bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimizing Clinical Status and Quality of Life With Iron Dextran in Gynecologic Patients With Iron Deficiency Anemia [8L]
Authors: Shukr Ghadear , Saeed Haleema , Girgis Marian , Basu Aparna , Kuriakose Phillip , Sangha Roopina
Published: May 2019

INTRODUCTION:

To assess improvement in quality of life (QoL) in women with iron deficiency anemia secondary to chronic blood loss from benign gynecological conditions. To concurrently assess clinical improvement in hematologic indices.

METHODS:

An IRB approved prospective observational and survey study of women in an urban-based healthcare system with hemoglobin (Hgb) <12 g/dL who were poor candidates for oral iron supplementation. These women received iron dextran and Health-related quality of life (HRQOL) survey and had labs drawn at treatment, 30-days and 90-days post-infusion.

RESULTS:

Clinical improvement was assessed with Ferritin, Iron profile, Retic count, Hemoglobin and Hematocrit. The questionnaire assessed quality of life with two categories 1) physical health score and 2) mental health score. 23 patients completed the baseline questionnaire and labs. 13 patients completed the 30-day questionnaire, 7 of which completed the labs. Eight completed the survey and labs at 90-days. At baseline, average physical health T-score was 41, mental health T-score of 44, hgb 9.0 g/dL, ferritin 8.47 ng/mL, iron 35 µg/dL and TIBC of 481 mcg/dL. At 30 days, average physical health T-score was 43, mental health T-score of 45, hgb 11.6 g/dL, ferritin 162 ng/mL, iron 76 µg/dL and TIBC 285 mcg/dL. At 90-days, the average physical health T-score was 43, mental health T-score of 42, hgb 12.2 g/dL, ferritin 72 ng/mL, iron 76 µg/dL and TIBC 323 mcg/dL.

CONCLUSION:

Our study portrays the efficacy of iron dextran in improving hematologic indices without significant change in patient's QoL, including physical and mental health. Nonetheless, intravenous iron may be a good option for patients who are not candidates for oral iron supplementation.
Knowledge, Attitudes and Practices of Obstetricians for Postpartum Pain Control in the United States [33L]
Authors: Khan Muhammad Shoaib , Jackson Theresa N. , Mushtaq Nasir , Royall Nelson A. , Miller Barbara H. , Gold Karen P.
Published: May 2019

INTRODUCTION:

Postpartum pain is one of the most common morbidities in the postpartum period. Absence of clinical practice guidelines to treat postpartum pain combined with the ongoing opioid prescriptions epidemic has impacted the physicians' practices. The objective was to study the knowledge, attitudes and practices of obstetricians in regards to postpartum pain control across the United States.

METHODS:

This nation-wide cross-sectional study was conducted electronically from 3/2018 to 5/2018. Participants included obstetrics-gynecology or family medicine-trained obstetricians practicing in academic institutions. Survey included 34 questions and response rate was 35% (648/1878). Institutional review board approval was obtained for this study.

RESULTS:

Respondents' characteristics included mean age 46.2 (±11.0) years, females 422 (66%) and Caucasians 483 (75%). Regarding knowledge about guidelines, 153 (24%) were familiar with postpartum pain management and 351 (54%) were familiar with chronic pain management guidelines. Regarding the most common source of pain post-vaginal delivery, 87 (13%) correctly cited perineal pain, while post-cesarean delivery, 333 (51%) correctly cited incisional pain. Regarding pain level, 474 (72%) felt there is mild pain post-vaginal delivery, while 506 (78%) felt there is moderate pain post-cesarean delivery. Regarding opioids for treating postpartum pain, 367 (57%) felt that it should be considered only if the pain is unresolved, while 195 (30%) felt it is unnecessary most of the times. The national attention to opioids prescription epidemic has moderately to severely impacted practices of 230 (36%) respondents.

CONCLUSION:

This study provides unique obstetricians' perspectives around postpartum pain management that can help develop clinical practice guidelines for treating this common morbidity.
Labor Progression Slower Than the Zhang Standards Is Associated With Worse Maternal and Fetal Outcomes [35L]
Authors: Zdroik Anna , Altman Alan , Marcotte Michael Paul , Mincarelli Delores , Holbert Michael
Published: May 2019

INTRODUCTION:

In 2010, Zhang et al published data on over 62000 laboring patients that challenged the work of Friedman, which had been in place for over 50 years. This data included the 95th percentile of labor progression for each centimeter of cervical change in active labor. The purpose of this study was to investigate maternal and fetal outcomes in labors that progressed slower than these standards during the first stage of labor.

METHODS:

This was an IRB approved retrospective review of 9415 patients that had reached 6cm of dilation. The duration of each cervical change, up until complete dilation, was compared to the 95th percentile Zhang data. Maternal and neonatal outcomes were compared between labors that remained within these standards and those and those that progressed slower.

RESULTS:

Of the 9415 labors, 1467 (15.6%) had cervical dilation slower than the Zhang 95th percentile data. These labors were associated with greater risk of maternal ICU admission (RR 5.4, 1.4-21.6, p=0.02), maternal fever (RR 2.6, 2.2-3.0, p<0.0001), maternal blood transfusion (RR 3.0, 1.7-5.4, p=.0003), maternal readmission (RR 2.0, 1.3-2.9, p=0.0009). Neonatal macrosomia (RR 2.3, 1.5-3.5, p=0.0002), shoulder dystocia (RR 1.4, 1.1-1.8, p=0.0148), 5 minutes Apgar <7 (RR 3.0, 1.7-5.3, P=0.0002), and NICU admission (RR 1.7, 1.2-2.3, p=0.0017) were also increased. Overall combined maternal and neonatal morbidity was increased (RR 1.9, 1.7-2.1, p<0.0001).

CONCLUSION:

Labors characterized by cervical dilation slower than the 95th percentile Zhang standards are associated with worse maternal and fetal outcomes. Clinicians should be aware of this increased risk as they manage labors.
Eosinophilic esophagitis during sublingual and oral allergen immunotherapy
Authors: Cafone Joseph , Capucilli Peter , Hill David A. , Spergel Jonathan M.
Published: May 2019

Purpose of review

The aim of this review is to discuss the current evidence regarding the development of eosinophilic esophagitis (EoE) in individuals undergoing oral and sublingual immunotherapy (SLIT) for both food and environmental allergens. Cumulative incidence of EoE in patients on allergen immunotherapy for peanut, milk, and egg is estimated.

Recent findings

De novo development of EoE in patients undergoing oral and SLIT has been demonstrated on the scale of case reports and prospective randomized trials. However, few individuals with EoE-like symptoms during immunotherapy undergo endoscopy, and the long-term outcomes of immunotherapy-associated EoE are unknown.

Evidence exists to suggest that allergen immunotherapy could place individuals at risk for the development of EoE, the true incidence of which may vary depending on antigen exposure and methods used to define the condition.
Varied Surgical Approach to the Retrocalcaneal Spur and Haglund Deformity: A Technique Guide
Authors: Kibler Kurt , So Eric , Chu Anson , Logan Daniel
Published: May 2019

An enlargement of the posterosuperior aspect of the calcaneus, also known as Haglund deformity, is often associated with Achilles tendonitis/tendinosis and retrocalcaneal bursitis. A retrocalcaneal spur is associated with chronic pain from activity and shoe pressure. Both of these conditions are treated with conservative therapy, which provides reliable results. However, surgical intervention may be required for recalcitrant or severe cases and has the opportunity to provide relief when nonoperative measures fail. Many surgeons address both conditions through similar surgical dissection. The posterior heel has relatively little tissue overlaying the surgical site and traditional posterior heel surgery with calcaneal osteotomy and Achilles repair through posterior incisions has proven to be effective in correction of the deformity. However, the need for large amounts of suture and suture knots, during the repair can lead to wound complications after the repair, even with varied incision placement. Because of this, many surgeons are utilizing a knotless suture anchor technique to eliminate the bulky nature of the suture at the posterior heel and prevent unwanted suture reaction at the site. Using the same surgical approach for both conditions causes an increased operative time and recovery than necessary for those with Haglund deformity. A lateral approach can be performed, as complete Achilles detachment does not need to be performed in this group. This paper outlines 2 separate surgical techniques, with the use of knotless suture anchors, for treatment of these conditions and the surgical approach that may be used for each condition.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
AAFD Staging System: Did We Get It Right?
Authors: Li Shuyuan , Yao Lufeng , Myerson Mark S.
Published: May 2019

We present here an evolution of thinking of various classification systems that have been used to approach treatment of the adult flatfoot deformity. While the current popular classification is clinically useful, it is far from satisfactory. There are still too many outliers, and for any classification system to work, it must be applicable to all deformities, and all patients. We describe clinical as well as patient parameters which do not fit in with the current classification scheme, and make recommendations for future study.
It All Fell Apart … Now How Do I Reconstruct My End-stage Flatfoot?
Authors: Steginsky Brian , Haddad Steven L.
Published: May 2019

Plantigrade mechanical alignment is the hallmark of a successful extra-articular flatfoot reconstruction. When executed appropriately, joint-preserving flatfoot realignment surgery often results in good functional outcomes and acceptable patient satisfaction. However, flatfoot reconstruction can fail for multiple reasons including progressive arthritis at adjacent joints, soft-tissue hyperlaxity, nonunion of an osteotomy, and under or overcorrection of the deformity. The reasons for failure must be identified and adequately addressed to achieve a successful outcome following revision surgery. We frequently perform a triple arthrodesis, with an extended medial column fusion (as necessary), after recurrent medial column collapse. We present our diagnostic algorithm, surgical techniques, and pearls for the treatment of the failed extra-articular flatfoot reconstruction.
Human epidermal growth factor receptor 2-positive digestive tumors
Authors: Wagner Anna D. , Özdemir Berna C. , Rüschoff Josef
Published: May 2019

Purpose of review

This manuscript aims at providing an update and overview on the role of Human epidermal growth factor receptor 2 (HER2) testing and HER2-directed therapies in digestive tumors.

Recent findings

Phase 3 trial data demonstrating a survival benefit of HER2-targeting treatments are limited to gastric cancer. However, HER2 positivity is also found in 5–6% of colorectal, 7% of pancreatic, and 16% of extrahepatic biliary cancers. Although phase 2 trial data support the use of the combination of trastuzumab and lapatinib with chemotherapy in HER2-positive colorectal cancer, the patient's benefit from targeted treatment of HER2-positive biliary or pancreatic neoplasms is currently unclear, and further clinical trials are necessary.

With the exception of gastric cancer, there are currently no defined guidelines for HER2 testing in other digestive tumors. Various HER2-targeting therapies, which are standard of care in HER2-positive breast cancer, failed in HER2-positive gastric cancers. Thus, the predictive value of HER2 overexpression depends on the tumor type, and results of breast cancer trials cannot a priori be extrapolated to digestive cancers. Next-generation sequencing panel diagnostics may furthermore identify targetable activating mutations in gastric, extrahepatic biliary, and colorectal cancer, particularly if traditional testing (immunohistochemistry/in-situ hybridization) is negative. However, their clinical relevance needs to be determined.
The Reason Matters: Deep Wrist Injury Patterns Differ with Intentionality (Accident versus Suicide Attempt)
Authors: Kisch Tobias , Matzkeit Nico , Waldmann Annika , Stang Felix , Krämer Robert , Schweiger Ulrich , Mailänder Peter , Westermair Anna Lisa
Published: May 2019

Background:

Despite the clinical importance of suicidal deep wrist injuries (DWIs), we currently do not know whether their injury patterns differ from accidental injuries.

Methods:

This retrospective study included all patients admitted to the Clinic of Plastic Surgery for acute treatment of a DWI from 2008 to 2016, except for isolated injuries to the palmaris longus (PL) and amputations. Intentionality of the injury was determined using documentation of psychiatric evaluations; cases that could not be categorized regarding intentionality were excluded.

Results:

About 20% of DWIs stemmed from suicide attempts, which involved the nondominant hand in 94.5%. Suicidal DWIs were more likely to involve the median nerve, radial artery, PL, and flexor carpi radialis (FCR), especially on the nondominant hand, but were less likely to involve the ulnar artery and nerve on the dominant hand. The effect of the protective structures PL/flexor carpi ulnaris on the median nerve/ulnar artery could be confirmed for suicidal DWIs, but intactness of the FCR was associated with increased radial artery injuries. Longitudinal cut orientation in suicidal DWIs was associated with more radial artery injuries, but fewer injuries to tendons and nerves. Frequencies of various other injury constellations are tabulated to aid in clinical assessment.

Conclusions:

Suicidal and accidental DWIs differed in various aspects of injury pattern. Suicidal injuries were mostly localized to the nondominant radial side, and accidental injuries to the ulnar side. Also, the so-called protective structure FCR had the opposite effect in suicidal injuries. Thus, findings regarding injury patterns in accidental DWIs cannot be generalized to suicidal injuries.
Combined Method with Free Omentum Flap and Split-thickness Skin Flap for Hand Reconstruction Following Radical Excision of an Arteriovenous Malformation
Authors: Hatano Takaharu , Motomura Hisashi , Deguchi Ayaka , Fujikawa Heishiro , Maeda Shusaku
Published: May 2019

The treatment for arterial venous malformation (AVM) of functionally and aesthetically important parts such as the hand is considered to be challenging. AVM existed in the right forearm and the thenar region of 55-year-old man. Combined method with free omentum flap and split-thickness skin flap was performed for hand reconstruction after radical excision of an AVM. The postoperative course was good. Seven years have passed postoperatively, and functional but aesthetical results are satisfying with no recurrence. Our operative procedure with complete resection of AVM with placement of the free omental flap to the resected area and placing back the original skin as a skin graft is considered to be an ideal curative surgical treatment of the AVM.
Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in a Patient with a History of Toxic Epidermal Necrosis
Authors: Sinelnikov Mikhail Y. , Starceva Olesya I. , Melnikov Dmitriy V. , Ivanov Semen I. , Makarenko Dmitriy A.
Published: May 2019

Breast reconstruction is a procedure that is in increased demand due to high incidence of breast cancer. To provide high-quality esthetic and functional results, each patient should be properly managed. Patients with comorbid conditions have become more common and account for higher difficulty in perioperative patient management. Despite the ongoing diversification of comorbidities in patients undergoing breast reconstruction, it is the patient’s right to receive this final stage in rehabilitation after a mastectomy. We present a clinical vignette of a patient with a severe comorbid hypersensitivity disorder undergoing breast reconstruction with the deep inferior epigastric artery perforator flap. Despite early postoperative complications, our brigade managed to maintain flap viability without the use of surgical or pharmacological assistance in a patient with a history of toxic epidermal necrosis syndrome.
Long-term Prognosis of Mandibular Distraction in 3 Cases of Hypoglossia-Hypodactyly Syndrome without Extremity Anomalies
Authors: Imai Yoshimichi , Kochi Shoko , Nakajo Tetsu , Yamada Atsushi
Published: May 2019

Hypoglossia-hypodactyly, or aglossia-adactylia syndrome with or without limb anomalies, is an extremely rare congenital condition. It is characterized by a narrow, V-shaped mandibular dental arch with micrognathia, and is typically challenging to treat. We have previously reported 3 patients with hypoglossia-hypodactyly syndrome without limb anomalies who were treated with transverse distraction osteogenesis at the mandibular symphysis during childhood. In this report, we present the long-term prognoses of these 3 cases, until 18 years of age. Of the 3 total cases, sufficient and stable results in occlusion, speech, mastication, and facial appearance were obtained in 2 cases with subsequent orthodontic treatments. Similar results were not observed in the remaining case when continuous orthodontic treatments were not performed. Based on these results, we propose that the transverse distraction osteogenesis procedure at the mandibular symphysis during childhood could be a reliable method to correct the V-shaped mandibular arch of hypoglossia-hypodactyly syndrome, when subsequent orthodontic treatments are provided during the patient’s growing period.
Patient-reported Outcome Instruments in Lower Extremity Trauma: A Systematic Review of the Literature
Authors: Mundy Lily R. , Grier A. Jordan , Weissler E. Hope , Carty Matthew J. , Pusic Andrea L. , Hollenbeck Scott T. , Gage Mark J.
Published: May 2019

Background:

Advances in fracture fixation and soft tissue coverage continue to improve the care of patients after limb-threatening lower extremity (LE) trauma. However, debate continues regarding which treatment option—reconstruction or amputation—is most appropriate. Many authors have attempted to quantify the patient experience in this treatment paradigm; however, they have not used patient-reported outcome (PRO) instruments specific to this population. Our aim was to identify and evaluate PRO instruments developed specifically for LE trauma, applicable to reconstruction and amputation, using established PRO instrument development and validation guidelines.

Methods:

A multidisciplinary team used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to query PubMed, Medline Ovid, EMBASE, Cochrane, Medline Web of Science, and Psych Info databases from inception to November 2016. Publications were included that described the development and/or validation of a PRO instrument assessing satisfaction and/or quality of life in LE trauma, applicable to both amputation and reconstruction. Two authors independently reviewed each full-text citation.

Results:

After removing duplicates, 6,290 abstracts were identified via the database query. Following a preliminary title and abstract screen, 657 full-text citations were reviewed. Of these references, none satisfied the previously established inclusion criteria.

Conclusions:

No studies were identified that described a PRO instrument developed to assess outcomes in LE trauma patients applicable to both reconstruction and amputation. There is thus a need for a PRO instrument designed specifically for patients who have sustained limb-threatening LE trauma to guide treatment decisions.
Breast Implant Selection: Consensus Recommendations Using a Modified Delphi Method
Authors: Magnusson Mark R. , Connell Tony , Miroshnik Michael , Layt Craig , Ashton Mark , Deva Anand K. , Farrow Hamish , Januszkiewicz Janek
Published: May 2019

Background:

Geographical differences in breast implant selection approaches exist, and clinical data to guide the process are limited. Developing knowledge of implant-related risk factors further complicates the process. This analysis aimed to establish expert consensus on considerations for breast implant selection in Australia and New Zealand based on practice patterns in those countries.

Methods:

A modified Delphi method was used to gain consensus from experts in breast augmentation surgery in Australia and New Zealand. Panelists anonymously completed an initial questionnaire on current considerations in implant selection, discussed a summary of their responses in a live meeting, and completed a final consensus survey based on their live recommendations.

Results:

Seven panelists completed the final consensus survey. Consensus recommendations included ensuring consideration of proper surgical technique (pocket formation, positioning of implant) and patient tissue and anatomical characteristics, weighing relative expected results of various surface textures, sizes, and degrees of cohesivity, and careful contemplation of the migration risk.

Conclusions:

This modified Delphi exercise provided consensus recommendations on the key factors involved in implant selection from the perspective of plastic surgeons with practices in Australia and New Zealand. A primary recommendation was that the choice of implant for each patient should be individualized to patient tissue and anatomical characteristics.
Preliminary Dose Assessment for Emergency Response Exercise Using Unsealed Radioactive Contamination
Authors: Cochran Lainy D. , Marianno Craig M.
Published: May 2019

A preliminary dose assessment for an emergency response exercise using unsealed radioactive sources was performed based on conservative calculation methods. The assessment was broken into four parts: activation, distribution, exercise participation, and post-exercise monitoring. The computer code MicroShield was used to determine external exposure from the source during and after distribution. Internal exposure via inhalation and ingestion was estimated by assuming fractional intakes of activity and converting to dose using annual limits on intake and dose coefficients. It was determined from the dose assessment that a radionuclide-dependent range of 37 MBq to 1.5 GBq can be used to achieve detectable dose rates during the exercise without exceeding assumed administrative dose limits. Of the identified radionuclides, 99mTc results in the lowest dose and is recommended from a radiological safety standpoint. However, the choice of which radionuclide and what activity to use for an exercise should be made based on budget and the logistics of the actual exercise.
Providing Care for Comorbid Mental Health Conditions in the Polytrauma System of Care
Authors: Pastorek Nicholas J. , Petska Kelly S. , Duchnick Jennifer J. , Chard Kathleen M. , Belanger Heather G.
Published: May 2019

Objective:

To summarize challenges and best practices relevant to providing care for mental health comorbidities in veterans and service members (V/SM) treated in the Polytrauma System of Care (PSC) and to review themes that emerged during a May 2017 meeting of rehabilitation professionals on this topic. Management of comorbid mental health conditions remains a critical issue within the PSC, given the high rate of these comorbidities and the impact of mental health conditions on treatment planning and outcomes.

Design:

To identify the challenges of concomitantly treating TBI-related symptoms and mental health comorbidities in V/SM treated within the PSC, describe specialty programs within the Veterans Health Administration designed to treat these comorbid conditions, and report on the themes and recommendations identified by rehabilitation professionals at the 2017 meeting.

Conclusion:

To further develop mental health treatment within the PSC, the following recommendations were made: (1) continued support for family members as critical members of the rehabilitation team; (2) adding measures and mechanisms to monitor mental health within the PSC; and (3) exploration of modern technologies to enhance care of existing polytrauma clients and to better prepare to serve clients with all types of acquired brain injury.
Developing the Disorders of Consciousness Guideline and Challenges of Integrating Shared Decision-Making Into Clinical Practice
Authors: Armstrong Melissa J.
Published: May 2019

Objective:

To review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and highlight challenges to SDM in disorders of consciousness.

Methods:

We describe guideline development strategies and implications for use, approaches to SDM generally and with surrogate decision makers, and considerations when implementing the prolonged disorders of consciousness guideline into clinical care.

Results:

Clinical practice guidelines aim to improve high-quality patient care and outcomes by assessing the best medical evidence and incorporating this into care recommendations. This is accomplished through transparent methodology and compliance with published standards. Guidelines support SDM with patients and surrogate decision makers. Effective SDM can be challenging in conditions such as prolonged disorders of consciousness where surrogates are required, but assessment of patient values and incorporation of these values into SDM is ethically critical.

Conclusions:

Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for individuals with prolonged disorders of consciousness. They also provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is needed into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.
Use of Topical Steroids in Conjunctivitis: A Review of the Evidence
Authors: Holland Edward J. , Fingeret Murray , Mah Francis S.
Published: May 2019

Purpose:

Conjunctivitis, or inflammation of the conjunctiva, is a common condition that can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies. Treatment involves diagnosis of the underlying cause and use of appropriate therapies. A broad-spectrum therapy that can address multiple etiologies, and also the accompanying inflammation, would be very useful. In this review, we discuss the usefulness of topical ophthalmic corticosteroids and ophthalmic formulations that combine corticosteroids with anti-infectives/antibiotics for treating acute infectious conjunctivitis.

Methods:

A review of the published literature and relevant treatment guidelines.

Results:

Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis. This is partly due to risks associated with steroid use. These risks include potential for prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts. Most of these perceived risks are not, however, supported by high-quality clinical data. They are also associated with long-term steroid uses that are dissimilar to applications for infectious conjunctivitis. Clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks).

Conclusions:

Corticosteroids, in combination with anti-infectives, could be a promising treatment option for acute conjunctivitis subject to development of further evidence on their effectiveness and safety in conjunctivitis treatment.
Clinical Outcomes of Descemet Stripping Endothelial Keratoplasty in Eyes With Glaucoma Drainage Devices
Authors: Kang Joann J. , Ritterband David C. , Atallah Richard T. , Liebmann Jeffrey M. , Seedor John A.
Published: May 2019

Precis:

In this retrospective case series of 85 eyes, 31.8% developed graft failure and graft survival was 50% at 3 years. The presence of an aqueous shunt has a significantly adverse effect on long-term graft survival.

Purpose:

To report visual outcomes and complications of Descemet stripping endothelial keratoplasty (DSEK) in eyes with glaucoma drainage devices (GDD).

Materials and Methods:

A retrospective chart review was conducted of 122 procedures of 85 eyes of 83 patients who underwent DSEK and had prior or concurrent GDD implantation. Mean follow-up was 36.5±31.4 months. Patients with postoperative follow-up of <3 months were excluded from analysis. Outcome measures examined included visual acuity, donor dislocation rate, intraocular pressure (IOP), and graft survival.

Results:

The mean logMAR vision improved to 1.07 postoperatively from 1.43 preoperatively, with 61% of eyes experiencing improved visual acuity. Graft dislocation occurred in 27 (31.8%) eyes and required repeat injection of air in the anterior chamber. Primary graft failure occurred in 2 (2.4%) eyes, whereas secondary graft failure occurred in 27 (31.8%) of eyes, with an average time of 24.3 months for development. Estimated survival rates at 1, 2, and 3 years were 89%, 78%, and 50%, respectively. Escalation of IOP occurred in 21 (24.7%) eyes postoperatively, where 14 eyes underwent medical therapy and 7 eyes required surgical intervention/laser for IOP control.

Conclusions:

DSEK after GDD is a viable alternative to treat endothelial dysfunction, with the majority of patients achieving visual improvement. However, aqueous shunt implantation has a significantly adverse effect on long-term graft survival and close follow-up is warranted.
Ocular Cosmetics: Public Safety Problem or Harmless Products?
Authors: Janetos Timothy M. , Thyparampil Preeti
Published: May 2019

Purpose:

This perspective explores the safety profile of ocular cosmetics and explores the role ophthalmologists can play in mitigating potential ocular harm from unsafe products.

Methods:

N/A.

Results:

Cosmetics and personal care products represent a large industry that is currently unregulated in any meaningful way. Products intended for use around the eyes carry a risk of serious side effects including contact dermatitis and bacterial infection. Currently, legislation has been proposed to change regulation to provide more meaningful oversight of cosmetics.

Conclusions:

Ophthalmologists are often the first to recognize patterns in harmful products intended for use around the eye and can help mitigate potential future ocular harm by reporting adverse events to the Food and Drug Administration and by advocating for cosmetic regulation change.
Obesity Affects the Association of Bioelectrical Impedance Phase Angle With Mortality in People Living With HIV
Authors: Cogliandro Viola , Yester Donna , Westfall Andrew O. , Raper James L. , Saag Michael S. , Henostroza German , Overton E. Turner , Willig Amanda L.
Published: May 2019

Bioelectrical impedance analysis phase angle (BIA-PA) is a valid indicator of mortality risk in people living with HIV; however, it is not known whether BIA-PA is valid for people living with HIV who are overweight or obese. We assessed whether BIA-PA differentially predicted mortality by body mass index category in participants receiving clinical care at a single site between 2000 and 2012. Change in BIA-PA from the highest versus last available phase angle was assessed using multivariate logistic regression models. Eight hundred ninety participants were included in the final analyses, with 102 deaths recorded during the study period. Decline in BIA-PA was associated with mortality in underweight and normal weight participants but not in overweight or obese participants. Additional investigation is warranted to determine the appropriate clinical BIA-PA equations and parameters to identify overweight and obese patients with increased mortality risk.
Clinicopathological features and surgical outcomes of resected functional pancreatic neuroendocrine tumors: a single institution experience
Authors: Javed Ammar A. , Hasanain Alina , Haider Aleezay , Jones George , Javed Zunaira N. , Soares Kevin , Burkhart Richard A. , Cameron John L. , Weiss Matthew J. , Wolfgang Christopher L. , He Jin
Published: May 2019

Background:

Functional pancreatic neuroendocrine tumors (f-PanNETs) are rare tumors of the pancreas that are associated with excess hormone production. A majority of literature available on these tumors is limited to case reports and small series and discusses a particular subtype. Here, we report the clinicopathological features and outcomes of all f-PanNETs from a high-volume pancreatectomy center.

Methods:

A prospectively maintained database was used to identify patients who underwent resection for f-PanNETs between January 1995 and December 2015. Patients were stratified by the type of f-PanNET, and their clinicopathological features and outcomes were analyzed and reported.

Results:

We identified 69 patients with a mean age of 52 ± 16 years, and the majority were female (62%). The most common type of f-PanNET were insulinomas (70%) followed by gastrinomas (15%), and vasoactive intestinal peptidomas (VIPomas) (10%). There was considerable heterogeneity in the presenting symptoms. Patients with insulinomas presented with smaller tumors compared to the other subtypes. Nodal disease was most frequent in patients with VIPomas (71%), and gastrinomas (50%). The median overall survival (OS) was 7.4 years. Elevated Ki-67 and age >65 years were associated with poorer OS. Recurrence was observed in 8 patients (12%) and was most frequent in patients with VIPomas. Recurrence was associated with a poorer OS (P = .012).

Conclusion:

f-PanNETs are exceedingly rare and present with a wide variety of symptoms, histopathological findings, and outcomes. Surgical resection can help achieve good long-term survival.
The Challenges and Opportunities in Disaster Nursing Education in Turkey
Authors: Kalanlar Bilge
Published: May 2019

Despite the key role of nurses in the disaster management process, there are still few studies in Turkey that have investigated the unique role of nurses in disasters. The aim of this study is to assess the challenges and opportunities in disaster nursing education in Turkey. In this context, this article will discuss disaster nursing, the role of nurses in disasters, and topics related to disaster nursing education within the framework of the current national and international literature, and provide recommendations. An integrative narrative analysis was conducted of studies published in English and Turkish in the literature between 2011 and 2016. This study has found that the inadequacies in the fields of education, practice, and research present the most important challenges of disaster nursing education in Turkey, and due to these challenges disaster nursing in Turkey is not very well known and has not sufficiently developed. The results of this study indicate that there is a need for conducting undergraduate and graduate disaster nursing education on the national and international scale and delivering in-service training programs for working nurses.
A Retrospective Study of Transfusion Requirements in Trauma Patients Receiving Tranexamic Acid
Authors: Cornelius Brian , Moody Kelsey , Hopper Katelyn , Kilgore Phillip , Cvek Urska , Trutschl Marjan , Cornelius Angela P.
Published: May 2019

The Military Application of Tranexamic Acid in Trauma Emergency Resuscitation Study (MATTERs) and Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) studies demonstrate that tranexamic acid (TXA) reduces mortality in patients with traumatic hemorrhage. However, their results, conducted in foreign countries and U.S. military soldiers, provoke concerns over generalizability to civilian trauma patients in the United States. We report the evaluation of patient outcomes and transfusion requirements following treatment with TXA by a civilian air medical program. We conducted a retrospective chart review of trauma patients transported by air service to a Level 1 trauma center. For the purposes of intervention evaluation, patients meeting this criterion for the 2 years (2012–2014) prior to therapy implementation were compared with patients treated during the 2-year study period (2014–2016). Goals were to evaluate morbidity, mortality, transfusion requirements, and length of stay. During the review, 52 control (non-TXA) and 43 study (TXA) patients were identified as meeting inclusion criteria. Patients in the control group were found to be less acute, which correlated with shorter hospitals stays. There was reduced mortality for patients receiving TXA in spite of their increased acuity and decreased likelihood of survival. Trauma patients from this cohort study receiving TXA demonstrate decreased mortality in spite of increased acuity. This increased acuity is associated with increased transfusion requirements. Future research should evaluate patient selection with concern for fibrinolysis and provider bias. Randomized controlled trial is needed to evaluate the role of TXA administration in the United States.
Stress Mitigation Strategies for Trauma Nurses: A Case Study
Authors: Miller Amy , Marshall June , Edmonson Cole , Kobilansky Bonnie J. , Cross Emily
Published: May 2019

Trauma nurses encounter multiple intense stressors on a regular basis. These nurses not only treat the injured patient following a traumatic event but then interact with family members who are also impacted by the event. Repeated experiences with significant trauma can have cumulative effects and negatively impact these nurses and the entire trauma team. Professional nursing associations make recommendations promoting wellness, and health care organizations implement wellness programs that foster and support mind, body, and spirit health. Individuals cope with and respond to stress in different ways, dependent on their unique backgrounds, beliefs, and support systems. Because of these differences, it is important for organizations to offer various ways for nurses and team members to process their reactions and use effective strategies to effectively manage stress. The organization highlighted in this case study offers several stress mitigation programs and techniques designed to support the overall health of trauma nurses and restore their emotional well-being, so that they are best able to care for their injured patients.
In Vivo Real-time Remote Cochlear Implant Capacitive Impedance Measurements: A Glimpse Into the Implanted Inner Ear
Authors: Di Lella Federico Alberto , De Marco Diego , Fernández Florencia , Parreño Matías , Boccio Carlos Mario
Published: May 2019

Objectives:

To propose a remote, real-time, safe, and easy systematic method to determine electrode electric impedance components: access resistance, polarization capacitance, and polarization resistance.

Patients:

Patients who received a cochlear implant and had normal cochlear anatomy and complete array insertion were recruited. A total of four adult patients were included and separated in two groups according to implantation time.

Intervention:

Cochlear implant electrical impedance and its components were measured in all patients by using a novel diagnostic tool: a custom made software running in the patient's computer. Data is transmitted in real time to the investigator. Various stimulation and measuring strategies were used to obtain specific information in each cochlear region.

Main Outcome Measures:

Access resistance, polarization capacitance, and resistance of each patient were measured. Measurement success rate and required time for the patient were recorded.

Results:

Access resistance, polarization capacitance, and resistance were obtained in different modes, thus in every specific region of the cochlea. All measurements were successful. Each measurement took approximately 7 minutes and was transmitted in real time to the investigators.

Conclusion:

Routine use of this tool may allow constant assessment of cochlear health and could be eventually used to monitor the effect of drugs in the inner ear. This methodology provides an in vivo “electrical view” of the inside of the implanted cochlea.
Effects of Second-Hand Smoke on Pancreatitis in Children
Authors: Ballengee Cortney R. , Brooks Peter , Leong Traci , Geem Duke , Freeman A. Jay
Published: May 2019

Objectives

Pediatric pancreatitis incidence is increasing, but little is known about risk factors. Smoking increases the risk for adult pancreatitis and has been shown to affect CFTR function in vitro. Therefore, we evaluated passive smoke exposure effects on disease outcomes in children with various pancreatitis etiologies.

Methods

We conducted a 5-year retrospective chart review of patients admitted for pancreatitis to Children's Healthcare of Atlanta. Demographic data, etiology of pancreatitis, and number of hospitalizations with length of stay (LOS) were compared with smoking exposure, obtained through telephone query.

Results

Of the 134 subjects admitted for pancreatitis, 90 reported no smoke exposure (none), 33 reported outdoor smoke exposure (outside), and 11 reported exposure to indoor smoking (inside). Average hospital admissions (P = 0.038) and LOS (P = 0.004) were significantly higher among subjects with inside smoke exposure compared with those with outdoor or no exposure. Average hospital admissions were significantly higher in subjects with CFTR mutations compared with those with nongenetic or other genetic etiologies (P ≤ 0.001).

Conclusions

Second-hand smoke exposure may increase hospital admission rates and LOS for pediatric pancreatitis. Children with an identifiable CFTR mutation may have increased risk for hospital admissions compared with those who do not.
Enhanced Protein Diet for Preterm Infants
Authors: Atchley Courtney B. , Cloud Ann , Thompson David , Blunt Michelle H. , Satnes Kelli J. , Szyld Edgardo , Ernst Kimberly D.
Published: May 2019

Objective:

To evaluate dietary protein's effect on fat accretion and weight gain in hospitalized preterm infants.

Methods:

Prospective, randomized, double‐blind, controlled trial of 36 infants born at <32 weeks, hospitalized in a tertiary neonatal intensive care unit. After achieving full enteral volume, infants were randomized to either an enhanced protein diet (EPD) (protein‐energy ratio [PER] 4 g/100 calories) or a standard protein diet (SPD) (PER 3 g/100 calories). Macronutrients were calculated using published values for formula, donor milk bank analysis, or weekly analysis of a 24‐hour pooled maternal milk sample. Human milk fortifier and/or liquid protein were used to achieve the target PER until discharge or a maximum of 4 weeks. Body composition was measured weekly using air displacement plethysmography. The principal outcomes, rates of weight gain and fat accretion, were compared between groups in linear mixed models.

Results:

Thirty‐three infants received approximately 17 days of the study diet. Relative weight gain was 21.6 g · kg−1 · day−1 (95% confidence interval [CI] 19.5–23.8) for the EPD group (n = 16) versus 19.1 g · kg−1 · day−1 (95% CI 17.0–21.2) for the SPD group (n = 17), P = 0.095. Baseline percent fat mass (FM) in the EPD group was 5.15% (95% CI 3.58%–6.72%) compared with 7.29% (95% CI 5.73%–8.84%) in the SPD group, P = 0.0517. Percent FM increased 0.398%/day (95% CI 0.308–0.488) for the EPD group versus 0.284%/day (95% CI 0.190–0.379) for the SPD group (P = 0.0878).

Conclusions:

Preterm infants with a lower baseline FM percentage who received an EPD demonstrated a more pronounced catch‐up percentage of fat accretion.
A Newborn With Skin Lesions, Thrombocytopenia, and Gastrointestinal Bleeding
Authors: Razak Abdul , Wahab Muzafar G.A. , Dowhaniuk Jenna , Breakey Vicky R. , Ho Man H.E. , Arredondo Jorge , Shah Jay K.
Published: May 2019

A term infant girl was admitted for evaluation of severe thrombocytopenia. She also had purpura-like skin lesions. A complete blood count showed a platelet count of 40×109/L (normal value: 150 to 400×109/L). She received random donor platelet transfusions and intravenous immunoglobulin therapy; however, thrombocytopenia persisted. She developed bloody stools on day 5 of life and hematemesis on day 9. Upper gastrointestinal endoscopy revealed multiple small, 2 to 5 mm, vascular lesions throughout the stomach body and proximal duodenum. Our multidisciplinary team will discuss an approach towards a term infant with thrombocytopenia and gastrointestinal bleeding, the diagnostic challenges, and patient management.
Atypical Presentations of Exertional Collapse
Authors: Newman Caroline , Fields Karl B.
Published: May 2019

Exertional collapse associated with sickle trait (ECAST) is an underrecognized cause of exertional collapse triggered by complex mechanisms involving acidosis, rhabdomyolysis, and arrhythmias, all of which create sickling, vaso-occlusive problems, and ultimately end organ failure. Three cases are described in young athletes, as well as 12 other examples of ECAST noted in case reports and news sources. Exertional collapse associated with sickle trait can be differentiated from other common causes of collapse (exertional heat syndrome, acute cardiac events, and asthma) because it is a conscious collapse without neurological changes, occurs early in workout with only mildly elevated body temperature, and involves muscle pain and weakness but not cramping. Aggressive early management and transport to care facilities can reverse ECAST in certain cases. This article discusses tips for early recognition, initial treatment in the emergency department, and precautions that can be taken to prevent sickling collapse in athletes with sickle cell trait (SCT).
Treatment of Glenohumeral Subluxation
Authors: Cole Andrew , Cox Talitha
Published: May 2019

Objective

The aim of this review was to identify treatment strategies in the research literature to inform all health professionals on best practice strategies when addressing glenohumeral subluxation.

Design

Articles were identified by searching electronic databases. Two reviewers independently appraised the methodological quality of the selected studies. Discrepancies were resolved after corroboration of results.

Results

Research literature pertaining to five major treatment strategies was found (n = 40 peer-reviewed publications), spanning evidence levels I–V. The greatest number of studies concerned neuromuscular electrical stimulation (n = 19), five of which were level I studies, followed by manual preventive strategies, such as slings (n = 20), three of which were level I studies.

Conclusions

These findings indicate that the most high-quality research supports using neuromuscular electrical stimulation or manual preventive studies, although no studies used direct comparison methods to ascertain relative merits of each type of intervention when compared with others. No evidence suggested that harm was done by using neuromuscular electrical stimulation or manual preventive methods. This literature review suggests that the identified treatment strategies should be considered by clinicians as the treatment of choice for GHS. No literature was identified that reviewed treatment strategies in a pediatric population; however, the authors considerations for treatment in the pediatric population were included.