bluuebunny/crossref_metadata_2025 huggingface dataset:
Anti-MDA5 juvenile idiopathic inflammatory myopathy: a specific subgroup defined by differentially enhanced interferon-α signalling
Authors: Melki Isabelle , Devilliers Hervé , Gitiaux Cyril , Bondet Vincent , Duffy Darragh , Charuel Jean-Luc , Miyara Makoto , Bokov Plamen , Kheniche Ahmed , Kwon Theresa , Authier François Jérôme , Allenbach Yves , Belot Alexandre , Bodemer Christine , Bourrat Emmanuelle , Dumaine Cécile , Fabien Nicole , Faye Albert , Frémond Marie-Louise , Hadchouel Alice , Kitabayashi Naoki , Lepelley Alice , Martin-Niclos Maria José , Mudumba Sasi , Musset Lucile , Quartier Pierre , Rice Gillian I , Seabra Luis , Uettwiller Florence , Uggenti Carolina , Viel Sebastien , Rodero Mathieu P , Crow Yanick J , Bader-Meunier Brigitte
Published: October 2019

Objectives

JDM and juvenile overlap myositis represent heterogeneous subtypes of juvenile idiopathic inflammatory myopathy (JIIM). Chronic evolution can occur in up to 60% of cases, and morbidity/mortality is substantial. We aimed to describe the clinical, biological, histological and type I IFN status in JIIM associated with anti-melanoma differentiation-associated protein 5 (anti-MDA5) autoantibodies at presentation (group 1) in comparison with other JIIM (group 2).

Methods

This was a retrospective and prospective study of patients with JIIM ascertained from three French paediatric rheumatology reference centres between 2013 and 2019. Muscle biopsies were reviewed. Type I interferon pathway activity was assessed by dosage of IFNα serum protein and the expression of IFN-stimulated genes.

Results

Sixty-four patients were included, 13 in group 1 (54% JDM and 46% juvenile overlap myositis) and 51 in group 2 (76% JDM and 24% juvenile overlap myositis). Group 1 patients demonstrated more arthritis, skin ulcerations, lupus features and interstitial lung disease, and a milder muscular involvement. Serum IFNα levels were higher in group 1 than 2, and decreased after treatment or improvement in both groups. Outcome was similar in both groups. Unconventional treatment (more than two lines) was required in order to achieve remission, especially when skin ulceration was reported.

Conclusion

This study indicates a higher frequency of arthritis, skin ulcerations and interstitial lung disease, but milder muscular involvement, in JIIM with positive anti-MDA5 autoantibodies compared with other JIIM. Our data support an important role of systemic IFNα in disease pathology, particularly in the anti-MDA5 auto-antibody-positive subgroup. In severe and refractory forms of JIIM, IFNα may represent a therapeutic target.
Phylogeny of European Anodontini (Bivalvia: Unionidae) with a redescription of Anodonta exulcerata
Authors: Riccardi Nicoletta , Froufe Elsa , Bogan Arthur E , Zieritz Alexandra , Teixeira Amílcar , Vanetti Isabella , Varandas Simone , Zaccara Serena , Nagel Karl-Otto , Lopes-Lima Manuel
Published: October 2019

Freshwater bivalves are highly threatened and globally declining due to multiple anthropogenic impacts, making them important conservation targets. Because conservation policies and actions generally occur at the species level, accurate species identification and delimitation is critical. A recent phylogenetic study of Italian mussel populations revalidated an Anodonta species bringing the number of known European Anodontini from three to four species. The current study contributes to the clarification of the taxonomy and systematics of European Anodontini, using a combination of molecular, morphological and anatomical data, and constructs phylogenies based on complete mitogenomes. A redescription of A. exulcerata and a comparative analysis of morphological and anatomical characters with respect to the other two species of Anodonta present in the area are provided. No reliable diagnostic character has emerged from comparative analysis of the morphometric characters of 109 specimens from 16 sites across the Italian peninsula. In fact, the discriminant analysis resulted in a greater probability of correct assignment to the site of origin than to the species. This confirms the difficulties of an uncritical application of visual characters for the delimitation of species, especially for Anodontinae.
Arts-Based Reflection on the End of Life: Nursing Student Narrative Analysis
Authors: Forbes Maryann O. , Oates Virginia C.
Published: October 2019

Nurses play an essential role in providing compassionate evidence-based care at the end of life, yet many undergraduate students have limited opportunities to participate in end-of-life care experiences. Arts-based pedagogy has been explored as a strategy in nursing education that focuses on the affective domain of learning. The purpose of this qualitative narrative analysis was to explore the impact of an arts-based reflection assignment on student affective learning using artistic images depicting end-of-life scenarios. Student written narratives (n = 21) were analyzed using content analysis, and four themes emerged that described the components of affective learning in several areas.
Nonacademic Factors That Influence Nontraditional Nursing Student Retention
Authors: Priode Kimberly Slone , Dail Robin B. , Swanson Melvin
Published: October 2019

The purpose of this study is to identify the most supportive and restrictive factors contributing to students’ ability to persist through nursing program course completion as perceived by 59 nontraditional students enrolled in a nursing associate degree program. The Student Perception Appraisal-Revised tool was used. Results include that encouragement by friends within school is the top supportive factor, while financial status was found to be the most restrictive factor. Students’ perceptions of why they are not successful in staying in school may help nurse educators to plan and implement changes for improvement based on changing student needs.
The Relationship Between Social Identity, Stereotype Threat, and Academic Success Among Prenursing Students
Authors: Sullivan Katherine , Guzman Anissa S. , Ghaffari Dylan
Published: October 2019

The relationships between social identity, stereotype threat, and academic success were explored among prenursing students. Stereotype threat has been linked to academic success in students from underrepresented populations within the social sciences and educational literature but has not been explored in nursing. A descriptive correlational design was used with Picho and Brown’s Social Identities and Attitudes Scale emailed to 159 prenursing students. Stereotype threat was significantly related to race/ethnicity with no significant relationship between stereotype threat and academic success. Further exploration of stereotype threat in nursing is warranted; there may be implications for retention and support of diverse students.
Characteristics and Predictors of HCAHPS Nonresponse After Spine Surgery
Authors: Malpani Rohil , Adrados Murillo , Mercier Michael R. , McLynn Ryan P. , Galivanche Anoop R. , Pathak Neil , Grauer Jonathan N.
Published: October 2019

Study Design.

Retrospective cohort study.

Objective.

To assess nonresponder biases for the HCAHPS survey following spine surgery.

Summary of Background Data.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported patient satisfaction survey. In addition to having the potential of impacting a hospital's reputation, it is directly linked to government reimbursement. However, it is known that a minority of patients return this survey, and it is expected that there are nonresponder biases.

Methods.

All adult inpatient spine surgery patients at a single institution between January 2013 and August 2017 at a single institution were selected for retrospective analysis. Patient demographics and perioperative outcomes were assessed as potential predictors of not returning HCAHPS surveys. Univariate and multivariate analyses were performed.

Results.

Of 5517 spine surgeries analyzed, 1505 (27.3%) patients returned the HCAHPS survey. Response rate was variable based on patient characteristics (with statistically significant differences based on age, functional status, race, and American Society of Anesthesiologists score) but not variable based on anatomic region of the spine surgery. Multivariate analysis revealed that patients who did not return the HCAHPS survey were more likely to be black/African American (OR = 2.8, P < 0.001), have a higher American Society of Anesthesiologists score (OR 1.76, P < 0.001), and have had a major adverse event (OR = 1.66; P = 0.001), minor adverse event (OR = 2.50; P < 0.001), discharged to a destination other than home (OR = 2.16, P < 0.001), hospital readmission (OR = 2.58; P < 0.001), and a long hospital length of stay (OR = 1.28, P = 0.001).

Conclusion.

For spine surgery patients, patient characteristics and perioperative outcomes were found to be significantly associated with the nonresponder bias for HCAHPS surveys. Although the potential resultant bias in HCAHPS scores cannot be directly determined, this must be considered in interpreting the results of such satisfaction surveys given that less than one-third of patients actually completed this survey in the study population.

Level of Evidence: 3
Trends in Anterior Lumbar Interbody Fusion in the United States
Authors: Varshneya Kunal , Medress Zachary A. , Jensen Michael , Azad Tej D. , Rodrigues Adrian , Stienen Martin N. , Desai Atman , Ratliff John K. , Veeravagu Anand
Published: October 2019

Background:

Although the incidence of spinal fusions has increased significantly in the United States over the last quarter century, national trends of anterior lumbar interbody fusion (ALIF) utilization are not known.

Purpose:

The objective of this study was to characterize trends, clinical characteristics, risk factors associated with, and outcomes of ALIF in the United States.

Study Design:

This was an epidemiological study using national administrative data from the MarketScan database.

Methods:

Using a large administrative database, we identified adults who underwent ALIF in the United States from 2007 to 2014. The incidence of ALIF was studied longitudinally over time and across geographic regions in the United States. Data related to postoperative complications, length of stay, readmission, and cost were collected.

Results:

We identified 49,945 patients that underwent ALIF in the United States between 2007 and 2014. The total number of ALIF procedures increased from 3650 in 2007 to 6151 in 2014, accounting for an average increase of 24.07% annually. The Southern United States performed the highest number of ALIFs. The most common conditions treated were degenerative disc disease and spondylolisthesis. Over one third of patients (34.6%) underwent multilevel fusion. The most common complications were iron deficiency anemia, urinary tract infections, and pulmonary complications. Hospital and physician pay increased significantly during the study period.

Conclusions:

For the first time in our knowledge, we identified national trends in ALIF utilization, outcomes, and cost using a large administrative database. Our study reaffirms prior work that has demonstrated low rates of complications, mortality, and readmission following ALIF.

Level of Evidence:

Level III.
Outcomes of an Intraoperative Povidone-Iodine Irrigation Protocol in Spinal Surgery for Surgical Site Infection Prevention
Authors: Onishi Yuki , Masuda Kazuhiro , Tozawa Keiichiro , Karita Tatsuro
Published: October 2019

Study Design:

This was a retrospective observational study.

Objective:

The aim of this study was to evaluate the efficacy of our new protocol for preventing postoperative surgical site infection (SSI) following spinal surgery.

Summary of Background Data:

SSI following spinal surgery is a serious postoperative complication. Several studies have recently assessed the effectiveness of wound irrigation with povidone-iodine (PVP-I) for SSI prevention, but no consensus has been reached as to how PVP-I should be used in clinical practice. We formed a PVP-I irrigation protocol focusing on the pharmacological properties of PVP-I. This study aimed to evaluate the efficacy and safety of our protocol for preventing SSI.

Materials and Methods:

All cases of spinal surgery at our hospital between October 2011 and September 2016 were retrospectively reviewed. The exclusion criteria were PVP-I allergy, prior surgical debridement for infection, and implant removal surgery. The patients were subdivided into those who had received normal saline irrigation after 90 seconds of 1% PVP-I pooling every 1.5 hours (study group) or only routine saline irrigation every 1.5 hours (control group). The study and control groups comprised of 177 and 146 patients, respectively. This study compared the rate of SSI with and without the use of the PVP-I irrigation protocol.

Results:

The SSI rates were 1.7% for the study group (3/177 patients) and 3.4% for the control group (5/146 patients), showing no significant statistical difference (P=0.32). There were no cases of deep SSI in the study group, whereas there were 4 cases in the control group. The deep SSI rate significantly decreased in the study group (P=0.027). No adverse events occurred in the study group.

Conclusion:

In this study, 90 seconds of 1% PVP-I pooling every 1.5 hours followed by saline irrigation demonstrated the effectiveness of our protocol for the prevention of postoperative deep SSI after spinal surgery.
Matrine enhances the efficacy of adriamycin chemotherapy in osteosarcoma cells by the STAT3 pathway
Authors: Zhou Houming , Chen Shuqing , Yang Yubin , Yang Chaojie , Chen Danping , Yao Zhenrong , Sun Baoguo
Published: October 2019

Matrine and adriamycin have been extensively considered to be effective in anticancer therapies. However, the role of matrine in the antitumor activity of adriamycin against human osteosarcoma (OS) remains elusive. The aim of this study was to investigate the effect of matrine in OS chemotherapy of adriamycin. In the study, we found that matrine promoted the inhibitory effect of adriamycin against OS cell proliferation and growth. Wound healing and transwell assays showed that the inhibitory effect of adriamycin against migration and invasion of OS cells was significantly enhanced by matrine. For the underlying mechanism investigation, we showed that adriamycin reduced the protein level of PCNA, MMP-9, phosphorylated STAT3, and survivin, which was further intensified by the application of matrine. These results show that matrine could promote the therapeutic efficacy of adriamycin against human OS.
Appearance of cutaneous melanoma and subcutaneous metastases in metastatic gastric carcinoma undergoing chemotherapy with oral 5-fluorouracil prodrug
Authors: De Giorgi Vincenzo , Scarfì Federica , Trane Luciana , Silvestri Flavia , Maida Pierandrea , Gori Alessia , Covarelli Piero
Published: October 2019

Metastatic skin lesions of gastric cancers usually appear as nonspecific, firm, and hyperpigmented nodules. However, they occasionally present as unusual skin manifestations that mimic other skin disorders. We describe a case of multiple cutaneous metastases from gastric cancer resembling sebaceous cysts with a synchronous melanoma, in a patient after fluoropyrimidine-based systemic chemotherapy. Melanoma occurring as a second cancer has been recognized in patients having undergone previous chemotherapy or radiation for another cancer. We can assume that the capecitabine-based chemotherapy may have played a role in the development of the melanocytic neoplasm. Our observation adds extra evidence to the link between fluoropyrimidine-based immunosuppression and the induction of melanocytes’ proliferation and transformation. For these reasons, it is advisable to require dermatological checkups for patients undergoing chemotherapy treatments in order to identify suspicious melanocytic lesions as soon as possible.
Risk Adjustment for Sepsis Mortality to Facilitate Hospital Comparisons Using Centers for Disease Control and Prevention’s Adult Sepsis Event Criteria and Routine Electronic Clinical Data
Authors: Rhee Chanu , Wang Rui , Song Yue , Zhang Zilu , Kadri Sameer S. , Septimus Edward J. , Fram David , Jin Robert , Poland Russell E. , Hickok Jason , Sands Kenneth , Klompas Michael
Published: October 2019

Objectives:

Variability in hospital-level sepsis mortality rates may be due to differences in case mix, quality of care, or diagnosis and coding practices. Centers for Disease Control and Prevention’s Adult Sepsis Event definition could facilitate objective comparisons of sepsis mortality rates between hospitals but requires rigorous risk-adjustment tools. We developed risk-adjustment models for Adult Sepsis Events using administrative and electronic health record data.

Design:

Retrospective cohort study.

Setting:

One hundred thirty-six U.S. hospitals in Cerner HealthFacts (derivation dataset) and 137 HCA Healthcare hospitals (validation dataset).

Patients:

A total of 95,154 hospitalized adult patients (derivation) and 201,997 patients (validation) meeting Centers for Disease Control and Prevention Adult Sepsis Event criteria.

Interventions:

None.

Measurements and Main Results:

We created logistic regression models of increasing complexity using administrative and electronic health record data to predict in-hospital mortality. An administrative model using demographics, comorbidities, and coded markers of severity of illness at admission achieved an area under the receiver operating curve of 0.776 (95% CI, 0.770–0.783) in the Cerner cohort, with diminishing calibration at higher baseline risk deciles. An electronic health record–based model that integrated administrative data with laboratory results, vasopressors, and mechanical ventilation achieved an area under the receiver operating curve of 0.826 (95% CI, 0.820–0.831) in the derivation cohort and 0.827 (95% CI, 0.824–0.829) in the validation cohort, with better calibration than the administrative model. Adding vital signs and Glasgow Coma Score minimally improved performance.

Conclusions:

Models incorporating electronic health record data accurately predict hospital mortality for patients with Adult Sepsis Events and outperform models using administrative data alone. Utilizing laboratory test results, vasopressors, and mechanical ventilation without vital signs may achieve a good balance between data collection needs and model performance, but electronic health record–based models must be attentive to potential variability in data quality and availability. With ongoing testing and refinement of these risk-adjustment models, Adult Sepsis Event surveillance may enable more meaningful comparisons of hospital sepsis outcomes and provide an important window into quality of care.
Enteral Acetaminophen Bioavailability in Pediatric Intensive Care Patients Determined With an Oral Microtracer and Pharmacokinetic Modeling to Optimize Dosing
Authors: Kleiber Niina , Calvier Elisa , Mooij Miriam G. , Krekels Elke H. J. , Vaes Wouter H. J. , Tibboel Dick , Knibbe Catherijne A. J. , de Wildt Saskia N.
Published: October 2019

Objectives:

Decreasing morbidity and mortality by rationalizing drug treatment in the critically ill is of paramount importance but challenging as the underlying clinical condition may lead to large variation in drug disposition and response. New microtracer methodology is now available to gain knowledge on drug disposition in the intensive care. On the basis of studies in healthy adults, physicians tend to assume that oral doses of acetaminophen will be completely absorbed and therefore prescribe the same dose per kilogram for oral and IV administration. As the oral bioavailability of acetaminophen in critically ill children is unknown, we designed a microtracer study to shed a light on this issue.

Design:

An innovative microtracer study design with population pharmacokinetics.

Setting:

A tertiary referral PICU.

Patients:

Stable critically ill children, 0–6 years old, and already receiving IV acetaminophen.

Interventions:

Concomitant administration of an oral 14C radiolabeled acetaminophen microtracer (3 ng/kg) with IV acetaminophen treatment (15 mg/kg every 6 hr).

Measurements:

Blood was drawn from an indwelling arterial or central venous catheter up to 24 hours after 14C acetaminophen microtracer administration. Acetaminophen concentrations were measured by liquid chromatography-mass spectrometry and 14C concentrations by accelerated mass spectrometry.

Main Results:

In 47 patients (median age of 6.1 mo; Q1–Q3, 1.8–20 mo) the mean enteral bioavailability was 72% (range, 11–91%). With a standard dose (15 mg/kg 4 times daily), therapeutic steady-state concentrations were 2.5 times more likely to be reached with IV than with oral administration.

Conclusions:

Microtracer studies present a new opportunity to gain knowledge on drug disposition in the intensive care. Using this modality in children in the pediatric intensive care, we showed that enteral administration of acetaminophen results in less predictable exposure and higher likelihood of subtherapeutic blood concentration than does IV administration. IV dosing may be preferable to ensure adequate pain relief.
Bioelectrical Impedance Measurements for Assessment of Kidney Function in Critically Ill Patients
Authors: de Jong Lutea A. A. , Otten – Helmers Annemiek G. , Spronk Peter E. , van Kan Hendrikus J. M.
Published: October 2019

Objectives:

To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Jelliffe’s.

Design:

An open-label prospective observational cohort study.

Setting:

A 12-bed ICU at a nonuniversity major teaching hospital (Gelre ziekenhuizen Apeldoorn/Zutphen, The Netherlands).

Patients:

Adult critical care patients with an expected ICU length of stay at admission of at least 48 hours.

Interventions:

Each patient’s body composition was assessed using a validated Quadscan 4000 analyzer (Bodystat, Isle of Man, British Isles). Twenty-four hours urine was collected, and laboratory variables in serum including creatinine, urea, and albumin were obtained at the beginning and end of the collection period.

Measurements and Main Results:

A total of 151 patients, stratified to an acute and nonacute ICU-group, were enrolled in the study over a 2-year period. A formula to predict creatinine/urea clearance based on 24 hours urine collection was developed using stepwise linear regression using a training data set of 75 patients. This formula was subsequently tested and compared with other relevant predictive equations using a validation data set of 76 patients. Serum creatinine values ranged from 40 to 446 µmol/L. With the predictive model based on estimated body cell mass and a “prediction marker” more than 71% of the observed variance in creatinine/urea clearance based on 24 hours urine collection could be explained. Predictive performance was superior to the other eight evaluated models (R
2 = 0.39–0.55) and demonstrated to be constant over the whole range of creatinine/urea clearance based on 24 hours urine collection values.

Conclusions:

Multifrequency bioelectrical impedance analysis measurements can be used to predict creatinine/urea clearance based on 24 hours urine collection with superior performance than currently established prediction models. This rapid, noninvasive method enables correction for influences of a patient’s actual body composition and may prove valuable in daily clinical practice.
Angiogenesis inhibition in non-small cell lung cancer: a critical appraisal, basic concepts and updates from American Society for Clinical Oncology 2019
Authors: Cantelmo Anna Rita , Dejos Camille , Kocher Florian , Hilbe Wolfgang , Wolf Dominik , Pircher Andreas
Published: October 2019

Purpose of review

Recently, the combination of antiangiogenic agents, chemotherapy and immunotherapy has shown synergistic anticancer effects in non-small cell lung cancer (NSCLC). The future for this approach appears bright in lung cancer treatment; however, many challenges remain to be overcome regarding its true potential, optimal sequence and timing of therapy, and safety profile. In this review, we will discuss the current status and future direction of antiangiogenic therapy for the treatment of NSCLC, and highlight emerging strategies, such as tumor vessel normalization (TVN).

Recent findings

Bevacizumab was the first antiangiogenic agent approved for the treatment of advanced NSCLC. Recently, the combination of chemotherapy/antiangiogenic therapy with immunotherapy showed high efficacy in first-line settings. A subgroup of patients with liver metastasis and driver mutation-addicted tumors benefited most, suggesting that the metastatic location, as well as the genetic background of the tumor, are key determinants for therapy responses.

The efficacy of antiangiogenic therapies in unselected patients is rather limited. The tumor microenvironment has appeared to be more complex and heterogeneous than previously assumed. Only a contextual rather than a cell-specific approach might provide valuable insights towards the clinical validation of combinational therapies.
Effect of beta-blockers on survival of lung cancer patients: a systematic review and meta-analysis
Authors: Coelho Marisa , Squizzato Alessandro , Cassina Niccolò , Marino Franca , Ribeiro Laura Virgínia , Cosentino Marco
Published: October 2019

The recent interest in beta-blockers as possible agents for drug repurposing in oncology arises from many pre-clinical and epidemiologic studies suggesting a possible clinically relevant antitumour effect. In lung cancer, given the contradictory results obtained, it is crucial to further study its effects. A systematic review of the literature was planned to evaluate a possible beneficial effect of beta-blocker on overall survival in lung cancer patients. Medline and Embase databases were searched from inception until 1 May 2018 to identify published studies that assessed the effect beta-blocker use on overall survival in lung cancer patients. Risk of bias was evaluated by Newcastle-Ottawa scale. Hazard ratios and 95% confidence intervals for overall survival were estimated using a random-effects model. Of 920 studies, seven (all retrospective and observational, six cohort and one case-control), including 7448 patients, met the inclusion criteria. Beta-blocker users with lung cancer had no increased overall survival compared to non-users (hazard ratio = 1.00; 95% confidence interval = 0.91–1.10; I2 = 45%). Similarly, beta-blocker users with non-small cell lung cancer had no increased overall survival compared to beta-blocker non-users (hazard ratio = 0.96; 95% confidence interval = 0.80–1.17; I2 = 56%). Our findings do not suggest an overall survival advantage in patients with lung cancer using beta-blocker therapy when compared to non-users. Further prospective cohort studies, designed to overcome the intrinsic limitations of retrospective observational studies are warranted to definitively clarify any possible beneficial effect of beta-blockers on lung cancer overall survival.
Dermatologic Surgeons Can Positively Impact the Opioid Epidemic: A Quality Improvement Study of Pain Management in Dermatology Surgery
Authors: Raji Kehinde , Yeung Howa , Bein Amanda Ashley , Lequeux-Nalovic Katarina G.
Published: October 2019

BACKGROUND

The opioid epidemic is a national emergency, and it is imperative that all physicians are engaged in reducing exposure. Among dermatologists, dermatologic surgeons prescribe most opioids with the highest rates of prescription occurring in Southern states.

OBJECTIVE

Implement a quality improvement intervention to decrease opioids prescribed and filled to <10% of surgeries performed and have a 0% increase in the amount of patient complaints regarding postoperative pain.

MATERIALS AND METHODS

The number of opioids prescribed and filled in a single surgical facility in Georgia was obtained from the state's Prescription Drug Monitoring Program before, 1 month after, and 6 months after implementation of the quality improvement initiative. Telephone encounters regarding postoperative pain was also collected at the same specified periods.

RESULTS

Proportion of opioids prescribed and filled decreased from 58% to 5% at 1-month postintervention and remained low on 6-month follow-up at 4%. There was no increase in postoperative pain complaints. Rather, a decrease in complaints was noted from 8.6% to 3.1% at 1-month postintervention and sustained on 6-month follow-up at 4.9%.

CONCLUSION

Our data support the management of postoperative pain with nonopioid medications.
Caregiver-Delivered Foot Reflexology
Authors: Samancioglu Baglama Sevgin , Bakir Ercan
Published: October 2019

The aim of this study was to evaluate the effects of caregiver-delivered foot reflexology on patients with cancer and their caregivers. A 2-group pre- and posttest design was used in this study, and the study was conducted in an oncology hospital between January 2016 and February 2018. The study included 60 patients and 60 caregivers. Caregivers performed interventions once a day for 15 days. Patients in the experimental group received reflexology, and patients in the control group were included in the reading session. Mean pain, anxiety, and fatigue levels significantly decreased for the patients who received foot reflexology from their caregivers for 15 days compared with patients in the control group. The mean care burden score of the caregivers in both groups decreased. Clinicians should teach caregiving practices such as foot reflexology and know that these practices are a positive influence on both patients and caregivers.
Effects of Aromatherapy on Pain and Anxiety Scores in Adult Patients Admitted to a Community Hospital on the Medical Unit or Telemetry Unit
Authors: Lindgren Vicki , McNicholl Laura , Friesen Mary Ann , Barnett Scott , Collins Frances
Published: October 2019

The purpose of the study was to determine the impact of aromatherapy intervention on pain and anxiety. The hypothesis was that the use of aromatherapy will improve pain and anxiety scores when assessed within 30 to 60 minutes of administration. The study design was a prospective comparison of aromatherapy using a pre-/postdesign study. A convenience sample of patients was recruited from both a medical unit and a telemetry unit with patients aged 18+ years from a 182-bed acute care Magnet community hospital. Pain and anxiety levels were assessed prior to administration of a medication, within 60 minutes of receiving pain medication, and within 60 minutes of receiving aromatherapy. Ninety-six percent of the participants would use aromatherapy if offered again, would use it in the future, and would recommend its use to family and friends. Both pain and anxiety improved after the aromatherapy with a P value of <.0001. This pilot study demonstrated that aromatherapy is safe and effective at reducing pain and anxiety and should be considered as a valuable adjunct to symptom management.
Implementation of a Shared Medical Appointment as a Holistic Approach to CHF Management
Authors: Law Teresa , Jones Stacey , Vardaman Shellye
Published: October 2019

Congestive heart failure is a costly chronic disease within the United States. The purpose of this study was to examine the effect of a holistic shared medical appointment (SMA) approach to congestive heart failure. Findings suggest the SMA approach improves depression, quality of life (QOL), and health-promoting behaviors. This study implemented congestive heart failure self-management education in primary care using a holistic multidisciplinary approach with SMA to provide evidence-based interventions to improve depression, QOL, and health promotion outcomes. Patients participating in the holistic multidisciplinary SMA experienced improvement in depression, QOL, and health promotion behaviors. A comparison of the means between preintervention and postintervention showed an overall reduction in systolic blood pressure, weight, depression scores, QOL scores, and several indicators of health promotion lifestyle.
Validity and Reliability of the Korean Version of the Watson Caritas Patient Score
Authors: IM SookBin , CHO MiKyoung , HEO MyoungLyun
Published: October 2019

Background

The increasing use of information technology in healthcare settings has reduced human contact with healthcare providers and is hampering human-centered intrinsic nursing work associated with patient discomfort, emotional distress, and desire. The caring attitude of nurses affects patient compliance with medication instructions as well as the promotion of health behaviors and patient satisfaction.

Purpose

This study was designed to develop a Korean version of the Watson Caritas Patient Score (WCPS) developed by Watson and then verify its reliability and validity.

Methods

This was a methodological study. Data were collected from 240 patients in wards of the departments of internal medicine and surgery of a general hospital with more than 500 beds in Kunsan City between May 1 and June 8, 2017. Exploratory factor analysis and confirmatory factor analysis were used to verify the construct validity and model fit. The Patient Perception of Hospital Experience with Nursing was used to confirm convergence validity. Data were analyzed using descriptive analysis, Cronbach's alpha, factor analysis, and Pearson's product–moment correlation analysis.

Results

The internal consistency of the Korean version of the WCPS assessed using Cronbach's alpha was .94. The content validity index for each of the five items was 1.0. The communality ranged from .75 to .87, and the overall model fit was good. In addition, the average variance extracted was .61, the composite reliability was .89, and the convergent validity was .72 (p < .001).

Conclusions/Implications for Practice

The original English version and the Korean version of the WCPS both address a single factor, which confirmed the reliability and good fit of the model and showed both convergent and criterion-related validity. The Korean version of the WCPS is expected to contribute to improving the quality of nursing care in Korea by providing a simple scale that assesses patient perceptions of nursing care easily and accurately.
Mesothelioma Associated With the Use of Cosmetic Talc
Authors: Moline Jacqueline , Bevilacqua Kristin , Alexandri Maya , Gordon Ronald E.
Published: October 2019

Objective:

To describe 33 cases of malignant mesothelioma among individuals with no known asbestos exposure other than cosmetic talcum powder.

Methods:

Cases were referred for medico-legal evaluation, and tissue digestions were performed in some cases. Tissue digestion for the six cases described was done according to standard methodology.

Results:

Asbestos of the type found in talcum powder was found in all six cases evaluated. Talcum powder usage was the only source of asbestos for all 33 cases.

Conclusions:

Exposure to asbestos-contaminated talcum powders can cause mesothelioma. Clinicians should elicit a history of talcum powder usage in all patients presenting with mesothelioma.
Clinical and angiographic factors predicting fractional flow reserve and explaining the visual–functional mismatch in patients with intermediate coronary artery stenosis
Authors: Watanabe Heitaro , Onishi Kyohei , Kakehi Kazuyoshi , Takase Toru , Yamaji Kenji , Ueno Masafumi , Kobuke Kazuhiro , Miyazaki Shunichi , Iwanaga Yoshitaka
Published: October 2019

Background

Visual–functional mismatch between coronary angiography and fractional flow reserve (FFR) has been reported, and the underlying reason remains poorly understood. Therefore, the relationship between angiographic measurements and FFR was evaluated, and predictors for FFR in intermediate coronary artery stenosis were determined.

Methods

Consecutive 314 patients (405 lesions) with a lesion of 30–80% angiographic diameter stenosis who underwent invasive FFR were recruited. The myocardial area supplied by the coronary artery distal to the stenosis was evaluated using a modified version of the Bypass Angioplasty Revascularization Investigation (BARI) score. Participants underwent follow-up, and major cardiovascular events (MACE), including all-cause death, myocardial infarction (MI), and unplanned revascularization were recorded.

Results

Although % diameter stenosis was correlated with FFR (R = 0.279, P < 0.001), diameter stenosis-FFR mismatch was observed in 37.8% of the lesions. Although FFR values were not associated with clinical factors, such as age, sex, and comorbidities, it was correlated with minimal lumen diameter (MLD), diffuse lesion, presence of proximal lesion, and BARI score. In addition, the lesions in left anterior descending (LAD) coronary artery showed low FFR values compared with those in the left circumflex coronary artery or right coronary artery. In multivariate logistic analysis, MLD (β coefficient = 0.330), diffuse lesion (β coefficient = –0.266), proximal lesion (β coefficient = –0.144), BARI score (β coefficient = –0.219), and LAD lesion (β coefficient = –0.293) were all independent predictors for FFR value. The estimated FFR value based on these factors showed smaller mismatch and higher sensitivity. No difference was observed in the event rates for MACE and MI or revascularization between the FFR-guided and estimated FFR-guided strategies.

Conclusions

MLD, diffuse lesion, proximal lesion, BARI score, and lesion vessel were independent predictors for FFR in intermediate coronary stenosis. Not only the extent of local lesion stenosis but also the amount of myocardial supply and the lesion location may determine the physiological significance and explain the visual–functional mismatch. The estimation of FFR by these factors may be useful in clinical practice.
Combination therapies in the treatment of osteoporosis
Authors: Kelly Jennifer J. , Garapati Sree Susmitha
Published: October 2019

Purpose of review

Osteoporotic fractures are common and can be devastating. Although multiple different medications with unique mechanisms of action are currently available in our arsenal to attempt to prevent fractures, an ideal opportunity in which to use these medications in combination remains elusive. New data has emerged over the past few years in regards to assessing which medication combinations may be productive and efficacious.

Recent findings

Previous studies performed using different medications to treat osteoporosis in combination proved either not overall beneficial or inconclusive. More recent studies suggest a potential additive and synergistic benefit of certain combination therapies, particularly with the use of denosumab and teriparatide in select situations.

The knowledge of modern data as to when the potential use of combination therapy in treating osteoporosis may be useful is critical to the acquisition of proficiency in the ideal management of our patients at highest risk for fracture. Although not recommended yet by current guidelines, the advancement of expertise in this field, both in research studies, and clinical practice, will help us discern how to best consider the use of combination treatment now and in the future.
Hospital-Based Research Internship for Nurses: The Value of Academic Librarians as Cofaculty
Authors: Carey Mary G. , Trout Daniel R. , Qualls Brandon W.
Published: October 2019

With so few nurse scientists, it is important to increase the research activities of nurses. A nurse scientist and a librarian investigated if increasing library skills in a hospital-based research internship increases nurses' scholarship. Library-related content was added throughout the internship; interns were surveyed to measure specific skills. All interns improved their skills and valued librarians. Most interns conducted literature searches and utilized library resources. Research internships increased nurses' capacity for library-related skills.
Inpatient Maternal Mortality in the United States, 2002–2014
Authors: Mogos Mulubrhan F. , Liese Kylea L. , Thornton Patrick D. , Manuck Tracy A. , O'Brien William D. , McFarlin Barbara L.
Published: October 2019

Background

Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no published reports of maternal mortality data stratified by timing of its occurrence across the pregnancy continuum (antepartum, intrapartum, and postpartum).

Objective

The study objective was to determine whether the maternal mortality rate, trends over time, self-reported race/ethnicity, and associated factors vary based on the timing of the occurrence of death during pregnancy.

Methods

We conducted a cross-sectional analysis of the Nationwide Inpatient Sample database to identify pregnancy-related inpatient stays stratified by timing. Among women in the sample, we determined in-hospital mortality and used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify comorbidities and behavioral characteristics associated with mortality, including alcohol, drug, and tobacco use. Joinpoint regression was used to calculate rates and trends of in-hospital maternal mortality.

Results

During the study period, there were 7,411 inpatient maternal mortalities among an estimated 58,742,179 hospitalizations of women 15–49 years of age. In-hospital maternal mortality rate stratified by race showed that African Americans died at significantly higher rates during antepartum, intrapartum, and postpartum periods compared to hospitalizations for Whites or Hispanics during the same time period. Although the postpartum hospitalization represents only 2% of pregnancy-related hospitalizations among women aged 15–49 years, hospitalization during this time period accounted for 27.2% of all maternal deaths during pregnancy-related hospitalization.

Discussion

Most in-hospital maternal mortalities occur after hospital discharge from child birth (postpartum period). Yet, the postpartum period continues to be the time period with the least maternal healthcare surveillance in the pregnancy continuum. African American women experience three times more in-hospital mortality when compared to their White counterparts.
Characteristics and Practices Within Research Partnerships for Health and Social Equity
Authors: Dickson Elizabeth , Magarati Maya , Boursaw Blake , Oetzel John , Devia Carlos , Ortiz Kasim , Wallerstein Nina
Published: October 2019

Background

As federal research funding focuses more on academic/community collaborations to address health inequities, it is important to understand characteristics of these partnerships and how they work to achieve health equity outcomes.

Objectives

This study built on previous National Institutes of Health-funded research to (a) describe partnership characteristics and processes of federally funded, community-based participatory research (CBPR) or community-engaged research projects; (b) explore characteristics of these projects by stage of funding; and (c) build on previous understanding of partnership promising practices.

Methods

Between fall 2016 and spring 2017, we completed a cross-sectional analysis and principal component analysis of online survey data from key informants of federally funded CBPR and community-engaged research projects. Respondents for 179 projects (53% response rate) described project characteristics (e.g., type of partner, stage of partnership, and population) and the use of promising practices (e.g., stewardship, advisory board roles, training topics) by stage of partnership.

Results

Projects involved community, healthcare, and government partners, with 49% of respondents reporting their project was in the early stage of funding. More projects focused on Black/African American populations, whereas principal investigators were mostly White. The more established a partnership (e.g., with multiple projects), the more likely it employed the promising practices of stewardship (i.e., community safeguards for approval), community advisory boards, and training on values and power.

Conclusions

Community engagement is a developmental process with differences between early-stage and established CBPR partnerships. Engaging in active reflection and adopting promising partnering practices are important for CBPR partnerships working to improve health equity. The data provided in this study provide key indicators for reflection.
An Enteropathy-like Indolent NK-Cell Proliferation Presenting in the Female Genital Tract
Authors: Krishnan Rahul , Ring Kari , Williams Eli , Portell Craig , Jaffe Elaine S. , Gru Alejandro A.
Published: October 2019

Natural killer (NK) cell enteropathy is a lymphoproliferative disorder, initially described by Mansoor and colleagues, that presents in the gastrointestinal tract, and is often mistaken for extranodal NK/T-cell lymphoma on first assessment. This population of cells in this process have an NK-cell phenotype (CD3, CD56, CD2, CD7), lacks evidence of Epstein-Barr virus infection, has germline rearrangement of the T-cell receptor, and a very indolent clinical course. Indeed, many of such patients had been originally diagnosed as having an NK/T-cell lymphoma, and subsequently received chemotherapy. We report a unique case where an indolent lymphoproliferative disorder with features that resemble NK-cell enteropathy is encountered for the first time outside the gastrointestinal tract, specifically in the female genitourinary tract. We provide morphologic, immunophenotypic, and molecular documentation of such, in association with a completely indolent clinical behavior of this type of process.
Isolated Oculomotor Nerve Palsy in Mild Traumatic Brain Injury
Authors: Kim Taeyeon , Nam Kiyeun , Kwon Bum Sun
Published: October 2019

Background

Isolated oculomotor nerve palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of oculomotor nerve palsy.

Methods

We performed a search for all clinical studies of isolated oculomotor nerve palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following key words: traumatic brain injury, isolated oculomotor nerve palsy, mild head trauma, management, and prognosis.

Results

We identified 14 cases of isolated oculomotor nerve palsy after mild traumatic brain injury. In three cases, steroids were used to manage the oculomotor nerve palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0 ± 5.3 mos with a range of 0.5–18 mos.

Conclusions

This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies oculomotor nerve palsies, steroid therapy to reduce related brain edema, and oculomotor rehabilitation with training eye movement behavior.