bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Neurodevelopmental Outcomes in NICU Patients
Authors: Painter Leslie , Lewis Stephanie , Hamilton Bernita K.
Published: January 2019

Background:

Premature infants experience stressors such as external stimulation with sounds, light, touch, and open positioning in NICU that negatively affect outcomes.

Purpose:

The purpose of this study was to measure the effectiveness of a developmental positioning intervention on length of stay, weight gain, and tone/flexion compared with neonates without structured positioning.

Methods:

Study design was quasi-experimental with nonequivalent groups. A retrospective chart review of 50 neonates with the inclusion criteria of 34 weeks of gestation or less and no anomalies provided a preintervention sample. After the education in-service on positioning, a convenience sample of 27 infants was enrolled. Infant Position Assessment Tool was used as a visual guide for positioning and scoring by the researcher for intervention fidelity. Hammersmith scoring was completed by the occupational therapist prior to discharge.

Findings:

The postintervention group was younger and sicker than the control group (P < .05). The postintervention sample (M = 7.05 where 7 = 29 to <30 weeks of gestation) was younger than the preintervention sample (M = 7.22). The postintervention sample was smaller (M = 1302.15 g) than the preintervention sample (M = 1385.94 g). Results showed that the postintervention group had clinically significant weight gain and mean Hammersmith score (3.28) was higher showing positioning positively affected tone and flexion scores.

Implications for Practice:

With greater structure and consistent attention to developmental positioning, outcomes are positively affected.

Implications for Future Research:

Further research with larger sample sizes will identify stronger associations and relationships between positioning and outcome measures.
A Novel Technique for the Surgical Management of Chronic Lateral Epicondylitis
Authors: Wahegaonkar Abhijeet , Sanghavi Sahil , Bansode Anup , Mane Satish
Published: January 2019

Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in most cases. However, when conservative treatment fails, surgery is required for resistant cases. In this study, we describe a novel technique for the management of chronic lateral epicondylitis. The advantage of our technique is that all the 3 major components of the disease (as also all types of failure described by Morrey) are simultaneously dealt with, that is, pathology of the tendon, posterior interosseous nerve compression and intra-articular pathology are all addressed. We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated with our technique at our Institute from 2008 to 2013 with a minimum 2 years follow up. We included patients between 18 and 65 years of age who in addition to lateral epicondylitis also had an intra-articular pathology along with symptoms/signs suggestive of posterior interosseous nerve compression and had undergone a conservative trial of atleast 12 months. Excluded were those cases with localized infection and severe ankylosis, whereas previous surgery on the same elbow was a relative contraindication. Postoperatively all patients showed improvement in the VAS score and grip strength. Twelve of the 14 patients (85.7%) in our series had good to excellent functional outcomes on the Mayo Elbow Performance Index. This technique can therefore be recommended for wider surgical use; however, prospective randomized studies with a longer follow-up would add further evidence about the effectiveness of our technique.
Sunbeds and melanoma risk: time to close the debate
Authors: Suppa Mariano , Gandini Sara
Published: January 2019

Purpose of review

In spite of the established scientific evidence on the association of sunbed use with melanoma risk, some have recently expressed scepticism about the carcinogenicity of indoor tanning. This may have raised confusion among both physicians and patients. The purpose of this review is to make the point about the real impact of sunbed use on melanoma risk in light of the most recently published evidence.

Recent findings

Seven themes were covered: recent studies on age at first sunbed exposure and melanoma risk; sunbed use and melanoma at different body sites; sunbed use and development of additional primary melanomas; new studies on proportion of melanomas attributable to sunbed use; sunbed use and melanoma risk factors; economic burden of sunbed use; and recent debate over whether indoor tanning contributes to melanoma.

We were able to apply all epidemiological criteria for causality to the relationship between sunbed use and melanoma. Together with the new evidence on the strength, dose response, and temporality of the association of sunbeds with melanoma, this will hopefully close the debate over whether indoor tanning contributes to melanoma.
Therapeutic Presence: Its Contribution to the Doctor-Patient Encounter
Authors: Krogh Edwin , Langer Álvaro , Schmidt Carlos
Published: January 2019

In this article, we propose a model of doctor-patient encounter that integrates the concept of therapeutic presence (TP), derived from psychotherapy research, as an indispensable substrate for the benefit of the therapeutic alliance between patient and doctor. To this end, the concepts of the doctor-patient relationship and doctor-patient communication are revisited to explore their therapeutic dimensions. The concept of TP is defined, and existing literature about the relationship between that concept, the therapeutic alliance, and mindfulness is reviewed, alongside an examination of related concepts that have developed within nursing and medicine. We conclude that TP emerges as a transtheoretical concept that can be integrated into our understanding of the doctor-patient encounter to improve both doctor-patient communication and the doctor-patient relationship. The way in which the biomedical model may limit a present medicine is discussed, and the means of integrating such a model of doctor-patient encounter into medical training and practice is analyzed.
Creating Effective and Efficient Pediatric-Specific CME Content: More than Just Checking a Box
Authors: Nelson Benjamin A.
Published: January 2019

States dictate the type of continuing medical education (CME) required for licensing; however, CME providers are not mandated to create content relevant to all specialties. This often forces pediatricians to engage in educational activities that are irrelevant to their practice. This is contrary to what constitutes effective CME. The goal was to develop pediatric content using adult learning theory that aligns with effective CME principles while simultaneously satisfying state licensure requirements. A targeted needs assessment of pediatric providers revealed that pediatric-specific CME activities satisfying the state's requirement for pain management and end-of-life issues were lacking. Webinars adhering to adult learning principles were created in consultation with content experts. Five hundred ninety-seven learners across 30 states successfully completed the webinars and received CME credit. To satisfy ongoing state licensing requirements, 44% of learners had completed similar activities in the past, but 72% of those learners participated in activities focused on adult medicine due to the lack of available pediatric modules. Until states and regulators allow for more flexibility in satisfying licensing requirements, it will be incumbent on those who create CME to develop educational activities that satisfy state requirements while aligning with the principles of effective CME. With strategic planning, this is possible and will hopefully empower physicians to engage in CME without resorting to “checking a box.”
Emergency Surgery in Acute Diverticulitis: A Systematic Review
Authors: Beyer-Berjot Laura , Maggiori Léon , Loiseau Didier , De Korwin Jean-Dominique , Bongiovanni Jean-Pierre , Lesprit Philippe , Salles Nathalie , Rousset Pascal , Lescot Thomas , Henriot Aymeric , Lefrançois Magalie , Cotte Eddy , Parc Yann
Published: January 2019

BACKGROUND:

Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis.

OBJECTIVE:

The aim of this systematic review was to define the accurate surgical management of acute diverticulitis.

DATA SOURCES:

Medline, Embase, and the Cochrane Library were sources used.

STUDY SELECTION:

One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee.

INTERVENTIONS:

The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach.

MAIN OUTCOME MEASURES:

Morbidity, mortality, long-term stoma rates, and quality of life were measured.

RESULTS:

Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach.

LIMITATIONS:

Trials specifically assessing Hinchey IV diverticulitis have not yet been completed.

CONCLUSIONS:

High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Parental morphine exposure enhances morphine (but not methamphetamine) preference and increases monoamine oxidase-B level in the nucleus accumbens
Authors: Sadat-Shirazi Mitra-Sadat , Karimi Forough , Kaka Gholamreza , Ashabi Ghorbangol , Ahmadi Iraj , Akbarabadi Ardeshir , Toolee Heidar , Vousooghi Nasim , Zarrindast Mohammad-Reza
Published: January 2019

Opioid addiction is one of the most crucial issues in the world. Opioid abuse by parents makes children more prone to many psychological disorders such as drug addiction. Therefore, this study was carried out to examine the effect of morphine exposure 10 days before gestation on morphine and methamphetamine preference in male offspring. Adult Wistar rats (male and female) received morphine orally for 21 days and were drug free for 10 days. Thereafter, they were allowed to mate with either a morphine-abstinent or drug-naive rat. The male offspring were tested for morphine and methamphetamine preference with a three-bottle choice test. Moreover, the rewarding effects of morphine and methamphetamine were evaluated using a conditioned place preference test. To determine the mechanisms underlying these changes, monoamine oxidase-B (MAO-B) level was measured in the nucleus accumbens (NAC). Offspring of morphine-abstinent mothers and offspring of both-abstinent parents were found to consume morphine more than those of other groups, but in the case of methamphetamine, there were no differences. In addition, the offspring of morphine-abstinent parent(s) did not condition with a high dose of morphine in the conditioned place preference test. Administration of methamphetamine induced conditioning at different doses in controls and offspring of one or two morphine-abstinent parent(s), and there were no effects of parental morphine exposure on the dose of methamphetamine that was required for conditioning. Moreover, the level of MAO-B was increased in the NAC of offspring of morphine-abstinent parents as compared with the control group. These results demonstrate that offspring of a morphine-abstinent mother and a drug-naive father and offspring of two morphine-abstinent parents were more susceptible to opioid but not methamphetamine addiction. Moreover, parental morphine consumption did not have any effect on the reinforcing effect of methamphetamine in their offspring but induced morphine tolerance in the offspring. Although the level of MAO-B was elevated in the NAC, this did not correlate with the methamphetamine preference in offspring.
Recognizing maternal mental health disorders: beyond postpartum depression
Authors: Yeaton-Massey Amanda , Herrero Tiffany
Published: January 2019

Purpose of review

Maternal mental health disorders, including anxiety and depression, are one of the most common obstetric complications, presenting in pregnancy and postpartum.

Recent findings

Maternal mental health disorders are associated with adverse maternal and neonatal outcomes. Screening women in pregnancy and postpartum for mental health disorders is key to early identification and treatment of anxiety and depression in the perinatal population. Although universal screening is now recommended by numerous professional organizations, rates of screening are low and often not performed with a validated screening instrument. Although clinical assessment is important, it is insufficient to identify maternal mental health disorders. As symptoms may change throughout pregnancy, screening for anxiety and depression should be done at multiple time points in pregnancy, including intake and postpartum. In addition, it is important to complete a mental health history on intake to identify women who are either at risk for, or experiencing, anxiety and depression. All screening programmes must be accompanied by a protocol to respond to a positive screen to ensure appropriate follow-up and treatment.

Identification and treatment of maternal mental health disorders has important implications for maternal and child health. Obstetric providers should screen all women using a validated screening instrument and have systems in place to ensure timely diagnosis and treatment.
Systemic lupus erythematosus in pregnancy: high risk, high reward
Authors: Do Samantha C. , Druzin Maurice L.
Published: January 2019

Purpose of review

The aim of this study was to describe risks of systemic lupus erythematosus (SLE) in pregnancy and the importance of preconception counselling, medication optimization and close surveillance.

Recent findings

Advances in care for pregnant patients with SLE have led to improved obstetric outcomes, but maternal and foetal risks continue to be elevated. Conception during periods of disease quiescence and continuation of most medications decrease adverse pregnancy outcomes. Hydroxychloroquine (HCQ) appears protective against flares in pregnancy, neonatal congenital heart block and preterm birth.

SLE in pregnancy confers increased maternal and foetal risks, including disease flares, preeclampsia, preterm birth, foetal growth restriction, neonatal lupus erythematosus (NLE) and congenital heart block. Disease control on an effective medication regimen mitigates many of these risks, but pregnancy in women with SLE remains a high-risk condition requiring multidisciplinary care and an individualized approach to each patient.
Fibrinography: A Multiwavelength Light‐Scattering Assay of Fibrin Structure
Authors: Dassi Carhel , Seyve Landry , García Xabel , Bigo Emmanuelle , Marlu Raphaël , Caton François , Polack Benoît
Published: January 2019

We have previously developed a fibrin structural assay dedicated to purified fibrinogen‐thrombin system. Here, we extend the pertinence of this test, called Fibrinography, to tissue factor‐triggered plasma coagulation. We show that Fibrinography determines quantitatively the structure of fibrin fibers in plasma with an excellent reproducibility. We compare this assay with the commonly used single wavelength turbidity method, showing that the latter is not a proper structural assay, but determines essentially the fibrinogen content in plasma. In addition, we also show, in model plasmas, that Fibrinography is able to discriminate normal and hypocoagulant plasmas, and even between hypercoagulant plasmas. Therefore, Fibrinography, by measuring the final step of the coagulation cascade, may be used to evaluate patients’ plasma in hypo‐ or hypercoagulant diseases.
Do Donated Corneas Become Transplanted Corneas? The Causes of Discard in Southern Brazil
Authors: Almeida de Freitas Rosane , Dell'Agnolo Cátia Millene , Augusto de Melo Willian , de Andrade Luciano , Pimentel Rafael Rodrigo , Pelloso Sandra Marisa , Dalva de Barros Carvalho Maria
Published: January 2019

Purpose:

To analyze the number of discarded donated corneas and the causes associated with discard in southern Brazil.

Methods:

This retrospective, cross-sectional, and analytic study of donor corneal discards and their associated factors and geospatial distribution was based on a macroregional strategy conducted from 2011 to 2015 in Paraná, southern Brazil. The dataset included all cornea donations from patients who died of cardiac arrest at ages between 3 and 70 years.

Results:

A total of 9290 donor corneas were identified from 4645 donor patients; of these corneas, 4235 (45.6%) were discarded and 5055 (54.4%) transplanted. Mean age of the donors was 51.13 ± 14.30 years. The main causes of discard were positive serology (49.6%), corneal viability (19.8%), corneal tissue quality (8.5%), and others (16.0%). The discard rate was higher in the 50 to 64 year age group.

Conclusions:

The corneal discard rate was high in all macroregions studied, with positive serology, viability, and quality of the donated corneas being the main causes of discard. Discards were more prevalent in older age groups (50–64 years and 65 or above age groups). Considering the presented results, the assessment process of potential cornea donors should be changed to reduce losses and costs.
Peripheral Pneumatic Dissection and Scar Peeling to Complete Deep Anterior Lamellar Keratoplasty in Eyes With Healed Hydrops
Authors: Goweida Mohamed Bahgat , Sobhy Mohamed , Seifelnasr Mohamed , Liu Christopher
Published: January 2019

Purpose:

To describe a surgical technique to achieve the desired plane during deep anterior lamellar keratoplasty (DALK) in eyes with Descemet membrane (DM) tears due to previous hydrops.

Methods:

This was a prospective, consecutive, interventional case series of DALK in 12 keratoconic eyes with healed hydrops. Dissection of the peripheral cornea was performed by air injection and using the microbubble incision technique as a guide to the clear predescemetic stroma. The central posterior scar was then removed by peeling to bare DM.

Results:

DALK was successfully completed in all eyes, with DM tears ranging from a microperforation to approximately 4 mm. At 12 months, the mean logMAR best-corrected visual acuity was 0.38 ± 0.07, the mean keratometric astigmatism was 5.2 ± 1.9 diopters, and the mean endothelial cell density was 2364 ± 316.9 cells/mm2.

Conclusions:

Peripheral pneumatic dissection and central scar peeling technique is a useful technique to complete DALK in eyes with scars due to previous hydrops.
Sjögren's Syndrome: More Than Just Dry Eye
Authors: Akpek Esen K. , Bunya Vatinee Y. , Saldanha Ian J.
Published: January 2019

Purpose:

Sjögren's syndrome (SS) is a common autoimmune disease affecting about four million Americans. Although approximately 1 in 10 patients with clinically-significant aqueous deficient dry eye has underlying SS, widespread underappreciation of SS leads to significant underdiagnosis, delays in diagnosis, and consequent morbidity and mortality. The purpose of this article is to illustrate that in addition to dry eye, SS can cause serious, vision-threatening extraglandular ocular manifestations.

Methods:

We conducted a narrative review of studies that have examined the dry eye and extraglandular ocular complications of SS.

Results:

SS-related dry eye is a progressive condition with major negative impact on the quality-of-life of afflicted patients, not only due to symptoms of ocular discomfort but also visual dysfunction. In addition, SS can lead to corneal melt/perforation, uveitis, scleritis, retinal vasculitis, and optic neuritis. A major problem with currently-available SS disease activity measurement instruments is the lack of domains evaluating dry eye-related visual dysfunction. For example, one of the most commonly-used instruments for assessing patient symptoms in SS (the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]) only includes one item (out of three) that addresses the severity of overall dryness, without mention of dry eye symptoms or vision-related quality-of-life. Similarly, no extraglandular ocular complications are included in currently-available SS disease activity instruments (e.g., the EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI]).

Conclusions:

There needs to be a paradigm shift in which eye care providers and rheumatologists become more familiar with various SS-related extraglandular ocular manifestations. Existing disease activity measurement instruments must incorporate dry eye symptoms, particularly those related to visual dysfunction. An evidence-based screening algorithm for determining which patients with dry eye should be tested for underlying SS may be particularly helpful in preventing delays in diagnosis.
Intraoperative Optical Coherence Tomography to Guide Corneal Biopsy: A Case Report
Authors: Schmidt Eleanor M. , Stiefel Hillary C. , Houghton Donald C. , Chamberlain Winston D.
Published: January 2019

Purpose:

To report on a new application of intraoperative optical coherence tomography (OCT) as a real-time imaging tool to help guide corneal biopsy.

Methods:

Single case report. After the negative result of a corneal biopsy, we used intraoperative OCT during repeat biopsy to assist in depth and acquisition of an anterior stromal opacity suspected to be immunoglobulin deposits.

Results:

The use of intraoperative OCT is a novel tool, which assisted in successful identification and conservative biopsy of corneal immunoglobulin deposits.

Conclusions:

Intraoperative OCT is a novel tool that assists in the identification and location of corneal pathology for biopsy.
Biobanking of Dehydrated Human Donor Corneal Stroma to Increase the Supply of Anterior Lamellar Grafts
Authors: Romano Vito , Levis Hannah J. , Gallon Paola , Lace Rebecca , Borroni Davide , Ponzin Diego , Ruzza Alessandro , Kaye Stephen B. , Ferrari Stefano , Parekh Mohit
Published: January 2019

Purpose:

To investigate the effect of dehydration on human donor corneal stroma for biobanking.

Methods:

Epithelium and endothelium of research-grade human donor corneas (n = 12) were scraped off, leaving a bare stroma with attached sclera. The tissues were placed in a large Petri dish prefilled with silica gel in the periphery and stored at room temperature for 14 days. At the end of preservation, the tissues were rehydrated by being submerged in phosphate-buffered saline for 15 minutes. Transparency (using a custom-built device) and thickness (using optical coherence tomography) measurements were recorded before dehydration, after dehydration, and after rehydration of the tissues. Periodic acid-Schiff and alpha-smooth muscle actin (α-SMA) staining before dehydration and after rehydration were performed to determine the presence of keratocytes and expression of α-SMA. Tensile stress-strain before dehydration and after rehydration was performed to evaluate the biomechanical properties.

Results:

No difference in corneal transparency before dehydration (69.57 ± 6.41%) and after rehydration (67.37 ± 2.82%),P= 0.36, was observed. The corneas were more compact after dehydration. A significant change in thickness between before dehydration (625.8 ± 75.58 μm) and after rehydration (563.6 ± 15.77 μm) stage,P= 0.03, was noticed. The thickness was reduced to 147.6 ± 3.71 μm when dehydrated. Periodic acid-Schiff staining showed presence of stromal keratocytes and α-SMA protein expressed in control, dehydrated, and rehydrated corneas. There was no significant difference in the stiffness between control (27.86 ± 11.65 MPa) and rehydrated corneas (31.46 ± 11.41 MPa).

Conclusions:

Human donor corneal stroma can be biobanked for up to 2 weeks in a dehydrated condition without losing their molecular or biomechanical properties after rehydration.
Anterior Chamber XEN Gel Stent Movements: The Impact on Corneal Endothelial Cell Density
Authors: Gillmann Kevin , Bravetti Giorgio E. , Mermoud André , Mansouri Kaweh
Published: January 2019

Introduction:

Although there are several examples of glaucoma drainage devices’ dislocations in the literature, the movement of XEN gel stents is scarcely documented, and the impact of such displacements on the corneal endothelium remains unknown. In light of the recent global market withdrawal of the CyPass microstent over concerns with regard to endothelial cell loss, we present a case of XEN gel stent dislocation into the anterior chamber, with localized corneal damage.

Case Report:

We describe the case of a 64-year-old female patient who underwent bilateral XEN gel stent implantation for normal-tension glaucoma. While right eye surgery was uneventful, intraocular pressure increased in the left eye, and examination revealed a flat filtration bleb with no microstent visible through the conjunctiva. A 3 mm segment of the XEN stent was visible within the anterior chamber, with corneal contact during eye movement and blinking. Endothelial cell density was measured twice 1 month apart before the XEN gel stent was replaced.

Discussion:

First, our observations confirm that XEN gel stents can dislocate and advance within the anterior chamber. We speculate that this displacement was caused by regular eye rubbing after surgery. Second, this report illustrates that the position of a drainage device within the anterior chamber is dynamic and significantly influenced by eye movements and blinking. Finally, occasional corneal contact of a XEN gel stent can cause a reduction in endothelial cell density of 2.1% in a month, which represents 46.2% of the annual endothelial loss observed by Tan and colleagues in patients with a Baerveldt tube (4.54% annual decrease).
Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis
Authors: Aaron Rachel V. , Fisher Emma A. , de la Vega Rocio , Lumley Mark A. , Palermo Tonya M.
Published: January 2019

Numerous studies have examined how alexithymia (difficulty identifying and describing one's emotions and a preference for externally oriented thinking) relates to chronic pain and associated disability. We conducted a systematic review and meta-analysis to summarize individual studies that either assessed alexithymia in individuals with chronic pain vs controls or related alexithymia to pain intensity, physical interference, depression, and anxiety. We searched MEDLINE, Embase, and PsycINFO from inception through June 2017; 77 studies met the criteria (valid assessment of alexithymia in adults or children with any chronic pain condition) and were included in analyses (n = 8019 individuals with chronic pain). Primary analyses indicated that chronic pain samples had significantly higher mean alexithymia scores compared with nonclinical (d = 0.81) and clinical nonpain (d = 0.55) controls. In chronic pain samples, alexithymia was significantly positively associated with pain intensity (d = 0.20), physical interference (d = 0.17), depression (d = 0.46), and anxiety (d = 0.43). Secondary meta-analyses of 14 studies that conducted partial correlations that controlled for negative affect-related measures revealed that alexithymia was no longer significantly related to pain intensity or interference. Meta-analysis findings demonstrated that alexithymia is elevated in individuals with chronic pain and related to greater pain intensity and physical interference, although the latter relationships may be accounted for by negative affect. Critical future work is needed that examines alexithymia assessed using non–self-report measures, develops a person-centered perspective on this construct, and identifies how alexithymia is relevant to the assessment and treatment of individuals with chronic pain.
Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers
Authors: Nicholas Michael K. , Costa Daniel S.J. , Blanchard Megan , Tardif Hilarie , Asghari Ali , Blyth Fiona M.
Published: January 2019

Normative data for chronic pain questionnaires are essential to the interpretation of aggregate scores on these questionnaires, for both clinical trials and clinical practice. In this study, we summarised data from 13,343 heterogeneous patients on several commonly used pain questionnaires that were routinely collected from 36 pain clinics in Australia and New Zealand as part of the electronic Persistent Pain Outcomes Collaboration (ePPOC) including the Brief Pain Inventory (BPI); the Depression Anxiety and Stress Scales (DASS); the Pain Self-Efficacy Questionnaire (PSEQ); and the Pain Catastrophizing Scale (PCS). The data are presented as summarised normative data, broken down by demographic (age, sex, work status, etc) and pain site/medical variables. The mean BPI severity score was 6.4 (moderate-severe), and mean interference score was 7.0. The mean DASS depression score was 20.2 (moderate-severe), mean DASS anxiety was 14.0 (moderate), and mean DASS stress was 21.0 (moderate). The mean PCS scores were 10.0, 5.9, 14.1, and 29.8 for rumination, magnification, helplessness, and total, respectively. The mean PSEQ score was 20.7. Men had slightly worse scores than women on some scales. Scores tended to worsen with age until 31 to 50 years, after which they improved. Scores were worse for those who had a greater number of pain sites, were unemployed, were injury compensation cases, or whose triggering event was a motor vehicle accident or injury at work or home. These results and comparisons with data on the same measures from other countries, as well as their uses in both clinical practice and clinical trials, are discussed.
Mirogabalin for the management of postherpetic neuralgia: a randomized, double-blind, placebo-controlled phase 3 study in Asian patients
Authors: Kato Jitsu , Matsui Norimitsu , Kakehi Yoshihiro , Murayama Emiko , Ohwada Shoichi , Sugihara Masahiro
Published: January 2019

This study investigated the safety and efficacy of mirogabalin, a novel, potent, selective ligand of the α2δ subunit of voltage-dependent Ca2+ channels, for the treatment of postherpetic neuralgia (PHN). In this multicenter, double-blind, placebo-controlled phase 3 study, Asian patients ≥20 years with PHN were randomized 2:1:1:1 to placebo or mirogabalin 15, 20, or 30 mg/day for up to 14 weeks (NCT02318719). The primary efficacy endpoint was the change from baseline in average daily pain score at week 14, defined as a weekly average of daily pain (0 = “no pain” to 10 = “worst possible pain,” for the last 24 hours). Of 765 patients randomized, 763 received ≥ 1 dose of the study drug and were included in the analysis; 303, 152, 153, and 155 received placebo, mirogabalin 15, 20, or 30 mg/day, respectively. A total of 671 (87.7%) patients completed the study. At week 14, the difference in average daily pain score least squares mean vs placebo was −0.41, −0.47, and −0.77, respectively; all mirogabalin groups showed statistical significance. The most common treatment-emergent adverse events were somnolence, nasopharyngitis, dizziness, weight increase, and edema, and all of them were mild or moderate in severity. Mirogabalin was superior to placebo in all groups for relieving PHN and appeared well tolerated.
Distance to HIV and Antenatal Care: A Geospatial Analysis in Siaya County, Kenya
Authors: Kohler Pamela K. , Akullian Adam , Okanda John , Otieno George , Kinuthia John , Voss Joachim , Zierler Brenda , John-Stewart Grace
Published: January 2019

As maternal child health (MCH) programs expand in the setting of HIV, health systems are challenged to reach those most vulnerable and at the greatest need. Cross-sectional surveys of MCH clinics and recent mothers in the Siaya Health Demographic Surveillance System were conducted to assess correlates of accessing antenatal care and facility delivery. Of 376 recent mothers, 93.4% accessed antenatal care and 41.2% accessed facility delivery. Per-kilometer distance between maternal residence and the nearest facility offering delivery services was associated with 7% decreased probability of uptake of facility delivery. Compared with a reference of less than 1 km between home and clinic, a distance of more than 3 km to the nearest facility was associated with 25% decreased probability of uptake of facility delivery. Distance to care was a factor in accessing facility delivery services. Decentralization or transportation considerations may be useful to optimize MCH and HIV service impact in high-prevalence regions.
Using Opioids With Surgical Patients: Nurses' Attitudes and Experiences
Authors: Shoqirat Noordeen , Mahasneh Deema , Al-Khawaldeh Omar , Singh Charleen
Published: January 2019

Opioids such as morphine are effective analgesics and have been recognized worldwide for many years; yet, they are underutilized. The study explores the attitudes and experiences relating to opioids, in general, and morphine, in particular, among Jordanian surgical nurses. The Opioids Attitudes Scale was used. A total of 123 questionnaires were distributed, and 120 were returned, achieving a response rate of 96%. Focus group discussions (n = 4) were conducted with surgical nurses (n = 34). The majority of nurses believe that the addiction is the most serious side effects of opioids. Qualitative analysis revealed 2 major themes. The first theme was referred to as “not being in the same boat,” highlighting a lack of teamwork, and comprised 2 subthemes: blame culture and physicians versus nurses. The second “morphine as the last on the list” was also made up of 2 subthemes: the lack of confidence and the fear of legal persecution. Nurses showed negative attitudes and misconceptions about opioids and morphine use within a fragmented surgical unit culture. Therefore, serious efforts must be made to create and sustain an effective unit culture reform and communications path from patient to nurse and doctor.
Evaluation of 3D Printed Temporal Bone Models in Preparation for Middle Cranial Fossa Surgery
Authors: Freiser Monika E. , Ghodadra Anish , Hirsch Barry E. , McCall Andrew A.
Published: January 2019

Hypothesis:

Patient-specific 3D printed models are useful presurgical planning tools because they accurately represent the anatomy and drilling characteristics of the middle cranial fossa (MCF) approach to the internal auditory canal (IAC).

Background:

The MCF approach to the IAC can be challenging due to variability of the bony architecture along the floor of the middle fossa. Patient-specific 3D printed models may enhance surgeon knowledge of a given patient's anatomy when preparing for MCF surgery.

Methods:

Six temporal bone models were printed from photoacrylic resin based on CT data obtained from cadaveric specimens using a desktop stereolithography 3D printer. Critical structures to avoid injuring, the facial nerve and membranous labyrinth, were modeled as hollow cavities and filled with indicator paint. Two neurotologists each drilled three 3D printed models and the corresponding cadaveric specimens, and then completed a 41-item visual analog scale questionnaire (score range of each item: 0–10) to assess the model's accuracy, utility, and potential as a training tool.

Results:

Drilling the model was favorably rated (median score 9.2; range 7.3–9.6) for its ability to provide surgeons with an accurate mental image of the corresponding cadaveric anatomy. Overall similarity of feel of drilling the model in comparison to human bone was moderate (median 7.6; range 6.6–9.0). Surgeons would use this model to prepare for future cases (median 9.4; range 5.1–9.9) and felt it had excellent utility for training purposes (median 9.3; range 8.4–9.9).

Conclusions:

Patient-specific 3D printed models provide an anatomically accurate and favorable tool for preparing for MCF surgery.
The Use of the Exoscope in Lateral Skull Base Surgery: Advantages and Limitations
Authors: Garneau Jonathan C. , Laitman Benjamin M. , Cosetti Maura K. , Hadjipanayis Constantinos , Wanna George
Published: January 2019

Objective:

We describe our experience using the extracorporeal video microscope, the “exoscope” for various applications within the field of lateral skull base surgery.

Study Design:

A retrospective case series was performed investigating patient demographics, indications for surgery, procedure type, operative time, approach to the skull base, complications, adequacy of visualization, and surgeon comfortability.

Patients:

Six cases were performed with a three dimensional surgical exoscope, obviating the use of a traditional binocular microscope.

Setting:

Academic, tertiary referral center.

Main Outcome Measures:

Type of surgical approach, operative time, patient demographics, surgical complications, and surgeon comfortability.

Results:

The following procedures were performed; four vestibular schwannoma resections via suboccipital craniotomy and two combined transmastoid and transtemporal approaches for temporal lobe encephalocele repairs. The average operative time was 227 and 577 minutes for temporal lobe encephalocele repairs and vestibular schwannoma cases, respectively. No intraoperative complications were encountered during these cases. None of the procedures required abandonment of the exoscope in favor of the microscope during the procedure. Advantages include high-resolution three-dimensional visualization, increased degrees of freedom for exoscope adjustment, and reduced surgeon fatigue in a fixed, unnatural posture. Limitations include decreased depth perception and increased operative time.

Conclusion:

The exoscope system is a safe and effective alternative or adjunct to the existing binocular operating microscope for lateral skull based procedures. The exoscope provides the surgeon with a comfortable, high-resolution visualization without compromising surgical exposure and patient safety.

Level of evidence: 4
Fluids and hyperosmolar agents in neurocritical care: an update
Authors: Farrokh Salia , Cho Sung-Min , Suarez Jose I.
Published: January 2019

Purpose of review

To discuss recent updates in fluid management and use of hyperosmolar therapy in neurocritical care.

Recent findings

Maintaining euvolemia with crystalloids seems to be the recommended fluid resuscitation for neurocritical care patients. Buffered crystalloids have been shown to reduce hyperchloremia in patients with subarachnoid hemorrhage without causing hyponatremia or hypo-osmolality. In addition, in patients with traumatic brain injury, buffered solutions reduce the incidence of hyperchloremic acidosis but are not associated with intracranial pressure (ICP) alteration. Both mannitol and hypertonic saline are established as effective hyperosmolar agents to control ICP. Both agents have been shown to control ICP, but their effects on neurologic outcomes are unclear. A recent surge in preference for using hypertonic saline as a hyperosmolar agent is based on few studies without strong evidence.

Fluid resuscitation with crystalloids seems to be reasonable in this setting although no recommendations can be made regarding type of crystalloids. Based on current evidence, elevated ICP can be effectively reduced by either hypertonic saline or mannitol.
Acute kidney injury in cirrhosis: implications for liver transplantation
Authors: MacDonald Andrew J. , Nadim Mitra K. , Durand François , Karvellas Constantine J.
Published: January 2019

Purpose of review

Acute kidney injury (AKI) in cirrhosis consists of varying phenotypes, with hepatorenal syndrome (HRS) representing a single entity. Prompt recognition and diagnosis of AKI cause identifies appropriate therapeutic measures. This review provides an overview of AKI definitions, highlights challenges in quantifying renal impairment in cirrhosis, lists novel diagnostic AKI biomarkers, and summarizes transplantation implications.

Recent findings

Biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18, and liver-type fatty acid-binding protein) may assist in the identification of underlying acute tubular necrosis. Of these, neutrophil gelatinase-associated lipocalin is the most promising; however, significant overlap occurs among AKI phenotypes, with diagnostic values yet to be defined. Mainstay treatment of HRS consists of albumin and vasopressors. Acute-on-chronic liver failure grade independently predicts response to terlipressin treatment. Many end-stage liver disease patients with AKI have underlying chronic kidney disease with important implications on pre and postliver transplantation mortality. Simultaneous liver–kidney transplant candidacy is based on low likelihood of renal recovery.

Novel biomarkers may assist in identification of acute tubular necrosis and persistent/severe AKI. Norepinephrine has been suggested to be inferior to terlipressin, with additional research required. Increasing acute-on-chronic liver failure grade correlates with lower likelihood of vasopressor response in HRS. Severe preliver transplantation AKI confers significantly worse postliver transplantation renal outcomes.
Dyslipidemia in nonalcoholic fatty liver disease
Authors: Amor Antonio J. , Perea Verónica
Published: January 2019

Purpose of review

To summarize recent findings regarding the characterization of lipoprotein disturbances in nonalcoholic fatty liver disease (NAFLD) and their relationship with cardiovascular disease (CVD) and make recommendations for the management of this situation.

Recent findings

Advanced lipoprotein profile (using NMR spectroscopy) has shown profound lipoprotein derangements which are overlooked with conventional analyses: increased number and size of very low-density lipoproteins particles, increased number of low-density lipoprotein particles (especially small sized), smaller high-density lipoprotein particles, and an increase in the triglyceride content of all these lipoproteins. Other changes such as impaired functionality of high-density lipoprotein particles have also been observed. Beyond low-density lipoprotein-related parameters, the importance of triglyceride-rich lipoproteins in the pathogenesis of atherosclerosis has recently gained interest. Several studies suggest that these lipoproteins may have an independent role in CVD in NAFLD populations. Although outcome studies with lipid-lowering drugs in NAFLD are lacking, treatment with both statins, and especially, triglyceride-lowering drugs could be promising for these populations at high residual cardiovascular risk.

In addition to being the main determinant of dyslipidemia, disturbances in triglyceride-rich lipoproteins are thought to be the key factor of increased CVD risk in NAFLD. Treatments specifically aimed at modifying these derangements warrant further study in this high-risk population.
Risk factors for valvular calcification
Authors: Chen Hao Yu , Engert James C. , Thanassoulis George
Published: January 2019

Purpose of review

Recent literature is examined to identify established and emerging risk factors for valvular calcification, specifically calcific aortic valve disease and mitral annular calcification.

Recent findings

Strong evidence implicates older age, male sex, cigarette smoking, elevated blood pressure, dyslipidaemia, adiposity, and mineral metabolism as risk factors for calcific aortic valve disease. Emerging evidence suggests family history and lipoprotein(a) are additional risk factors. Recently, large-scale genome-wide analyses have identified robust associations for LPA, PALMD, and TEX41 with aortic stenosis. Factors predisposing to mitral annular calcification are less well characterized. Older age, cigarette smoking, increased BMI, kidney dysfunction, and elevated triglycerides are associated with greater risk of mitral annular calcification, but conflicting evidence exists for sex and C-reactive protein.

Established and emerging risk factors for calcific aortic valve disease, including some that overlap with atherosclerosis, may represent targets for pharmacological intervention. Mitral annular calcification is comparatively less well understood though some atherosclerosis risk factors do appear to increase risk.
Cannabinoid toxicity in pediatrics
Authors: Blohm Eike , Sell Peter , Neavyn Mark
Published: January 2019

Purpose of review

The advent of legalized cannabis in multiple regions of the United States has rendered the drug more accessible to pediatric patients. Pediatricians and Pediatric Emergency Medicine Providers face new challenges in counseling both patients and their parents, diagnosing exploratory ingestions of cannabinoids in toddlers, and managing complications of prolonged, heavy cannabis use in adolescents. The purpose of this review article is to provide clinicians a succinct summary of recent literature regarding tetrahydrocannabinol (THC) pharmacokinetics, pharmacodynamics, impacts on development, as well as presentations of acute and chronic toxicity.

Recent findings

Many young children being admitted to the hospital for cannabis toxicity have been exposed to high concentration products, such as edibles, resins, or vaping fluid. These products contain extremely high concentrations of cannabinoids, and lead to sedation, respiratory depression, and other adverse effects. Chronic toxicity associated with cannabis consumption includes neurocognitive changes and cannabinoid hyperemesis syndrome.

Clinicians should provide guidance for pediatric patients and their caregivers to reduce the risk of accidental cannabis exposure, particularly with high concentration products. In addition, clinicians should consider chronic cannabis exposure when evaluating certain complaints, such as chronic vomiting or educational performance at school.
Laparoscopic right hepatectomy for living donor
Authors: Kwon Choon Hyuck David , Choi Gyu-Seong , Joh Jae-Won
Published: January 2019

Purpose of review

Many institutions have started or are planning to start a purely laparoscopic right hepatectomy (PLRH) for adult living donor recipients but the experience is relatively very limited. The present review will look at the current status of PLRH and go over some of the technical details important for a safe operation. Necessary elements and different strategies to start a safe and reproducible PLRH program will be discussed.

Recent findings

Several publications with a relatively large number of cases have been published in the last few years. The initial results of PLRH seem to be comparable to open donor hepatectomy when performed by surgeons with sufficient expertise laparoscopic and donor hepatectomy.

With the ongoing accumulation of experience in laparoscopic liver surgery and living donor liver transplantation, it is most likely that PLRH will be performed more widely than the present time. Institutions should implement a step-by-step approach with proctorship, standardization of surgical procedures and a balanced selection criterion for donors for a safe transition from open method to a PLRH program.