bluuebunny/crossref_metadata_2025 huggingface dataset:
Decline in Prenatal Buprenorphine/Naloxone Fills during the COVID-19 Pandemic in the United States
Authors: O’Donoghue Ashley L. , Reichheld Alyse , Anderson Timothy S. , Zera Chloe A. , Dechen Tenzin , Stevens Jennifer P.
Published: September 2023

Objectives

Pregnancy provides a critical opportunity to engage individuals with opioid use disorder in care. However, before the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these existing barriers. To quantify these changes, we examined trends in the number of individuals filling buprenorphine/naloxone prescriptions during the COVID-19 pandemic.

Methods

We estimated an interrupted time series model using linked national pharmacy claims and medical claims data from prepandemic (May 2019 to February 2020) to the pandemic period (April 2020 to December 2020). We estimated changes in the growth rate in the monthly number of individuals filling buprenorphine/naloxone prescriptions in the 6 months preceding a delivery claim, per 100,000 pregnancies, during the COVID-19 pandemic.

Results

We identified 2947 pregnant individuals filling buprenorphine/naloxone prescriptions. Before the pandemic, there was positive growth in the monthly number of individuals filling buprenorphine/naloxone prescriptions (4.83%; 95% confidence interval [CI], 3.82–5.84%). During the pandemic, this monthly growth rate declined for both individuals on commercial insurance and individuals on Medicaid (all payers: −5.53% [95% CI, −6.65% to −4.41%]; Medicaid: −7.66% [95% CI, −10.14% to −5.18%]; Commercial: −3.59% [95% CI, −5.32% to −1.87%]).

Conclusion

The number of pregnant individuals filling buprenorphine/naloxone prescriptions was increasing, but this growth has been lost during the pandemic.
Effect of COVID-19 on the Long-term Cardiovascular Outcomes among Patients with Alcohol Use Disorder: A Retrospective Cohort Study Including 45,842 Patients
Authors: Liu Ting-Hui , Wu Jheng-Yan , Huang Po-Yu , Tsai Ya-Wen , Lai Chih-Cheng
Published: September 2023

Objectives

This study was conducted to determine the risk of major acute cardiovascular events (MACEs) following COVID-19 among patients with alcohol use disorder (AUD).

Methods

This is a 1-year follow-up retrospective cohort study that used data from TriNetX, a multi-institutional research network platform. We compared the risks of incident MACEs in patients with AUD who had a positive diagnosis for COVID-19 and patients who had not had COVID-19 during the follow-up year.

Results

We enrolled 45,842 patients with AUD with and without COVID-19 history who had similar baseline characteristics from matching. During the follow-up period, the patients with AUD with COVID-19 history had a higher risk of overall MACEs than that of those without COVID-19 history (hazard ratio [HR], 2.013; 95% confidence interval [CI], 1.810–2.240). In addition, the patients with AUD with COVID-19 history had a higher risk of myocardial infarction (HR, 3.778; 95% CI, 2.873–4.969), stroke (HR, 2.411; 95% CI, 2.016–2.883), heart failure (HR, 2.206; 95% CI, 1.866–2.607), arrhythmia (HR, 2.359; 95% CI, 2.041–2.727), and inflammatory heart disease (HR, 3.042; 95% CI, 1.976–4.682).

Conclusions

Patients with AUD who survived COVID-19 had a significantly higher risk of incident cardiovascular diseases within 12 months than that of the patients with AUD without COVID-19 history.
Drop landing analysis of rotational osteotomies
Authors: Stevens Peter M. , Grothaus Olivia F. , MacWilliams Bruce A.
Published: September 2023

Pathomechanics resulting from rotational deformities of the long bones in an idiopathic population have not been extensively studied, and are chiefly limited to level over ground walking. Thirty-five adolescents with excessive idiopathic outward tibial torsion (TT), femoral rotation, or both (pan genu) were studied both before and after corrective surgery. Data collected included computational motion analysis of a drop jump and patient-reported outcomes consisting of PODCI and Goal Attainment Scores. Results were compared to an age-matched typically developing cohort (n = 25). Subjects with femoral anteversion (FA) exhibited compensatory hip rotations to normalize knee progression angles at landing. Subjects with only TT did not compensate at the hip, landing with typical knee progression but excessive outward foot progression. These strategies resulted in elevated frontal plane knee moments for FA (P = 0.008), and elevated lateral knee forces in all groups compared to typical, with the TT group reaching significance (P < 0.001). Rotational osteotomies successfully restored elevated kinematics and kinetics to within or below typically developing ranges. Patient-reported outcomes generally improved after surgery across all domains studied. Drop jump testing elucidated compensation strategies employed by these cohorts. Compensation did not fully alleviate elevated forces at the knees. Surgical intervention normalized pathokinematics and pathokinetics, reduced pain, and improved patients’ perception of their functional abilities. Greater improvements were found in individuals in the two groups with FA compared to the group with TT only.
Impact of risk perception and disease cognition on the willingness to participate in screening for lung cancer in a high-risk population
Authors: Rong Feng , Shi Rui , Hu Lili , Wang Daoyue , Lv Xiazhi , Zhao Yong
Published: September 2023

Objective

Risk perception and disease cognition may influence the efficiency of lung cancer screening by affecting the participation rate. There is still some uncertainty regarding the association between risk perception and disease cognition and how they affect participation in lung cancer screening. Therefore, we explored the influence of risk perception and disease cognition on the willingness to participate in screening among people at high risk of lung cancer.

Methods

Subjects with high-risk factors for lung cancer were recruited in Lu’an City, Anhui Province, China. Questionnaires were used to determine their demographic characteristics, risk perception, disease cognition, and willingness to engage in screening.

Results

Of the 1955 subjects with high risk factors for lung cancer, 1136 (58.12%) were willing to participate in lung cancer screening. Univariable and multivariable analyses showed that disease cognition (adjOR = 2.012, 95% CI: 1.528–2.649, P = 0.000), cognitive risk (adjOR = 7.661, 95% CI: 6.049–9.704, P = 0.000), and affective risk (adjOR = 5.964, 95% CI: 4.552–7.815, P = 0.000) were significant factors in promoting screening participation. For those with moderate risk perception, improving disease cognition was a key approach to increase screening participation.

Conclusion

This study elucidated the relationship between various factors and lung cancer screening participation and proposed a feasible route for the screening implementation, providing a theoretical basis to further improve the participation rate and efficiency of lung cancer screening.
Redo inferior pubectomy for failed anastomotic urethroplasty in pelvic fracture urethral injury
Authors: Wang Lin , Song Wenxiong , Peng Xufeng , Lyu Rong , Wang Jijian , Jin Chongrui , Feng Chao , Lyu Xiangguo , Sa Yinglong , Liu Yidong
Published: September 2023

Objectives

To assess the effect of redo inferior pubectomy on the management of complicated pelvic fracture urethral injury (PFUI) in patients with a history of failed anastomotic urethroplasty.

Materials and methods

We retrospectively reviewed all patients receiving redo anastomotic urethroplasty with redo inferior pubectomy for failed PFUI between January 2010 and December 2021. Patients with incomplete data and those who were lost to follow-up were excluded. Successful urethroplasty was defined as the restoration of a uniform urethral caliber without stenosis or leakage and further intervention. Functional results, including erectile function and urinary continence, were evaluated. Descriptive statistical analyses were then performed.

Results

Thirty-one patients were included in this study. Among them, concomitant urethrorectal fistula occurred in 2 patients, and concomitant enlarged bladder neck occurred in 1. The stenosis site was the bulbomembranous urethra in 2 patients and the prostatomembranous urethra in 29. The mean length of urethral stenosis in all patients was 3.1 cm (range, 2.0–5.0 cm). After a mean follow-up of 34.6 months, the final success rate was 96.8%. The incidence of erectile dysfunction reached 77.4% (24/31). Normal continence was achieved in 27 (87.1%) patients. One patient developed urinary incontinence of grade II requiring urinary pads because of an enlarged bladder neck. According to the Clavien-Dindo classification, postoperative complications of grade I occurred in 7 patients and grade II in 4.

Conclusions

Repeat anastomotic urethroplasty with repeat inferior pubectomy provides reliable success rates for failed PFUI. In complicated cases, it should be known and mastered.
Receipt of Behavioral Therapy in Preschool-Age Children with ADHD and Coexisting Conditions: A DBPNet Study
Authors: Mittal Shruti , Bax Ami , Blum Nathan J. , Shults Justine , Barbaresi William , Cacia Jaclyn , Deavenport-Saman Alexis , Friedman Sandra , LaRosa Angela , Loe Irene M. , Tulio Shelby , Vanderbilt Douglas , Harstad Elizabeth
Published: September 2023

Objective:

Practice guidelines from the American Academy of Pediatrics and Society for Developmental and Behavioral Pediatrics recommend evidence-based behavioral therapy (BT) as first-line treatment for preschool-age children with ADHD, prior to medication initiation. Thus, this study's objective is to present the frequency of physician-documented receipt of BT in preschool-age children with ADHD prior to medication initiation and to determine factors associated with receipt BT receipt.

Methods:

This retrospective medical record review was conducted across 7 Developmental Behavioral Pediatrics Research Network (DBPNet) sites. Data were abstracted for children <72 months old seen by a DBP clinician and initiated on ADHD medication between 1/1/2013-7/1/2017. From narrative text of the medical records, BT receipt was coded as: parent training in behavior management (PTBM), Applied Behavior Analysis (ABA), other, or did not receive.

Results:

Of the 497 children in this study; 225 children (45%) had reported receipt of any BT prior to ADHD medication initiation, with 15.9% (n = 79) receiving PTBM. Children with co-existing diagnoses of ASD or disruptive behavior disorder were more likely to receive BT than children without co-existing conditions (59.3% vs 69.0% vs 30.6%). There was significant site variability in reported receipt of BT, ranging from 22.4% to 74.1%, and sex and insurance were not associated with BT rates.

Conclusion:

The percentage of children with documented receipt of any BT, and particularly PTBM, was low across all sites and co-existing conditions. These findings highlight the universal need to increase receipt of evidence-based BT for all young children with ADHD.
First-trimester Procedural Abortion
Authors: McLaren Hillary , Hennessey Catherine
Published: September 2023

First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can include Rh typing, hemoglobin, and cervicitis testing as indicated by a patient’s risk factors. Procedural abortion in the first trimester includes cervical dilation with or without cervical preparation, and uterine evacuation utilizing a manual vacuum aspirator or electric vacuum aspirator. Complications occur rarely and are often easily managed at the time of diagnosis.
Contraception After Abortion
Authors: Pearlman Shapiro Marit , Stowers Paris , Raidoo Shandhini
Published: September 2023

After a spontaneous or induced abortion, people may desire to delay or prevent a future pregnancy and many desire to use contraceptive methods to do so. Contraception counseling and provision at the time of abortion care are important components to improve contraceptive access and convenience for people undergoing abortion care. The majority of hormonal and barrier contraceptive methods may be safely initiated at the time of medication or procedural abortion or shortly thereafter, although delayed initiation may be necessary in certain circumstances. A patient-centered approach to contraceptive counseling can identify patients’ priorities and mitigate provider coercion or pressure.
Self-managed Medication Abortion in the United States
Authors: Jung Christina , Nippita Siripanth
Published: September 2023

Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person’s decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices for clinicians in the United States who may interface with individuals undergoing self-managed medication abortion at any point in the process through a harm reduction approach.
Reproductive Justice as a Framework for Abortion Care
Authors: Hall Bianca , Akwatu Cynthia , Danvers Antoinette A.
Published: September 2023

This article presents an in-depth analysis of abortion access and rights within the Reproductive Justice framework, underscoring the health, social, and economic consequences of limited access. It emphasizes the critical role of abortion as essential, safe health care and highlights the complexities surrounding abortion decisions and the barriers faced by poor and historically marginalized populations. Amid the escalating access restrictions, the article concludes with a call to action for obstetricians and gynecologists and our allied health care providers to recognize, support, and advocate for safe, legal, and affordable abortion services as fundamental to health care equity and human rights.
Clinical Course, Therapeutic Management and Outcome of Coronavirus Disease in Patients With Inborn Errors of Immunity: A Retrospective Multicenter Experience From Iran
Authors: Karimi Abdollah , Jamee Mahnaz , Shokri Youssef , Heidari Atefeh , Nazarpack Fatemeh , Fallahi Mazdak , Shiari Reza , Li Philip H. , Sharifinejad Niusha , Sharafian Samin , Mahdaviani Seyed Alireza , Mansouri Davood , Zeinali Amirreza , Alyasin Soheila , Chavoshzadeh Zahra ,   on behalf of the Study Group
Published: September 2023

Background:

Inborn errors of immunity (IEIs) are characterized by defects in the structure and function of the immune system. This study was designed to assess the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on this potentially particularly susceptible group of patients.

Methods:

This retrospective cross-sectional study analyzed patients from 3 referral immunodeficiency centers in Iran. The demographic, clinical, laboratory and therapeutical data of confirmed IEI patients with SARS-CoV-2 infection were collected and analyzed.

Results:

A total of 19 IEI patients, 52.6% male and 47.4% female, with coronavirus disease 2019 (COVID-19) were enrolled. The most common diagnosed IEIs were (severe) combined immunodeficiency ((S)CID) (9, 47.4%) and predominantly antibody deficiencies (7, 36.8%). The main presenting symptoms included fever (16, 84.2%), cough (12, 63.2%), dyspnea (9, 47.4%) and myalgia (8, 42.1%). Among additional preexisting comorbidities, atopy (P = 0.087) and renal disorders (P = 0.087) were more strongly associated with the development of respiratory failure, although not statistically significant. SARS-CoV-2 infection was determined by polymerase chain reaction (n = 19, 100%) within a median (interquartile range) of 1 (0–6) days following admission. Among all laboratory indices, thrombocytopenia (P = 0.009) was associated with a need for intensive care unit admission. The overall mortality rate was 36.9% and highest among (S)CID patients (4, 44.4%).

Conclusions:

Severe COVID-19 most frequently affected (S)CID and predominantly antibody deficiencies patients among this multicenter Iranian cohort. Further studies are required to evaluate the impact of additional preexisting comorbidities and the development of thrombocytopenia on the severity and prognosis of COVID-19 in IEIs.
Intranasal CRMP2-Ubc9 inhibitor regulates NaV1.7 to alleviate trigeminal neuropathic pain
Authors: Loya-Lopez Santiago I. , Allen Heather N. , Duran Paz , Calderon-Rivera Aida , Gomez Kimberly , Kumar Upasana , Shields Rory , Zeng Rui , Dwivedi Akshat , Saurabh Saumya , Korczeniewska Olga A. , Khanna Rajesh
Published: September 2023

Dysregulation of voltage-gated sodium NaV1.7 channels in sensory neurons contributes to chronic pain conditions, including trigeminal neuropathic pain. We previously reported that chronic pain results in part from increased SUMOylation of collapsin response mediator protein 2 (CRMP2), leading to an increased CRMP2/NaV1.7 interaction and increased functional activity of NaV1.7. Targeting this feed-forward regulation, we developed compound 194, which inhibits CRMP2 SUMOylation mediated by the SUMO-conjugating enzyme Ubc9. We further demonstrated that 194 effectively reduces the functional activity of NaV1.7 channels in dorsal root ganglia neurons and alleviated inflammatory and neuropathic pain. Here, we used a comprehensive array of approaches, encompassing biochemical, pharmacological, genetic, electrophysiological, and behavioral analyses, to assess the functional implications of NaV1.7 regulation by CRMP2 in trigeminal ganglia (TG) neurons. We confirmed the expression of Scn9a, Dpysl2, and UBE2I within TG neurons. Furthermore, we found an interaction between CRMP2 and NaV1.7, with CRMP2 being SUMOylated in these sensory ganglia. Disrupting CRMP2 SUMOylation with compound 194 uncoupled the CRMP2/NaV1.7 interaction, impeded NaV1.7 diffusion on the plasma membrane, and subsequently diminished NaV1.7 activity. Compound 194 also led to a reduction in TG neuron excitability. Finally, when intranasally administered to rats with chronic constriction injury of the infraorbital nerve, 194 significantly decreased nociceptive behaviors. Collectively, our findings underscore the critical role of CRMP2 in regulating NaV1.7 within TG neurons, emphasizing the importance of this indirect modulation in trigeminal neuropathic pain.
Initial chemotherapy option for pancreatic ductal adenocarcinoma in patients with adequate performance status
Authors: Xing Jiazhang , Ge Yuping , Gong Xiaolei , Liu Yuan , Cheng Yuejuan
Published: September 2023

Pancreatic ductal adenocarcinoma (PDAC) is a highly progressive lethal malignancy, with chemotherapy being the primary treatment modality. This article provides a review of the initial chemotherapy options for PDAC patients with adequate performance status, comparing FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, and leucovorin) or modified FOLFIRINOX and gemcitabine plus nab-paclitaxel (GEM-NabP) regimens. The availability of limited evidence from randomized trials restricts a direct comparison between the 2 regimens. Based on our review, (m)FOLFIRINOX yields superior survival outcomes compared to GEM-NabP in metastatic PDAC. For locally advanced PDAC, either (m)FOLFIRINOX or GEM-NabP can be considered initial chemotherapy. In the neoadjuvant setting for borderline resectable PDAC, both regimens have demonstrated promising results in achieving feasible resection rates. However, mFOLFIRINOX remains the preferred choice for adjuvant chemotherapy. The selection of initial chemotherapy for PDAC depends on the disease stage, patients’ performance status, and tumor molecular alterations. Further research and clinical trials are necessary to optimize treatment approaches for PDAC patients.
The role of predictive and prognostic values of inflammatory markers in acute pancreatitis: a narrative review
Authors: Rafaqat Saira , Sattar Aqsa , Anjum Farhan , Gilani Mahrukh , Rafaqat Sana
Published: September 2023

Pancreatitis is an inflammatory condition affecting the pancreas and is classified into 2 types, acute and chronic, which can manifest in various forms. This review article summarizes the role of predictive and prognostic values of inflammatory markers in the pathogenesis of acute pancreatitis, mainly focused on preclinical and clinical studies. It includes serum amyloid A (SAA), monocyte chemotactic protein-1 (MCP-1), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), C-reactive protein (CRP), IL-10, myeloperoxidase, pentraxin 3, and plasminogen activator inhibitor 1. SAA3 plays a crucial role in developing acute pancreatitis by triggering a receptor-interacting protein 3–dependent necroptosis pathway in acinar cells. Targeting SAA3 could be a potential strategy for treating acute pancreatitis. The recruitment of monocytes/macrophages and the activation of the systemic MCP-1 signaling pathway play a role in the progression of pancreatitis, and blocking MCP-1 may have a suppressive effect on the development of pancreatic fibrosis. The ESR can predict severe acute pancreatitis with slightly lower accuracy than CRP. When ESR and CRP levels are combined at 24 hours, they predict severe acute pancreatitis accurately. IL-6 plays a crucial role in activating the Janus kinase/signal transducers and activators of the transcription pathway, exacerbating pancreatitis and contributing to the initiation and progression of pancreatic cancer. Endogenous IL-10 plays a crucial role in controlling the regenerative phase and limiting the severity of fibrosis and glandular atrophy induced by repeated episodes of acute pancreatitis in mice. The predictive and diagnostic roles of these inflammatory factors in pancreatitis were introduced in detail in this review.
Transitions in care: Piloting a neurocritical care clinic with nurse practitioners and physician associates
Authors: Michaelis Chloe , Hundt Elizabeth , Lombardi William , Howie Esquivel Jill
Published: September 2023

The transition period from hospital to home is a vulnerable time for rehospitalization and adverse events for patients. Follow-up clinic visits within 7–14 days of discharge is an effective strategy for reducing hospital readmissions. Neurocritical care patients have a unique set of needs to safely transition to home. We evaluated the feasibility of a Neuroscience Rapid Follow-Up Clinic with nurse practitioners (NPs) and physician associates (PAs) to meet transitional care gaps in neurocritical care patients and prevent rehospitalization. Clinic procedures and documentation templates were customized for the pilot clinic. Five NPs and one PA underwent a brief training course for the ambulatory care setting. Eligible patients were tracked throughout the hospitalization and the team made follow-up appointments. The pilot clinic took place from October 2022 to January 2023. Nine patients were seen in the clinic approximately 8 days after discharge. The clinic attendance rate was 90%. Among the clinic attendees, 66% received referrals to a primary care provider or other services, one third received medication changes or refills and all received patient-specific education. There were no rehospitalizations among the clinic patients. Implementation of this pilot clinic was possible with the current departmental resources. This innovative model of care has the potential to reduce hospital readmissions.
Dietary fiber deficiency in individuals with metabolic syndrome: a review
Authors: Veluvali Arvind , Snyder Michael
Published: September 2023

Purpose of review

Metabolic syndrome (MetS) refers to a group of risk factors, which increase the risk of cardiovascular disease (CVD), type 2 diabetes (T2D), and other chronic diseases. Dietary fiber has been shown to mitigate many of the effects of various risk factors associated with MetS. Our review summarizes the recent findings on the association between dietary fiber deficiency and MetS.

Recent findings

A number of studies have shown that dietary fiber deficiency is associated with an increased risk of MetS. The main mechanisms by which dietary fiber may reduce the risk of MetS include reduction of cholesterol levels; improvement of blood sugar control; reduction of inflammation; and promotion of weight loss.

Literature suggests that a deficiency in dietary fiber consumption is a risk factor for MetS. An increase in dietary fiber intake may help to reduce the risk of developing MetS and its associated chronic diseases.
Intestinal microbiome in short bowel syndrome: diagnostic and therapeutic opportunities
Authors: Chowdhury Fariha , Hill Lee , Shah Nyah , Popov Jelena , Cheveldayoff Paige , Pai Nikhil
Published: September 2023

Purpose of review

The intestinal microbiome plays a strong, complementary role in the development and integrity of the intestinal epithelium. This biology is crucial for intestinal adaptation, particularly after the mucosal insults that lead to short bowel syndrome (SBS). The purpose of this review is to discuss relationships between the intestinal microbiota and the physiology of intestinal adaptation.

Recent findings

We will address interactions between the intestinal microbiome and nutritional metabolism, factors leading to dysbiosis in SBS, and common compositional differences of the gut microbiome in SBS patients as compared to healthy controls. We will also discuss novel opportunities to expand diagnostic and therapeutic interventions in this population, by using our knowledge of the microbiome to manipulate luminal bacteria and study their resultant metabolites. As microbial therapeutics advance across so many fields of medicine, this review is timely in its advocacy for ongoing research that focuses on the SBS population.

Our review will discuss 4 key areas: 1) physiology of the intestinal microbiome in SBS, 2) clinical and therapeutic insults that lead to a state of dysbiosis, 3) currently available evidence on microbiome-based approaches to SBS management, and 4) opportunities and innovations to inspire future research.

The clinical implications of this review are both current, and potential. Understanding how the microbiome impacts intestinal adaptation and host physiology may enhance our understanding of why we experience such clinical variability in SBS patients’ outcomes. This review may also expand clinicians’ understanding of what ‘personalized medicine’ can mean for this patient population, and how we may someday consider our nutritional, therapeutic, and prognostic recommendations based on our patients’ host, and microbial physiology.
Comparative Different Interventions to Improve Exercise Adherence in Patients in the Postoperative Breast Cancer Phase of Care
Authors: Ma Ximei , Zhuang Simin , Hou Jiawen , Zhao Yanan , Xiao Guanghong , Chen Mengyun , Wang Yanhong
Published: September 2023

Background

Global Cancer Statistics 2020 reported that breast cancer had exceeded lung cancer as the most frequently diagnosed cancer. Surgery is the primary treatment modality for breast cancer, but postoperative upper limb dysfunction often occurs; functional exercise can alleviate this and restore upper limb function. However, exercise compliance is low in postoperative breast cancer patients; thus, many studies have been conducted in recent years to improve patient compliance with exercise.

Objective

The aim of this study was to compare the effectiveness of different interventions to improve exercise adherence in postoperative breast cancer patients.

Methods

We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, CNKI, VIP, and CBM databases for eligible studies. Exercise adherence rate and quality-of-life difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. Risk of bias was assessed using the risk-of-bias table in RevMan 5.4. Surface under the cumulative ranking was used to estimate the rankings among different interventions.

Results

Twenty-five randomized controlled trials involving 9 interventions were included, and the network meta-analysis results showed that patients in the pedometer + counseling group had the best exercise adherence.

Conclusion

Pedometer + counseling care measures are recommended to improve exercise adherence in postoperative breast cancer patients.

Implications for Practice

Oncology nurses can improve patients’ exercise compliance through counseling and by giving them pedometers to wear.
Assessing Nurse Competency in the Veterans Health Administration Registered Nurse Transition-to-Practice Residency Program
Authors: Barrett Blake , Toyinbo Peter , Couig Mary Pat , Chavez Margeaux , Rugs Deborah , Melillo Christine , Cowan Linda , DeMasi Kim , Sullivan Sheila Cox , Powell-Cope Gail
Published: September 2023

Background:

New graduate registered nurse (RN) competencies are complex and difficult to measure. Psychometrically sound tools are needed to evaluate competencies for nurses participating in nurse residencies.

Purpose:

Project aims were to develop an item pool for a tool to measure new graduate RN competencies for the Veterans Health Administration RN Transition-to-Practice Residency Program; validate item pool content; and use consensus methods to improve item pool content validity.

Methods:

A sequential, mixed-methods design was used. Item pool creation, content validation, and revisions included a collaborative process with the evaluation team, operational stakeholders, and subject matter experts (SMEs).

Results:

Inclusion of SMEs in item development enhanced item pool content validity to measure nurse competency. Stakeholder feedback ensured programmatic logistical and evaluation concerns were met.

Conclusions:

Engaging SMEs in conceptualization, item development, and aligning existing standards enhanced item pool content validity to measure nurse competencies for new graduate RNs.
Self-efficacy in Quality Improvement Competency of Frontline Acute Care Registered Nurses
Authors: Ledbeter Lauri
Published: September 2023

Background:

Registered nurses (RNs) are attuned to health care quality and safety concerns but may lack competency in quality improvement (QI) to advance care quality.

Purpose:

To describe frontline acute care RNs' self-efficacy in QI competencies, evaluate differences based on educational attainment, and evaluate relationships based on years of RN experience.

Methods:

The study used a descriptive, quantitative, correlational, comparative cross-sectional survey design to evaluate RNs' self-efficacy in QI competency using the 2021 American Association of Colleges of Nursing The Essentials: Core Competencies for Professional Nursing Education.

Results:

Frontline RNs' overall QI self-efficacy showed variability in knowledge, skills, and attitudes, with no relationship between self-efficacy and years of RN experience, nor difference based on educational attainment.

Conclusions:

Insufficient self-efficacy signals the need for further QI focus in nursing education, nursing practice, and health care policy to harness RNs' ability to advance care outcomes.
Cross-sectional Study Exploring Vision-related Quality of Life in Dry Eye Disease in a Norwegian Optometric Practice
Authors: Erøy Åsmund André , Utheim Tor Paaske , Sundling Vibeke
Published: September 2023

SIGNIFICANCE

Dry eye disease causes ocular pain, blurred vision, reduced visual quality of life, and reduced workplace performance. This disease is underreported and underdiagnosed despite being highly prevalent in optometric care.

PURPOSE

This study aimed to explore the vision-related quality of life of patients with dry eye disease and the potential benefits of screening for dry eye disease in Norwegian optometric practice.

METHODS

This study adopted an observational, prospective, cross-sectional design. All patients between 18 and 70 years of age who were examined between June 8 and July 5, 2018, at Erøy Optikk, Kristiansand, Norway, were invited to participate. Dry eye disease was assessed according to Tear Film & Ocular Surface Society International Dry Eye Workshop II report recommendations. Vision-related quality of life was assessed with the National Eye Institute 25-item Visual Function Questionnaire.

RESULTS

Forty-nine patients participated in the study; 29 (59%) were female, and 29 (59%) had dry eye disease. The patients with dry eye disease reported significantly more ocular pain and (vision-specific) role difficulties than the patients without dry eye disease. After adjusting for age, sex, and habitual visual acuity, dry eye disease was found to be an independent predictor of both ocular pain (r
2 = 0.328, P = .001) and (vision-specific) role difficulties (r
2 = 0.240, P = .02). Both habitual visual acuity and dry eye disease were predictors of reduced general vision, a reduced score for near activity and reduced (vision-specific) mental health.

CONCLUSIONS

Dry eye disease was an independent predictor of ocular pain (vision-specific), role difficulties, and reduced general vision, near vision, and (vision-specific) mental health. Optometrists should consider dry eye disease as a cause of reduced vision and quality of vision. Furthermore, we propose that screening for dry eye disease in Norwegian optometric practice can promote better vision and health among patients.
Histopathologic Changes in Congenital Corneal Stromal Dystrophy: Report of 4 Cases in 2 Families
Authors: Colino Gallardo Ana M. , De la Torre Serrano Montserrat , Alarcón García Lorenzo , Casado Fariñas Isabel , De Pablo Velasco David , Martínez-Useros Javier , Barderas Rodrigo , Fernández-Aceñero María J.
Published: September 2023

Corneal dystrophies are hereditary diseases affecting the corneal tissue; they are bilateral, symmetrical and unrelated to environmental or systemic conditions. Congenital corneal stromal dystrophy is a very rare autosomal dominant dystrophy that is caused by a mutation in the DCN gene that encodes decorin (a proteoglycan of the extracellular matrix). We herein report 4 cases of congenital stromal corneal dystrophy in 2 families, highlighting the previously undescribed histopathologic features, the possible differential diagnosis of this entity and the key role played by decorin staining in its diagnosis.
Nipple Lesions of the Breast
Authors: Brogi Edi , Scatena Cristian
Published: September 2023

Because of the unique anatomic structure of the nipple, a few specific breast lesions occur only at this site. Large lactiferous sinuses may be involved by inflammatory conditions such as squamous metaplasia of lactiferous ducts and ductal ectasia or be the site of uncommon superficial epithelial neoplasms such as nipple adenoma or syringomatous tumor of the nipple. Paget disease of the nipple may be secondary to intraepidermal extension of ductal carcinoma in situ in the underlying lactiferous ducts or develop from malignant transformation of Toker cells. Invasive breast cancer may also arise primarily in the nipple. Most of these conditions present as a palpable mass and/or skin changes with or without nipple discharge. Due to the delicate location and often relatively small size of nipple lesions, biopsy specimens are often superficial and fragmented, and the interpretation is challenging. Knowledge of the morphologic and immunophenotypic features of nipple lesions is essential in making the correct diagnosis. Information on the molecular alterations underpinning nipple neoplasms is currently very limited.
Predictors of Lumpectomy Size after Breast-Conserving Surgery in Patients with Breast Cancer: A Retrospective Cohort Study
Authors: Makineli Seher , Strijbis Rogier , Tsehaie Jonathan , Schellekens Pascal P. A. , Moman Maaike R. , Veenendaal Liesbeth M. , Ferdinandus Patrick I. , Witkamp Arjen J. , Richir Milan C. , Maarse Wies
Published: September 2023

Background:

Oncoplastic reconstructive surgery as an extension of breast-conserving surgery leads to better aesthetic results, an increase in tumor-free margins, and a reduction in reexcision rates. Oncologic resection is often more extensive than expected, sometimes resulting in the plastic surgeon deviating from the predetermined plan. For optimal planning of the reconstruction, it is mandatory to estimate volume defects after lumpectomy as accurately as possible. The authors aimed to identify preoperative predictors of lumpectomy resection size.

Methods:

All consecutive patients diagnosed with invasive breast carcinoma or carcinoma in situ and treated primarily with breast-conserving surgery between 2018 and 2020 at the University Medical Center Utrecht or Alexander Monro Hospital were included. Patient and tumor characteristics were measured. Data were analyzed in a multiple linear regression analysis.

Results:

A total of 410 patients (423 cases) were included, with a median age of 58 years (range, 32 to 84 years) and a mean body mass index (BMI) of 25.0 (SD 9.3). The mean maximum radiologic tumor diameter was 18.0 mm (SD 13.2), and the mean maximum lumpectomy diameter was 58.8 mm (SD 19.2). Multiple linear regression analysis found an explained variance of R2 = 0.60 (P < 0.00), corrected for operating surgeon. Significant predictors for postoperative lumpectomy size were BMI, breast size, and maximum preoperative radiologic tumor diameter. A predictive tool for lumpectomy size was developed and a web-based application created to facilitate use of the tool in a clinical setting.

Conclusions:

Postoperative lumpectomy size can be predicted using BMI, breast size, and radiologic tumor size. This model could be beneficial for breast surgeons in planning reconstructions and preparing and informing their patients more accurately.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Simultaneous Reconstruction of Smiling Eye Using V-Shaped Long Latissimus Dorsi Muscle Transfer in Patients with Flaccid Facial Paralysis
Authors: Okazaki Mutsumi , Miyamoto Shimpei , Tomioka Yoko , Fujisawa Kou
Published: September 2023

Various neurovascular free muscle transfers for smile reconstruction in patients with facial paralysis have been reported. However, these methods focused on perioral smiling rather than eye smiling. Although the lower eyelid does not contribute significantly to eyelid closure, dynamic reanimation of the upward movement of the lower eyelid with bulging of the malar region during smiling is important in smile reconstruction. The authors present a novel procedure for smiling eye and perioral smiling. The V-shaped latissimus dorsi muscle flap containing the descending branch (DB) of the thoracodorsal nerve (TDN) was used. Muscle A (15 to 17 cm), which is located along the main trunk of the DB, is much longer than muscle B (10 to 12 cm), which is along the branch of DB. A distal stump of the TDN involved in muscle B was prepared. The true trunk and distal stump of the TDN were sutured to the contralateral facial and ipsilateral masseteric nerves, respectively. The central region of muscle A was positioned at the lateral part of the lower eyelid; the distal end of long muscle A was affixed to the temporal region, which enabled periocular movements and narrowing of the palpebral fissures alongside perioral smiling when muscle A contracted. Nine patients with complete flaccid facial paralysis were treated. All patients attained muscle contraction induced by the ipsilateral masseteric and contralateral facial nerves. The smiling eye appearance was observed in 7 of 9 patients. This procedure simultaneously improves paralytic ectropion at rest and aids eyelid closure and enables early voluntary smile and a later spontaneous smile.
Three Pedicle–Based Nipple-Sparing Skin-Reducing Mastectomy Combined with Prepectoral Implant-Based Breast Reconstruction
Authors: La Padula Simone , Pensato Rosita , Al-Amer Rasmieh , Hersant Barbara , Meningaud Jean Paul , Noel Warren , D’Andrea Francesco , Rocco Nicola
Published: September 2023

Background:

Nipple-sparing mastectomy (NSM) and immediate breast reconstruction have demonstrated positive aesthetic outcomes and high patient satisfaction. However, challenges arise when performing NSM on patients with large and ptotic breasts because of the higher risk of nipple-areola complex (NAC) necrosis. This study proposes a new technique: the three pedicle–based nipple-sparing skin-reducing mastectomy (TP-NSSRM), combined with direct-to-implant (DTI) breast reconstruction, aimed at reducing complications.

Methods:

A prospective study was conducted from November of 2021 to April of 2022, enrolling patients with large and drooping breasts requiring mastectomy for breast cancer treatment or risk reduction. Patient selection criteria included a sternal notch–to-nipple distance of greater than or equal to 23 cm, grade 3 ptosis, and eligibility for immediate prepectoral DTI breast reconstruction. Patient satisfaction was assessed using BREAST-Q modules.

Results:

Seventy-two TP-NSSRM procedures combined with immediate DTI-based breast reconstruction were performed on a total of 45 patients. High patient satisfaction was observed, and statistically significant improvements were noted in postoperative BREAST-Q scores (P = 0.001). The complication rate was low, and preservation of the nipple-areola complex was achieved in all cases.

Conclusions:

The TP-NSSRM technique offers a potential solution for patients with large and drooping breasts undergoing NSM. It aims to minimize complications and achieve satisfactory outcomes. This study demonstrates favorable results in terms of patient satisfaction and quality of life. Further research and long-term follow-up are necessary to validate these findings and evaluate the long-term outcomes of this technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A core outcome set for appendicitis: A consensus approach utilizing modified Delphi methodology
Authors: Butts Christopher A. , Byerly Saskya , Nahmias Jeffry , Gelbard Rondi , Ziesmann Markus , Bruns Brandon , Davidson Giana H. , Di Saverio Salomone , Esposito Thomas J. , Fischkoff Katherine , Joseph Bellal , Kaafarani Haytham , Mentula Panu , Podda Mauro , Sakran Joseph V. , Salminen Paulina , Sammalkorpi Henna , Sawyer Robert G. , Skeete Dionne , Tesoriero Ronald , Yeh Daniel Dante
Published: September 2023

BACKGROUND

Appendicitis is one of the most common pathologies encountered by general and acute care surgeons. The current literature is inconsistent, as it is fraught with outcome heterogeneity, especially in the area of nonoperative management. We sought to develop a core outcome set (COS) for future appendicitis studies to facilitate outcome standardization and future data pooling.

METHODS

A modified Delphi study was conducted after identification of content experts in the field of appendicitis using both the Eastern Association for the Surgery of Trauma (EAST) landmark appendicitis articles and consensus from the EAST ad hoc COS taskforce on appendicitis. The study incorporated three rounds. Round 1 utilized free text outcome suggestions, then in rounds 2 and 3 the suggests were scored using a Likert scale of 1 to 9 with 1 to 3 denoting a less important outcome, 4 to 6 denoting an important but noncritical outcome, and 7 to 9 denoting a critically important outcome. Core outcome status consensus was defined a priori as >70% of scores 7 to 9 and <15% of scores 1 to 3.

RESULTS

Seventeen panelists initially agreed to participate in the study with 16 completing the process (94%). Thirty-two unique potential outcomes were initially suggested in round 1 and 10 (31%) met consensus with one outcome meeting exclusion at the end of round 2. At completion of round 3, a total of 17 (53%) outcomes achieved COS consensus.

CONCLUSION

An international panel of 16 appendicitis experts achieved consensus on 17 core outcomes that should be incorporated into future appendicitis studies as a minimum set of standardized outcomes to help frame future cohort-based studies on appendicitis.

LEVEL OF EVIDENCE

Diagnostic Test or Criteria; Level V.
A simple model of wake capture aerodynamics
Authors: Nabawy Mostafa R. A.
Published: September 2023

Flapping wings may encounter or ‘capture’ the wake from previous half-stroke, leading to local changes in the instantaneous aerodynamic force on the wing at the start of each half-stroke. In this paper, I developed a simple approach to integrating prediction of these wake capture effects into existing analytical quasi-steady models for hovering insect flapping flight. The local wake flow field is modelled as an additional induced velocity component normal to the stroke plane of the flapping motion that is blended/switched in at the start of each half-stroke. Comparison of model results against experimental data in the literature shows satisfactory agreement in predicting the wake capture lift and drag variations for eight different test cases. Sensitivity analysis shows that the form of the translation velocity time history has a significant effect on the magnitude of wake capture forces. Profiles that retain high translational velocity right up to stroke reversal evoke a much larger effect from wake capture compared with sinusoidal. This result is significant because while constant flapping translation velocity profiles can be generated in the laboratory, the very high accelerations required near stroke reversals incur high mechanical cost that prevents practical adoption in nature or engineered flapping flight vehicles.
Impact of reference electrode position on motor unit number estimation (MUNE) in the tibialis anterior muscle using MScanFit: test-retest reliability
Authors: Almokdad M , Yang BG , Jantz B , Abrahao A , Jones KE
Published: September 2023

Objectives

This study aimed to assess the effect of varying the reference electrode position, specifically comparing position A3 (medial patella) to routine position 1 (R1) and the MScan multicenter protocol position (M1), on compound muscle action potential (CMAP) and motor unit number estimation (MUNE) in the tibialis anterior muscle of healthy participants.

Methods

Twenty healthy participants underwent repeated MScanFit MUNE assessments with a 7-14 day interval between tests. The reference electrode (E2) was placed in three positions at each visit (A3, R1, and M1), while the active electrode (E1) remained constant. An additional seventeen participants were included to establish the minimal detectable true change in MUNE values using MScanFit, with the reference electrode exclusively in the M1 position.

Results

The reference electrode position significantly influenced CMAP and MUNE, with R1 resulting in lower values. However, no significant difference was observed between M1 and A3 positions. Relative and absolute reliability indicators favored using the M1 position for reference in MScanFit MUNE. In a combined dataset of 37 healthy participants, the average tibialis anterior muscle motor unit count was estimated at 148 (SD 25.2), with a minimal detectable true change of 55 units.

Conclusions

The preference for the M1 position over the alternative A3 position is supported, particularly for MScanFit MUNE assessments in the tibialis anterior muscle. Clinically, a true change in MUNE should consider the minimal detectable change of 55 motor units, underscoring the reality that large changes in MUNE are required to conclude a genuine change beyond measurement error.

Significance

For MUNE examinations of the tibialis anterior muscle, adhering to the electrode positions outlined in the MScan multicenter protocol is advisable. Awareness of measurement error limitations in MScanFit MUNE underscores its applicability in making longitudinal clinical decisions forindividualpatients.