bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-Sided Deafness—Outcomes of Three Interventions for Profound Unilateral Sensorineural Hearing Loss: A Randomized Clinical Trial
Authors: Fogels Jonas , Jönsson Radi , Sadeghi André , Flynn Mark , Flynn Traci
Published: April 2020

Objective:

A comparison of three interventions for profound unilateral sensorineural hearing loss.

Study Design:

Prospective, crossover randomized clinical trial.

Participants:

Fifteen participants with profound unilateral sensorineural hearing loss.

Interventions:

Three potential technical interventions were compared: Bone Conduction Device on softband, Contralateral Routing of Signal (CROS), and Remote Microphone . Each intervention was randomly trialed for a period of 3 weeks, separated by a 1 week washout period.

Outcome Measures:

Speech in noise recognition test performed under four conditions (lateral noise poorer ear, lateral noise better ear, speech poorer ear, speech better ear). Standardized questionnaires (Abbreviated Profile of Hearing Aid Benefit, Bern Benefit in Single Sided Deafness Questionnaire, and Speech, Spatial, and Other Qualities 12) were used to evaluate amplification benefit at baseline and following each intervention.

Results:

The use of remote microphone provided the best results in the speech recognition in noise test. A benefit in some signal-to-noise ratios was presented of the CROS over bone conduction device on softband in the Speech Poor Ear condition. On questionnaires of benefit, participants did not rate a particular intervention as significantly better than any other. Following the study, CROS was the intervention preferred by the 8 of 15 participants (53%). The majority of participants (80%) chose to continue with an intervention rather than no treatment.

Conclusion:

The use of all interventions resulted in increased performance in speech recognition in noise and rated higher on subjective benefits in comparison with baseline. People with SSD are a heterogeneous population when considering perceived difficulties. Future research should focus on segmenting the population of SSD depending on factors such as etiology, high frequency loss in the better ear, and age of acquired loss for the poorer ear. This stratification may possibly increase the benefit for the patient in terms of more individual-based clinical routines.
Cerumenolytic Efficacy of 2.5% Sodium Bicarbonate Versus Docusate Sodium: A Randomized, Controlled Trial
Authors: Piromchai Patorn , Laohakittikul Chanticha , Khunnawongkrit Sirichoke , Srirompotong Somchai
Published: April 2020

Objectives:

To evaluate the efficacy of 2.5% sodium bicarbonate and docusate sodium in patients with complete occlusion of the ear canal from impacted cerumen.

Study Design:

Randomized controlled trial.

Method:

We enrolled patients with unilateral complete cerumen occlusion of the ear canal that was unable to be removed using suction. Either 2.5% sodium bicarbonate or docusate sodium was applied and allowed to sit for 15 minutes. The ear canal was then cleaned under a microscope for up to 3 minutes until the tympanic membrane was completely visible. A second attempt with the same agent was performed in subjects in whom the first application was unsuccessful. The outcomes were compared between the two groups in terms of cleaning, the success rate, time taken to clean the canal, and adverse events.

Results:

There were 91 participants enrolled in this study. The mean age of the participants was 48.0 years. The patients’ demographic did not differ between the two groups. At the end of the treatment, the tympanic membrane was completely visible in 41 (91.11%) subjects treated with 2.5% sodium bicarbonate and 38 (82.61%) subjects treated with docusate sodium, with a 1.10 success ratio between the two groups (95% CI: 0.94–1.29, p = 0.23). The mean successful suctioning time was 103.61 seconds using 2.5% sodium bicarbonate and 124.13 using docusate sodium. The mean difference was 20.52 seconds (95% CI: –10.55–51.59).

Conclusion:

2.5% sodium bicarbonate demonstrated non-inferior efficacy and safety compared with docusate sodium. We recommend using this agent in clinical practice.

Trial Registration:

Clinicaltrials.in.th/TCTR20160803001.
Hearing Loss's Incidence and Impact on Employment in the United States
Authors: Tehranchi Kian , Jeyakumar Anita
Published: April 2020

Objective:

To determine the incidence of hearing loss (HL) as well as differences in wages and labor force participation rates between individuals with and without HL.

Study Design:

Retrospective ecological study.

Patients:

1% of the US population including individuals with and without HL from the public use micro data sample (PUMS) of the 2011 to 2016 American Community Survey (ACS) was analyzed.

Main Outcome Measure:

ACS census data on individual age, self-reported hearing loss, labor force participation, and monetary earnings between 2011 and 2016.

Results:

HL incidence rates were 13.4, 0.4, 3.8, 18.1, and 117.1 per 10,000 people among 0 to 2, 3 to 17, 18 to 44, 45 to 64, and 65+ years old, respectively. HL 18 to 44, 45 to 64, and 65+ years old participated in the labor force at 86, 81, and 61% of the rate of hearing individuals. HL 18 to 44, 45 to 64, and 65+ years old earned 78, 73, and 72% of the wages earned by non-HL individuals.

Conclusions:

Calculated HL incidence and labor force participation rates were higher than previously published in literature analyzing 1991 census data. The changes may be due to the methodology used in this study but may also reflect improvements in diagnosis, access to technology, and the implementation of the Americans with Disabilities Act (ADA) of 1990.
Electrocochleography and Cochlear Implantation: A Systematic Review
Authors: Trecca Eleonora M. C. , Riggs William J. , Mattingly Jameson K. , Hiss Meghan M. , Cassano Michele , Adunka Oliver F.
Published: April 2020

Objective:

Given the heterogeneity of papers about electrocochleography (ECochG) and cochlear implantation (CI) and the absence of a systematic review in the current literature, the aim of this work was to analyze the uses of ECochG in the different stages of CI.

Data Sources:

A search of PubMed from inception to December 8, 2019, with cross-references, was executed. Keywords were: “Cochlear Implant” OR “Cochlear Implantation” AND “Electrocochleography” OR “ECochG.” The main eligibility criteria were English-language articles, investigating the use of ECochG in the different phases of CI.

Study Selection:

Literature reviews, editorials, case reports, conference papers were excluded, as were papers in which ECochG was just sporadically executed.

Data Extraction:

The quality of the included studies was assessed using “The Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) Statement.

Data Synthesis:

A total of 95 articles were identified and 60 papers were included. The included articles covered a timeframe from 2003 to 2019. Of the 60 papers, 46 were human studies, 12 animal studies, and two involved more data sets. Eleven related to the diagnostic phase, 43 described intraoperative monitoring, and 10 were regarding follow-up testing. Hearing preservation was the most discussed topic with 25 included articles.

Conclusions and Relevance:

ECochG measurements appeared to be useful in many aspects of CI, such as hearing preservation. Our review is the first that shows the evolution of the technique and how much has been achieved from the earliest experiments to the most recent signal process refinements and device implementation in CI.
Regulation of lipoprotein lipase-mediated lipolysis of triglycerides
Authors: Basu Debapriya , Goldberg Ira J.
Published: April 2020

Purpose of review

To discuss the recent developments in structure, function and physiology of lipoprotein lipase (LpL) and the regulators of LpL, which are being targeted for therapy.

Recent findings

Recent studies have revealed the long elusive crystal structure of LpL and its interaction with glycosylphosphatidylinositol anchored high-density lipoprotein binding protein 1 (GPIHBP1). New light has been shed on LpL being active as a monomer, which brings into questions previous thinking that LpL inhibitors like angiopoietin-like 4 (ANGPTL4) and stabilizers like LMF1 work on disrupting or maintaining LpL in dimer form. There is increasing pharmaceutical interest in developing targets to block LpL inhibitors like ANGPTL3. Other approaches to reducing circulating triglyceride levels have been using an apoC2 mimetic and reducing apoC3.

Lipolysis of triglyceride-rich lipoproteins by LpL is a central event in lipid metabolism, releasing fatty acids for uptake by tissues and generating low-density lipoprotein and expanding high-density lipoprotein. Recent mechanistic insights into the structure and function of LpL have added to our understanding of triglyceride metabolism. This has also led to heightened interest in targeting its posttranslational regulators, which can be the next generation of lipid-lowering agents used to prevent hypertriglyceridemic pancreatitis and, hopefully, cardiovascular disease.
The next generation of triglyceride-lowering drugs: will reducing apolipoprotein C-III or angiopoietin like protein 3 reduce cardiovascular disease?
Authors: Reeskamp Laurens F. , Tromp Tycho R. , Stroes Erik S.G.
Published: April 2020

Purpose of review

Apolipoprotein C-III (ApoC-III) and angiopoietin like protein 3 (angptl3) have emerged as key regulators of triglyceride metabolism. Based on Mendelian randomisation studies, novel therapeutic strategies inhibiting these proteins using monoclonal antibodies or gene silencing techniques might reduce residual cardiovascular disease (CVD) risk in dyslipidemic patients. This article aims to review the role of apoC-III and angptl3 in triglyceride metabolism and combine early clinical evidence of CVD reducing potential of these new therapeutic targets.

Recent findings

Angptl3 inhibition by mAb or antisense therapy has recently completed phase I and II studies, respectively and demonstrate robust apolipoprotein B (apoB) lowering up to 46%. Volanesorsen is an antisense therapy approved for patients with extremely elevated plasma triglyceride levels in which it showed no consistent apoB reduction. However, the GalNAc-conjugated oligonucleotide showed moderate (up to ∼30%) apoB reduction in a phase 1/2a dose-finding study.

Angptl3 and apoC-III are novel targets in lipoprotein metabolism that reduce triglycerides when inhibited. The expected CVD risk reduction may be mediated through reduced triglyceride-rich lipoprotein particle number, reflected by apoB, rather than triglyceride reduction per se. Limited human evidence shows that apoC-III and angptl3 inhibition both potently lower triglycerides, but since angptl3 inhibition reduces apoB more robustly it may be expected to confer more favorable CVD risk reduction.
The Effect of Adalimumab Treatment on Linear Growth in Children With Crohn Disease
Authors: Matar Manar , Shamir Raanan , Lev‐Zion Raffi , Broide Efrat , Weiss Batia , Ledder Oren , Guz‐Mark Anat , Rinawi Firas , Cohen Shlomi , Topf‐Olivestone Chani , Shaoul Ron , Yerushalmi Baruch , Assa Amit
Published: April 2020

Objectives:

Growth impairment is common in children with Crohn disease (CD). We aimed to assess the effect of adalimumab (ADL) treatment on linear growth in children with CD in a post‐hoc analysis of the Pediatric Crohn's Disease AdalImumab Level–based Optimization Treatment randomized controlled trial.

Methods:

Children 6 to 17 years who responded to ADL induction were assessed consecutively for anthropometric parameters. Associations of these parameters with disease characteristics and disease activity were analyzed.

Results:

Overall, 66 patients completed 72 weeks of follow‐up (25% girls, mean age of 15.6 ± 2.5 years). Median (interquartile range [IQR]) height z score improved from −0.6 (−1.6–0.15) at baseline to −0.33 (−1.3–0.5) at week 72 (P = 0.005) with lesser improvement in patients with perianal disease. Similar effect was noted in children with growth potential (boys younger than 16 years, girls younger than 14 years). Median (IQR) height velocity standard deviation was −0.32 (−1.5–0.8) at week 26, and +0.11 (−1.1–1.3) at week 72. Median weight z score increased from −0.54 (−1.2–0.15) to −0.1 (−0.9–0.6), P < 0.001 and body mass index from −0.4 (−1.0–0.5) to 0.0 (−0.8–0.9), P = 0.005. Pediatric CD activity index and erythrocyte sedimentation rate at week 4 correlated negatively with height z score changes (P = 0.043 and P = 0.048, respectively), whereas sustained clinical and biologic remission (week 4–72) were positively associated with changes in height z scores. Significant improvement in linear growth was predicted by lower pediatric CD activity index and erythrocyte sedimentation rate at the end of induction and sustained clinical remission (P = 0.05) and sustained normal C‐reactive protein (P = 0.001) at all visits.

Conclusion:

In children with moderate‐to‐severe CD, ADL treatment had a significant effect on linear growth, with normalization of weight and body mass index (clinicaltrials.gov no: NCT02256462).
IKZF1 Deletions as a Prognostic Factor in Costa Rican Patients With Pediatric B-Cell Acute Lymphoblastic Leukemia
Authors: Granados-Zamora Melissa , Chaves-Herrera Karla , Morera-Araya Estela , Granados-Alfaro Paola , Valverde-Muñoz Kathia , Soto-Herrera Gabriela , Santamaría-Quesada Carlos
Published: April 2020

The IKZF1 gene encodes for Ikaros, a transcriptional factor in B-cell development. Deletions in this gene have been associated with a worse prognosis in B-cell acute lymphoblastic leukemia (B-ALL). We evaluated the presence of these alterations in all Costa Rican pediatric patients diagnosed with B-ALL between 2011 and 2014, treated with a modified Berlin-Frankfurt-Münster therapeutic protocol. Multiplex polymerase chain reaction with 2 detection methods (agarose gel and gene scanning) was used to detect intragenic deletions and multiplex ligation-dependent probe amplification for whole-gene deletions. Differences between groups (normal vs. deleted IKZF1) were analyzed by the χ2 test, the Kaplan-Meier test was used to calculate relapse-free survival and overall survival, and Cox regression was performed for multivariant analysis. Minimum follow-up was 4.5 years. Incidence of IKZF1 deletions was 12.9% (n=20), with an equal amount of intragenic and complete gene deletions. Adverse karyotype (P=0.048), high-risk category (P=0.030), occurrence of relapse (P=0.021), and medullar relapse (P=0.011) were statistically associated with the presence of deletions in IKZF1. Relapse-free survival at 54 months was lower in patients harboring an IKZF1 deletion than that in patients with IKZF1-wt (40.0% vs. 66.7%; P=0.014). Patients with B-ALL and IKZF1 deletions, showed a poorer relapse-free survival, in comparison with patients with IKZF1-wt, suggesting that IKZF1 status is an independent prognostic factor for pediatric patients with B-ALL.
Development and Pilot Testing of a Multidimensional Learning Environment Survey
Authors: Jessee Mary Ann , Russell Regina G. , Kennedy Betsy B. , Dietrich Mary S. , Schorn Mavis N.
Published: April 2020

Background

Multiple, complex factors comprise the learning environment and influence student learning outcomes, yet comprehensive evaluation of the learning environment in nursing schools is limited.

Purpose

The Learning Environment Survey (LES) was developed to facilitate nursing students' report of perceptions of the complex learning environment in nursing education.

Methods

Systematic exploration of the literature, conceptual operationalization of the learning environment, and development of an item pool were completed. Content validity was established with expert assessment, student testing for clarity, and calculation of scale-content validity index/average (S-CVI/Ave). Pilot testing was completed at 1 school of nursing with baccalaureate-equivalent prelicensure and advanced practice master's level students, and doctor of nursing practice students.

Results

The CVI (S-CVI/Ave) was 0.92. Domain scores demonstrated Cronbach's α reliabilities of 0.67 or higher with most being > 0.85.

Conclusion

The LES establishes a mechanism for eliciting comprehensive learning environment data for systematic assessment and national comparison of multiple nursing learning environments.
Nursing Student Medication Administration Performance
Authors: Jarvill Melissa
Published: April 2020

Background

Nurses must be adequately prepared for safe medication administration.

Purpose

The specific aims of the study were to compare first- and final-semester nursing students' medication administration performance, describe graduating nursing student performance, assess the long-term effect of an Individual Simulation-Based Experience (ISBE), and determine if nursing assistant experience impacted performance.

Methods

The study was a longitudinal, descriptive, experimental, 2-group pretest-posttest design. The Medication Administration Safety Assessment Tool was used to assess nursing student (n = 68) medication administration performance at 3 points in time: after learning the skill, after participation in an ISBE or traditional practice session, and prior to graduation.

Results

Only one-third of senior nursing students accurately demonstrated medication administration. There was no significant difference between first- and last-semester performance.

Conclusion

Findings suggest nursing students are not prepared for safe medication administration upon graduation. The reality of practice opportunities to perform this skill throughout a nursing program should be examined.
Trends of Human Immunodeficiency Virus, Syphilis, and Hepatitis C Infections Among Men Who Have Sex With Men in Chongqing, China: A Serial Cross-sectional Survey From 2011 to 2018
Authors: Lu Rongrong , Zhang Xiangjun , Zhou Chao , Zhang Wei , Ouyang Lin , Xing Hui , Shao Yiming , Ruan Yuhua , Wu Guohui
Published: April 2020

Background

Human immunodeficiency virus (HIV) prevalence and incidence rates have expeditiously increased among Chongqing men who have sex with men (MSM) over the past decade. This study investigated the trends of HIV, syphilis, and hepatitis C virus (HCV) infections and behavioral attributes of Chongqing MSM.

Methods

Chongqing MSM who were 18 years or older were recruited annually from 2011 to 2018. Interviewer-administered paper-pencil interviews were used to collect demographics, behavioral information, and sexually transmitted diseases history. Blood samples were collected for the tests of HIV, syphilis, and HCV. A stepwise regression model was conducted to assess the associations of demographics, behaviors, and syphilis and HCV infections with HIV infection.

Results

A total of 4900 MSM participated in the study. The average HIV, syphilis, and HCV prevalence over 8 years were 15.4%, 4.0%, and 0.3%, respectively. The HIV prevalence ranged from 13.5% to 16.4%. Syphilis and HCV were generally low and stable across years. An increased proportion of participants received HIV counseling, testing, and condoms. Multivariable regression indicated that HIV-positive MSM were more likely to be older, married, and less educated, and they were more likely to perform unprotected anal intercourse with male partners in the past 6 months, have syphilis, and less likely to receive HIV counseling, testing, condoms, and peer education in the past year.

Conclusions

The HIV counseling, testing, and peer education programs showed a negative association with HIV-positive status among Chongqing MSM. The HIV prevalence is still high. More programs must be implemented to effectively curb the HIV epidemic.
Sexual Mixing Patterns and Anal Human Papillomavirus Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in 2 Cities in the United States, 2012–2014
Authors: Assaf Ryan D. , Javanbakht Marjan , Meites Elissa , Gratzer Beau , Steinau Martin , Crosby Richard A. , Markowitz Lauri E. , Unger Elizabeth R. , Gorbach Pamina M.
Published: April 2020

Background

Human papillomavirus (HPV) is a common sexually transmitted infection. Men who have sex with men (MSM) and transgender women (TGW) are at high risk for anal HPV infection and subsequent anal cancer. This study assessed the association of partner discordances with prevalent high-risk anal HPV (HRAHPV) among MSM and TGW.

Methods

Participants were enrolled in the cross-sectional young men's HPV study of gay, bisexual, and other MSM, and TGW, aged 18 to 26 years, from 2 cities. Participants completed a confidential standardized computer-assisted interview and provided self-collected anal swabs for type-specific HPV DNA testing. Multivariate analyses were conducted for 3 discordances of interest (i.e., partner age, race/ethnicity, and concurrent partner) to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results

Eight hundred sixty-two participants were included for partner race/ethnicity discordance, 601 for partner age discordance, and 581 for concurrent partner analysis. Most reported being older than 21 years, cisgender male, and gay. Adjusted odds of HRAHPV were not significantly increased among participants reporting partner age discrepancy >10 years (aOR, 0.89; 95% CI, 0.51–1.56), partner race/ethnicity discordance (aOR, 0.88; CI, 0.62–1.24), or partner with concurrent partners (aOR, 0.85; 95% CI, 0.50–1.42), compared with those who did not.

Conclusions

This analysis did not identify any partner discordances associated with HRAHPV. Because HPV infection can persist for years, sexual mixing patterns with early partners might be more relevant than the most recent sex partner. Prevalence of HRAHPV was high and could be preventable by preexposure vaccination, as recommended for everyone through age 26 years including MSM and TGW.
Immunohistochemical Validation of Rare Tissues and Antigens With Low Frequency of Occurrence: Recommendations From The Anatomic Pathology Patient Interest Association (APPIA)
Authors: Lott Robert L. , Riccelli Peter V. , Sheppard Elizabeth A. , Wharton Keith A. , Walk Eric E. , Kennedy George , Portier Bryce
Published: April 2020

Laboratories worldwide find it challenging to identify enough tissues and cases for verification and validation studies of low-incidence, rare antigens. These antigens have a low frequency of occurrence in the population, or have little or no expression in normal tissues. Validation studies are essential to assure testing standardization before introducing a new instrument, product, or test into the clinical laboratory. The College of American Pathologists has published comprehensive guidelines for the verification and validation of new immunohistochemical tests introduced into the laboratory menu. Within the guidelines, varied numbers of cases are required for nonpredictive versus predictive markers. However, regarding low-incidence antigens, the laboratory medical director determines the extent of validation required. Recommended practical solutions available to clinical laboratories for low-incidence validation include developing internal resources using the laboratory information system with retrospective and prospective search(s) of archival material and purchase of tissue microarray blocks, slides, or cell lines from external resources. Utilization of homemade multitissue blocks has proved to be extremely valuable in biomarker research and demonstrated great utility in clinical immunohistochemistry laboratories. Participation in External Quality Assessment program(s) may provide insufficient numbers or the ability to calculate concordance rates. However, supplementation with in-house tissues can allow a laboratory to reach the optimal number of cases needed for verification and/or validation schemes. An alternative approach is conducting a thorough literature search and correlating staining patterns of the new test to the expected results. These solutions may be used uniquely or together to assure consistent standardized testing.
Racial/Ethnic Minority Children With Cancer Experience Higher Mortality on Admission to the ICU in the United States*
Authors: Leimanis Laurens Mara , Snyder Kristen , Davis Alan T. , Fitzgerald Robert K. , Hackbarth Richard , Rajasekaran Surender
Published: April 2020

Objective:

We investigated whether differences in survival exist between children of various racial/ethnic groups with cancer admitted to the PICU.

Design:

A retrospective multicenter analysis was conducted using Virtual Pediatric Systems data from reporting centers. Demographic information, Pediatric Risk for Mortality III score, and outcome variables were analyzed using mixed-effects logistic regression modeling to assess for differences in mortality.

Setting:

One hundred thirty-five PICUs in the United States.

Patients:

Pediatric patients with cancer admitted to PICUs in the United States.

Interventions:

None.

Measurements and Main Results:

This study details the analysis of 23,128 PICU admissions of 12,232 unique oncology patients representing 3% of all PICU admissions with 1,610 deaths (7.0% case fatality). African American (8.5%) and Hispanic children (8.1%) had significantly higher mortality (p < 0.05) compared with Caucasian children (6.3%). Regional analysis showed Hispanic patients to have higher mortality in the West in the United States, whereas African American patients in the South in the United States had higher mortality. A pulmonary disease diagnosis in Hispanics increased odds of mortality (odds ratio, 1.39; 95% CI, 1.13–1.70), whereas a diagnosis of shock/sepsis increased risk for mortality in African Americans (odds ratio, 1.56; 95% CI, 1.11–2.20) compared with Caucasians. There were no differences between races/ethnic groups in the rates of limitations of care. After controlling for Pediatric Risk of Mortality III, PICU length of stay, stem cell transplant status, readmissions, cancer type (solid, brain, hematologic), mechanical ventilation days, and sex, Hispanic (odds ratio, 1.24; 95% CI, 1.05–1.47) and African Americans (odds ratio, 1.37; 95% CI, 1.14–1.66) had significantly higher odds of mortality compared with Caucasians.

Conclusions:

The results show that after controlling for severity and cancer type, a child’s race, ethnicity, and region of presentation influence mortality in the PICU. This suggests that additional investigation is warranted along with a need to rethink our approach to the evaluation and treatment of critically ill African American and Hispanic children with cancer.
Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review
Authors: Haire-Joshu Debra , Morshed Alexandra B. , Phad Allison , Johnston Shelly , Tabak Rachel G.
Published: April 2020

Objectives:

The purpose of this review was to use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to assess the extent to which weight gain prevention studies targeting young adults reported on elements of external validity.

Design:

Systematic review.

Eligibility Criteria:

Articles of interest included a lifestyle/behavioral intervention targeting weight gain prevention. Eligibility criteria included the following: study design of randomized controlled trials, quasi-randomized control trials, or natural experiments; average participant age between 18 and 35 years; study duration of at least 12 months; and published in English between January 2008 and May 2018. Studies had to report weight or body mass index as a measured outcome and were excluded if they were paired with smoking cessation programs, were conducted in specific groups (ie, pregnant women, breast cancer survivors), or were follow-ups to weight loss studies.

Study Selection:

After removing duplicates, the search yielded 11426 articles. Titles and abstracts were screened by 1 reviewer; 144 articles were assessed in a full-text review by 2 reviewers. Discrepancies were resolved by consensus. Nine studies (13 articles) were included in the review.

Main Outcomes Measure(s):

Reported elements of the RE-AIM framework.

Results:

A total of 9 studies met the selection criteria. All studies lacked full reporting on external validity elements. Of the total of 60 RE-AIM reporting criteria, 8 were reported by all 9 studies, 26 criteria were reported by fewer than 4 studies, and 22 criteria were not reported by any of the studies.

Discussion:

There remains inadequate reporting of elements of external validity and generalizability in weight gain prevention studies. This is a significant scientific constraint that limits the information required to disseminate and implement prevention of weight gain interventions for population impact. Standardized reporting may be needed to ensure results that demonstrate not only internal validity but also external validity and generalizability are needed to promote public health impact.
Concentric and Eccentric Resistance Training Comparison on Physical Function and Functional Pain Outcomes in Knee Osteoarthritis
Authors: Vincent Kevin R. , Vincent Heather K.
Published: April 2020

Objective

The aim of the study was to compare the effectiveness of concentrically focused resistance training to eccentrically focused resistance training on physical function and functional pain in knee osteoarthritis.

Design

This is a randomized, single-blinded controlled 4-mo trial. Older adults with knee osteoarthritis (N = 88; 68.3 ± 6.4 yrs, 30.4 ± 6.9 kg/m2, and 67.4% women) were randomized to eccentrically focused resistance training, concentrically focused resistance training, or no-exercise control. Main outcomes included chair rise time, stair climb time, 6-min walk test distance, temporal-spatial parameters of gait, community ambulation, and functional pain.

Results

Leg muscle strength improved in both training groups compared with no-exercise control. There were no significant group × time interactions for any functional performance score (chair rise time, stair climb time, 6-min walk test distance, gait parameters, community ambulation). Compared with no-exercise control, functional pain scores were reduced for chair rise (−38.6% concentrically focused resistance training, −50.3% eccentrically focused resistance training vs. +10.0%) and stair climb (−51.6% concentrically focused resistance training, −41.3% eccentrically focused resistance training vs. +80.7%; all P < 0.05). Pain scores were reduced during the 6-min walk and in early recovery with concentrically focused resistance training compared with the remaining two groups (P < 0.05).

Conclusions

Either resistance exercise type improves activity-related knee osteoarthritis pain, but concentrically focused resistance training more effectively reduced severity of ambulatory pain and pain upon walking cessation.
Retrospective Review of the Safety and Efficacy of Virtual Reality in a Pediatric Hospital
Authors: Caruso Thomas J. , O’Connell Chloe , Qian Jimmy J. , Kung Tiffany , Wang Ellen , Kinnebrew Susan , Pearson Molly , Kist Madison , Menendez Maria , Rodriguez Samuel T.
Published: April 2020

Introduction:

Virtual reality (VR) is an emerging tool for anxiety and fear reduction in pediatric patients. VR use is facilitated by Certified Child Life Specialists (CCLS) at pediatric hospitals. The primary aim of this study was to retrospectively review the safety of VR by analyzing adverse events after the utilization of VR under CCLS supervision. Secondary objectives were to characterize the efficacy of VR in enhancing patient cooperation, describe the integration of VR into Child Life services, and identify interventions that accompanied VR.

Methods:

The Stanford Chariot Program developed VR applications, customized VR interfaces, and patient head straps, and distributed these to CCLS. Chart review analyzed VR utilization through CCLS patient notes. Inclusion criteria were all patients ages 6 to 18-years-old who received a Child Life intervention.

Results:

From June 2017 to July 2018, 31 CCLS saw 8,098 patients, 3,696 of which met age criteria with pre- and post-intervention cooperation data. Two hundred thirteen patients received VR with an accompanying intervention, while 34 patients received only VR. Adverse events were rare, and included increased anxiety (3.8%, n=8), dizziness (0.5%, n=1), and nausea (0.5%, n=1). Patients were more likely to be cooperative after receiving VR (99.5%, n=212) compared to pre-intervention (96.7%, n=206, p=0.041). VR use was most common in the perioperative setting (60%, n=128), followed by outpatient clinics (15%, n=32).

Conclusion:

VR is safe in pediatric patients with appropriate hardware, software, and patient selection. Side effects were rare and self-limited. VR appears to be associated with improvements in cooperation.
Feasibility of Surgeon-Delivered Audit and Feedback Incorporating Peer Surgical Coaching to Reduce Fistula Incidence following Cleft Palate Repair: A Pilot Trial
Authors: Sitzman Thomas J. , Tse Raymond W. , Allori Alexander C. , Fisher David M. , Samson Thomas D. , Beals Stephen P. , Matic Damir B. , Marcus Jeffrey R. , Grossoehme Daniel H. , Britto Maria T.
Published: April 2020

Background:

Improving surgeons’ technical performance may reduce their frequency of postoperative complications. The authors conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial.

Methods:

A nonrandomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair. Participants completed a baseline audit of fistula incidence. Participants with a fistula incidence above the median were allocated to an intensive feedback intervention that included selecting a peer surgical coach, observing the coach perform palate repair, reviewing operative video of their own surgical technique with the coach, and proposing and implementing changes in their technique. All others were allocated to simple feedback (receiving audit results). Outcomes assessed were proportion of surgeons completing the baseline audit, disclosing their fistula incidence to peers, and completing the feedback intervention.

Results:

Seven surgeons enrolled in the trial. All seven completed the baseline audit and disclosed their fistula incidence to other participants. The median baseline fistula incidence was 0.4 percent (range, 0 to 10.5 percent). Two surgeons were unable to receive the feedback intervention. Of the five remaining surgeons, two were allocated to intensive feedback and three to simple feedback. All surgeons completed their assigned feedback intervention. Among surgeons receiving intensive feedback, fistula incidence was 5.9 percent at baseline and 0.0 percent following feedback (adjusted OR, 0.98; 95 percent CI, 0.44 to 2.17).

Conclusion:

Surgeon-delivered audit and feedback incorporating peer coaching on technical performance was feasible for surgeons.
Integrated Plastic Surgery Match: Trends in Research Productivity of Successful Candidates
Authors: Ngaage Ledibabari M. , Elegbede Adekunle , McGlone Katie L. , Knighton Brooks J. , Cooney Carisa M. , Cooney Damon S. , Lifchez Scott D. , Slezak Sheri , Rasko Yvonne M.
Published: April 2020

Background:

Plastic surgery continues to be one of the most competitive specialties in the residency match. Research productivity is a key component of the selection process. Nevertheless, potential applicants have a poor understanding of the strength of their research credentials in comparison to other applicants.

Methods:

The authors identified successful applicants from the 2012 to 2017 integrated plastic surgery residency application cycles. The authors performed a bibliometric analysis of these residents using Scopus, PubMed, and Google Scholar to identify published articles at the time of application. The authors then calculated the h-index of each applicant at the time of application.

Results:

The authors included 829 integrated residents. The median h-index was 0 (interquartile range, 0 to 3) and the median number of publications was 2 (interquartile range, 0 to 5) for all applicants. The proportion of applicants with at least one publication at the point of application increased significantly over time (60 percent in 2012 versus 76 percent in 2017; p = 0.0072). In addition, the number of publications per applicant increased over time (one in 2012 versus two in 2017; p = 0.0005), as did h-index (0 in 2012 versus 1 in 2017; p = 0.0015). Strikingly, the number and percentage of review articles among applicants increased significantly over this time frame (9 percent versus 14 percent; p = 0.0299).

Conclusions:

The increasing level of academic productivity among applicants may reflect the increasing competitiveness of the integrated plastic surgery residency application process. As the pressure to compete for a training position increases, students may seek faster-to-publish articles to gain an edge.
Surviving the COVID-19 Pandemic: Surge Capacity Planning for Nonemergent Surgery
Authors: Squitieri Lee , Chung Kevin C.
Published: April 2020

The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.
Central nervous system infections produced by varicella zoster virus
Authors: Nagel Maria A. , Niemeyer Christy S. , Bubak Andrew N.
Published: April 2020

Purpose of review

Varicella zoster virus (VZV) causes varicella, establishes latency, then reactivates to produce herpes zoster. VZV reactivation can also cause central nervous system (CNS) disease with or without rash. Herein, we review these CNS diseases, pathogenesis, diagnosis, and treatment.

Recent findings

The most common CNS manifestation of VZV infection is vasculopathy that presents as headache, cognitive decline, and/or focal neurological deficits. VZV vasculopathy has also been associated with cerebral amyloid angiopathy and moyamoya syndrome. Rarely, VZV will produce a meningitis, encephalitis, cerebellitis, and myelopathy. Pathogenic mechanisms include direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability. Diagnosis is confirmed by the temporal association of rash to disease onset, intrathecal synthesis of anti-VZV antibodies, and/or the presence of VZV DNA in CSF. Most cases respond to intravenous acyclovir with corticosteroids.

VZV produces a wide spectrum of CNS disorders that may be missed as some cases do not have an associated rash or a CSF pleocytosis. Clinicians must be vigilant in including VZV in their differential diagnosis of CNS infections as VZV is a ubiquitous pathogen; importantly, VZV CNS infections are treatable with intravenous acyclovir therapy and corticosteroids.
Pure Laparoscopic Versus Open Right Hepatectomy in Live Liver Donors
Authors: Hong Suk Kyun , Tan Ming Yuan , Worakitti Lapisatepun , Lee Jeong-Moo , Cho Jae-Hyung , Yi Nam-Joon , Lee Kwang-Woong , Suh Kyung-Suk
Published: April 2020

Objective:

The aim of the study was to present the safety and feasibility of pure laparoscopic donor right hepatectomy (PLDRH) in comparison with those of conventional donor right hepatectomy.

Summary Background Data:

Although the use of PLDRH is gradually spreading worldwide, its outcomes, including the long-term outcomes in both donors and recipients, have not yet been evaluated in a large comparative study.

Methods:

We retrospectively reviewed the medical records of 894 donors who underwent living donor liver transplantation between January 2010 and September 2018 at Seoul National University Hospital. We performed 1:1 propensity score matching between the PLDRH and conventional donor right hepatectomy groups. Subsequently, 198 donor-recipient pairs were included in each group.

Results:

The total operation time (P< 0.001), time to remove the liver (P< 0.001), and warm ischemic time (P< 0.001) were longer in the PLDRH group. None of the donors required intraoperative transfusion or experienced any irreversible disabilities or mortalities. The length of postoperative hospital stay was significantly shorter in the PLDRH group (P< 0.001). The rate of complications in donors was similar between the 2 groups. Although other complication rates in recipients were, however, similar, the rates of early (P= 0.019) and late (P< 0.001) biliary complications in recipients were higher in the PLDRH group. There was no significant difference in overall survival and graft survival between the 2 groups.

Conclusions:

PLDRH is feasible when performed at an experienced living donor liver transplantation center. Further studies on long-term recipient outcomes including biliary complications are needed to confirm the safety.
Gasless Laparoscopic Myomectomy Using A J-shaped Retractor and Suture Technique
Authors: Hwang Jong Ha , Kim Bo Wook
Published: April 2020

Objective:

This study aimed to compare gasless single-port access (SPA) laparoscopic myomectomy using a J-shaped retractor and conventional SPA laparoscopic myomectomy.

Study Design:

The medical records of 60 patients who underwent laparoscopic myomectomy between January 2016 and August 2019 were reviewed. Thirty patients underwent gasless SPA laparoscopic myomectomy using a J-shaped retractor, and 30 patients underwent conventional SPA laparoscopic myomectomy. The 2 groups were compared in terms of surgical outcomes. In gasless laparoscopic myomectomy, closure of the uterine defect after myomectomy was performed using an extracorporeal suture technique with a Kelly clamp and knot pusher.

Results:

On comparing gasless SPA and conventional SPA laparoscopic myomectomy, no significant differences were observed in age, body mass index, parity, previous abdominal surgery, and size of the dominant uterine myoma. The median retraction setup time from skin incision was 8 minutes (range, 5 to 15 min) with gasless SPA laparoscopic myomectomy. The median total operation times were 105 minutes (range, 62 to 210 min) with gasless SPA myomectomy and 110 minutes (range, 60 to 270 min) with conventional SPA myomectomy, and there was no significant difference (P=0.251). There was no difference between the groups in terms of estimated blood loss. None of the patients experienced laparotomy conversion in both groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups.

Conclusion:

Gasless SPA laparoscopic myomectomy using a J-shaped retractor is a safe and feasible approach, which allows for easy and convenient suturing of a uterine defect after myomectomy.
Cannabis and cannabinoids in cancer pain management
Authors: Meng Howard , Dai Tianyang , Hanlon John G. , Downar James , Alibhai Shabbir M.H. , Clarke Hance
Published: April 2020

Purpose of review

An increasing number of patients are turning to cannabis and cannabinoids for management of their palliative and nonpalliative cancer pain and other cancer-related symptoms. Canadians have a legal framework for access to medical cannabis, which provides a unique perspective in a setting lacking robust clinical evidence. This review seeks to delineate the role of cannabis and cannabinoids in cancer pain management and offers insight into the Canadian practice.

Recent findings

A cohort study using nabiximols on advanced cancer pain in patients already optimized on opioids, over 3 weeks, demonstrated improved average pain score. A large observational study of cancer patients using cannabis over 6 months demonstrated a decreased number of patients with severe pain and decreased opioid use, whereas the number of patients reporting good quality of life increased.

Good preclinical animal data and a large body of observational evidence point to the potential efficacy of cannabinoids for cancer pain management. However, there are relatively weak data pointing to clinical efficacy from clinical trial data to date. In Canada, the burgeoning cannabis industry has driven the population to embrace a medicine before clinical evidence. There remains a need for high-quality randomized controlled trials to properly assess the effectiveness and safety of medical cannabis, compared with placebo and standard treatments for cancer-related symptoms.
Anatomical Distance From the Cervicovaginal Junction to the Uterovesical Peritoneal Reflection
Authors: Liu Xiaochun , Guo Zhuodan , Yu Bing , Wang Wenzhen , Hao Qian , Wang Wenyan , Wen Yaling
Published: April 2020

Objective

The objective of this study was to measure the anatomical distance from the cervicovaginal junction to the uterovesical peritoneal reflection (CJ-PR).

Methods

A total of 120 hysterectomy patients were selected as study subjects. The uterus was removed, and the CJ-PR distance was immediately measured. For total vaginal hysterectomy, measurement was performed intraoperatively. The cervical length was also measured postoperatively.

Results

The median (interquartile) CJ-PR distance for all subjects was 3.3 (2.9–3.7) cm. Comparison of premenopausal and postmenopausal women without prolapse revealed median CJ-PR distances of 3.3 (3.0–3.6) cm and 3.0 (2.6–3.4) cm, respectively. The CJ-PR distance was longer in women with prolapse (4.6 [3.7–5.6] cm) than in those without prolapse (3.2 [2.8–3.6] cm). The median cervical lengths were 3.1 (2.7–3.6) cm for postmenopausal patients without prolapse and 4.4 (3.6–5.8) cm for postmenopausal patients with prolapse.

Conclusions

Knowledge of the CJ-PR distance may help gynecologists predict how far the uterovesical PR is from the anterior vaginal incision.