bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicopathological Features of Seborrheic-Like Dermatitis in HIV-Infected Adults: A Single Institutional Descriptive Cross-Sectional Study
Authors: Mahlangeni Gcina M. , Tod Bianca M. , Jordaan Hendry Francois , Schneider Johann W.
Published: May 2020

Background:

Atypical and severe clinical presentations of seborrheic-like dermatitis (SLD) are associated with HIV infection, correlating with advanced disease or low CD4 counts. Previous studies documented histological findings characteristic of seborrheic dermatitis in HIV-positive patients.

Objective:

To expand current knowledge of the clinicopathological characteristics of SLD in South African HIV-seropositive individuals.

Methods:

This prospective study included HIV-seropositive adult patients presenting with SLD to a dermatology clinic from March 2017 to April 2018. A dermatologist established the diagnosis of SLD and the severity of the disease. Detail about antiretroviral therapy (ART), the latest CD4 count, and the viral load was retrieved from the patients' clinical records. Histopathological assessment of the patients' skin biopsies was recorded using standardized data sheets and semiquantifiable grades.

Results:

This study included 13 women and 17 men. Fifty percent of patients showed severe or very severe SLD. Six (20.0%) patients presented with erythroderma. Statistical analysis did not show a significant correlation between severity of disease and CD4 count, viral load, or ART, respectively. This study confirmed that the presence of confluent parakeratosis, necrotic keratinocytes, plasma cells, neutrophils with leukocytoclasia, and leukoexocytosis are histopathological clues to SLD occurring in HIV-seropositive patients.

Conclusion:

SLD in HIV patients may present with varying clinical severity, including erythroderma. The association between the prevalence and severity of SLD with CD4 count, viral load, and ART requires further studies with larger patient populations. The presence of specific histopathological features in a skin biopsy of SLD is a clue to the diagnosis of HIV.
Plasma YKL-40 as a biomarker in patients with nonmetastatic bone and soft tissue sarcomas: a prospective exploratory clinical study
Authors: Thorn Andrea P. , Harving Mette L. , Lausten Gunnar S. , Johansen Julia S. , Sørensen Michala S. , Petersen Michael M.
Published: May 2020

Purpose:

YKL-40 is a glycoprotein with a role in inflammation, tissue remodeling, tumor angiogenesis, and protection against apoptosis. We hypothesized that high preoperative plasma YKL-40 in patients with nonmetastatic bone and soft tissue sarcoma (STS) is associated with short overall survival (OS), and that plasma YKL-40 is an independent predictor for OS.

Materials and methods:

Plasma was collected preoperatively from 65 patients with nonmetastatic bone (n=14) or STS (n=51) in the lower extremities (n=43), the upper extremities (n=16) or the trunk wall/spine (n=6). All patients underwent surgical cancer treatment. Twenty patients developed metastases during the follow-up period (minimum 5 y). The plasma concentration of YKL-40 was determined by enzyme-linked immunosorbent assay.

Results:

Twenty-seven patients died [mean: 3.2 (range: 0.2–7.3) y postoperatively] and 38 patients were still alive after a follow-up of mean 6.9 (5.8–8.2) years postoperatively. Plasma YKL-40 was higher in patients who died during follow-up (P=0.008), in males (P=0.007) and in patients 61 years of age and above (P=0.001).

The 5-year OS was 68% and OS was lower in patients with high (≥95% percentile age-corrected) plasma YKL-40 (P=0.021), age 61 years and above (P=0.013), high histologic malignancy grade (P=0.047) and male sex (P=0.051). Multivariable analysis showed that only plasma YKL-40 (age-corrected (hazard ratio=2.80, 95% confidence interval: 1.13–6.91, P=0.026) and malignancy grade (hazard ratio=9.9×107, 95% confidence interval: 0–∞, P=0.007) remained independent prognostic factors for OS.

Conclusions:

High preoperative plasma YKL-40 was related to short OS in patients with nonmetastatic bone and STS and plasma YKL-40 (age-corrected) was an independent prognostic risk factor for OS.
Reticular Corneal Edema or Corneal Honeycombing in Eyes Treated With Netarsudil: A Case Series
Authors: Moumneh Khaled , Sheybani Arsham , Fellman Ronald L. , Godfrey David G. , Grover Davinder S.
Published: May 2020

This is a descriptive case series of 3 patients with uncontrolled intraocular pressure that developed reticular corneal changes after initiating netarsudil (0.02%). In all cases, upon observing reticular corneal edema, netarsudil (0.02%) was stopped followed by disappearance of corneal honeycombing. With the increasing use of this novel glaucoma medication, potentially more rare side effects will be observed. Reticular corneal edema or corneal honeycombing is an ocular examination finding that can rarely occur after initiating netarsudil (0.02%) regardless of prior corneal edema status. In our experience, the reticular changes resolve upon cessation of netarsudil.
Comparison of the Progression of Localized Retinal Nerve Fiber Layer Defects in Red-free Fundus Photograph, En Face Structural Image, and OCT Angiography Image
Authors: Ji Min Jung , Park Ji-Hye , Yoo Chungkwon , Kim Yong Yeon
Published: May 2020

Precis:

This study demonstrated the high topographic correlation between the red-free fundus photographs and en face structural images in eyes with glaucomatous progression.

Purpose:

The purpose of this study was to compare the progression of localized retinal nerve fiber layer (RNFL) defects in red-free fundus photographs, en face structural images, and optical coherence tomography angiography (OCTA) images.

Methods:

We performed a retrospective, comparative study on 45 glaucomatous eyes showing RNFL defect widening in red-free photography. The localized RNFL defect in the red-free photographs was termed as red-free defect. The wedge-shaped hyporeflective area radiating from the optic nerve head in the optical coherence tomography (OCT) en face structural images and OCTA images was defined as en face defect and OCTA defect, respectively. The baseline and follow-up angular parameters of each red-free defect were compared with those of en face defect and OCTA defect.

Results:

When the baseline angular parameters were compared, there were no significant differences between red-free defect and en face defect, and between red-free defect and OCTA defect (all, P>0.017). In addition, the follow-up angular parameters showed no difference between red-free defect and en face defect. However, the OCTA defect showed significantly greater values compared with red-free defect and en face defect with respect to the distal angular location and angular width at follow-up visit (36.78±15.10 vs. 34.10±15.09 vs. 33.40±15.05 degrees, both, P<0.001).

Conclusions:

Localized RNFL defects detected in red-free photographs showed high topographic correlation with defects detected in OCT en face structural images, and this correlation was also noted in eyes with progressive glaucoma. The OCT en face structural images may be an alternative to red-free photography for identifying progressive RNFL defects in eyes with glaucoma.
A Case of Choroidal and Vitreous Hemorrhage Following Micropulse Transscleral Cyclophotocoagulation
Authors: Aldaas Khalid M. , Brasington Chadwick , Zhang Alice Yang
Published: May 2020

Choroidal hemorrhages involve bleeding into the potential space between the choroid and sclera and are a serious ocular complication. Common causes of choroidal hemorrhages include intraocular surgeries, such as scleral buckling, cataract extractions, and glaucoma filtering procedures, or trauma. We report a case of choroidal and vitreous hemorrhage after micropulse cyclophotocoagulation. An 82-year-old female presented postoperative day 1 with blurry vision and pain in her right eye. Examination showed that she had a choroidal hemorrhage, 200 degrees of ciliary body swelling, and vitreous hemorrhage. Although the choroidal hemorrhage resolved with steroids, the vitreous hemorrhage required pars plana vitrectomy. To the best of our knowledge, this article discusses the first reported case of choroidal and vitreous hemorrhage due to micropulse cyclophotocoagulation.
Predictors of Success in Selective Laser Trabeculoplasty: Data From the Lausanne Laser Trabeculoplasty Registry
Authors: Elahi Sina , Rao Harsha L. , Dumitru Alina , Mansouri Kaweh
Published: May 2020

Purpose:

The purpose of this study was to determine the factors associated with the outcomes of selective laser trabeculoplasty (SLT).

Patients and Methods:

This was a database analysis (Lausanne Laser Trabeculoplasty Registry) of patients who had SLT between 2015 and 2017. Exclusion criteria were age below 40 years and diagnosis other than ocular hypertension and open-angle glaucoma. Intraocular pressure (IOP) and number of medications were recorded before and at various follow-ups after laser treatment. Success was defined as “complete” if an IOP reduction of at least 20% was observed at a given time, and “qualified” if any reduction of IOP was observed with either at least a 20% difference from baseline or a reduction in IOP-lowering medications. Associations of complete and qualified success with patients’ baseline characteristics, laser settings, and clinical examination findings were studied using multivariate regression and survival analysis.

Results:

A total of 170 eyes (126 patients) were included. Mean age was 68.3±12.2 years and 57.9% of the study cohort were female individuals. Average baseline IOP was 18.7±4.8 mm Hg, and average IOP reduction was 3.3±4.3 (−17.6% from baseline) and 3.5±3.9 mm Hg (−18.7% from baseline) at years 1 and 2, respectively. Male sex [odds ratio (OR)=2.79, P=0.02], baseline IOP (OR=1.15, P<0.01), and medical treatment before SLT (OR=2.57, P=0.03) were positive predictors of success. Total energy was associated with the duration of success. SLT outcome was strongly correlated to the outcome of the fellow eye, which represented the strongest predictor (OR=17.33, P<0.01).

Conclusions:

SLT achieved good IOP-lowering in a majority of patients with mild-to-moderate glaucoma, while it was inefficient in up to 35% of eyes. SLT success in the fellow eye was a strong predictive factor.
Influenza or Meningococcal Immunization During Pregnancy and Mortality in Women and Infants
Authors: Clark Dayna R. , Omer Saad B. , Tapia Milagritos D. , Nunes Marta C. , Cutland Clare L. , Tielsch James M. , Wairagkar Niteen , Madhi Shabir A. ,   for BMGF Supported Maternal Influenza Immunization Trials Investigators Group
Published: May 2020

This analysis includes pooled data from 2 placebo-controlled maternal influenza immunization trials, with a separate analysis on a meningococcal conjugate vaccine-controlled maternal influenza immunization trial. Maternal influenza immunization was not associated with infant or maternal all-cause mortality in placebo-controlled trials. In the meningococcal conjugate vaccine-controlled trial, there were fewer deaths during low or any influenza circulation weeks among infants whose mothers received meningococcal conjugate vaccine. ClinicalTrials.gov identifiers: NCT01430689, NCT01034254 and NCT02465190.
A Case of Childhood COVID-19 Infection with Pleural Effusion Complicated by Possible Secondary Mycoplasma Pneumoniae Infection
Authors: Chen Hong-Rui , Zou Hao , Xue Mei , Chen Zhen-Bing , Chen Wan-Xin
Published: May 2020

We report a case of childhood coronavirus disease 2019 infection with pleural effusion complicated by possible secondary Mycoplasma pneumoniae infection. Fever and pulmonary lesions on computed tomography were the early clinical manifestations, and the patient developed nonproductive cough later. The hydrothorax in this coronavirus disease 2019 case was exudative, showing predominantly mature lymphocytes.
Day-Case Admission for External Dacryocystorhinostomy in Preschool Children
Authors: Juniat Valerie , Rose Geoffrey E. , Timlin H. , Wagh V.J. , Abou-Rayyah Y. , Uddin J. , Verity David H.
Published: May 2020

Purpose:

Epistaxis during or after dacryocystorhinostomy may present a risk of circulatory compromise, particularly in young children. In view of this concern, we reviewed the outcome and complications of external dacryocystorhinostomy in preschool children, aged less than 4½ years.

Design:

Retrospective noncomparative series.

Patients and Methods:

A case-note review for a series of preschool children undergoing external dacryocystorhinostomy as a day-case admission at Moorfields Eye Hospital between 1992 and 2018; all surgery was consultant-led. Details were taken of the type of surgery, any intraoperative or postoperative complications (surgical or anesthetic), any unplanned admissions after surgery, and the functional outcome. To assess the veracity of the medical records, the parents for a sample of 67 children were contacted to check whether there had been any unrecorded events or concerns.

Outcome Measures:

Anesthetic or surgical complications, unplanned admissions, and postoperative events.

Results:

One-hundred and eighty-seven children (117 boys; 63%) underwent 228 external dacryocystorhinostomies during 201 admissions, the average admission age being 36.8 months (median, 37.5; range, 5.5–53.5 months). Forty-one children (20%) underwent bilateral dacryocystorhinostomy: the 27 having simultaneous bilateral surgery dacryocystorhinostomy were operated at a mean age of 38.2 months (median, 37.5; range, 15.5–53.5 months), this being significantly different from the average age at first operation in 14 children undergoing sequential admission for bilateral dacryocystorhinostomy (mean, 24.9 months; median, 27.0; range, 5.5–42.5) (p = 0.0023). No adverse anesthetic events were recorded, 2 children (2 dacryocystorhinostomies) required temporary nasal packing at the end of surgery for epistaxis, and one further child was admitted for overnight observation because of persistent mild epistaxis after bilateral dacryocystorhinostomy. Three children (3 dacryocystorhinostomies) had a mild, self-limiting secondary epistaxis, and there were no unplanned emergency admissions. The telephone survey did not reveal any disparity in the medical records.

Conclusion:

With experienced surgeons and anesthetists in a suitable specialist hospital, external dacryocystorhinostomy in preschool children would appear to be a safe and effective procedure, with few and minor complications. Although facilities for overnight observation should be available, the surgery can typically be planned as a day-case admission, and simultaneous bilateral surgery is also possible in this age-group.
Associations Among Perceived Control, Depressive Symptoms, and Well-being in Patients With Heart Failure and Their Spouses
Authors: Strömberg Anna , Liljeroos Maria , Ågren Susanna , Årestedt Kristofer , Chung Misook L.
Published: May 2020

Background

High levels of perceived control and lower levels of depressive symptoms are associated with better well-being in both patients with heart failure and their spouses at an individual level. However, there is a knowledge gap about how these individual factors have reciprocal influences on partners' well-being within the patient-spouse dyads.

Objective

The aims of this study were to examine dyads of patients with heart failure and their spouses on whether the patients' perceived control over the management of heart failure and depressive symptoms predicts their own and their spouses' physical and emotional well-being and to examine whether patients' perceived control predicts their own and their spouses' depressive symptoms.

Methods

A total 155 patient-spouse dyads (patients: 75% male, mean age of 71 years, 53% classified as New York Heart Association III; spouses: 75% female, mean age of 69 years) were recruited from 2 hospital-based outpatient heart failure clinics. Participants completed the Control Attitude Scale, the Beck Depression Inventory, and the Short-Form 36. Dyadic data were analyzed using multilevel regression of the actor-partner interdependence model.

Results

Perceived control had an actor effect on emotional well-being only for patients, and there were partner effects of perceived control on emotional well-being for both patients and their spouses. Depressive symptoms exhibited an actor effect on physical and emotional well-being for patients and spouses, but there were no partner effects of depressive symptoms on emotional well-being. Perceived control had partner effects on depressive symptoms for patients and spouses, but an actor effect of depressive symptoms was only found for patients.

Conclusion

In an interdependent relationship within the patient-spouse dyads, each dyad member's perceived control influenced their partner's emotional well-being as well as depressive symptoms. The findings suggest development of dyadic interventions that can increase perceived control over the heart condition.
Perceived Control Predicts Symptom Status in Patients With Heart Failure
Authors: Lin Chin-Yen , Miller Jennifer L. , Lennie Terry A. , Biddle Martha J. , Mudd-Martin Gia , Hammash Muna , Moser Debra K.
Published: May 2020

Background

Symptom status is an important indicator of disease progression in patients with heart failure (HF). Perceived control is a target of most self-care interventions and is associated with better outcomes in HF; however, little is known about the relationship between perceived control and symptom status in patients with HF.

Objective

The aims of this study were to (1) determine the relationship of perceived control to HF symptom status and (2) examine the associations of perceived control to self-care and of self-care to symptom status.

Methods

A total of 115 patients with HF were included. Data on symptom status (Memorial Symptom Assessment Scale-HF), perceived control (Control Attitudes Scale-Revised), and self-care (Self-Care of Heart Failure Index) were collected. Other covariates included were age, gender, New York Heart Association class, comorbidity burden, and depressive symptoms. Multiple regression analyses were performed to analyze the data.

Results

Lower perceived control predicted worse symptom status after controlling for covariates (P = .009). Other covariates predictive of worse symptom status were younger age, New York Heart Association class III/IV, and higher levels of depressive symptoms. Higher levels of perceived control were associated with better self-care (P = .044). Better self-care was associated with better symptom status (P = .038).

Conclusions

Lower levels of perceived control were independently associated with worse symptom status in patients with HF. Intervention strategies targeting perceived control should be tested to determine whether they could improve symptom status.
Associations Between Sleep and Personality Factors Among Patients Living With Coronary Artery Disease
Authors: Kjellsdotter Anna , Edéll-Gustafsson Ulla , Yngman-Uhlin Pia
Published: May 2020

Background

Insomnia symptoms have become increasingly common in patients with coronary artery disease (CAD). Increasing evidence suggests comorbidity between personality traits and health status. Considering personality traits may act as a predisposition for future illness; this state may influence sleep quality and it appears to precipitate cardiac events in high-risk patients.

Objective

The aim of this study was to investigate self-reported sleep deficiency in relation to vicious cycle of sleeplessness (VCS) behavior, hyperarousal behavioral trait (H-personality), and type D personality traits in patients with CAD and in a population-based group. Furthermore, our aim was to explore the association of VCS behavior with H-personality trait and type D personality. Finally, we investigated to what extent type D personality can explain self-reported too little sleep in patients with CAD.

Methods

An observational case-control design was applied comprising 859 patients in cardiac outpatient care and 859 participants from a population-based group. Questionnaires assessing VCS behavior, H-personality, type D personality, and perceptions of too little sleep were used.

Results

Statistically significant higher scores of a hyperarousal and sleeplessness behavior were revealed for those with too little sleep compared with those with sufficient sleep in both the patient and the population-based group. Age, female gender, or sleeplessness behavior significantly predicted too little sleep (P < .001).

Conclusions

The current study highlights the advantage of studying heterogeneity in patients with CAD from a person-centered perspective with focus to identify distressed individuals in order to prevent or treat sleep deficiency. A cluster of factors may be a more accurate predictor of patient-reported outcomes than a single psychosocial factor.
The Effect of Semirecumbent and Right Lateral Positions on the Gastric Residual Volume of Mechanically Ventilated, Critically Ill Patients
Authors: FARSI Zahra , KAMALI Maa'soumeh , BUTLER Samantha , ZAREIYAN Armin
Published: May 2020

Background

Delay in stomach discharge is a challenge for patients who are tube fed and may result in serious side effects such as pneumonia and malnutrition.

Purpose

This study was designed to determine the respective effects of the semirecumbent (SR) supine and right lateral (RL) with a flatbed positions on the gastric residual volume (GRV) of mechanically ventilated, critically ill adult patients.

Methods

A randomized, crossover clinical trial design was used to investigate GRV in 36 critically ill, ventilated adult patients who were hospitalized in the intensive care unit. GRV was measured at 3 hours after three consecutive feedings. GRV was first measured in all of the participants in the supine position; after which, participants were randomly assigned into one of two therapeutic positioning groups (Group A: assessment in the SR position and then the RL position; Group B: assessment in the RL position and then the SR position).

Results

GRV was significantly lower in both the SR and RL positions than in the supine position. GRV in the SR and RL positions did not vary significantly. The in-group measurements for GRV did not significantly differ for any of the three positions. In Group A, GRV was significantly lower at each subsequent measurement point.

Conclusion/Implications for Practice

Positioning patients in the RL and SR positions rather than in the supine position is an effective strategy to reduce GRV. Furthermore, placing patients in either the RL or SR position is an effective intervention to promote faster digestion and feedings.
Patients With Type 2 Diabetes Mellitus: Obstacles in Coping
Authors: FİDAN Özlem , TAKMAK Şenay , ZEYREK Arife Şanlialp , KARTAL Asiye
Published: May 2020

Background

Diabetes mellitus is a major global threat to public health. Reducing the daily obstacles of coping with the disease for patients with diabetes may improve management.

Purpose

The aim of this study was to investigate daily obstacles to coping with Type 2 diabetes mellitus (T2DM) and related factors.

Methods

A descriptive and cross-sectional design was used. Data were collected from 186 patients with T2DM who were hospitalized in an endocrinology clinic in Turkey. The Hospital Anxiety and Depression Scale and the Diabetes Obstacles Questionnaire were used to collect data. Multiple linear regression analysis was performed to explore the predictors of obstacles to coping in patients with T2DM.

Results

The highest mean score was achieved on the obstacles to coping with diabetes (2.57 ± 3.78) among the subscales of the Diabetes Obstacles Questionnaire. After regression analysis, level of treatment compliance was identified as the most significant predictor (β = .289, p < .001). Anxiety, depression, smoking status, and highest level of education were also identified as significant predictors.

Conclusions

On the basis of these results, nurses should plan and implement interventions to improve treatment compliance and assist patients to overcome obstacles to disease management. Moreover, patient anxiety, depression, and lifestyle behaviors should be addressed.
The Relationship Between Positive Perceptions Toward Organizational Politics and the Work-Related Outcomes of Nurses
Authors: MOVAHEDI Ali , BIDKHORI Mohammad , ARAZI Tajmohammad , KHALEGHIPOUR Mostafa , AMINI Fatemeh
Published: May 2020

Background

Organizational politics (OP) exists to varying degrees in all organizations. OP plays an important role in creating synergy between employees and the goals of the organization.

Purpose

We aimed to investigate the relationship between positive perceptions toward OP and work-related outcomes in nurses, including stress level, burnout level, turnover intention, and job satisfaction.

Methods

This descriptive, analytical study was conducted from April to June 2018 on nurses at Neyshabur University of Medical Sciences Hospitals in Neyshabur, northeastern Iran. The study included 280 nurses working in two teaching hospitals. Five standardized tools were used, including the Perception of Organizational Politics Scale, the Nursing Stress Scale, the Burnout Measure Scale, the Turnover Intention Inventory Scale, and the Minnesota Satisfaction Questionnaire.

Results

The results indicate that the participants did not hold positive perceptions toward OP. The mean Perception of Organizational Politics Scale score was 2.63 ± 0.55. Multiple linear regression analyses showed a significant and positive relationship between positive perception toward OP and job satisfaction and a negative relationship between positive perception toward OP and turnover intention, burnout, and job stress.

Conclusions

Nurses who perceive the work environment to be political will experience greater levels of stress, turnover intention, and burnout and lower levels of job satisfaction. Politics is an issue that should be handled by all levels of management. Managers should use supportive, nonpolitical workplace strategies to improve the work-related outcomes of employees.
Twenty-eight years of experience measuring autonomy using the Dempster Practice Behavior Scale
Authors: Goolsby Mary Jo , Pierson Charon A. , Sheer Barbara
Published: May 2020

Background:

Autonomy in practice is an important attribute of all professions and a cornerstone of advanced nursing practice. The Dempster Practice Behavior Scale was conceptualized, constructed, and psychometrically tested to make available a generalizable, empirically sound, and useful tool capable of measuring previously unrecognized dimensions of autonomy in practice. Nurse practitioner (NP) practice continues to evolve as new models of care emerge, requiring more autonomy in the NP role.

Purpose:

The purpose was to describe the development and psychometric testing of the Dempster Practice Behavior Scale (DPBS), review the extant research on its use in research on nursing and other professions, and determine where future research is needed on the concept of autonomy in professional practice with a focus on advanced practice registered nurses (APRNs).

Methods:

Research articles, theses, dissertations using the DPBS as an instrument to measure practice autonomy were reviewed.

Results:

Twenty-one unique publications were examined for reports of psychometric properties in various populations. For the APRN population (total N = 1,669 in 10 studies), psychometrics for the DPBS support the reliability of the instrument for research. The remaining 11 studies included 2,285 participants who were not APRNs.

Implications for practice:

Questions remain about the relationships between autonomy and external factors such as regulatory environment, practice setting, models of care, years of experience, and practice mix.
Implementation of a new cardiology hospital service leveraging nurse practitioners to improve patient access and outcomes
Authors: Horne Michael P. , Estes Krista R.
Published: May 2020

Background:

Delays in patient access due to excessive wait times for clinic consult appointments impair timely diagnosis and treatment, resulting in worse outcomes.

Local problem:

Average days wait (ADW) for clinic consult appointments for the cardiology group of a regional managed care organization was too long. A quality improvement project (QIP) was undertaken to improve efficiency/efficacy of patient coverage and reduce ADW by implementing a new cardiology hospital service with expanded roles for nurse practitioners (NPs).

Methods and intervention:

The QIP used the Institute for Healthcare Improvement's Model for Improvement. The new cardiology hospital service deployed a group of 11 cardiologists and three cardiology NPs who rotated between hospital and clinic service. Two cardiologists and one NP covered all cardiology inpatients, alleviating the need for clinic-assigned cardiologists to also see hospitalized patients, thus improving capacity. The primary measure was ADW, whereas secondary measures included patient satisfaction with access, hospital readmissions, clinic cancellations, and provider job satisfaction.

Results:

All measures were assessed on pre/post 6-month averages. Average days wait reduced from 28 to 14; patient satisfaction improved from 39% to 52%; readmissions reduced from 13.2% to 9.7%, and provider job satisfaction with the intervention was 91% positive. There were no significant changes in potential confounding factors and no identified negative consequences.

Conclusions:

Implementation of a cardiology hospital service leveraging NPs was feasible, increased capacity to improve patient access and associated outcomes, and did not manifest any known adverse impacts.
Extracorporeal shockwave therapy combined with alginate dressing for treatment of sacroiliac decubital necrosis in older adults
Authors: Duan Haoyang , Li He , Liu Hongying , Zhang Hong , Liu Na , Dong Qingjun , Li Zhenlan
Published: May 2020

Rationale:

Pressure sores are major clinical problems with limited treatment options.

Patient concern:

A 62-year-old man, admitted with unresponsive, indifferent mood, and malnutrition. A noval-shaped skin lesion deeping into the fascia was found in the sacrococcygeal region.

Diagnosis:

The patient was diagnosed with delayed carbon monoxide poisoning encephalopathy and stage IV sacrococcygeal pressure sores.

Intervention:

The patient received neurologic rehabilitation therapy and simple debridement dressing care followed by extracorporeal shockwave therapy.

Outcomes:

The scores for the pressure ulcer healing scale were 17 points, 13 points, 9 points, and 5 points, respectively, before treatment and at the 4-, 8-, and 12-week follow-ups. At 2 weeks after discharging the total pressure ulcer healing scale score was 0, which signifies that the sacroiliac decubital necrosis healed without adverse reactions and side effects.

Lessons:

This study presents a therapeutic solution for treating older adults with pressure ulcers by using extracorporeal shockwave with alginate dressing, which proved effective and safe.
In vivo investigation on bio-markers of perimenopausal panic disorder and catgut embedding acupoints mechanism
Authors: Chen Guizhen , Wang Xue , Zhang Shuo , Xu Xiaokang , Liang Junquan , Xu Yunxiang
Published: May 2020

Background:

Panic disorder (PD), defined by repeated and unexpected panic attacks, severely affects patients’ living quality and social function. Perimenopausal women are high-risk group of PD and suffer greatly from it. Modern medicine therapies for this disorder have many side reactions and poor effects, so nonpharmacological modality is an urgent need. Although acupoint catgut embedding is widely used in clinical practice, there is no persuasive evidence of its effect for perimenopausal PD. The aim of this study is to investigate the effectiveness and safety of acupoint catgut embedding for perimenopausal PD and to elucidate the correlations among brain neural activation, bio-markers (amino acids) and clinical outcomes with radiographic evidence, thus to explore its neural mechanism.

Methods:

The parallel designed, exploratory randomized controlled trial will include 70 outpatients with perimenopausal PD recruited from two hospitals of Chinese Medicine. These subjects will be randomly allocated to an intervention group (Group Embedding) and a control group (Group Medication) in a 1:1 ratio. The subjects in the intervention group will receive acupoint catgut embedding treatment two weeks a time in the following predefined acupuncture points: Shenshu (BL23), Sanyinjiao (SP6), Guanyuan (RN4), Ganshu (BL18), Zusanli (ST36) and Pishu (BL20). The included women of the control group will take 0.4 mg Alprazolam tablet orally, 1 tablet a time, 3 times a day. There is a study period of 3 months and a follow-up period of 1 month for each group. The primary outcomes will be the following therapeutic indexes: the frequency of panic attack, Panic Disorder Severity Score (PDSS), and Panic-associated Symptoms Score (PASS) during the observation period and follow-up period. The changes in Hamilton Anxiety Scale (HAMA) Score and Symptom Checklist 90 (SCL-90) Score will also be compared between these two groups. Additionally, functional magnetic resonance imaging (fMRI) and proton magnetic resonance spectroscopy (1H-MRS) scans will be done before and after the observation period to show cranial neuroimaging changes.

Discussion:

We present a study design and rationale to explore the effectiveness and neural mechanism of acupoint catgut embedding for perimenopausal PD. There are still several factors restrict our research such as no unified standard of diagnostic criteria and curative effect evaluation.

Trial registration:

Chinese Clinical Trial Registry, ChiCTR-INR-16009724, registered in November 2016.
The effectiveness of electrical stimulation for the management of benign prostatic hyperplasia
Authors: Han Wei-jun , Guo Yu-ge , Wang Yun-qi , Wang Jin-wan
Published: May 2020

Background:

This study will aim to assess the effectiveness and safety of electrical stimulation (ES) for the treatment of patients with benign prostatic hyperplasia (BPH).

Methods:

PubMed, EMBASE, Web of science, Springer, Cochrane Library, PsycINFO, Allied and Complementary Medicine Database, CBM, and China National Knowledge Infrastructure will be retrieved from inception to the September 1, 2019. No language limitation will be applied to this study. Randomized controlled trials (RCTs) that assessed the effectiveness and safety of ES for the treatment of patients with BPH will be considered for inclusion. Literature selection, data collection, and risk of bias assessment will be conducted by 2 investigators independently. Statistical analysis will be carried out using RevMan 5.3 Software.

Results:

This study will summarize high quality RCTs based on the present evidence of ES for the treatment of BPH in several aspects, including changes in urological symptoms, changes in prostate size, urodynamic parameters, quality of life, and number and severity of adverse events.

Conclusion:

The findings of this study will provide latest evidence to appraise whether ES is an effective and safety intervention for patients with BPH.

PROSPERO registration number:

PROSPERO CRD42019157241.
Malignant pulmonary embolism associated with renal sarcoma
Authors: Yang Jun Ho , Song Dae Hyun , Lee Chunwoo , Kang Dong Hoon , Jung Jae Jun , Kim Sung Hwan , Byun Joung Hun , Kim Jong Woo , Moon Seong Ho
Published: May 2020

Rationale:

The preoperative diagnosis of massive pulmonary tumor embolism associated with renal neoplasms is relatively rare. In most cases, pulmonary tumor embolism is detected intraoperatively during renal tumor resection. Moreover, primary renal sarcoma is rare, and primary renal sarcoma complicated by pulmonary tumor embolism is extremely rare; accordingly, there is no optimal treatment for such cases. Herein, we report a case of renal sarcoma associated with pulmonary tumor embolism.

Patient concerns:

A 39-year-old man was admitted to the emergency room owing to the sudden onset of dyspnea and palpitation.

Diagnosis:

Contrast-enhanced computed tomography (CT) revealed a large mass in the right kidney involving the infrahepatic inferior vena cava, with massive pulmonary emboli in both the pulmonary arteries.

Interventions:

Emergency pulmonary embolectomy with radical nephrectomy was performed.

Outcomes:

The patient experienced apparent remission of dyspnea, and resolution of right ventricle dysfunction. However, although remnant emboli were detected in the segmental arteries on postoperative CT, complete resolution of pulmonary embolism was observed after adjuvant chemotherapy.

Lessons:

Thus, concomitant cytoreductive nephrectomy with pulmonary embolectomy along with chemotherapy may be effective for patients with renal sarcoma with pulmonary tumor embolism.
Novel β-Lactam/β-Lactamase inhibitor combinations vs alternative antibiotics in the treatment of complicated urinary tract infections
Authors: Lu Li-Chin , Lai Chih-Cheng , Chang Shen-Peng , Lan Shao-Huan , Hung Shun-Hsing , Lin Wei-Ting
Published: May 2020

Objectives:

This meta-analysis assessed the efficacy and safety of novel β-lactam/β-lactamase inhibitor combinations in the treatment of complicated urinary tract infection (cUTI)/acute pyelonephritis (APN).

Methods:

PubMed, Web of Science, EBSCO (Elton B. Stephens Co.), Cochrane Library, Ovid MEDLINE, and Embase databases were accessed until November 21, 2019. In this meta-analysis, only randomized controlled trials comparing the treatment efficacy of novel β-lactam/β-lactamase inhibitor combinations with other antibiotics for cUTI/APN in adult patients were included. The outcomes included the clinical and microbiological responses, and risk of adverse events (AEs).

Results:

Overall, the experimental group treated with a novel β-lactam/β-lactamase inhibitor combination and the control group comprised 1346 and 1376 patients, respectively. No significant difference in the clinical response rate at test-of-cure was observed between the novel β-lactam/β-lactamase inhibitor combination and comparators among the microbiological modified intent-to-treat population (89.1% vs 88.3%, OR, 1.04; 95% confidence interval [CI], 0.76–1.42; I

2
 = 28%) and the microbiologically evaluable population (95.2% vs 94.7%, OR, 1.12; 95% CI, 0.68–1.84; I

2
 = 0%). Additionally, the novel β-lactam/β-lactamase inhibitor combination was associated with a better microbiological response at test-of-cure than the comparators among the microbiological modified intent-to-treat population (74.4% vs 68.5%, OR, 1.34; 95% CI, 1.04–1.72; I

2
 = 45%) and microbiologically evaluable population (80.1% vs 72.5%, OR, 1.49; 95% CI, 1.06–2.10; I

2
 = 58%). Finally, the risk of AEs associated with the novel β-lactam/β-lactamase inhibitor combination was similar to that associated with the comparators (treatment-emergent adverse events [TEAE], OR, 1.04; 95% CI, 0.87–1.23; I

2
 = 19%; serious AEs, OR, 1.21; 95% CI, 0.82–1.76; I

2
 = 0%; treatment discontinuation for drug-related TEAE, OR, 077; 95% CI, 0.38–1.56, I

2
 = 5%). The all-cause mortality did not differ between the novel β-lactam/β-lactamase inhibitor combination and comparators (OR, 1.19; 95% CI, 0.37–3.81; I

2
 = 0%).

Conclusions:

The clinical and microbiological responses of novel β-lactam/β-lactamase inhibitor combinations in the treatment of cUTI/APN are similar to those of other available antibiotics. These combinations also share a safety profile similar to that of other antibiotics.
Acute spinal subdural hematoma
Authors: Yokota Kazuya , Kawano Osamu , Kaneyama Hironari , Maeda Takeshi , Nakashima Yasuharu
Published: May 2020

Rationale:

Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH.

Patient concerns:

A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression.

Diagnosis:

Based on MRI findings, the diagnosis was SSDH.

Interventions:

We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset.

Outcomes:

Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization.

Lessons:

Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.
Acute cerebral infarction with acute myocardial infarction due to patent foramen ovale
Authors: Chen Jinghong , Li Rui , Chen Jingjing , Zhao Jingru , Li Na , Sun Sujuan , Yang Baoming
Published: May 2020

Rationale:

Patent foramen ovale (PFO) is not considered to be the main cause of stroke and is classified as the infarction of undetermined cause. The relationship between PFO and cerebral embolism is still unclear and cerebral embolism accompanied with coronary artery embolization in PFO patient is rare. In this case, we reported a patient with PFO suffered acute cerebral and myocardial infarction simultaneously, and analyzed the source of emboli and potential pathogenesis.

Patient concerns:

A 53-year-old female presented with chief complaints of intermittent palpitations and chest tightness for 6 years, aggravated for 3 days.

Diagnoses:

During the hospitalization, acute cerebral infarction and acute myocardial infarction occurred at the same time in the patient. The patient felt paroxysmal abdominal pain repeatedly. Finally, we detected PFO in the patient

Interventions:

Double antiplatelet therapy was given to the patient of acute cerebral and myocardial infarction with PFO.

Outcomes:

Two weeks after the onset of the disease, the condition was relatively stable. But after 2 months, the patient experienced repeated heart failure, transthoracic echocardiography manifested no significant change in the PFO gap but significant cardiac function reduction.

Lessons:

Although a growing number of people are aware that PFO is a risk factor for arterial embolization especially when coexisting with atrial septal aneurysm, a significant proportion of patients have paradoxical embolism after PFO closure. Therefore, transesophageal echocardiography should be routinely performed to find the possible cause of embolism when infarction of undetermined cause occurs, and PFO closure and anti-platelet aggregation or anticoagulant therapy should be given at the same time in order to reduce the occurrence of arterial thrombosis.
Omega-3 PUFA intake and the risk of digestive system cancers
Authors: Wang Jian , Zhang Yueyang , Zhao Long
Published: May 2020

Background:

A growing number of epidemiological studies have suggested a possible association between long-chain omega-3 polyunsaturated fatty acid (PUFA) intake and the risk of cancers, but the results have been inconsistent. We aimed to conduct a meta-analysis to assess the association of omega-3 PUFA consumption with digestive system cancers.

Methods:

Relevant observational studies were identified through a comprehensive search of PubMed, Embase, and the Web of Science through December 2019 and by reviewing the references of the retrieved articles. The relative risks (RRs) of digestive system cancers associated with omega-3 PUFA intake were estimated using a random-effect model and were stratified by region, sex, study design, type of omega-3 PUFAs, smoking status, alcohol consumption, BMI, and physical activity.

Results:

Twenty-five studies (8 case–control studies and 17 cohort studies) involving 1,247,271 participants and 23,173 patients with digestive system cancers were included in this analysis. The risk of digestive system cancers decreased by 17% in individuals who consumed omega-3 PUFAs (RR = 0.83, 95% confidence interval (CI), 0.76–0.91). The risk estimates of digestive system cancers varied by cancer sites, study location, study design, type of omega-3 PUFAs, and other confounders (smoking, alcohol consumption, body mass index, and physical activity). Visual inspection of funnel plots and the Begg's and Egger's tests revealed no evidence of publication bias.

Conclusion:

The findings show that omega-3 PUFAs should be as a healthy dietary component for the prevention of digestive system cancers. Cancer incidence decreases with increasing omega-3 PUFAs intake for most digestive system cancer sites. The relation between omega-3 PUFAs and digestive system cancers RR is similar among different populations.
Efficacy of neural stem cell transplantation for the treatment of patients with spinal cord injury
Authors: Tang Hua-yu , Li Yu-zhi , Tang Zhao-chen , Wang Lu-yao , Wang Tian-shu , Araujo Fernando
Published: May 2020

Background:

The aim of this study is to evaluate the efficacy of neural stem cell transplantation (NSCT) for the treatment of patients with spinal cord injury (SCI).

Methods:

All potential randomized controlled trials (RCTs) on NSCT in the treatment of patients with SCI will be searched from the following electronic databases: Cochrane Library, MEDILINE, EMBASE, Web of Science, Scopus, CBM, WANGFANG, and CNKI. We will search all electronic databases from their initiation to the January 31, 2020 in spite of language and publication date. Two contributors will independently select studies from all searched literatures, extract data from included trials, and evaluate study quality for all eligible RCTs using Cochrane risk of bias tool, respectively. Any confusion will be resolved by consulting contributor and a consensus will be reached. We will utilize RevMan 5.3 software to pool the data and to conduct the data analysis.

Results:

This study will summarize the most recent RCTs to investigate the efficacy and safety of NSCT in the treatment of patients with SCI.

Conclusion:

This study will provide evidence to assess the efficacy and safety of NSCT in the treatment of patients with SCI at evidence-based medicine level.

Systematic review registration:

PROSPERO CRD42020173792.