with 138% (CoV = 1.38) in Pennsylvania. MUR was not significantly correlated with patient comorbidity or Centers for Medicare and Medicaid Services risk scores.

Conclusions:

There was significant variation in the price of otologic surgery across geographic regions and procedures. The MUR for otology is lower or comparable to that reported in other surgical fields.
Prone positioning in children with respiratory failure because of coronavirus disease 2019
Authors: Leroue Matthew K. , Maddux Aline B. , Mourani Peter M.
Published: March 2021

Purpose of review

Acute respiratory distress syndrome (ARDS) is a common manifestation of severe COVID-19. Prone positioning has been used successfully in adult patients with ARDS and has been shown to decrease mortality. The efficacy of prone positioning in pediatric ARDS is less clear. In this review, we discuss the physiologic principles and literature on prone positioning in adults and children relative to COVID-19.

Recent findings

There are limited published data on prone positioning in respiratory failure because of COVID-19. The use of proning in nonintubated patients with COVID-19 may improve oxygenation and dyspnea but has not been associated with improved outcomes. Initial adult cohort studies of intubated patients undergoing prone positioning in severe ARDS related to COVID-19 have shown an improvement in mortality. Although the use of proning in children with severe COVID-19 is recommended, data supporting its use is scarce.

Additional studies to evaluate the efficacy of prone positioning in pediatric ARDS are needed to provide evidence for or against this treatment strategy in children. Given the unknown evolution of this pandemic, collaborative research efforts across pediatric centers provides the greatest opportunity to develop a data driven-approach to make use of this potential therapy
Coronavirus disease 2019 in the pediatric emergency department: unique considerations in preparation and response
Authors: Beno Suzanne , Ross Caitlin , Principi Tania
Published: March 2021

Purpose of review

Pediatric Emergency Departments (PEDs) have experienced unique considerations throughout the coronavirus disease 2019 (COVID-19) pandemic. We review the adaptations and challenges surrounding the preparation and response for pediatric emergency patients, with a specific focus on operational modifications, evolving personal protected equipment (PPE) needs, protected resuscitation responses, clinical characteristics in children, and the unintended effects on children and youth.

Recent findings

COVID-19 has thus far proven to have a milder course in children, with manifestations ranging from asymptomatic carriage or typical viral symptoms, to novel clinical entities such as ‘COVID toes’ and multisystem inflammatory syndrome in children (MIS-C), the latter associated with potentially significant morbidity. It has had an important effect on primary prevention, injury rates, reduced presentations for emergency care, and increased mental health, abuse and neglect rates in children and youth. PEDs have prepared successfully. The most significant adjustments have occurred with screening, testing, and consistent and effective use of PPE, along with protected responses to resuscitation, adaptations to maintain family-centered care, and technological advances in communication and virtual care. Simulation has been key to the successful implementation of many of these strategies.

COVID-19 has pushed PEDs to rapidly adapt to evolving clinical and societal needs, with both resultant challenges and positive advances. Further experience and research will guide how in the face of a global pandemic we can further optimize the clinical and operational care of children and youth, ensure robust educational training programs, and maintain provider safety and wellness.
No Evidence for Sex‐specificity in Vitamins C, E, and Fatty Acid Content of Human Milk from Healthy Polish Mothers
Authors: Zagierski Maciej , Krukowska Anna , Kawska Karolina , Sznurkowska Katarzyna , Martysiak‐Żurowska Dorota , Szlagatys‐Sidorkiewicz Agnieszka
Published: March 2021

Objectives:

Human milk (HM) is a complex fluid that meets the nutritional needs of infants. Its composition is associated with environmental, maternal, and fetal variables. It provides nutrients and bioactive substances, including cytokines, immunoglobulins, and constituents with antioxidative properties. Boys are reportedly more susceptible to oxidative stress. This study aimed to determine the relationship between infant sex and the antioxidants vitamins C and E, and the fatty acid (FA) profile of HM. Results of this investigation may infer sex differences for the composition of infant formulas.

Methods:

Thirty days after delivery, a sample of HM was collected from 152 healthy, non‐smoking mothers of full‐term new‐borns (77 males) born in good clinical condition. After FAs were extracted from the fat component, they were converted into methyl esters and separated using high‐performance gas chromatography. Tocopherol content was determined using a method described in a previous study. Vitamin C content was determined using reversed‐phase high‐performance liquid chromatography with ultraviolet detection, as described in the same study.

Results:

The study groups (male vs female offspring) did not differ in terms of vitamin and FA content in HM. The only difference found was in gondoic acid 20:1 (n‐9), with a higher concentration in the HM of mothers with female offspring (mean 0.63 ± 0.18 vs 0.59 ± 0.15 g/100 g FA; P < 0.047).

Conclusions:

Despite the acknowledged differences in the composition of HM associated with infant sex and the increased oxidative stress in males, antioxidant content did not appear to differ according to infant sex. These results suggest that there is no need for the antioxidant content of infant formulas to be sex‐specific.
Simulated Learning Experience in Advance Care Planning Conversations
Authors: Ellis Brandy , Winn Sheryl , MacMillan Deborah , Bouthillet Kelly , Purcell Cynthia
Published: March 2021

The Centers for Disease Control and Prevention reports that one-third of all Americans have not done any advance care planning, which is essential for maintaining autonomy when people are no longer able to communicate wishes directly at the end of life. The Institute of Medicine reports that providers have limited training in communication techniques and low confidence in holding advance care planning conversations. Forty-four family nurse practitioner students received classroom communication training using evidence-based end-of-life nursing education consortium materials and role-play opportunities. One month later, students participated in a palliative care simulation experience in a high-fidelity simulated medical office environment with standardized patient. The family practice nurse practitioner students were required to communicate bad news of a poor diagnosis to a family member and begin the advance care planning conversation using the SPIKES protocol. Findings include a significant increase in postintervention advance care planning communication knowledge scores and self-confidence in holding these conversations (mean, 30.55 [SD, 2.992]; 95% confidence interval, 29.64-31.46; median, 31; range, 11-35) and satisfaction with the learning experience (mean, 18.14 [SD, 2.11]; 95% confidence interval, 17.50-18.78; median, 19; with range between 13 and 20).
Prevalence and Clinical Manifestations of Penile Gonococcal Cutaneous and Accessory Gland Infections in Men With Gonorrhea
Authors: Fan Wenge , Zhang Qingsong , Zhang Jing , Fan Zhijiang , Jiang Tingwang
Published: March 2021

Background

No studies have focused on the prevalence and clinical manifestations of penile gonococcal cutaneous and accessory gland infections in men with gonorrhea.

Methods

We enrolled patients with penile gonococcal cutaneous and accessory gland infections and patients with urethral gonorrhea from January 2014 to February 2020. Demographic data, occurrence sites, and manifestations of all patients were recorded.

Results

Fifty-one patients with penile gonococcal cutaneous and accessory gland infections were observed among 1994 (2.6%; 95% confidence interval, 1.9%–3.4%) patients with urethral or penile gonorrhea. Lesions were present at the external urethral orifice in 22 (43%) patients, at the glans in 11 (21%), in the side of the frenulum of the prepuce in 7 (14%), in the penile raphe in 5 (10%), in the inner plate of the prepuce in 1 (2%), in the external urethral orifice and side of the frenulum of the prepuce in 3 (6%), and in the glans and side of the frenulum of the prepuce in 2 (4%). The lesions manifested as sinus-like lesions in 22 (43%) patients, abscesses in 14 (27%), nodules in 10 (20%), pustules in 3 (6%), nodules with sinus tracts in 1 (2%), and ulcers in 1 (2%).

Conclusions

Penile gonococcal cutaneous and accessory gland infections in men probably are more common than previously understood. They mainly involve the paraurethral duct, glans, Tyson's gland, and penile raphe. Lesions mainly present as sinus-like lesions, abscesses, and nodules.
Multifactorial Correlates of Incident Bacterial Sexually Transmitted Infections Among Black Men Who Have Sex With Men Recruited in 6 US Cities (HIV Prevention Trials Network 061)
Authors: Allan-Blitz Lao-Tzu , Menza Timothy W. , Cummings Vanessa , Gaydos Charlotte A. , Wilton Leo , Mayer Kenneth H.
Published: March 2021

Background

Black men who have sex with men are at a disproportionate risk for sexually transmitted infections (STI). Understanding the drivers of those disparities can lead to culturally tailored interventions. We aimed to characterize the incidence and correlates of STI among Black individuals from HIV Prevention Trials Network 061, a multicity cohort study conducted from 2009 to 2011 in the United States.

Methods

We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHRs) accounting for within-participant correlation over multiple follow-up visits (enrollment, 6 and 12 months). We examined correlates of incident rectal and urethral STI as well as incident syphilis.

Results

Among 1522 individuals, the incidences of urethral and rectal Neisseria gonorrhoeae infection were 1.0 (95% confidence interval, 0.6–1.8) and 4.6 (95% CI, 3.5–6.3) cases per 100 person-years, respectively. The incidences of urethral and rectal Chlamydia trachomatis infection were 2.5 (95% CI, 1.7–3.6) and 2.5 (95% CI, 1.7–3.7) cases per 100 person-years, respectively. The incidence of syphilis was 3.6 (95% CI, 2.7–4.9) cases per 100 person-years. Younger age was associated with increased odds of incident urethral (aHR, 5.1; 95% CI, 2.3–11.1) and rectal (aHR, 2.6; 95% CI, 1.6–4.3) STI. Diagnosis of a rectal STI at baseline (aHR, 2.3; 95% CI, 1.1–4.0) and use of saliva as lubricant (aHR, 1.7; 95% CI, 1.1–2.8) were associated with incident rectal STI. Diagnosis of syphilis at baseline was associated with incident syphilis during follow-up (aHR, 5.6; 95% CI, 2.5–12.2).

Conclusions

Younger participants had the highest STI incidence. Use of saliva as lubricant may be a driver of rectal infection, which deserves further study.
Characteristics and Population Size Estimation of Female Sex Workers in Bhutan
Authors: Khandu Lekey , Tobgay Tashi , Kinley Kinley , Choida Ngawang , Tashi Tshering , Wangdi Tashi , Tashi Ugyen , Dechenmo Dechenmo , Choden Karma Choden , Tsheten Tashi , Gyeltshen Tenzin , Zangmo Kencho , Choden Sonam , McFarland Willi
Published: March 2021

Background

Knowing the number of persons at risk for sexually transmitted diseases (STDs) and their risk behaviors are needed to allocate limited resources, set targets for prevention and care activities, gauge the reach of programs, and assess their impact. Female sex workers (FSWs) are a population at high risk for STD worldwide; little is known about FSW in Bhutan.

Methods

We conducted a community-based survey and population size exercise of FSW in Bhutan. The survey used a hybrid venue-based/peer-referral sampling method. Population size estimation methods were key informant mapping, census and enumeration, unique object multiplier, and capture-recapture.

Results

Of 517 women surveyed, 67.5% provided sex for money in the last year. Compared with FSWs at venues, FSWs referred by peers were more likely to have sex with alcohol (80.1% vs. 51.5%, P < 0.001) and more paying partners (mean, 3.5 vs. 2.0; P = 0.001), and less likely to have tested for an STD (28.3% vs. 51.0%, P < 0.001) or have outreach worker contact (27.6% vs. 41.5%, P = 0.007). The estimated number of FSWs in the 9 districts was 353 (95% confidence interval, 345–362). Extrapolation to the whole country projected 597 (417–777) FSWs nationally.

Conclusions

Our estimate of the number of FSW in Bhutan corresponds to 0.71% of adult urban women, a figure in line with other countries in South and Southeast Asia. Our data highlight the need for outreach beyond venues where women are employed to reach FSW at higher risk for STD but who have less access to interventions.