bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Motor Repertoire in 3- to 5-Month-Old Infants With Obstetric Brachial Plexus Lesion
Authors: Kahraman Aysu , Mutlu Akmer , Livanelioğlu Ayşe
Published: March 2020

Purpose:

The aim of this study was to define the movement characteristics and postures of infants with obstetric brachial plexus lesion.

Methods:

The study group included 20 infants with obstetric brachial plexus lesion and a control group of 20 infants with normal neurological outcome, aged 9 to 17 weeks postterm. Infants were evaluated by global and detailed general movements assessment.

Results:

There were no significant differences between the motor optimality scores of the 2 groups. However, there were some differences in terms of concurrent movements and the posture. Infants with obstetric brachial plexus lesion demonstrated more excitement bursts, head rotation, hand-knee contact, rolling, and few finger posture and postural asymmetry, and performed jerky movements when compared with the control group.

Conclusions:

Obstetric brachial plexus lesion did not affect the quality of fidgety movements of the infants but leads to compensatory movements in concurrent movements on the unaffected sides.
Motor Development and Health-Related Fitness in Trisomy X: A Case Report
Authors: Varela Silvia , Pérez María , González Sara , Diz José , Lemos Iván , Ayán Carlos
Published: March 2020

Purpose:

This case study provides information regarding the motor development and health-related fitness level of a female with 47,XXX. The Movement Assessment Battery for Children–Second Edition (MABC-2) and the Test of Gross Motor Development-Second Edition (TGMD-2) batteries were used to assess motor competence and gross motor development, respectively. Cardiorespiratory, muscular fitness, and flexibility were assessed by means of field-based tests. Two groups of children developing typically were used for comparison purposes.

Summary of Key Points:

Results from the MABC-2 indicated that the participant was placed in the 37th percentile, whereas the comparison group was placed in the 68th percentile. The participant scored above the 50th percentile in the TGMD-2 and showed lower fitness values than those in the comparison group.

Recommendations for Clinical Practice:

Contrary to what is generally expected, supernumerary 47,XXX does not have to negatively impact motor competence, although a low health-related physical fitness can be present.
EURO-MUSCULUS/USPRM Global Report on Musculoskeletal Ultrasound Publications
Authors: Kara Murat , Gürçay Eda , Ekiz Timur , Sekizkardeş Merve , Yorulmaz Elem , Ata Ayşe Merve , Chang Ke-Vin , Wu Wei-Ting , Akkaya Nuray , Mezian Kamal , Picelli Alessandro , Coraci Daniele , Serrano Simão , Tiftik Tülay , Barotsis Nikolaos , Aydin Gülümser , Giraldo-Prieto Mario , Franchignoni Franco , Özçakar Levent
Published: March 2020

The developments in technology have improved access to the use of musculoskeletal ultrasound (MSUS) in different clinical settings. Accordingly, MSUS has been applied to a wide range of musculoskeletal problems including inflammatory and degenerative diseases, sport injuries, and regional pain syndromes both for clinical practice and research. In this report, the authors aimed to globally examine the publications on MSUS among different specialties, countries, and topics. Sixteen reviewers under the umbrella of the European Musculoskeletal Ultrasonography Society Group and the Ultrasound Study Group of International Society of Physical and Rehabilitation Medicine have evaluated approximately 15,000 publications on MSUS. The authors believe that the results of this comparative analysis may provide a holistic snapshot with regard to the utility of MSUS, not only for clinicians/academicians but also for the industry. Accordingly, while aiming to further increase their awareness, this article would possibly guide future investments as well.
Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000–2013
Authors: Tedesco Dario , Moghavem Nuriel , Weng Yingjie , Fantini Maria Pia , Hernandez-Boussard Tina
Published: March 2020

Objectives

Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms.

Methods

This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ’s PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013.

Results

Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (−31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (−3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives.

Conclusions

National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.
Evidence That Nurses Need to Participate in Diagnosis: Lessons From Malpractice Claims
Authors: Gleason Kelly Therese , Jones Rebecca , Rhodes Christopher , Greenberg Penny , Harkless Gene , Goeschel Chris , Cahill Maureen , Graber Mark
Published: March 2020

Objectives

There is a pressing need for nurses to contribute as equals to the diagnostic process. The purpose of this article is twofold: (a) to describe the contributing factors in diagnosis-related and failure-to-monitor malpractice claims in which nurses are named the primary responsible party and (b) to describe actions healthcare leaders can take to enhance the role of nurses in diagnosis.

Methods

We conducted a review of the Controlled Risk Insurance Company Strategies’ repository of malpractice claims, which contain approximately 30% of United States claims. We analyzed the malpractice claims related to diagnosis (n = 139) and physiologic monitoring (n = 647) naming nurses as the primary responsible party from 2007 to 2016. We used logistic regression to determine the association of contributing factors to likelihood of death, indemnity, and expenses incurred.

Results

Diagnosis-related cases listing communication among providers as a contributing factor were associated with a significantly higher likelihood of death (odds ratio [OR] = 3.01, 95% confidence interval [CI] = 1.50–6.03). Physiologic monitoring cases listing communication among providers as a contributing factor were associated with significantly higher likelihood of death (OR = 2.21, 95% CI = 1.49–3.27), higher indemnity incurred (U.S. $86,781, 95% CI = $18,058–$175,505), and higher expenses incurred (U.S. $20,575, 95% CI = $3685–$37,465).

Conclusions

Nurses are held legally accountable for their role in diagnosis. Raising system-wide awareness of the critical role and responsibility of nurses in the diagnostic process and enhancing nurses’ knowledge and skill to fulfill those responsibilities are essential to improving diagnosis.
Comparison of Patient Safety Incident Reporting Systems in Taiwan, Malaysia, and Indonesia
Authors: Dhamanti Inge , Leggat Sandra , Barraclough Simon , Liao Hsun-Hsiang , Abu Bakar Nor’Aishah
Published: March 2020

Objectives

Incident reporting is one of the tools used to improve patient safety that has been widely used in health facilities in many countries. Incident reporting systems provide functionality to collect, analyze, and disseminate lessons learned to the wider community, whether at the hospital or national level. The aim of this study was to compare the patient safety incident reporting systems of Taiwan, Malaysia, and Indonesia to identify similarities, differences, and areas for improvement.

Methods

We searched the official Web sites and homepages of the responsible leading patient safety agencies of the three countries. We reviewed all publicly available guidelines, regulatory documents, government reports that included policies, guidelines, strategy papers, reports, evaluation programs, as well as scientific articles and gray literature related to the incident reporting system. We used the World Health Organization components of patient safety reporting system as the guidelines for comparison and analyzed the documents using descriptive comparative analysis.

Results

Taiwan had the most incidents reported, followed by Malaysia and Indonesia. Taiwan Patient Safety Reporting (TPR) and the Malaysian Reporting and Learning System had similar attributes and followed the World Health Organization components for incident reporting. We found differences between the Indonesian system and both of TPR and the Malaysian system. Indonesia did not have an external reporting deadline, analysis and learning were conducted at the national level, and there was a lack of transparency and public access to data and reports. All systems need to establish a clear and structured incident reporting evaluation framework if they are to be successful.

Conclusions

Compared with TPR and Malaysian system, the Indonesian patient safety incident reporting system seemed to be ineffective because it failed to acquire adequate national incident reporting data and lacked transparency; these deficiencies inhibited learning at the national level. We suggest further research on the implementation at the hospital level to see how far national guidelines and policy have been implemented in each country.
Preventing Dental Surgical Fires: Characterizing Nasal-Cannulated Supplemental Oxygen Pooling in an In Situ Dental Procedure
Authors: Cox Bradley W. , Jones James E. , Saxen Mark A. , Yepes Juan F.
Published: March 2020

Objectives

Surgical operatory fires continue to occur in the United States, often with devastating consequences. Because more than 21% concentrations of oxygen are necessary for the onset of such combustion, this study examined fluctuations of surgical site oxygen levels. Better understanding how these more than 21% concentrations occur will not only add to surgical fire prevention efforts generally but also potentially reduce patient or staff harm and practitioner liability as well.

Methods

Performing an in situ dental procedure with supplemental nasal-cannulated oxygen and a dental dam, we measured oxygen pooling, defined as any fraction of inspired oxygen (FIO2) greater than the 21% FIO2 of air, on top of and behind a dental dam, and during the application of high-volume intraoral suction.

Results

Findings indicated statistically significantly higher concentrations (as much as twice the <30% recommended safe level) behind the dental dam compared with on top of it. During real-time measurements of FIO2 for four 120-second trials per participant, oxygen levels exhibited significant fluctuation above and below a more stringent 24.9% safety threshold established in prior research. Application of high-speed intraoral dental suction reduced FIO2 to near atmospheric levels in 30 (96.7%) of 31 of the cases by 60 seconds.

Conclusions

These results demonstrate the elevated risk associated with above-safe levels of oxygen pooling during a simple dental procedure. Although future research is needed to still more exactly characterize conditions leading to the onset of surgical fires, this study also demonstrates the ability of high-speed intraoral suction to dramatically and rapidly decrease that risk.
Systemic Therapies for Melanoma Brain Metastases: A Primer for Radiologists
Authors: Dodson Cassidy , Smith Daniel A. , Richards Tyler J. , Devita Robert R. , Hoimes Christopher J. , Ramaiya Nikhil H.
Published: March 2020

Objective

The purpose of this article is to provide a primer for radiologists outlining the modern systemic therapies used in melanoma brain metastases, including tyrosine kinase inhibitors and immune checkpoint inhibitors. The role of radiologic treatment response evaluation will be discussed from the standpoint of both modern systemic therapies and more traditional treatments.

Conclusion

Understanding the role of systemic treatments in melanoma brain metastases is critical for oncologic imaging interpretation in this unique patient population.
Single-Energy Retrospective Metal Artifact Reduction Using Adaptive Thresholding for Metal Implants in the Abdomen and Pelvis
Authors: Dommaraju Sujithraj , Nakhaei Masoud , Zhang Da , Camacho Andres , Boos Johannes , Appel Elisabeth , Brook Olga R.
Published: March 2020

Objective

To assess impact of single-energy metal artifact reduction (SEMAR) algorithm utilizing retrospective adaptive thresholding in reducing metal artifacts in the abdomen and pelvis.

Methods

In this prospective institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study, 90 patients with various metals (n = 97) on computed tomography of abdomen and pelvis (Canon Medical, Aquilion ONE and PRIME) scanned 07/2017–09/2018 with SEMAR retrospectively applied were included. Density was measured in the near and far field to the metals. Density standard deviation (SD), representing artifact severity, was compared with and without SEMAR applied. Two trained human observers independently evaluated severity of artifacts on a five-point scale (0, no artifact; 5, severe artifact).

Results

The SEMAR significantly decreased artifact severity in the near field of high-density metal implants (SD of 204 ± 101HU without vs. 66 ± 40HU with SEMAR, P < 0.001). In the far field, the artifact severity was similar (40 ± 31HU without vs. 36 ± 27HU with SEMAR, P = 0.41). Artifact severity was decreased adjacent to low-density metal in the near field (SD of 86 ± 56HU without vs 49 ± 30HU with SEMAR, P < 0.001). In the far field to the low-density metals artifact severity was similar (33 ± 29HU without vs. 31 ± 27HU with SEMAR, P = 0.79). Subjectively, artifacts severity decreased for high-density metals in near field by 1.3 ± 1.0, and in far field by 0.7 ± 0.7 and for low-density metals in the near field by 0.7 ± 1.0, far field 0.4 ± 0.5, all P < 0.05.

Conclusions

The SEMAR retrospective algorithm with adaptive thresholding subjectively and objectively reduced near-field artifacts generated by high- and low-density metals.
Anatomy of the Anterior Clinoid Process in Human Fetuses
Authors: Beger Orhan , Hamzaoğlu Vural , Özalp Hakan , Taghipour Pourya , Çakir Salim , Akbulut Şuranur , Vayisoğlu Yusuf , Bağdatoğlu Celal , Öztürk Ahmet Hakan , Talas Derya Ümit
Published: March 2020

Purpose:

The main objective of this study was to display the morphologic properties of the anterior clinoid process (ACP) in human fetuses in term of early childhood surgeries.

Methods:

Twenty-four (10 females and 14 males) fetal cadavers aged from 16th to 28th weeks of gestation (at mean, 21.54 ± 3.11 weeks) were included in the present study. The dimensions of ACP were measured with a digital image analysis software.

Results:

Taking into account the length, width, and angle of ACP, it was classified as Type 1 in 20.83% (10 cases), Type 2 in 10.42% (5 cases), Type 3 in 10.42% (5 cases), Type 4 in 2.08% (1 case), Type 5 in 8.33% (4 cases), Type 6 in 16.67% (8 cases), Type 7 in 8.33% (4 cases), and Type 8 in 22.92% (11 cases). According to the attachment site of the optic strut (OS) relative to ACP, OS was identified as the anterior 3/5 in 16.67% (8 cases), anterior 4/5 in 68.75% (33 cases), and posterior 1/5 in 14.58% (7 cases). Neither right-left nor male-female significant differences were observed between the quantitative values belonging to ACP and OS.

Conclusion:

The percentage of the most complex and challenging type of ACP (the long, narrow, and narrow-angled ACP) in fetuses was found to be close to adults. Thus, routine adult surgical procedures such as anterior clinoidectomy might be successfully used in young children and infants. The attachment site of OS relative to ACP in adults was more anterior according to fetuses probably due to postnatal development such as the pneumatization of the sphenoid bone. In this regard, for pediatric neurosurgeons to avoid iatrogenic injuries and to select appropriate surgical approaches, further studies conducted on the attachment of OS relative to ACP in children are needed.
A New Bony Anatomical Landmark for Lateral Skull Base Surgery
Authors: Liu Zhen , Yi Zhiqiang
Published: March 2020

Background and Objective:

The aim of the study was to propose a new bony landmark, point O, which is the junction point of the temporosphenoid suture and the infratemporal ridge; this landmark may improve the identification and preservation of neurovascular structures when approaches are used to access the middle cranial fossa in lateral skull base tumor surgeries.

Methods:

Fifteen cadaveric heads were measured for anatomical analysis. Related surgical landmarks were studied using the Destroscope virtual reality system and during the dissection procedures, and the results were analyzed and compared.

Results:

From the perspective of the middle skull base, the radial lines from point O to the interior point of the superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum are approximately equal in length, with an average length of 23.22 mm, and the above 5 points form a sector with an angle of 66.07° and an area of 310.71 mm2.

Conclusions:

Identification of point O as a landmark for lateral skull base surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complicated operations. The interior points of the superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum are distributed on the arc of a circle whose center is point O. The sector formed by the above 5 points is not only a crucial area for the communication of lesions between the middle skull base and the infratemporal fossa but also a safe avenue through which to remove skull base lesions.
Change in Incisional Design in Primary Unilateral Cleft Lip Repair Under General Anesthesia
Authors: Tsuda Tomoko , Lan Lan , Morioka Daichi , Sato Nobuhiro , Tosa Yasuyoshi , Ohkubo Fumio , Kadomatsu Koichi
Published: March 2020

Nasolabial features of infants with unilateral cleft lip (UCL) are different when they are under general anesthesia for lip repair compared to when they are awake. This study aimed to investigate changes in the incisional design of cheiloplasty according to patient position and anesthesia: upright and awake versus supine and under general anesthesia. Three-dimensional images of 20 infants with UCL were randomly selected. Two different incisional designs were drawn on the images captured while the infants were awake. Those incisional designs were anthropometrically compared to the designs drawn on the images captured while the infants were under general anesthesia. Under general anesthesia, vermillion height of both the medial and lateral sides of the cleft became significantly greater. In the rotation-advancement design, the incisional line of the rotation flap on the medial lip element became significantly shorter under general anesthesia, whereas the advancement flap on the lateral lip element was not significantly altered. In an anatomical subunit approximation, both lengths of the philtral ridge on the noncleft side and incisional line along the philtral ridge on the cleft side became significantly shorter under general anesthesia, but these alterations did not affect the calculation of the width of the small triangular flap on the lateral lip element. These changes in nasolabial features after general anesthesia may cause surgical error, which result in secondary cleft lip deformities. However, because these changes varied among infants, preoperative planning using three-dimensional facial images of infants who are awake may be able to avoid surgical error.
Comparing Hemorrhage in Human Physiology Simulation Tools: How They Compare With Expected Human Physiology and Each Other
Authors: Barnes John Jacob , Kiberenge Kenneth , Sweet Robert , Keller Jon , Konia Mojca R.
Published: March 2020

Introduction

Several different whole-body physiology simulation tools (PST) using modeling techniques are now available with potential use for healthcare simulation, but these novel technologies lack objective analysis from an independent organization.

Methods

We identified BioGears, HumMod, and Muse as 3 PSTs that met our requirements for testing. We ran mild, moderate, and severe hemorrhage scenarios on each PST and collected outputs for comparison with each other and published human physiology data.

Results

All PSTs tested followed the expected tachycardic and hypotensive response to hemorrhage for all levels of severity with variable qualitative patterns. Complete data for analysis were not available in all PSTs for urine output, stroke volume, blood volume, hemoglobin, and serum epinephrine concentration, but the partial findings are discussed in detail. We determined the predicted time to reach hemorrhage shock based on the hemorrhage guidelines and compared this with time to cardiovascular collapse from each PST. Overall, the differences from known human physiology were much larger than expected before testing and trends show HumMod with the smallest difference for severe (−6.25%) and moderate (−1.42%) and Muse with the smallest difference for mild hemorrhage (27.9%). BioGears demonstrated the largest differences in all classifications of severity.

Conclusions

Our analysis of currently available whole-body PSTs provides insight into the novel, evolving field. We hope our efforts shed light to a wider audience to the exciting developments and uses of mathematical modeling for whole-body simulation and the potential for integration into healthcare simulation for medical education.
A Low-Cost Trainer for the Surgical Management of Postpartum Hemorrhage
Authors: Chuang Meleen , Purswani Heena , Fazzari Melissa J. , Kaplan Julie , Pardanani Setul , Banks Erika H.
Published: March 2020

Introduction

Simulation-based training to manage surgical postpartum hemorrhage allows for improved preparation for these rarely needed life-saving procedures. Our objectives were to design a low-tech simulation model for use in training and evaluation of surgical techniques for the management of postpartum hemorrhage and to present evidence of its validity in assessment and training.

Methods

Fifty-two obstetrics and gynecology residents and 25 attending physicians from an academic hospital were video recorded while performing the O'Leary and B-Lynch techniques on the low-tech model. Performance was evaluated using a Technical Skills Checklist, for B-Lynch and O'Leary techniques, and the Reznick's Global Rating Scale. Interrater reliability was computed to assess the consistency of the ratings between 2 raters. Average scores were determined and compared between incoming residents, junior residents, senior residents, and attending physicians to show construct validity.

Results

For the B-Lynch, Technical Skills Checklist scores (maximum 17 points) of attendings (15.04) and senior residents (15.12) were higher than those of junior residents (5.63) and new residents (3.38). Global Rating Scale scores (maximum 25 points) on the B-Lynch reflected the same increase (22.38, 19.35 vs. 8.85, 6.75, respectively). For the O'Leary stitch, the scores of attendings, senior, junior, and incoming residents were as follows: 15.20, 13.65, 11.54, and 2.83, respectively (maximum 19 points). This supports the construct validity of the model. The model was considered realistic and useful for improving surgical skills in 71.4% of participants.

Conclusions

This low-cost, easily constructed model is a useful tool for training these surgical skills.
DebriefLive
Authors: Wong Nelson L. , Peng Cynthia , Park Chan W. , Pérez José , Vashi Anita , Robinson Jane , Okuda Yasuharu
Published: March 2020

Introduction

The quality of healthcare simulation learning relies heavily on effective debriefers. Traditional methods of faculty development in debriefing lack a structured approach to achieve expertise via graduated and reflective practice.

Methods

The Simulation Learning, Education and Research Network (SimLEARN) developed DebriefLive, a virtual teaching environment, bringing together faculty and participant debriefers from across the Veterans Health Administration. Recorded simulation sessions were viewed followed by the opportunity for participant debriefers to debrief virtual learners. Participant debriefers were then provided structured and objective debriefings of the debriefings with the added opportunity for immediate practice. Program evaluation data for the pilot sessions were collected via electronic survey including a mix of Likert scale questions as well as short answer responses.

Results

On a 7-point Likert scale, participant debriefers (n = 15) rated the content as effective (mean = 6.67, SD = 0.47) and appropriate to their level (mean = 6.47, SD = 0.47). The technology of video-based scenarios (mean = 6.6, SD = 0.61), followed by avatar-based debriefing sessions (mean = 6.6, SD = 0.8), was felt to be accurate and appropriate. All participants would agree or strongly agree with recommending this training program to colleagues.

Conclusions

Simulation instructors and fellows across the spectrum of the Veterans Health Administration found the innovative computer-based faculty development program DebriefLive acceptable as well as effective in increasing self-efficacy in debriefing. DebriefLive is an innovative and potentially disruptive tool, combining best practices in simulation theory and virtual technologies, for the training and assessment of debriefers.
Perioperative Outcomes for Combined Ventral Rectopexy With Sacrocolpopexy Compared to Perineal Rectopexy With Vaginal Apical Suspension
Authors: Smith Pamela E. , Hade Erinn M. , Pandya Lopa K. , Nekkanti Silpa , Hundley Andrew F. , Hudson Catherine O.
Published: March 2020

Objectives

To describe and compare perioperative complications in women undergoing combined ventral rectopexy with sacrocolpopexy compared with perineal rectopexy with vaginal apical suspension.

Methods

Current Procedural Terminology codes were used to identify women in the National Surgical Quality Improvement Program database who underwent ventral rectopexy with sacrocolpopexy or perineal rectopexy with vaginal apical suspension from 2006 to 2015. Perioperative complication was defined as any of the following within 30 days of surgery: death, return to the operating room, transfusion, or vascular, wound, respiratory, infectious, or renal morbidity. Secondary outcomes included length of hospital stay, operative time, blood loss, readmission, and rate of urinary tract infections. Modified Poisson regression was used to estimate the adjusted relative risks of complication associated with surgical approach, abdominal versus perineal.

Results

Of the 273 women included, 240 (88%) underwent surgery with an abdominal approach, and 33 (12%) underwent surgery with a perineal approach. Perioperative complications occurred in 24 (9%) patients; 19 (8%) in the abdominal group and 5 (15%) in the perineal group. The age-adjusted risk of perioperative complications was not significantly different between those with a perineal approach compared with those with an abdominal approach (adjusted relative risk, 1.78; 95% confidence interval, 0.73–4.33).

Conclusions

Patients in this database who underwent surgery with a vaginal/perineal approach were not more likely to have a postoperative complication after adjusting for age compared with those undergoing an abdominal approach. Larger studies are needed to determine a more precise estimate of the impact of surgical approach on rates of perioperative complications.
“Landmark” Articles in Female Pelvic Medicine and Reconstructive Surgery: Do We Read What We Cite?
Authors: Gupta Ankita , Kennedy Bridget , Meriwether Kate V. , Hobson Deslyn T. G. , Francis Sean L. , Stewart J. Ryan
Published: March 2020

Objective

The aim of the study was to describe the provision of a “landmark” article reading list to trainees by their Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship programs.

Methods

In this cross-sectional study, a web-based survey was sent to program coordinators of accredited FPMRS programs. Available reading lists were collected, and a master list compiled. Nonparametric tests were used to investigate the association between the number of faculty members and presence of a reading list.

Results

We received a response from 46 (92%) of the 50 Accreditation Council for Graduate Medical Education programs contacted. Half the programs (23/46, 50%) reported that they do not offer a recommended reading list, 5 programs were unsure and over more than 60% with a list (12/18, 67%) shared their list with the investigators. Programs had between 2 and 14 core faculty members with a median (interquartile range) of 4 (3–6). Programs with a reading list had significantly fewer faculty members (3.5, 3–5 vs 5, 3–6, P = 0.03). There were 323 unique articles across the 12 lists, with a median of 25 articles per list. Thirty-four articles were on 4 or more lists; 9 of these (9/34, 26%) have previously been identified as citation classics.

Conclusions

At least 50% of the Accreditation Council for Graduate Medical Education accredited programs do not provide their fellows with a recommended reading list, and fewer core faculty members are associated with the presence of such a list. Although some commonalities are found between reading lists, a universal reading list of “landmark” articles could improve the consistency of FPMRS fellowship education.
Risk Factors for Returning to the Operating Room for a Second Surgery After Midurethral Sling for Stress Urinary Incontinence
Authors: Sharif Fatima , Mahmud Fizza , Suman Sahil , Cheng An-Lin , Shepherd Jonathan P. , Sutkin Gary
Published: March 2020

Objectives

The objective of this study was to identify risk factors for having to return to the operating room for a second surgery after midurethral sling (MUS).

Methods

We used a case-control design. Cases return to operating room were a composite of 6 surgical complications or recurrent stress urinary incontinence because we believed that women would consider return to the operating room (OR) a similar MUS-related complication regardless of indication. Cases were obtained from Cerner Health Facts database, including 213 hospitals, using current procedural technology codes 57288 (repeat sling), 57287 (sling revision), and 53500 (urethrolysis) for procedures after index MUS. Controls no return to OR were randomly selected in 4:1 ratio from the remaining slings without these procedures. Multivariable regression analysis included all variables with P < 0.10 on univariable analysis.

Results

Between January 1, 2010, and December 31, 2016, 1247 patients returned to the OR of 17,953 patients who underwent initial MUS (6.9%). After adjusting for confounders, white race (OR, 1.47 [1.20–1.81]), lack of concomitant prolapse surgery (OR, 1.37 [1.18–1.59]), immunosuppressant drugs (OR, 1.27 [1.12–1.45]), and blood thinner use (OR, 1.38 [1.18–1.62]) significantly impacted the odds for returning to the OR. Anticholinergic use and smoking tobacco or marijuana, although significant on univariable analysis, were no longer significant after adjusting for confounders.

Conclusions

The rate of a second surgery after MUS using a composite outcome, over a 7-year period including multiple diagnoses, is 6.9%. White race, using immunosuppressant drugs, using blood thinners, and not having concomitant prolapse surgery are all risk factors for having second surgery after MUS.
The Design of a Prospective Trial to Evaluate the Role of Preoperative Frailty Assessment in Older Women Undergoing Surgery for the Treatment of Pelvic Organ Prolapse: The FASt Supplemental Trial
Authors: Erekson Elisabeth , Menefee Shawn , Whitworth Ryan E. , Amundsen Cindy L. , Arya Lily A. , Komesu Yuko M. , Ferrando Cecile A. , Zyczynski Halina M. , Sung Vivian W. , Rahn David D. , Tan-Kim Jasmine , Mazloomdoost Donna , Gantz Marie G. , Richter Holly E. ,   on behalf of the Eunice Kennedy Shriver NICHD Pelvic Floor Disorders Network (PFDN)
Published: March 2020

Objective

We present the rationale for and the design of a prospective trial to evaluate the role of preoperative frailty and mobility assessments in older women undergoing surgery for the treatment of pelvic organ prolapse (POP) as a planned prospective supplemental trial to the ASPIRe (Apical Suspension Repair for Vault Prolapse In a Three-Arm Randomized Trial Design) trial. The Frailty ASPIRe Study (FASt) examines the impact of preoperative frailty and mobility on surgical outcomes in older women (≥65 years) participating in the ASPIRe trial. The primary objective of FASt is to determine the impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgery for POP.

Methods

The selection of the preoperative assessments, primary outcome measures, and participant inclusion is described. Frailty and mobility measurements will be collected at the preoperative visit and include the 6 Robinson frailty measurements and the Timed Up and Go mobility test. The main outcome measure in the FASt supplemental study will be moderate to severe postoperative adverse events according to the Clavien-Dindo Severity Classification.

Conclusions

This trial will assess impact of preoperative age, multimorbidity, frailty, and decreased mobility on postoperative outcomes in older women (≥65 years old) undergoing surgical procedures for the correction of apical POP. Information from this trial may help both primary care providers and surgeons better advise/inform women on their individual risks of surgical complications and provide more comprehensive postoperative care to women at highest risk of complications.
Identification of injury and shock driven effects on ex vivo platelet aggregometry: A cautionary tale of phenotyping
Authors: Starr Nichole E. , Matthay Zachary A. , Fields Alexander T. , Nunez-Garcia Brenda , Callcut Rachael A. , Cohen Mitchell J. , Kornblith Lucy Zumwinkle
Published: March 2020

BACKGROUND

Platelet behavior in trauma-induced coagulopathy is poorly understood. Injured patients have impaired platelet aggregation (dysfunction) in ex vivo agonist-stimulated platelet aggregometry (PA). However, PA assumes that platelets are inactivated before ex vivo stimulated aggregation, which may be altered by injury. We hypothesized that following trauma, platelet aggregation (area under the curve) is decreased regardless of injury burden, but that (1) minor injury is associated with an increased baseline electrical impedance, characteristic of a functional platelet phenotype (platelets that activate in response to injury), and that (2) severe injury is not associated with an increased baseline electrical impedance, characteristic of a dysfunctional phenotype (platelets that do not activate well in response to injury) compared with healthy controls.

METHODS

Blood from 458 trauma patients and 30 healthy donors was collected for PA. Baseline electrical impedance (Ω); platelet aggregation stimulated by adenosine diphosphate, collagen, thrombin, and arachidonic acid; and rotational thromboelastometry were measured. Multivariate regression was performed to identify associations of PA measures with blood transfusion.

RESULTS

Compared with healthy controls, injured patients had impaired platelet aggregation in response to ex vivo stimulation, regardless of injury burden. However, minorly injured patients had increased endogenous platelet activation (baseline electrical impedance, Ω: with shock, p = 0.012; without shock, p = 0.084), but severely injured patients did not have significant increases in endogenous platelet activation (baseline electrical impedance, Ω: with shock, p = 0.86; without shock, p = 0.37). For every 10 Ω increase in baseline electrical impedance, there was an 8% decrease in units of blood transfused in the first 24 h (−0.08; confidence interval, −0.14 to −0.02; p = 0.015).

CONCLUSION

Injury and shock confer differential patterns of platelet aggregation in PA. Minor injury overestimates the presence of platelet dysfunction, while severe injury induces a truly dysfunctional phenotype—platelets that do not activate nor aggregate appropriately after injury. This is consequential in improving accurate phenotyping of postinjury platelet behavior for platelet-based therapeutics.

LEVEL OF EVIDENCE

Prognostic, level IV.
Liver Transplantation for Cholangiocarcinoma and Mixed Hepatocellular Cholangiocarcinoma: Working Group Report From the ILTS Transplant Oncology Consensus Conference
Authors: Sapisochin Gonzalo , Javle Milind , Lerut Jan , Ohtsuka Masayuki , Ghobrial Mark , Hibi Taizo , Kwan Nancy Man , Heimbach Julie
Published: March 2020

Liver transplantation for cholangiocarcinoma has been an absolute contraindication worldwide due to poor results. However, in recent years and thanks to improvements of patient management and treatments of this cancer, this indication has been revisited. This consensus paper, approved by the International Liver Transplant Society, aims to provide a collection of expert opinions, consensus, and best practices surrounding liver transplantation for cholangiocarcinoma.
Pseudomonas piscis sp. nov., isolated from the profound head ulcers of farmed Murray cod (Maccullochella peelii peelii)
Authors: Liu Yang , Rao Qiuhua , Blom Jochen , Lin Qiu , Luo Tuyan
Published: March 2020

A Gram-stain-negative, strictly aerobic, motile, rod-shaped bacterium with monopolar flagella, designated as MC042T, was isolated from the profound head ulcers of farmed Murray cod sampled from Zhejiang Province, China. Analysis of its 16S rRNA gene sequence and multilocus sequence analysis phylogeny showed that strain MC042T belonged to the genus

Pseudomonas

, showing the highest 16S rRNA gene sequence similarity to

Pseudomonas juntendi

BML3T (98.9 %), and less than 98.8 % similarity to other

Pseudomonas

species with validly published names. Whole-genome sequencing and phylogenetic reconstruction based on a core set of 1563

Pseudomonas

genes further indicated that strain MC042T was most closely related to the clade formed by

Pseudomonas protegens

CHA0T and

Pseudomonas saponiphila

DSM 975T and distantly related to any of the validly published species of the genus

Pseudomonas

. Furthermore, strain MC042T could be distinguished from its closely related species of the genus

Pseudomonas

by its ability to assimilate maltose, d-xylose and melibiose, but not d-mannitol. The principal fatty acids were C16 : 0, summed feature 3 (iso-C15 : 0 2-OH and/or C16 : 1ω7c) and summed feature 8 (C18 : 1
ω7c and/or C18 : 1
ω6c). The respiratory quinone was Q-9. Polar lipids of strain MC042T comprised diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, unidentified glycolipids, an unidentified lipid, an unknown glycolipid and aminolipid. Based on its phenotypic, chemotaxonomic and phylogenetic features, strain MC042T is considered to represent a novel species, for which the name Pseudomonas piscis sp. nov. is proposed. The type strain is MC042T (=KCTC 72033T=MCCC 1K03575T).
Guidelines for preventing respiratory illness in older adults aged 60 years and above living in long-term care
Authors: Rios Patricia , Radhakrishnan Amruta , Thomas Sonia M. , Darvesh Nazia , Straus Sharon E. , Tricco Andrea C.
Published: March 2020

Background

The overall objective of this rapid review was to identify infection protection and control recommendations from published clinical practice guidelines (CPGs) for adults aged 60 years and older in long-term care settings

Methods

Comprehensive searches in MEDLINE, EMBASE, the Cochrane Library, and relevant CPG publishers/repositories were carried out in early March 2020. Title/abstract and full-text screening, data abstraction, and quality appraisal (AGREE-II) were carried out by single reviewers.

Results

A total of 17 relevant CPGs were identified, published in the USA (n=8), Canada (n=6), Australia (n=2), and the United Kingdom (n=1). All of the CPGs dealt with infection control in long-term care facilities (LTCF) and addressed various types of viral respiratory infections (e.g., influenza, COVID-19, severe acute respiratory syndrome). Ten or more CPGs recommended the following infection control measures in LTCF: hand hygiene (n=13), wearing personal protective equipment (n=13), social distancing or isolation (n=13), disinfecting surfaces (n=12), droplet precautions (n=12), surveillance and evaluation (n=11), and using diagnostic testing to confirm illness (n=10). While only two or more CPGs recommended these infection control measures: policies and procedures for visitors, staff and/or residents (n=9), respiratory hygiene/cough etiquette (n=9), providing supplies (n=9), staff and/or residents education (n=8), increasing communication (n=6), consulting or notifying health professionals (n=6), appropriate ventilation practices (n=2), and cohorting equipment (n=2). Ten CPGs also addressed management of viral respiratory infections in LTCF and recommended antiviral chemoprophylaxis (n=10) and one CPG recommended early mobilization of residents.

Conclusion

The recommendations from current guidelines overall seem to support environmental measures for infection prevention and antiviral chemoprophylaxis for infection management as the most appropriate first-line response to viral respiratory illness in long-term care.
Bedrock radioactivity influences the rate and spectrum of mutation
Authors: Saclier Nathanaëlle , Chardon Patrick , Malard Florian , Konecny-Dupré Lara , Eme David , Bellec Arnaud , Breton Vincent , Duret Laurent , Lefébure Tristan , Douady Christophe J.
Published: March 2020

All organisms on Earth are exposed to low doses of natural radioactivity but some habitats are more radioactive than others. Yet, documenting the influence of natural radioactivity on the evolution of biodiversity is challenging. Here, we addressed whether organisms living in naturally more radioactive habitats accumulate more mutations across generations using 14 species of waterlice living in subterranean habitats with contrasted levels of radioactivity. We found that the mitochondrial and nuclear mutation rates across a waterlouse species’ genome increased on average by 60 and 30%, respectively, when radioactivity increased by a factor of three. We also found a positive correlation between the level of radioactivity and the probability of G to T (and complementary C to A) mutations, a hallmark of oxidative stress. We conclude that even low doses of natural bedrock radioactivity influence the mutation rate through the likely accumulation of oxidative damage, in particular in the mitochondrial genome.
AntiCP 2.0: An updated model for predicting anticancer peptides
Authors: Agrawal Piyush , Bhagat Dhruv , Mahalwal Manish , Sharma Neelam , Raghava Gajendra P. S.
Published: March 2020

Increasing use of therapeutic peptides for treating cancer has received considerable attention of the scientific community in the recent years. The present study describes thein silicomodel developed for predicting and designing anticancer peptides (ACPs). ACPs residue composition analysis revealed the preference of A, F, K, L and W. Positional preference analysis revealed that residue A, F and K are preferred at N-terminus and residue L and K are preferred at C-terminus. Motif analysis revealed the presence of motifs like LAKLA, AKLAK, FAKL, LAKL in ACPs. Prediction models were developed using various input features and implementing different machine learning classifiers on two datasets main and alternate dataset. In the case of main dataset, ETree Classifier based model developed using dipeptide composition achieved maximum MCC of 0.51 and 0.83 AUROC on the training dataset. In the case of alternate dataset, ETree Classifier based model developed using amino acid composition performed best and achieved the highest MCC of 0.80 and AUROC of 0.97 on the training dataset. Models were trained and tested using five-fold cross validation technique and their performance was also evaluated on the validation dataset. Best models were implemented in the webserver AntiCP 2.0, freely available athttps://webs.iiitd.edu.in/raghava/anticp2. The webserver is compatible with multiple screens such as iPhone, iPad, laptop, and android phones. The standalone version of the software is provided in the form of GitHub package as well as in docker technology.
Functional Localization of an Attenuating Filter within Cortex for a Selective Detection Task in Mice
Authors: Aruljothi Krithiga , Marrero Krista , Zhang Zhaoran , Zareian Behzad , Zagha Edward
Published: March 2020

An essential feature of goal-directed behavior is the ability to selectively respond to the diverse stimuli in one’s environment. However, the neural mechanisms that enable us to respond to target stimuli while ignoring distractor stimuli are poorly understood. To study this sensory selection process, we trained male and female mice in a selective detection task in which mice learn to respond to rapid stimuli in the target whisker field and ignore identical stimuli in the opposite, distractor whisker field. In expert mice, we used widefield Ca2+imaging to analyze target-related and distractor-related neural responses throughout dorsal cortex. For target stimuli, we observed strong signal activation in primary somatosensory cortex (S1) and frontal cortices, including both the whisker representation of primary motor cortex (wMC) and anterior lateral motor cortex (ALM). For distractor stimuli, we observe strong signal activation in S1, with minimal propagation to frontal cortex. Our data support only modest subcortical filtering, with robust, step-like attenuation in distractor processing between mono-synaptically coupled regions of S1 and wMC. This study establishes a highly robust model system for studying the neural mechanisms of sensory selection and places important constraints on its implementation.

Responding to task-relevant stimuli while ignoring task-irrelevant stimuli is critical for goal-directed behavior. Yet, the neural mechanisms involved in this selection process are poorly understood. We trained mice in a detection task with both target and distractor stimuli. During expert performance, we measured neural activity throughout cortex using widefield imaging. We observed responses to target stimuli in multiple sensory and motor cortical regions. In contrast, responses to distractor stimuli were abruptly suppressed beyond sensory cortex. Our findings localize the sites of attenuation when successfully ignoring a distractor stimulus, and provide essential foundations for further revealing the neural mechanism of sensory selection and distractor suppression.