bluuebunny/crossref_metadata_2025 huggingface dataset:
Picturing the Unusual: Uncertainty in the Historiography of Medical Photography
Authors: Engelmann Lukas
Published: October 2019

The article explores and expands the historiography of medical photography. First, it revisits historical scholarship on medical photography to demonstrate the absence of a consensus as to what counts as medical photography and what does not. Secondly, the article illustrates the shortcomings of current analytical perspectives with two examples. The first picture was taken by the board of health in Honolulu in 1900 to visualise bubonic plague but resists recognition as a medical representation. The second, a 1986 picture of a person with AIDS, has been perceived as a medicalised photograph contrary to the artist’s intention. Both pictures, rather than delivering diagnostic inferences sustained notions of uncertainty and unusualness. With these examples, I outline the often overlooked significance of picturing uncertainty in the historiography of medical photography. Finally, I ask if these visualisations might be better addressed as elements of experimental systems rather than as representations of disease.
The Preoperative and Postoperative Colon: What the Radiologist Needs to Know
Authors: Keshav Nandan , Carter Scott , Thompson William M.
Published: October 2019

Colon surgery may be performed for a broad range of benign and malignant causes, mainly carcinoma, diverticular disease, and inflammatory bowel disease. Given a plethora of colon surgical techniques, resultant aberrant anatomy, and postoperative complications, interpreting examinations of the postoperative colon can be a challenging endeavor. The colon surgical technique used most often is dependent upon the underlying lesion, the patient's hemodynamic status, and the surgeon's preference. Colon surgical techniques are diverse and include abdominoperineal resection, anterior resection, restorative proctocolectomy, and segmental resection.
Measles
Authors: Perkins Amanda
Published: October 2019

Currently, we're seeing the highest number of measles cases in the US since it was declared eliminated. Here's what you should know about this preventable, potentially life-threatening respiratory virus.
Interprofessional Substance Use Disorder Education in Health Professions Education Programs: A Scoping Review
Authors: Muzyk Andrew , Smothers Zachary P.W. , Andolsek Kathryn M. , Bradner Melissa , Bratberg Jeffrey P. , Clark Seth A. , Collins Kathryn , Greskovic Gerard A. , Gruppen Larry , MacEachern Mark , Ramsey Susan E. , Ruiz Veve Jennifer , Tetrault Jeanette M.
Published: October 2019

Purpose

The authors conducted this scoping review to (1) provide a comprehensive evaluation and summation of published literature reporting on interprofessional substance use disorder (SUD) education for students in health professions education programs and (2) appraise the research quality and outcomes of interprofessional SUD education studies. Their goals were to inform health professions educators of interventions that may be useful to consider as they create their own interprofessional SUD courses and to identify areas of improvement for education and research.

Method

The authors searched 3 Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Analytics Web of Science from inception through December 7, 2018. The authors used the Medical Education Research Study Quality Instrument (MERSQI) to assess included studies’ quality.

Results

The authors screened 1,402 unique articles, and 14 met inclusion criteria. Publications dated from 2014 to 2018. Ten (71%) included students from at least 3 health professions education programs. The mean MERSQI score was 10.64 (SD = 1.73) (range, 7.5–15). Interventions varied by study, and topics included general substance use (n = 4, 29%), tobacco (n = 4, 29%), alcohol (n = 3, 21%), and opioids (n = 3, 21%). Two studies (14%) used a nonrandomized 2-group design. Four (29%) included patients in a clinical setting or panel discussion. Ten (72%) used an assessment tool with validity evidence. Studies reported interventions improved students’ educational outcomes related to SUDs and/or interprofessionalism.

Conclusions

Interprofessional SUD educational interventions improved health professions students’ knowledge, skills, and attitudes toward SUDs and interprofessional collaboration. Future SUD curriculum design should emphasize assessment and measure changes in students’ behaviors and patient or health care outcomes. Interprofessional SUD education can be instrumental in preparing the future workforce to manage this pressing and complex public health threat.
The Rise of Nontenured Faculty in Obstetrics and Gynecology by Sex and Underrepresented in Medicine Status
Authors: Esters Danielle , Xierali Imam M. , Nivet Marc A. , Rayburn William F.
Published: October 2019

OBJECTIVE:

To assess the changing landscape in nontenured faculty, stratified by sex and underrepresented in medicine status, for obstetrician–gynecologists at all U.S. medical schools.

METHODS:

In this retrospective observational study, we used data from the Association of American Medical Colleges Faculty Roster to identify trends in career pathways of full-time faculty at all U.S. MD-granting medical schools from 1978 to 2017. Proportions of nontenured faculty were compared with other clinical departments, according to sex and race–ethnicity. Two-sample t-testing and simple linear regression were used for statistical comparisons.

RESULTS:

The number of full-time obstetrics and gynecology faculty increased from 1,688 to 6,347, with most being nontenured (from 535 to 4,951; 9.3-fold increase) rather than tenured (from 457 to 587; 1.3-fold increase) or tenure-eligible (from 397 to 514; 1.3-fold increase). The proportions of all faculty who were nontenured increased from 29.6% to 72.5% (a 2.5-fold increase; P<.010) for men and from 43.4% to 81.4% (a 1.9-fold increase; P<.01) for women. The proportion who were nontenured increased similarly for faculty who were underrepresented in medicine (from 27.4% to 83.5%; a 3.0-fold increase; P<.01) and for those who were not underrepresented in medicine (from 32.0% to 77.1%; a 2.4-fold increase; P<.01). Trends in the increased proportions of nontenured obstetrics and gynecology faculty were similar with those in other major clinical departments.

CONCLUSIONS:

The substantial rise in the number of obstetrics and gynecology faculty was largely among those who were nontenured, regardless of sex or underrepresented in medicine status. This finding signals the essential need for examining career development and academic accomplishment for promoting nontenured faculty.
Minimally Invasive Subscapularis Release: A Novel Technique and Results
Authors: Shah Maulin M. , Naik Nischal , Patel Tejas , Gupta Gaurav , Makadia Akash
Published: October 2019

Background:

Shoulder imbalance secondary to residual brachial plexus birth palsy requires release of internal rotation contracture and tendon transfer. Subscapularis is considered as the prime element of internal rotation contracture and various methods have been described for subscapularis lengthening. It includes open subscapularis slide or lengthening and arthroscopic release. We hypothesized that subscapularis can be released through minimally invasive approach from the medial border of scapula and thus avoiding formal open procedures and risk of weakening the internal rotation strength.

Methods:

Safety zones to avoid injury to important neurovascular structures while performing minimally invasive subscapularis release (MISR) were determined through cadaveric dissection. Between 2014 and 2016, 45 patients underwent MISR. A concomitant conjoined Latissimus Dorsi and Teres Major transfer was performed. Twenty patients with minimum 2-year follow-up were included in this study. Average age of patients was 6.4 years. A 5-point modified Mallet Score, degrees of active and passive rotations and abduction were used as outcome measures. Axial MRI imaging were available to classify the gleno-humeral deformity.

Results:

Mean improvement in passive external rotation was 80 degrees and in active external rotation was 43 degrees (P <0.001) at 3 months, which was maintained at final follow-up. Average shoulder abduction improved from preoperative—101 degrees to postoperative—142 degrees. Aggregate 5-point Mallet Score improved from 12.8 points (range, 11 to 16) preoperatively to 18.5 points (range, 16 to 21) postoperatively. None of the patients developed external rotation contracture. The results were comparable with other existing techniques of subscapularis release with conjoint tendon transfer.

Conclusions:

MISR with conjoined tendon transfer is an effective way of treating internal rotation contracture in children with congruent glenohumeral joints. This procedure has shown beneficial outcomes even in patients with noncongruous glenohumeral joints, when performed in children younger than 4 years. Advantages of MISR include less risk to neurovascular structures, minimal soft tissue trauma, directly addressing the medial tight subscapularis fibers, significantly less surgical time and minimum learning curve.

Levels of Evidence:

Level III—retrospective comparative study.
Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease
Authors: Carrwik Christian , Olerud Claes , Robinson Yohan
Published: October 2019

Study Design.

Retrospective cohort study.

Objective.

To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival.

Summary of Background Data.

Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and to help the clinician to select surgical or nonsurgical treatment.

Methods.

Three hundred fifteen adult patients (213 men, 102 women, mean age 67 yr) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006 to 2012 were included. Data were collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores, and Modified Bauer Scores were calculated and compared with actual survival data from the Swedish Population Register.

Results.

The mean estimated survival time after surgery for all patients included was 12.4 months (confidence interval 10.6–14.2) and median 5.9 months (confidence interval 4.5–7.3). All four scores had significant correlation to survival (P < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer Score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases.

Conclusion.

Predictive scores underestimate survival for the patients which might affect important clinical decisions.

Level of Evidence: 3
Anterior Sacral Meningocele: A New Classification and Treatment Using the Dorsal Transsacral Approach
Authors: Cheng Cheng , Tao Benzhang , Bai Shaocong , Gao Gan , Li Shiqiang , Shang Aijia
Published: October 2019

Study Design.

Retrospective case series.

Objective.

Anterior sacral meningocele (ASM) is a rare disorder. We reviewed 11 cases of congenital ASM and classified them into three types based on the anatomy and relationship between the cyst and sacral nerve roots.

Summary of Background Data.

The cohort with ASM is relatively large; the classification is novel and has not been previously reported.

Methods.

Eleven consecutive patients with ASM who underwent surgery between February 2014 and January 2019 were retrospectively analyzed. They included four males and seven females. The dorsal transsacral approach was adopted in all cases. The follow-up time was at least 3 months.

Results.

We attempted to classify ASM into three types. Of the 11 cases, six were caudal type, two were paraneural type, and three were nerve-root type. The meningocele was ligated after exploring no nerve involvement, in Type I and II. For Type III, the herniating sac and involved nerve roots were ligated when the nerve roots were indicated as nonfunctional on neurophysiological monitoring; otherwise, the sacral nerve roots were protected and imbricated on the residual sac like a hand-in-glove, and sutured to reconstruct the nerves sleeve. Eight cases were accompanied by tethered cord syndrome (TCS); spinal cord detethering was done with one-stage operation. Ten patients’ presenting symptoms improved at 3 to 6 months’ follow-up; notably, constipation significantly improved. Only one case accompanied by an epidermoid cyst had a second laparoscopic surgery by a general surgeon.

Conclusion.

Aim of surgical treatment is to obliterate the communication between the subarachnoid space and herniated sac, detether the spinal cord, and resect the congenital tumor. The new classification helps to recognize the relationship between the meningocele and sacral nerve roots, and subsequently adopt different surgical strategies. We consider the dorsal transsacral approach relatively feasible, safe, and with lower complication.

Level of Evidence: 4
The Impact of Preoperative Chronic Opioid Therapy in Patients Undergoing Decompression Laminectomy of the Lumbar Spine
Authors: Kha Stephanie T. , Scheman Judith , Davin Sara , Benzel Edward C.
Published: October 2019

Study Design.

Retrospective review of electronic medical records (EMR).

Objective.

This study aims to (1) characterize the pattern of opioid utilization in patients undergoing spine surgery and (2) compare the postoperative course between patients with and without chronic preoperative opioid prescriptions.

Summary of Background Data.

Postoperative pain management for patients with a history of opioid usage remains a challenge for spine surgeons. Opioids are controversial in this setting due to side effects and potential for abuse and addiction. Given the increasing rate of opioid prescriptions for spine-related pain, more studies are needed to evaluate patterns and risks of preoperative opioid usage in surgical patients.

Methods.

EMR were reviewed for patients (age > 18) with lumbar spinal stenosis undergoing lumbar laminectomy in 2011 at our institution. Data regarding patient demographics, levels operated, pre/postoperative medications, and in-hospital length of stay were collected. Primary outcomes were length of stay and duration of postoperative opioid usage.

Results.

One hundred patients were reviewed. Fifty-five patients had a chronic opioid prescription documented at least 3 months before surgery. Forty-five patients were not on chronic opioid therapy preoperatively. The preoperative opioid group compared with the non-opioid group had a greater proportion of females (53% vs. 40%), younger mean age (63 yrs vs. 65 yrs), higher frequency of preoperative benzodiazepine prescription (20% vs. 11%), longer average in-hospital length of stay (3.7 d vs. 3.2 d), and longer duration on postoperative opioids (211 d vs. 79 d).

Conclusion.

Patients on chronic opioids prior to spine surgery are more likely to have a longer hospital stay and continue on opioids for a longer time after surgery, compared with patients not on chronic opioid therapy. Spine surgeons and pain specialists should seek to identify patients on chronic opioids before surgery and evaluate strategies to optimize pain management in the pre- and postoperative course.

Level of Evidence: 3
Identification of Different Form Tim-3 Proteins by a Unique Set of Tim-3 Monoclonal Antibodies
Authors: Wang Zhuocai , Yan Guangning , Cui Wenzhi , Gao Feng , Chen Jing , Luo Luqiao , Zhang Minghui , Li Zhi
Published: October 2019

T-cell immunoglobulin and mucin domain-3 (Tim-3) has been suggested to be a critical immune checkpoint target for cancer immunotherapy. However, limited progress with Tim-3 immunotherapy has been achieved over the last decade due to the lack of specific Tim-3 monoclonal antibodies. In this study, we have successfully developed a unique set of Tim-3 antibodies that are able to detect different molecular weights (by Western blot mobility) of Tim-3 proteins ectopically expressed in the same CHO cells. Some of the antibody clones detect only 33 or 55 kDa bands, the rest can recognize both 33 and 55 kDa bands on polyacrylamide gel electrophoresis gel. Antibody clones with 55 kDa specificity uniquely bind to the membrane form of Tim-3 on macrophage, which colocalizes with the CD68, and could be used as a specific marker for tumor-associated macrophage, whereas other clones showed cytoplasmic staining in tumor cells. The membrane form of Tim-3 on tumor-associated macrophages may bear significant roles for clinical application of Tim-3, but less likely for cytoplasmic one. The availability of this unique set of antibodies will be critical for an ultimate understanding of Tim-3 function in tumor microenvironment and potential clinical applications.
Cost-Effectiveness Analysis of Upfront SBRT for Oligometastatic Stage IV Non–Small Cell Lung Cancer Based on Mutational Status
Authors: Kim Hayeon , Vargo John A. , Ling Diane C. , Beriwal Sushil , Smith Kenneth J.
Published: October 2019

Objectives:

Current National Comprehensive Cancer Network (NCCN) guidelines support systemic therapy based on mutational status in stage IV non–small cell lung cancer (NSCLC), with stereotactic body radiation therapy (SBRT) reserved for oligoprogression. We aimed to evaluate the cost-effectiveness of the routine addition of SBRT to upfront therapy in stage IV NSCLC by mutational subgroup.

Materials and Methods:

A Markov state transition model was constructed to perform a cost-effectiveness analysis comparing SBRT plus maintenance therapy with maintenance therapy alone for oligometastatic NSCLC. Three hypothetical cohorts were analyzed: epidermal growth factor receptor or anaplastic lymphoma kinase mutation-positive, programmed death ligand-1 expressing, and mutation-negative group. Clinical parameters were obtained largely from clinical trial data, and cost data were based on 2018 Medicare reimbursement. Strategies were compared using the incremental cost-effectiveness ratio with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness to pay threshold of $100,000 per QALY gained.

Results:

SBRT plus maintenance therapy was not cost-effective at a $100,000/QALY gained threshold, assuming the same survival for both treatments, resulting in an incremental cost effectiveness ratio of $564,186 and $299,248 per QALY gained for the epidermal growth factor receptor or anaplastic lymphoma kinase positive and programmed death ligand-1 positive cohorts, respectively. Results were most sensitive to the cost of maintenance therapy. A large overall survival gain with SBRT could potentially result in upfront SBRT becoming cost-effective. For the mutation-negative cohort, upfront SBRT was nearly cost-effective, costing $128,424 per QALY gained.

Conclusion:

Adding SBRT to maintenance therapy is not a cost-effective strategy for oligometastatic NSCLC compared with maintenance therapy alone for mutation-positive groups. However, this should be validated via randomized trials.
Role of Perioperative Chemotherapy in Lymph Node-negative Esophageal Cancer After Resection
Authors: Yang Yang , Zhou Xia , Tang Luoyong , Xu Xiaoling , Du Xianghui , Qiu Guoqin
Published: October 2019

Background:

Multimodality treatment is increasingly accepted and becoming the standard care for local advanced esophageal cancer (EC) patients. However, for early stage lymph node-negative EC patients, surgery alone is still the primary treatment approach, and the role of perioperative chemotherapy remains unclear.

Methods:

Patients with lymph node-negative EC were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Survival was compared by the log-rank test. Cox proportional hazards analysis was used to identify covariates associated with overall survival (OS). Propensity score-matched analysis was also performed to control for confounding.

Results:

A total of 3071 patients (T1-4N0M0) were identified, 1363 (44.4%) of which received perioperative chemotherapy. The effect of chemotherapy on OS was remarkably dependent on the T stage. For stage T1 patients, chemotherapy was inversely associated with OS (hazard ratio [HR]=1.54; 95% confidence interval [CI], 1.27-1.86), and no impact of chemotherapy on OS was found for T2 patients (HR=0.92; 95% CI, 0.712-1.18), whereas a significant improvement in OS was observed with the addition of chemotherapy for patients with stages T3 (HR=0.52; 95% CI, 0.43-0.62) and T4 (HR=0.60; 95% CI, 0.36-0.98) disease. Multivariable analysis with demonstrated that chemotherapy usage, age, sex, tumor grade, and T stage (P<0.05) were significantly associated with OS in T3-T4 patients. The results were similar in subgroup analyses stratified by confounding covariates, and the propensity score-matched analysis.

Conclusions:

This population-based study indicates perioperative chemotherapy is associated with improved survival in stage T3-4N0M0 patients with EC, which needs to be further validated by randomized trials.
Suboptimal learning of tactile-spatial predictions in patients with complex regional pain syndrome
Authors: Brown Christopher A. , Scholtes Ingrid , Shenker Nicholas , Lee Michael C.
Published: October 2019

In complex regional pain syndrome (CRPS), tactile sensory deficits have motivated the therapeutic use of sensory discrimination training. However, the hierarchical organisation of the brain is such that low-level sensory processing can be dynamically influenced by higher-level knowledge, eg, knowledge learnt from statistical regularities in the environment. It is unknown whether the learning of such statistical regularities is impaired in CRPS. Here, we used a hierarchical Bayesian model of predictive coding to investigate statistical learning of tactile-spatial predictions in CRPS. Using a sensory change-detection task, we manipulated bottom-up (spatial displacement of a tactile stimulus) and top-down (probabilistic structure of occurrence) factors to estimate hierarchies of prediction and prediction error signals, as well as their respective precisions or reliability. Behavioural responses to spatial changes were influenced by both the magnitude of spatial displacement (bottom-up) and learnt probabilities of change (top-down). The Bayesian model revealed that patients' predictions (of spatial displacements) was found to be less precise, deviating further from the ideal (statistical optimality) compared with healthy controls. This imprecision was less context dependent, ie, more enduring across changes in the probabilistic context and less finely tuned to statistics of the environment. This caused greater precision on prediction errors, resulting in predictions that were driven more by momentary spatial changes and less by the history of spatial changes. These results suggest inefficiencies in higher-order statistical learning in CRPS. This may have implications for therapies based on sensory retraining whose effects may be more short-lived if success depends on higher-order learning.
Natural elimination of a video capsule after retention for 1 year in a patient with small bowel Crohn disease
Authors: Lee So Yeon , Lee Ju Yup , Lee Yoo Jin , Park Kyung Sik
Published: October 2019

Introduction:

Video capsule endoscopy (VCE) is a useful tool to differentiate small intestinal bleeding, inflammatory bowel disease, and other small bowel disease. The most common adverse effect of VCE is capsule retention; the incidence varies greatly depending on the underlying disease, which is known to increase from 1.5% in healthy individuals to 21% in patients with small bowel Crohn disease. We report this case on a patient who had asymptomatic capsule retention for 12 months and experienced natural elimination with medication.

Patient concerns:

A 21-year-old woman presented to the hospital with chronic abdominal pain and persistent diarrhea for 2 years.

Diagnoses:

The patient was diagnosed with small bowel Crohn disease using VCE, and radiography revealed capsule retention.

Intervention:

Symptoms of obstruction were not distinctive, it was decided to increase the dosages of azathioprine and infliximab to 50 and 500 mg (10 mg/kg), at 5 months after VCE. And at month 11 of capsule retention, she was admitted and started on a regimen of hydrocortisol 300 mg for 4 days and hydrocortisol injection 200 mg for 10 days.

Outcomes:

At month 12, abdominal radiography in the clinic confirmed that the capsule had been naturally retrieved.

Lessons:

Capsule retention could be initially treated conservatively with medication and if the treatment fails, it is recommended to remove the capsule surgically. But in the case of the clinical condition of the patient is favorable without symptoms of bowel obstruction, the medication should be continued and the patient followed up.
The effects of acupuncture on cognitive impairment of vascular dementia patients
Authors: Tang Yinshan , Shao Shujun , Zhou You , Xiong Bing , Cao Jin , Li Zhigang , Wu Jihong , Wang Chao
Published: October 2019

Background:

Vascular dementia (VaD) is the second prevalent dementia worldwide attributable to cognitive impairments. Acupuncture has been applied in clinic as a therapeutic modality to treat VaD. This systematic review and meta-analysis aims to evaluate current evidence to explore the effectiveness and safety of acupuncture treatment to cognitive impairment of VaD.

Methods:

Randomized controlled trials will be searched restricted to their inception from January 1, 2000 to September 15, 2019. The following literature databases will be searched, including 4 English databases: PubMed, Excerpta Medica Database, the Cochrane Library, Medline, and 4 Chinese databases, namely the China National Knowledge Infrastructure Database, the Wanfang Database, the Chinese Scientific Journal Database, and the Chinese BioMedical Literature Database. After the selection and extraction of eligible studies, a meta-analysis will be undertaken to assess the efficacy and safety of acupuncture on VaD. The Review Manager Software V.5.3.5 will be employed for meta-analysis to assess the risk of bias, data synthesis, and subgroup analysis.

Results:

The systematic review and meta-analysis will be carried out to evaluate the efficacy and safety of acupuncture in the treatment of VaD, further provide an evidence-based synthesis for clinical and research applications.

Conclusions:

The summary of our systematic review will determine whether acupuncture intervention to VaD is safe and well-tolerated in global status.
Familial hemophagocytic lymphohistiocytosis type 5 in a Chinese Tibetan patient caused by a novel compound heterozygous mutation in STXBP2
Authors: Tang Xue , Guo Xia , Li Qiang , Huang Zhuo
Published: October 2019

Rationale:

Familial hemophagocytic lymphohistiocytosis (FHL) is a fatal autosomal recessive immunodeficiency disease whose rapid and accurate diagnosis is paramount for appropriate treatment. Mutations in STXBP2 gene have been associated with FHL type 5 (FHL-5). Here, we report the first Tibetan Chinese patient diagnosed with FHL-5 caused by a novel compound heterozygous mutation in STXBP2.

Patient concerns:

A 9-year-old girl who presented with recurrent fever, splenomegaly, pancytopenia, hypofibrinogenemia, and conspicuous bone marrow hemophagocytosis was diagnosed with haemophagocytic lymphohistiocytosis (HLH).

Diagnosis:

FHL mutation analysis of the patient and her parents revealed that she presented compound heterozygosity for STXBP2: a novel missense mutation c.663G > C (p.Glu221Asp) and the known pathogenic splice-site mutation c.1247-1G > C (p.Val417LeufsX126). Bioinformatics analyses predicted that the new mutation was pathogenic and the FHL-5 diagnosis was confirmed.

Interventions:

Upon diagnosis, HLH-2004-directed chemotherapy was instituted, but there was a relapse. Allogeneic hematopoietic stem cell transplantation (HSCT) was performed.

Outcomes:

After transplantation, the patient presented implantation dysfunction, chronic graft-versus-host disease, and 5 episodes of pancreatitis. A follow-up after 5 years revealed that the patient had died of pancreatitis.

Lessons:

This finding expands the spectrum of FHL-5-related mutations in Chinese patients and indicates a clear genotype-phenotype correlation of FHL-5 in China.
Impact of circadian rhythms on female reproduction and infertility treatment success
Authors: Mills Jacqueline , Kuohung Wendy
Published: October 2019

Purpose of review

In recent years, new studies have investigated the role and influence of sleep on female fertility and early pregnancy outcomes, providing a growing body of knowledge demonstrating how regulation by sleep of hormones are important to reproduction, and how disruptions in sleep, circadian rhythms, and genes regulating circadian rhythmicity can negatively impact fertility and early pregnancy outcomes. This review aims to summarize the most recent research on the relationship among circadian rhythms, fertility, and early pregnancy outcomes in women, and to explore possible fertility interventions.

Recent findings

Recent studies have found altered levels of FSH, LH, and prolactin with sleep disturbance or circadian dysrhythmia. Disruption of circadian rhythms in the form of shift work, jet lag, and daylight savings time changes have been associated with poorer fertility and early pregnancy outcomes. Alterations in the expression of circadian rhythm-regulating circadian locomotor output cycles kaput (CLOCK) genes have been associated with decreased fertility and increased rates of miscarriage.

Overall, undisrupted sleep and circadian rhythmicity appear to optimize fertility and early pregnancy outcomes and may play an important role in the success of fertility treatment.
Trough Levels of Infliximab at Week 6 Are Predictive of Remission at Week 14 in Pediatric Crohn's Disease
Authors: Courbette Olivier , Aupiais Camille , Viala Jérôme , Hugot Jean‐Pierre , Roblin Xavier , Candon Sophie , Louveau Baptiste , Chatenoud Lucienne , Martinez‐Vinson Christine
Published: October 2019

Objective:

Infliximab (IFX) is a frequent therapeutic option for Crohn disease (CD) patients. Early detection of responders to IFX is critical for the management of CD in order to avoid long‐term exposure to the drug without benefit. This retrospective study aimed at analysing which early parameters recorded during the induction period are able to predict response to IFX during the maintenance period in pediatric CD.

Patients and Methods:

Medical records of all CD patients ages from 2 to 18 years who received IFX at a tertiary IBD center were retrospectively analyzed. Children were classified in 3 groups according to their response at week 14 (W14) (1) remission, (2) clinical response or (3), no response. The factors recorded at W0, W2, and W6, which were associated with remission at W14 were analyzed using a logistic regression.

Results:

Among the 111 patients included, 74.8% patients were responders to IFX at W14, including 38.7% in clinical remission and 36% with partial clinical response. Clinical remission at W14 was associated with normal growth (P < 0.01), and normal albuminemia (P = 0.01) at baseline, It was also associated with trough levels to IFX >8.3 μg/ml at week 6 (P < 0.01).

Conclusion:

Trough levels to IFX >8.3 μg/ml at week 6 are predictive of remission at W14 for luminal disease.
Why You Need a Plan
Authors: Graystone Rebecca
Published: October 2019

Succession planning is an important business strategy in many industries, but healthcare has been slow to recognize its value. In this month's Magnet Perspectives column, learn why succession planning and mentoring are critical for nursing, how they affect key outcomes, and who benefits from preparing the next generation of nurses. Chief nursing officers discuss the importance of identifying and grooming top talent and share their personal stories of how succession planning and mentoring impacted their careers. The column includes tips to create a succession planning program and explores how the Magnet® environment promotes a culture of mentoring and leadership continuity.
Using a Sleep Protocol to Limit Sleep Interruptions on a Medical-Surgical Unit
Authors: Lampron Shaun , Copeland Donna
Published: October 2019

A quality improvement effort was designed to coordinate care in minimizing sleep interruptions to allow patients 6 or more hours of uninterrupted sleep. An interprofessional team developed a sleep protocol (HUSH) and coordinated care activities to reduce sleep interruptions on a 30-bed medical-surgical-telemetry unit. Changes in patient perceptions of noise and number of hours of restful sleep were compared before and after implementation. Results indicate a 9% improvement in quiet domain scores.
Retention Outcomes of New Graduate Nurse Residency Programs
Authors: Asber Samantha R.
Published: October 2019

OBJECTIVE

The purpose of this integrative literature review is to examine the effects that nurse residency programs (NRPs) have on the retention of new graduates.

BACKGROUND

The Institute of Medicine recommends implementing NRPs and evaluating their effectiveness. Nursing leaders need to understand if an investment in a residency program is beneficial to their organization.

METHODS

A database search was performed for research from 2010 to 2016 reporting outcomes of new graduate NRPs relating to retention.

RESULTS

In the articles reviewed, the 1-year retention was higher than the national average for new graduate nurses ranging from 74% to 100%. Higher rates were associated with national programs such as the University Hospital Consortium/American Association of Colleges of Nursing or Versant compared with organization-based programs.

CONCLUSIONS

NRPs can increase 1-year retention of new graduate nurses. More controlled and comparative studies are needed to evaluate program differences. Nurse leaders need evidence to ascertain which programs are the most effective in supporting retention and return on investment.
Exploring the Relationship Between Contact Frequency, Leader-Member Relationships, and Patient Safety Culture
Authors: Anderson Albert D. , Floegel Theresa A. , Hofler Linda , Swanson Melvin
Published: October 2019

OBJECTIVE

This study uses Leader-Member Exchange theory to explore the associations between contact frequency (CF) of nurse leaders and their team members, leader-member relationship, and patient safety culture.

BACKGROUND

Leader-member relationships are an important part of patient safety culture development. The behaviors of leaders to achieve these relationships are unknown. This study explores CF as a leader behavior to improve patient safety culture.

METHODS

Cross-sectional survey of bedside nurses (N = 746) from an 8-hospital system.

RESULTS

A significant association was found between relationship strength and patient safety culture; CF's effect on relationship and patient safety culture was demonstrated.

CONCLUSION

Contact frequency may support relationships between leaders and members and improve patient safety culture on nursing units. Future studies should explore factors that could be enhancing and limiting CF.
Intervention Effects of the MINDBODYSTRONG Cognitive Behavioral Skills Building Program on Newly Licensed Registered Nurses' Mental Health, Healthy Lifestyle Behaviors, and Job Satisfaction
Authors: Sampson Marlene , Melnyk Bernadette M. , Hoying Jacqueline
Published: October 2019

OBJECTIVE

The purpose of this study was to evaluate the effects of the MINDBODYSTRONG for Healthcare Professionals Program on stress, anxiety, depressive symptoms, healthy lifestyle behaviors, and job satisfaction on newly licensed RNs (NLRNs) participating in a nurse residency program.

BACKGROUND

The constellation of burnout, depression, and suicide in clinicians is a public health epidemic that affects the quality and safety of healthcare. The National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience has called for an increase in evidence-based interventions to combat this alarming problem. The MINDBODYSTRONG Program is a novel adaptation of an evidence-based cognitive behavioral skills–building intervention that provides a theory-based approach to improve the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction of NLRNs.

METHODS

A 2-group, cluster randomized controlled trial was used with 89 new nurses participating in a new-graduate nurse residency program. The experimental intervention, MINDBODYSTRONG, consisted of 8 manualized weekly 45-minute sessions. Data were collected at baseline, immediately following, and 3 months after intervention that measured stress, depressive symptoms, anxiety, healthy lifestyle beliefs and behaviors, and job satisfaction. Repeated-measures analysis of variance was used for data analysis.

RESULTS

The intervention group scored significantly better with moderate to large positive effects on the mental health variables as well as healthy lifestyle beliefs and healthy lifestyle behaviors at both follow-up time points compared with the attention control group. Moderate to large positive effects also were found for job satisfaction.

CONCLUSIONS

The MINDBODYSTRONG Program has excellent potential as an evidence-based intervention for improving the mental health, healthy lifestyle beliefs and behaviors, and job satisfaction, in NLRNs.
Stress Management and Resiliency Training in a Nurse Residency Program
Authors: Chesak Sherry S. , Morin Karen H. , Cutshall Susanne , Carlson Marny , Joswiak M. Ellen , Ridgeway Jennifer L. , Vickers Kristin S. , Sood Amit
Published: October 2019

Stress is a well-recognized phenomenon in the nursing profession, particularly for new nurses. This study (a) assessed nurse residents’ experience with a stress management program and (b) informed adjustments to the program. Analysis of qualitative data revealed three themes: (a) enhanced personal and professional development, (b) sensitivity to learner needs, and (c) fostering the principles of mindfulness. A stress management program has the potential to positively enhance the new nurse’s transition to work.
Short- and Long-Term Outcome of Systemic Lupus Erythematosus Peripheral Neuropathy
Authors: Fargetti Simone , Ugolini-Lopes Michelle R. , Pasoto Sandra G. , Seguro Luciana P. C. , Shinjo Samuel K. , Bonfa Eloisa , Borba Eduardo F.
Published: October 2019

Background/Objective

Our aim was to describe the short- and long-term outcome of peripheral neuropathy (PN) attributed exclusively to systemic lupus erythematosus (SLE).

Methods

Systemic lupus erythematosus patients with defined PN (clinical and electroneuromyography) were retrospectively evaluated at onset, 1-year, and 5-year follow-up using a standardized electronic chart database that started in 2000. Exclusion criteria were comorbidities, drugs, and infections. Age-, sex-, and disease duration–matched SLE patients without PN were selected as controls.

Results

Lupus PN was identified in 38 (1.8%) of 2074 patients, and almost two thirds had PN onset in the first 5 years of SLE (63.2%). Peripheral neuropathy SLE had higher frequencies of cutaneous vasculitis (50% vs 21.1%, p = 0.002), lymphopenia (60.5% vs 36.8%, p = 0.027), anti-Sm (52.6% vs 27.6%, p = 0.013), and higher SLEDAI-2K scores (11.5 ± 10.5 vs 4.9 ± 6.7, p < 0.001) compared with controls. The most common type was polyneuropathy (71.1%) with sensory-motor pattern (68.4%). At PN diagnosis, all patients received glucocorticoid and 97.4% started immunosuppressive therapy (50% intravenous cyclophosphamide, 42.1% azathioprine). After 1-year follow-up, 92.1% had a favorable outcome with complete (36.8%) or partial remission (55.2%), in parallel with a decrease in prednisone dose (48.3 ± 17.9 vs 15.3 ± 13.4 mg/d, p < 0.001), symptomatic therapy (57.9% vs 29.7%, p = 0.02), and SLEDAI-2K score (11.5 ± 10.5 vs 1.7 ± 3.7, p < 0.001). SLEDAI-2K scores were higher in patients who had PN onset with less than 1 year of SLE duration, compared with those with more than 5 years of disease (21.3 ± 9.1 vs 3.9 ± 5.3, p < 0.001). Early-PN-onset group had a better response to treatment (complete remission at 1-year follow-up 61.5% vs 25%, p = 0.039). At 5-year follow-up, 89.3% remained with complete/partial remission.

Conclusions

Peripheral neuropathy attributed to SLE itself is a rare manifestation with a bimodal pattern, characterized by a predominant early-onset group associated with high disease activity and a higher rate of complete remission, and a late-onset group with low disease activity and a partial therapy response.
Learning Curve From 450 Cases of Robot-Assisted Pancreaticoduocectomy in a High-Volume Pancreatic Center
Authors: Shi Yusheng , Wang Weishen , Qiu Weihua , Zhao Shulin , Wang Jian , Weng Yuanchi , Huo Zhen , Jin Jiabin , Wang Yue , Deng Xiaxing , Shen Baiyong , Peng Chenghong
Published: October 2019

Objective:

We aimed to describe our experience and the learning curve of 450 cases of robot-assisted pancreaticoduodenectomy (RPD) and optimize the surgical process so that our findings can be useful for surgeons starting to perform RPD.

Summary Background Data:

Robotic surgical systems were first introduced 20 years ago. Pancreaticoduodenectomy (PD) is a challenging surgery because of its technical difficulty. RPD may overcome some of these difficulties.

Methods:

The medical records of 450 patients who underwent RPD between May 2010 and December 2018 at the Shanghai Ruijin Hospital were retrospectively analyzed. Operative times and estimated blood loss (EBL) were analyzed and the learning curve was determined. A cumulative sum (CUSUM) analysis was used to identify the inflexion points. Other postoperative outcomes, postoperative complications, and long-term follow-up were also analyzed.

Results:

Operative time improved graduallyovertimefrom405.4 ± 112.9 minutes (case 1–50) to 273.6 ± 70 minutes (case 301–350) (P < 0.001). EBL improved from 410 ± 563.5 mL (case 1–50) to 149.0 ± 103.3 mL (case 351–400) (P
< 0.001). According to the CUSUM curve, there were 3 phases in the RPD learning curve. The inflexion points were around cases 100 and 250. The incidence of pancreatic leak in the last 350 cases was significantly lower than that in the first 100 cases (30.0% vs 15.1%, P = 0.003).

Conclusions:

RPD is safe and feasible for selected patients. Operative and oncologic outcomes were much improved after experience of 250 cases. Our optimization of the surgical process may have also contributed to this. Future prospective and randomized studies are needed to confirm our results.
Comparison of Clinical Features and Outcome of Pediatric Posttransplant Lymphoproliferative Disorder in Recipients of Small Bowel Allograft Versus Isolated Liver Transplantation
Authors: Chiou Fang Kuan , Beath Sue V. , Morland Bruce , Hartley Jane , van Mourik Indra , Abdel-Hady Mona , Kelly Deirdre A. , Sharif Khalid , Gupte Girish L.
Published: October 2019

Background.

Higher incidence of posttransplant lymphoproliferative disorder (PTLD) is reported in the pediatric small bowel transplant (SBTx) population, which may be associated with more aggressive disease and poorer outcome as compared to liver transplant (LTx) recipients. We aim to compare the characteristics and outcome of PTLD in pediatric SBTx against LTx patients at a single center.

Methods.

Retrospective review of pediatric SBTx and LTx patients diagnosed with PTLD from 1989 to 2016 was conducted. Diagnosis of PTLD was biopsy-proven based on World Health Organization histologic criteria. Treatment protocol consisted of reduction of immunosuppression (RIS), rituximab (from 2000), cytotoxic T-lymphocyte (CTL) therapy (available in 1999–2004 and from 2011), and chemotherapy.

Results.

Thirty-seven PTLD patients were included following LTx (n = 23, incidence = 2.8%) and SBTx (n = 14, incidence = 14.9%). Monomorphic PTLD made up 64% of SBTx and 43% of LTx cases. RIS alone resulted in remission in 50% of LTx patients but none of the SBTx patients (P = 0.002). Poorer overall remission (57% versus 96%, P = 0.004), 2-year (46% versus 91%, P = 0.003), and 5-year survival rates (39% versus 90%, P = 0.002) were observed in the SBTx group. Risk factors associated with mortality following PTLD were SBTx (odds ratio [OR], 12.00; 95% confidence interval [CI], 2.34-61.45; P = 0.003), monomorphic histology (OR, 10.63; 95% CI, 1.88-60.25; P = 0.008), multisite involvement (OR, 6.38; 95% CI, 1.35-30.14; P = 0.019), and tumor involvement of allograft (OR, 5.33; 95% CI, 1.14-24.90; P = 0.033). Introduction of CTL therapy was associated with improved survival.

Conclusions.

Majority of PTLD following pediatric SBTx are of monomorphic subtype and associated with poorer outcome as compared to LTx patients. RIS is inadequate as a single strategy in managing PTLD in SBTx and prompt escalation to rituximab and CTL is recommended.
Bupropion Hydrochloride Sustained Release and Diurnal Enuresis: A Previously Unreported Adverse Effect
Authors: Schwitalla Theresa A. , Patel Raj A. , Catalano Glenn , Nirmalani-Gandhy Anjali
Published: October 2019

Bupropion hydrochloride (HCl) is an antidepressant that has many different biological targets, acting as both a norepinephrine-dopamine reuptake inhibitor as well as a nicotinic antagonist. This second-generation antidepressant is available in 3 bioequivalent formulations: immediate release, sustained release, and extended release, allowing providers to customize a patient's regimen for maximum tolerability and compliance. Although bupropion HCl's safety and tolerability have been demonstrated through several clinical trials, there are still a number of adverse effects that have been reported in the literature. These include headache, agitation, tremor, and insomnia. There is also an increased risk of developing seizures during bupropion treatment. Although urinary symptoms were noted during the clinical trials, these are relatively rare adverse effects. Here we report the case of a 61-year-old man who developed diurnal enuresis during treatment with bupropion HCl sustained release. We will review the adverse effect burden associated with the use of bupropion and discuss the neuropharmacology of urinary symptoms associated with antidepressant treatment.
Collective turns in jackdaw flocks: kinematics and information transfer
Authors: Ling Hangjian , Mclvor Guillam E. , Westley Joseph , van der Vaart Kasper , Yin Jennifer , Vaughan Richard T. , Thornton Alex , Ouellette Nicholas T.
Published: October 2019

The rapid, cohesive turns of bird flocks are one of the most vivid examples of collective behaviour in nature, and have attracted much research. Three-dimensional imaging techniques now allow us to characterize the kinematics of turning and their group-level consequences in precise detail. We measured the kinematics of flocks of wild jackdaws executing collective turns in two contexts: during transit to roosts and anti-predator mobbing. All flocks reduced their speed during turns, probably because of constraints on individual flight capability. Turn rates increased with the angle of the turn so that the time to complete turns remained constant. We also find that context may alter where turns are initiated in the flocks: for transit flocks in the absence of predators, initiators were located throughout the flocks, but for mobbing flocks with a fixed ground-based predator, they were always located at the front. Moreover, in some transit flocks, initiators were far apart from each other, potentially because of the existence of subgroups and variation in individual interaction ranges. Finally, we find that as the group size increased the information transfer speed initially increased, but rapidly saturated to a constant value. Our results highlight previously unrecognized complexity in turning kinematics and information transfer in social animals.