bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Matrix Metalloproteinase 9 in Ocular Surface Disorders
Authors: Jamerson Emery C. , Elhusseiny Abdelrahman M. , ElSheikh Reem H. , Eleiwa Taher K. , El Sayed Yasmine M.
Published: February 2020

Objectives:

(1) To explore the role and significance of Matrix Metalloproteinase 9 (MMP-9), a proteolytic enzyme, in various ocular surface diseases of inflammatory, infectious, and traumatic etiology (2), to further elucidate the molecular mechanisms responsible for its overexpression in ocular surface disease states, and (3) to discuss possible targets of therapeutic intervention.

Methods:

A literature review was conducted of primary sources from 1995 onward using search results populated from the US National Library of Medicine search database.

Results:

MMP-9 overexpression has been found in in vitro and in vivo models of dry eye disease (DED), corneal ulceration, microbial keratitis, corneal neovascularization, ultraviolet light-induced radiation, and a host of additional surface pathologies. MMP-9 is involved in an intricate signal transduction cascade that includes induction by many proinflammatory molecules including interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-a), nuclear factor kappa light chain enhancer of activated B cells (NF-kB), platelet-activating factor, activator protein 1 (AP-1), and transforming growth factor beta (TGF-B). MMP-9 expression is blunted by a diverse array of molecular factors, such as tissue inhibitors of metalloproteinases, cyclosporine A (CyA), PES_103, epigalloccatechin-3-gallate (EGCG), N-acetylcysteine (NaC), ascorbate, tetracyclines, and corticosteroids. Inhibition of MMP-9 frequently led to improvement of ocular surface disease.

Conclusions:

Novel insights into the mechanistic action of MMP-9 provide potential for new therapeutic modulations of ocular surface diseases mediated by its overexpression.
Brain perfusion patterns are altered in chronic knee pain: a spatial covariance analysis of arterial spin labelling MRI
Authors: Iwabuchi Sarina J. , Xing Yue , Cottam William J. , Drabek Marianne M. , Tadjibaev Arman , Fernandes Gwen S. , Petersen Kristian K. , Arendt-Nielsen Lars , Graven-Nielsen Thomas , Valdes Ana M. , Zhang Weiya , Doherty Michael , Walsh David , Auer Dorothee P.
Published: February 2020

Chronic musculoskeletal pain is a common problem globally. Current evidence suggests that maladapted central pain pathways are associated with pain chronicity, for example, in postoperative pain after knee replacement. Other factors such as low mood, anxiety, and tendency to catastrophize are also important contributors. We aimed to investigate brain imaging features that underpin pain chronicity based on multivariate pattern analysis of cerebral blood flow (CBF), as a marker of maladaptive brain changes. This was achieved by identifying CBF patterns that discriminate chronic pain from pain-free conditions and by exploring their explanatory power for factors thought to drive pain chronification. In 44 chronic knee pain and 29 pain-free participants, we acquired both CBF and T1-weighted data. Participants completed questionnaires related to affective processes and pressure and cuff algometry to assess pain sensitization. Two factor scores were extracted from these scores representing negative affect and pain sensitization. A spatial covariance principal component analysis of CBF identified 5 components that significantly discriminated chronic pain participants from controls, with the unified network achieving 0.83 discriminatory accuracy (area under the curve). In chronic knee pain, significant patterns of relative hypoperfusion were evident in anterior default-mode and salience network hubs, while hyperperfusion was seen in posterior default mode, thalamus, and sensory regions. One component correlated positively with the pain sensitization score (r = 0.43, P = 0.006), suggesting that this CBF pattern reflects neural activity changes encoding pain sensitization. Here, we report a distinct chronic knee pain-related representation of CBF, pointing toward a brain signature underpinning central aspects of pain sensitization.
Peripheral and central nervous system alterations in a rat model of inflammatory arthritis
Authors: Locke Samantha , Yousefpour Noosha , Mannarino Matthew , Xing Shuran , Yashmin Fatima , Bourassa Valerie , Ribeiro-da-Silva Alfredo
Published: February 2020

It is consistently reported that in inflammatory arthritis (IA), pain may continue despite well-controlled inflammation, most likely due to interactions between joint pathology and pain pathway alterations. Nervous system alterations have been described, but much remains to be understood about neuronal and central non-neuronal changes in IA. Using a rat model of IA induced by intra-articular complete Freund's adjuvant injection, this study includes a thorough characterization of joint pathology and objectives to identify peripheral innervation changes and alterations in the spinal dorsal horn (DH) that could alter DH excitatory balancing. Male and female rats displayed long-lasting pain-related behavior, but, in agreement with our previous studies, other pathological alterations emerged only at later times. Cartilage vascularization, thinning, and decreased proteoglycan content were not detectable in the ipsilateral cartilage until 4 weeks after complete Freund's adjuvant. Sympathetic and peptidergic nociceptive fibers invaded the ipsilateral cartilage alongside blood vessels, complex innervation changes were observed in the surrounding skin, and ipsilateral nerve growth factor protein expression was increased. In the DH, we examined innervation by peptidergic and nonpeptidergic nociceptors, inhibitory terminal density, the KCl cotransporter KCC2, microgliosis, and astrocytosis. Here, we detected the presence of microgliosis and, interestingly, an apparent loss of inhibitory terminals and decreased expression of KCC2. In conclusion, we found evidence of anatomical, inflammatory, and neuronal alterations in the peripheral and central nervous systems in a model of IA. Together, these suggest that there may be a shift in the balance between incoming and outgoing excitation, and modulatory inhibitory tone in the DH.
Evaluation of Fundamental Forensic Knowledge and Perceived Ability in Emergency Nurse Practitioner Education via Forensic Simulation
Authors: Drake Stacy A. , Godwin Kyler M. , Wolf Dwayne A. , Gallagher Martina
Published: February 2020

Introduction

The need for trauma care and forensic services is among the top five reasons for seeking healthcare in the United States. Critical aspects of caring for a forensic patient include early recognition of the need for implementing forensic approaches to care: assessment, evidence collection and preservation, and forensic documentation. The intent of this study was to examine fundamental forensic knowledge and perceived ability of graduate-level emergency nurse practitioner students.

Methods

The study was designed to assess fundamental forensic knowledge of graduate-level emergency nurse practitioners using a pretest-and-posttest prospective design utilizing simulation.

Results

Students showed an increase in their knowledge of forensic nursing concepts from pretest to posttest (t(39) = 9.63, p < 0.001). In addition, there was an increase in students' perceived ability (confidence) to recognize the forensic aspects of patient care. Two unexpected findings were revealed during debriefing. Although the students were interested in gaining forensic knowledge, they felt it was more important to know when to refer a patient rather than to gain the requisite knowledge to perform forensic functions on their own. Furthermore, students developed an awareness of how their previous clinical experiences influenced their care.

Conclusion

Findings from this study will inform further development of graduate-level nursing education to include forensic and multidisciplinary simulation exercises.
Sexual Assault Victimization Among Children and Youth With Developmental Disabilities: Responding With Trauma-Informed Care
Authors: Reese Shannonlee , Deutsch Stephanie Anne
Published: February 2020

Sexual assault victimization is a traumatic experience for children and youth, and care of survivors requires a trauma-informed approach. Children and youth with developmental disabilities are sexually victimized at higher rates than those without disabilities. Children with autism spectrum disorder (ASD), in particular, may be at an increased risk for both traumatic events and developing traumatic sequelae after sexual assault victimization. In this report, we present the case of a youth with ASD who sought acute sexual assault care, but whose care was compromised because of multiple systems failures, including gaps in communication regarding her unique needs, and inconsistent knowledge among multidisciplinary team members regarding necessary adaptations in the implementation of trauma-informed care for youth with ASD. Lessons learned, including proposed solutions to improve communication and education, and approaches to prevent unintended retraumatization are discussed.
Nursing Management of Gastrointestinal Adverse Events Associated With Delayed-Release Dimethyl Fumarate: A Global Delphi Approach
Authors: Campbell Trudy L. , Lefaux Béatrice Jenny , Mayer Lori Lee , Namey Marie , Riemer Gisela , Robles-Sanchez Miguel A. , White Sarah , Edwards Michael , Minor Charles
Published: February 2020

BACKGROUND: Gastrointestinal (GI) adverse events (AEs) are commonly encountered with delayed-release dimethyl fumarate (DMF), an approved treatment for relapsing multiple sclerosis (MS). METHODS: Two hundred thirty-nine MS nurses from 7 countries were asked to complete a 2-round Delphi survey developed by a 7-member steering committee. Questions pertained to approaches for mitigating DMF-associated GI AEs. RESULTS: Ninety-six percent of nurses followed the label recommendation for DMF dose titration in round 1, but 77% titrated the DMF dose more slowly than recommended in round 2. Although 86% of nurses advised persons with relapsing forms of MS (PWMS) to take DMF with food, patients were not routinely informed of appropriate types of food to take with DMF. Most nurses recommended both pharmacologic and nonpharmacologic symptomatic therapies for PWMS who experienced GI AEs on DMF. Pharmacologic and nonpharmacologic symptomatic therapies were regarded as equally effective at keeping PWMS on DMF. In round 2, 58% of nurses stated that less than 10% of PWMS who temporarily discontinued DMF went on to permanently discontinue treatment. Sixty-six percent of nurses stated that less than 10% of PWMS permanently discontinued DMF because of GI AEs in the first 6 months of treatment in round 1. Most nurses agreed that patient education on potential DMF-associated GI AEs contributes to adherence. CONCLUSION: This first real-world nurse-focused assessment of approaches to caring for PWMS with DMF-associated GI AEs suggests that, with implementation of slow dose titration, symptomatic therapies, and educational consultations, most PWMS can remain on DMF and, when necessary after temporary discontinuation, successfully restart DMF.
High-Risk Human Papillomavirus Identification in Precancerous Cervical Intraepithelial Lesions
Authors: Zheng Ruifang , Heller Debra S.
Published: February 2020

Objective

This review aims to summarize the currently available human papillomavirus (HPV) testing methods for precancerous cervical intraepithelial lesions.

Materials and Methods

A literature search of PubMed using key words “high-risk HPV, precancerous cervical intraepithelial lesions, FDA-approved HPV tests, p16 IHC, Ki 67 IHC, fluorescent in situ hybridization for HPV, Pap smear, HPV vaccines, HPV tests using self-collected samples, and next-generation sequencing” was performed between January 1 and June 14, 2019. The package inserts of the Food and Drug Administration–approved HPV tests were obtained from the companies' Web sites.

Results

Multiple morphology-based, immunohistochemical staining and nucleic acid HPV tests were reviewed, including the material required, methodologies, result interpretations, as well as their advantages, limitations, and futures. The structure of HPV and its natural history of infection and transmission were touched on as well for a better understanding of these testing methods.

Conclusions

Human papillomavirus tests are a critical component for cervical cancer screening, and understanding of these tests helps test results interpretation and patients' triage.
What Genes Can Tell: A Closer Look at Vestibular Schwannoma
Authors: Aaron Ksenia A. , Manojlovic Zarko , Tu Nathan , Xu Yili , Jin Yuxin , Chang Sharon , Kwok Eric , Webb Michelle , Hurth Kyle , Friedman Rick A.
Published: February 2020

Objective:

Comprehensive molecular profiling of radioresistant and cystic vestibular schwannoma (VS) subtypes.

Study Design:

Our study utilized whole-exome sequencing (WES), RNA-sequencing (RNAseq), and correlated clinical data from 12 samples (2 samples of solid sporadic subtype, 8 with cystic changes, and 2 previously irradiated).

Setting:

Academic medical center.

Patients:

Patients diagnosed with VS who required surgical treatment. Inclusion: Cystic and radioresistant tumors matched to age and tumor volume, with solid sporadic VS samples as control; Exclusion: NF-2 patients.

Intervention(s):

WES using custom probes for copy number analysis. A modified version of the Agilent Human Whole Exome sequencing hybrid capture system was used to process samples. Recurrent variants were identified and compared between groups. Leukocyte-derived DNA was utilized as internal control to reduce false-positives.

Main Outcome Measure(s):

Analysis of genetic landscape of VS subtypes (naive solid VS, cystic VS, and previously irradiated VS) by performing deep next-generation sequencing.

Results:

WES data achieved a mean coverage of 202X and RNAseq generated an average of 74 million total reads. As a group, 25% of samples had 22q loss. Somatic analysis identified previously reported genes and multiple novel mutations across samples. Differential expression analysis of RNAseq data found significantly mutated genes such as COL6A3, CLMP, ART4, Lumican that were shared by both cystic VS and irradiated VS, but not seen in sporadic VS.

Conclusions:

Using WES we were able to demonstrate that cystic and irradiated samples are subtypes of VS with an increased mutation burden and a unique genetic fingerprint. We identified differences between the genomic and molecular profile of cystic VS and radioresistant VS. Our results help advance the understanding of the pathophysiology of these tumor subtypes and suggest possible molecular targets for novel treatment strategies.
Binaural Hearing Rehabilitation Improves Speech Perception, Quality of Life, Tinnitus Distress, and Psychological Comorbidities
Authors: Ketterer Manuel Christoph , Häussler Sophia-Marie , Hildenbrand Tanja , Speck Iva , Peus Dominik , Rosner Bastian , Knopke Steffen , Graebel Stefan , Olze Heidi
Published: February 2020

Objectives:

To determine and compare the benefit of binaural hearing rehabilitation via cochlear implantation (CI) on speech perception, assessment of auditory abilities, tinnitus distress, health-related quality of life (HRQoL) and psychological comorbidities in patients suffering from asymmetric hearing loss (AHL) as well as bilaterally-deafened and sequentially bilaterally-implanted patients.

Methods:

53 patients were implanted between 2011 and 2016. 24 AHL patients were implanted unilaterally, using a hearing aid on the other side. 29 bilaterally-deafened patients were sequentially implanted bilaterally. Speech perception, subjective hearing quality, HRQoL, tinnitus distress, anxiety, depressiveness, perceived stress level and coping abilities were evaluated before implantation, as well as 6 and 24 months postoperatively.

Results:

Before CI, AHL and bilaterally-deaf patients showed significant differences regarding assessment of auditory abilities, speech discrimination, tinnitus distress and HRQoL. 24 months after CI both groups significantly improved in those scales. We could not find a significant difference between the groups after 2 years. Tinnitus distress significantly decreased 6 and 24 months postoperatively in both groups.

Conclusions:

This study demonstrates the long-term benefit of binaural hearing rehabilitation in AHL and bilaterally-deaf patients not only regarding speech perception but also HRQoL, tinnitus distress and subjective hearing quality. Bilaterally-deafened patients present lower scores preoperatively, but they did not differ from AHL patients 2 years after CI. Up to now, this is the first study evaluating the outcome of CI in AHL patients compared to bilaterally-implanted patients and demonstrating the benefit of binaural hearing rehabilitation in these specific groups.
Viral respiratory infections: a cause of community-acquired pneumonia or a predisposing factor?
Authors: Arnold Forest W. , Fuqua Joshua L.
Published: February 2020

Purpose of review

A cause for community-acquired pneumonia (CAP) is only identified in ∼50% of cases. Nasopharyngeal PCR panels contain more viruses than previously. The problem then becomes determining the relevance of the organisms identified rather than figuring out which virus is present. This review addresses how to distinguish between viral CAP and bacterial CAP, how viral CAP predisposes to bacterial CAP and some novel antiviral treatment being conducted.

Recent findings

The pneumonia severity index has been studied in patients with viral CAP. There are new studies using biomarkers to help determine when antimicrobial treatment is needed in CAP patients, and there is still no consensus. Newer devices are being invented in an effort to separate upper from lower respiratory organisms to make test results more relevant. Several outcome studies in patients with viral CAP are reviewed.

In addition to clinical correlation, using biomarkers can be useful to distinguish viral from bacterial CAP. Outcomes in patients with a co-infection are generally worse as a viral infection may predispose someone to a bacterial pneumonia. Influenza CAP treatment may be initially accompanied with antimicrobials until a patient's diagnosis is clear (∼48–72 h). Future research is being conducted for antiviral treatment more than for influenza.
Less invasive surfactant administration: best practices and unanswered questions
Authors: Herting Egbert , Härtel Christoph , Göpel Wolfgang
Published: February 2020

Purpose of review

The purpose of this review is to describe current concepts in the field of Less Invasive Surfactant Administration (LISA). The use of continuous positive airway pressure (CPAP) has become standard for the treatment of premature infants with respiratory problems throughout the world. However, if CPAP fails, technologies like LISA are needed that can combine surfactant delivery and spontaneous breathing with the support of noninvasive modes of ventilation.

Recent findings

LISA with thin catheters has been in use in Germany for more than 15 years. In the last 5 years, there was substantial interest in this method around the world. Randomized studies and recent metaanalyses indicate that the LISA technique helps to avoid mechanical ventilation especially in emerging respiratory distress syndrome (RDS). LISA is also associated with improved outcomes of preterm infants, specifically in the prevention of bronchopulmonary dysplasia (BPD) and intracranial hemorrhage (ICH). By now, a variety of different LISA catheters, devices and techniques have been described. However, most of the technologies are still connected with the unpleasant experience of laryngoscopy for the affected infants, so that the search for even less invasive techniques, for example, surfactant application by nebulization, goes on.

Maintenance of spontaneous breathing with support by the LISA technique holds big promise in the care of preterm infants. Patient comfort and lower complication rates are strong arguments to further investigate and promote the LISA approach. Open questions include exact indications for different patient groups, the usefulness of devices/catheters that have recently been built for the LISA technique and -- perhaps most urgently -- the issue of analgesia/sedation during the procedure. Studies on long-term outcome after LISA are under way.
Update on penicillin allergy delabeling
Authors: Shaker Marcus , McWilliams Samuel , Greenhawt Matthew
Published: February 2020

Purpose of review

To review phenotyping and risk classification of penicillin allergy and provide an update on penicillin allergy delabeling strategies for primary care.

Recent findings

Beta-lactams are considered the treatment of choice for a wide range of bacterial pathogens; however, many patients receive second-line agents due to being labeled as having an allergy to penicillin. This approach can lead to antibiotic resistance and inferior health outcomes. While 10% of the population is labeled as penicillin allergic, penicillin anaphylaxis occurs in less than 1% of patients. For patients with delayed benign skin rashes (e.g., urticaria or maculopapular exanthem >1 h after administration) attributable to beta-lactam administration occurring more than 12 months ago, direct oral challenge (rechallenge with antibiotic in the clinical setting) can be a safe and effective strategy, with immediate reactions occurring in less than 5% of such low-risk patients and delayed reactions appearing infrequently. In patients with penicillin-associated immediate urticaria, other IgE-mediated features, or anaphylaxis, further allergy evaluation and penicillin skin testing is warranted. Any severe idiosyncratic cutaneous adverse reaction is rare, but can be dangerous so prompt removal of the inciting agent is required.

Penicillin allergy delabeling is a high-value service that can be effectively delivered through a multidisciplinary collaborative approach.
Autism: considerations for transitions of care into adulthood
Authors: Enner Stephanie , Ahmad Samiya , Morse Anne M. , Kothare Sanjeev V.
Published: February 2020

Purpose of review

The steady rise in number of youth diagnosed with autism spectrum disorder (ASD) has led to the need to examine transition of care considerations specific to ASD. Improved understanding and guidance addressing these needs will allow pediatric and adult providers to work together to optimize social, medical, and occupational outcomes for these patients.

Recent findings

Health-care transition is a delicate time when children with ASD outgrow the services of pediatric programs and enter a fragmented healthcare system that is unfamiliar, insufficiently knowledgeable, and underfunded for their needs.

Increasing autism prevalence and an aging population with autism lend urgency to improve outcomes in children transitioning to adult-care. Research reveals poor consequences in social support, education, vocational training and employment, housing, and healthcare. Specific considerations to address these issues and ensure successful transition from pediatric to adult care are needed.
Vitamin D Deficiency and Sleep Quality in Minority Pregnant Women
Authors: Woo Jennifer , Penckofer Susan , Giurgescu Carmen , Yeatts Paul E.
Published: February 2020

Purpose:

To examine if vitamin D deficiency was associated with poor sleep quality in a sample of African American and Hispanic pregnant women. We also examined if race moderates the relationship between serum 25(OH)D levels and sleep quality among participants in this sample.

Study Design and Methods:

Using a cross-sectional design, a sample of 115 African American and Hispanic pregnant women were enrolled from a federally qualified health center in the Midwest. Women completed questionnaires and had blood drawn for serum 25(OH)D levels between 24- and 32 weeks gestation. The questionnaires included demographic characteristics, the Pittsburgh Sleep Quality Index, and dietary vitamin D and calcium intake.

Results:

The overall regression model indicated that the predictors explained 17% of variance in sleep quality (F
(5, 103) = 4.10, p = .002, R
2 = 0.17). Serum 25(OH)D levels were significant predictors of sleep quality after controlling for covariates (i.e., race, maternal age, prepregnancy body mass index, gestational age at data collection). Race did not moderate the association between serum 25(OH)D levels and sleep quality among women in this sample.

Clinical Implications:

Pregnant women should be screened for vitamin D deficiency. Women who have vitamin D deficiency should be provided vitamin D supplementation. Vitamin D supplementation may be a simple solution to enhance sleep quality at this critical time in a woman's life.
Transformational Leadership Principles and Tactics for the Nurse Executive to Shift Nursing Culture
Authors: Pearson Madelyn M.
Published: February 2020

Nurse executives must embody the principles of transformational leadership to meet the leadership imperative of achieving high-quality outcomes in this ever-changing healthcare environment. This article describes the 4 domains of transformational leadership and provides pragmatic examples a nurse executive used to impact culture, outcomes, and the journey to Magnet® designation. The strategies were utilized to support enculturation of Magnet principles by engaging clinical nurses, nursing leadership, and colleagues. Helping clinical nurses understand the alignment of their existing practice and values to the Magnet standards was ultimately a successful strategy.
Impact of Single Sign-on Adoption in an Assessment Triage Unit
Authors: James Neely , Marwaha Shruti , Brough Stacie , John Thomas T.
Published: February 2020

BACKGROUND

Clinician time is a valuable and costly resource. In an age where computer and clinical application usage is increasing, the need for providers to remember multiple usernames and passwords is increasingly inefficient. Further complexity is added to clinical workflows if clinicians must log into smart devices frequently without a simple solution for access and data security.

OBJECTIVE

The purpose of this study was to measure the average time required and time savings when taking vital sign measurements using the Single Sign-On (SSO) (badge scan and go) on the electronic medical record–connected vital sign monitors versus using 2-factor authentication (entry of username and password). In addition, user satisfaction, system usability, workflow preference, and efficacy of the deployment of Network Connectivity Engine, that is, the host middleware for SSO, were evaluated through surveys.

METHODS

A preimplementation and postimplementation study was performed in the unit piloting the initiative before hospital-wide deployment. Clinician usability and workflow preference surveys were conducted postimplementation.

RESULTS

Analysis showed significance in time savings by adopting SSO.

CONCLUSION

SSO had a positive impact on staff efficiency and was the preferred method versus the 2-factor log-in.
Clinical Nurse Specialists on the Night Shift
Authors: Fischer-Cartlidge Erica , Arenas Elizabeth , Ogbuagu Linda , Remondini Carla , Murphy Jane
Published: February 2020

Background

Night-shift nurses care for complex and acutely ill patients but are frequently more junior compared with day shift. They often have less access to support resources such as educators and clinical nurse specialists (CNSs). This article describes the addition of night CNS positions, their roles, and associated outcomes.

Intervention

The night CNSs were implemented to perform a highly flexible set of activities including proactive rounding on high-risk patients and medications; code/rapid response support; education; nursing practice/policy reinforcement; providing psychosocial support to nurses, patients, and families; and responding to consults. To capture work effort at night and truly define the role of the night CNS, a shared consultation log was created.

Outcomes

Between October 2017 to April 2019, 6053 CNS encounters were captured in 24 different categories. The top 5 reasons for consultation included policy/procedure education or change, education/in-service, nursing practice review/reinforcement, medication/blood administration, and clinical assist. Five hundred sixty-nine rapid response/codes have been responded to. There was also a 17% increase in event reporting on the night shift. Outcomes have continued to support additional budgeted positions for the nights and weekends.

Implications

Night CNS expertise and knowledge are vital to offsetting novice nurse deficits in advanced assessment, which is paramount to patient outcomes. They provide support with on-the-spot education and empower individual development. Organizations should strongly consider implementation of this role or, if that is not possible, consider flexible scheduling into evening hours to support night staff.
CPR to the Rescue!
Authors: Heath Janie , Walmsley Lee Anne , Aker Rachelle M. , Ferrin Shelley , Stone Dan , Norton James C.
Published: February 2020

Purpose/Objectives

The hCATS (health Colleges Advancing Team Skills) to CPR (Cultivating Practices for Resilience) Camp was an interprofessional pilot program to promote resilience, introduce strategies for coping with stress, cultivate compassion, and promote work-life balance to prevent burnout among health profession students, faculty, and healthcare professionals who team to provide patient care.

Program Description

The University of Kentucky (UK) College of Nursing received funding to partner with the UK Center for Interprofessional Health Education for immersive weekend activities utilizing KORU and Mindfulness Based Stress Reduction models, conducted by certified UK faculty experts in self-stewardship techniques such as mindfulness practices.

Outcomes

Thirty-nine participants from 7 UK colleges and UK HealthCare participated in 4 distinct CPR Camps, completed program assessments, and created team projects. Mean scores from each cohort significantly increased in a retrospective pre/post analysis of student perception of knowledge in all of the following categories: (1) habits and practices for resilient people, (2) strategies for building resilience and preventing/coping with stress/burnout in self and others, and (3) work-life balance (with the exception of cohort 4, for work-life balance). Students indicated on open-response items specific strategies they were willing to adopt going forward. These outcomes met our objectives for developing participants' understanding of resilience practices and adopting useful stress reduction practices. Planning and implementation of team projects successfully brought different professions together to advance learning in resilience.

Conclusion

The CPR Camp initiative is an effective model for promoting and sustaining resilience-building strategies among health profession students. Similar programming conducted and/or attended by academic and/or health system leaders, such as clinical nurse specialists, can help cultivate practices for resilience among the members of the interprofessional workforce, enabling teams to better cope with stress, prevent burnout, and ultimately improve team-based care delivery for patients and their families.
Classification of Subtypes of Crouzon Syndrome Based on the Type of Vault Suture Synostosis
Authors: Lu Xiaona , Sawh-Martinez Rajendra , Forte Antonio Jorge , Wu Robin , Cabrejo Raysa , Wilson Alexander , Steinbacher Derek M. , Alperovich Michael , Alonso Nivaldo , Persing John A.
Published: February 2020

Background:

Patients with Crouzon syndrome develop various types of anatomic deformities due to different forms of craniosynostosis, yet they have similar craniofacial characteristics. However, exact homology is not evident. Different pathology then may be best treated by different forms of surgical technique. Therefore, precise classification of Crouzon syndrome, based on individual patterns of cranial suture involvement is needed.

Methods:

Ninety-five computed tomography (CT) scans (Crouzon, n = 33; control, n = 62) were included in this study. All the CT scans are divided into 4 types based on premature closure of sutures: class I = coronal and lambdoidal synostosis; class II = sagittal synostosis; class III = pansynostosis; and class IV = “Others.” The CT scan anatomy was measured by Materialise software.

Results:

The class III, pansynostosis, is the most prevalent (63.6%). The classes I, III, and IV of Crouzon have significantly shortened entire anteroposterior cranial base length, with the shortest base length in class III. The external cranial measurements in class I show primarily a decreased posterior facial skeleton, while the class III presented with holistic facial skeleton reduction. Class II has the least severe craniofacial malformations, while class III had the most severe.

Conclusion:

The morphology of patients with Crouzon syndrome is not identical in both cranial base and facial characteristics, especially when they associated with different subtypes of cranial suture synostosis. The classification of Crouzon syndrome proposed in this study, summarizes the differences among each subgroup of craniosynostosis suture involvement, which, theoretically, may ultimately influence both the timing and type of surgical intervention.
Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion?
Authors: Liu Kai , Wei Hongpu , Dai Jiewen , Wang Xudong
Published: February 2020

Purpose:

To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes.

Material and Methods:

Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate.

Results:

Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively.

Conclusion:

SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.
Resorbable Versus Titanium Fixation of Le Fort I Osteotomy
Authors: Passeri Luis Augusto , Bento Adriano Mesquita , Vanni Tazio
Published: February 2020

Resorbable and titanium systems have been used in maxillary fixation. The aim of this review was to evaluate stability and morbidity of Le Fort I osteotomy by comparing both systems. It was performed in 11 databases, and reported according to preferred reporting items for systematic reviews and meta-analysis. Randomized and nonrandomized clinical trials, and retrospective comparative studies with patients who underwent nonsegmented Le Fort I osteotomy were included. Eleven articles were selected, with a total of 262 patients treated with resorbable and 252 with titanium fixation. The meta-analysis showed that when measured at point A, horizontal stability was 0.06 mm (95% confidence interval [CI] −0.19, 0.30), vertical stability for impaction was −0.43 mm (95% CI −0.94, 0.07), and for inferior repositioning was −1.29 mm (95% CI −2.62, 0.04). Morbidity was similar in the groups. Regarding infection, resorbable presented an absolute risk (AR) = 0.032, and titanium an AR = 0.025 (P = 1.0). For soft tissue reaction, an AR = 0.120 was shown for resorbable, and an AR = 0.132 for titanium (P = 0.85). Removal of fixation showed an AR = 0.024 for resorbable, and an AR = 0.025 for titanium (P = 1.0). Based on these results, resorbable and metal fixation systems seem to be equivalent with respect to stability and morbidity. This review was limited by the quality of the studies. Future studies should address these quality limitations to improve comparison between these 2 fixation approaches.
Fentanyl impairs but ketamine preserves the microcirculatory response to hemorrhage
Authors: Xiang Lusha , Calderon Alfredo S. , Klemcke Harold G. , Scott Laura L. , Hinojosa-Laborde Carmen , Ryan Kathy L.
Published: February 2020

BACKGROUND

Peripheral vasoconstriction is the most critical compensating mechanism following hemorrhage to maintain blood pressure. On the battlefield, ketamine rather than opioids is recommended for pain management in case of hemorrhage, but effects of analgesics on compensatory vasoconstriction are not defined. We hypothesized that fentanyl impairs but ketamine preserves the peripheral vasoconstriction and blood pressure compensation following hemorrhage.

METHOD

Sprague-Dawley rats (11–13 weeks) were randomly assigned to control (saline vehicle), fentanyl, or ketamine-treated groups with or without hemorrhage (n = 8 or 9 for each group). Rats were anesthetized with Inactin (i.p. 10 mg/100 g), and the spinotrapezius muscles were prepared for microcirculatory observation. Arteriolar arcades were observed with a Nikon microscope, and vessel images and arteriolar diameters were recorded by using Nikon NIS Elements Imaging Software (Nikon Instruments Inc. NY). After baseline perimeters were recorded, the arterioles were topically challenged with saline, fentanyl, or ketamine at concentrations relevant to intravenous analgesic doses to determine direct vasoactive effects. After arteriolar diameters returned to baseline, 30% of total blood volume was removed in 25 minutes. Ten minutes after hemorrhage, rats were intravenously injected with an analgesic dose of fentanyl (0.6 μg/100 g), ketamine (0.3 mg/100 g), or a comparable volume of saline. For each drug or vehicle administration, the total volume injected was 0.1 mL/100 g. Blood pressure, heart rate, and arteriolar responses were monitored for 40 minutes.

RESULTS

Topical fentanyl–induced vasodilation (17 ± 2%), but ketamine caused vasoconstriction (−15 ± 4%, p < 0.01). Following hemorrhage, intravenous ketamine did not affect blood pressure or respiratory rate, while fentanyl induced a slight and transient (<5 minutes, p = 0.03 vs. saline group) decrease in blood pressure, with a profound and prolonged suppression in respiratory rate (>10 minutes, with a peak inhibition of 57 ± 8% of baseline, p < 0.01). The compensatory vasoconstriction observed after hemorrhage was not affected by ketamine treatment. However, after fentanyl injection, although changes in blood pressure were transiently present, arteriolar constriction to hemorrhage was absent and replaced with a sustained vasodilation (78 ± 25% to 36 ± 22% of baseline during the 40 minutes after injection, p < 0.01).

CONCLUSION

Ketamine affects neither systemic nor microcirculatory compensatory responses to hemorrhage, providing preclinical evidence that ketamine may help attenuate adverse physiological consequences associated with opioids following traumatic hemorrhage. Microcirculatory responses are more sensitive than systemic response for evaluation of hemodynamic stability during procedures associated with pain management.
Predictors of hemodynamic decompensation in progressive hypovolemia: Compensatory reserve versus heart rate variability
Authors: Schlotman Taylor E. , Suresh Mithun R. , Koons Natalie J. , Howard Jeffrey T. , Schiller Alicia M. , Cardin Sylvain , Convertino Victor A.
Published: February 2020

BACKGROUND

Hemorrhage remains the leading cause of death following traumatic injury in both civilian and military settings. Heart rate variability (HRV) and heart rate complexity (HRC) have been proposed as potential “new vital signs” for monitoring trauma patients; however, the added benefit of HRV or HRC for decision support remains unclear. Another new paradigm, the compensatory reserve measurement (CRM), represents the integration of all cardiopulmonary mechanisms responsible for compensation during relative blood loss and was developed to identify current physiologic status by estimating the progression toward hemodynamic decompensation. In the present study, we hypothesized that CRM would provide greater sensitivity and specificity to detect progressive reductions in central circulating blood volume and onset of decompensation as compared with measurements of HRV and HRC.

METHODS

Continuous, noninvasive measurements of compensatory reserve and electrocardiogram signals were made on 101 healthy volunteers during lower-body negative pressure (LBNP) to the point of decompensation. Measures of HRV and HRC were taken from electrocardiogram signal data.

RESULTS

Compensatory reserve measurement demonstrated a superior sensitivity and specificity (receiver operator characteristic area under the curve [ROC AUC] = 0.93) compared with all HRV measures (ROC AUC ≤ 0.84) and all HRC measures (ROC AUC ≤ 0.86). Sensitivity and specificity values at the ROC optimal thresholds were greater for CRM (sensitivity = 0.84; specificity = 0.84) than HRV (sensitivity, ≤0.78; specificity, ≤0.77), and HRC (sensitivity, ≤0.79; specificity, ≤0.77). With standardized values across all levels of LBNP, CRM had a steeper decline, less variability, and explained a greater proportion of the variation in the data than both HRV and HRC during progressive hypovolemia.

CONCLUSION

These findings add to the growing body of literature describing the advantages of CRM for detecting reductions in central blood volume. Most importantly, these results provide further support for the potential use of CRM in the triage and monitoring of patients at highest risk for the onset of shock following blood loss.
French civilian surgical expertise still inadequately prepared for mass casualties 3 years after major terror attacks in Paris (2015) and Nice (2016)
Authors: Destan Clement , De Carbonnière Anne , Moritz Céline , Gaudric Julien , Malgras Brice , Desterke Christophe , Bonnet Stéphane , Hornez Emmanuel
Published: February 2020

BACKGROUND

Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a nonselected population of practicing French surgeons.

METHODS

A questionnaire was sent between July and December 2017 to French students and practicing surgeons, using the French Surgical Colleges' mailing lists. Items analyzed included education, training, interest and clinical activity in trauma care and damage-control surgery (DCS).

RESULTS

622 questionnaires were analyzed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in Level I trauma centers (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of ‘interest in trauma care’ was 8/10. Factors associated with a higher score were being a resident doctor (p = 0.01), a digestive surgeon (p = 0.0013), in the military (p = 1,71 × 10−6) and working in TC1 (p = 0.034). The mean “DCS techniques knowledge” score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively, p = 0.0007 and p = 0.001) and in the military (respectively p = 1.74 × 10−8 and p = 3.94 × 10−7). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons.

CONCLUSION

French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate.

LEVEL OF EVIDENCE

Level III, Study Type Survey.
Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock
Authors: Moore Hunter B. , Tessmer Matthew T. , Moore Ernest E. , Sperry Jason L. , Cohen Mitchell J. , Chapman Michael P. , Pusateri Anthony E. , Guyette Francis X. , Brown Joshua B. , Neal Matthew D. , Zuckerbraun Brian , Sauaia Angela
Published: February 2020

BACKGROUND

Randomized clinical trials (RCTs) support the use of prehospital plasma in traumatic hemorrhagic shock, especially in long transports. The citrate added to plasma binds with calcium, yet most prehospital trauma protocols have no guidelines for calcium replacement. We reviewed the experience of two recent prehospital plasma RCTs regarding admission ionized-calcium (i-Ca) blood levels and its impact on survival. We hypothesized that prehospital plasma is associated with hypocalcemia, which in turn is associated with lower survival.

METHODS

We studied patients enrolled in two institutions participating in prehospital plasma RCTs (control, standard of care; experimental, plasma), with i-Ca collected before calcium supplementation. Adults with traumatic hemorrhagic shock (systolic blood pressure ≤70 mm Hg or 71–90 mm Hg + heart rate ≥108 bpm) were eligible. We use generalized linear mixed models with random intercepts and Cox proportional hazards models with robust standard errors to account for clustered data by institution. Hypocalcemia was defined as i-Ca of 1.0 mmol/L or less.

RESULTS

Of 160 subjects (76% men), 48% received prehospital plasma (median age, 40 years [interquartile range, 28–53 years]) and 71% suffered blunt trauma (median Injury Severity Score [ISS], 22 [interquartile range, 17–34]). Prehospital plasma and control patients were similar regarding age, sex, ISS, blunt mechanism, and brain injury. Prehospital plasma recipients had significantly higher rates of hypocalcemia compared with controls (53% vs. 36%; adjusted relative risk, 1.48; 95% confidence interval [CI], 1.03–2.12; p = 0.03). Severe hypocalcemia was significantly associated with decreased survival (adjusted hazard ratio, 1.07; 95% CI, 1.02–1.13; p = 0.01) and massive transfusion (adjusted relative risk, 2.70; 95% CI, 1.13–6.46; p = 0.03), after adjustment for confounders (randomization group, age, ISS, and shock index).

CONCLUSION

Prehospital plasma in civilian trauma is associated with hypocalcemia, which in turn predicts lower survival and massive transfusion. These data underscore the need for explicit calcium supplementation guidelines in prehospital hemotherapy.

LEVEL OF EVIDENCE

Therapeutic, level II.