bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple Merkel cell carcinoma: a case report
Authors: Omar Abdullah , Alassil Houda , Alloush Duha
Published: August 2023

Merkel cell carcinoma (MCC) is an uncommon, fast-growing tumour, classified as a neuroendocrine neoplasm that affects the skin and spreads quickly to other parts of the body. It often affects aged, immunosuppressed people with a history of sun exposure and has a slight tendency to affect men. This report represents a case of multiple MCC nodules distributed on the chest and head of a 65-year-old Syrian male. The lesions occurred 1 year before presentation. The excisional biopsy confirmed the diagnosis of MCC. Further investigations indicated to assess metastasis, but the patient passed away before completing our recommendation. In this report, we aim to confirm the vital role of early detection when dealing with an aggressive tumour such as MCC, with a 50% chance of survival for 5 years. Otherwise, more lesions will worsen the prognosis, precisely like what occurred with our patient.
Aspergillosis and pulmonary tuberculosis co-infection in a 9-year-old with B-cell acute lymphoblastic leukemia
Authors: Iamwat Wirapatra , Cheawcharnprapan Krit , Yenjabog Patcha , Lertkovit Oranooj , Isaranimitkul Daranee , Kanjanaphan Thiraporn
Published: August 2023

This case report highlights the infrequent occurrence of coinfection involving invasive aspergillosis and Mycobacterium tuberculosis (MTB) in pediatric patients. We present the case of a 9-year-old Thai girl diagnosed with B-cell acute lymphoblastic leukemia, who experienced prolonged febrile neutropenia lasting 1 month during chemotherapy. Chest computed tomography (CT) revealed lung nodules with an air crescent sign, while CT angiography of the brain detected an infected ruptured brain aneurysm, which exhibited septate hyphae with acute angle branching, consistent with invasive aspergillosis. Despite voriconazole treatment, the patient’s high-grade fever and dyspnea persisted. Further investigations revealed a lung abscess and wedge resection confirmed AFB 1+ and positive MTB detection via polymerase chain reaction, leading to the initiation of combined treatment for pulmonary tuberculosis and invasive aspergillosis. Considering drug–drug interactions was an essential aspect of the management. This case report highlights challenges of coinfection between invasive aspergillosis and MTB.
The disappearing act: case of a migrating left renal vein stent
Authors: Cooley Christopher , Alexander Robert A , Johns Pradeep , Fanning Thomas , Oommen Jerry Z
Published: August 2023

Introduction: Nutcracker syndrome (NS) is a rare condition in which the abdominal aorta and superior mesenteric artery compress the left renal vein (LRV). One treatment option is the placement of an endovascular stent into the LRV, which carries the risk of stent migration.

Case Report: A 30-year-old female with NS status-post LRV stenting 6 months prior presented to the emergency department with suprapubic pain. An incidental finding on abdominal computed tomography scan noted interval removal of LRV stent, which had not been surgically removed. A subsequent chest radiograph showed the stent lodged in the left pulmonary artery.

Discussion: To our knowledge, this is the first documented case of LRV stent migration to the pulmonary artery. This case demonstrates the importance of physician awareness of stent migration as a potential complication after stent placement, and careful review of all imaging findings, even if unrelated to the chief complaint.
The Disenchantment of Chiromancy: Reading Modern Hands from Palmistry to Genetics
Authors: Bashford Alison
Published: August 2023

We might expect chiromancy in the modern period to be analysed best within the well-known late nineteenth-century occult revival. The specific practice of palmistry, as it happens, is minimally examined in that historiographical context. Yet the purpose here is not to reinstate palmistry into our already extensive understanding of an Anglo-American modern occult, but to show how other readers of hands, including those trained in biomedical sciences, exceeded occultism altogether, and often enough repudiated it. This article considers modern palmistry in the first instance through an intellectual and social historiography of mind–body knowledges and practices. It shows not only how various ‘psychic’ practices turned into ‘psy’ practices, but also how reading signs of the hand morphed into clinical diagnostics, into primatology, comparative anatomy and eventually into early medical genetics, especially through the so-called ‘simian line’ correlated with Down syndrome. Through analysis of a suite of London-based hand experts, this twentieth-century history of palm-reading argues for a plain ‘disenchantment’ of chiromancy, qualifying historians’ common commitment to theses of re-enchantment. One strand of palm-reading’s recent past turns out to be part of the history of scientific naturalism, not super-naturalism at all.
كُلّنا شرطة - مبادرة شرطة أبوظبي للمشاركة المجتمعية
Authors: المنهالي سعادة الحي , الكعبي الدكتور فيصل , الهنائي الرائد محمد
Published: August 2023

الملخص

يتم دعم مفهوم الشرطة المجتمعية عالميَّا من خلال تطبيقه في العديد من الاستراتيجيات المخصصة لتلبية احتياجات البيئات الفردية من خلال أهداف مشتركة، والتي تشمل إشراك المجتمع لاستكمال الأعمال الأساسية للشرطة وسلامة المجتمع. وفي الوقتِ ذاته، طورت الأجهزة الشرطية متعددة الأحجام والجنسيات مجموعة من الحملات المستهدفة لدعم وتعزيز مشاركة المجتمع مع الشرطة للمساهمة في بناء مجتمعات آمنة. إن الجمع بين استراتيجيات “القوة اللينة” أو حملات الشرطة المجتمعية تُعَدّ بمثابة العقيدة الرئيسية لشرطة أبوظبي وهي مبادرة كلنا شرطة. يُبرز هذا المقال جولة استكشافية لمبادرة كلنا شرطة والنتائج لأكثر من 200 جنسية مجتمعة ضمن 1.48 مليون نسمة من سكان أبوظبي تساهم المواءمة بين رؤية وأهداف وغرض وقبول وتأثير الاستراتيجية المجتمعية لشرطة أبوظبي في إثراء المناقشات المتعلقة بالسياسات والممارسات المرتبطة بحفظ الأمن لمجتمع حديث.
Establishment of institutional diagnostic reference level for coronary angiography procedures in Sri Lanka
Authors: Ramanathan Vijitha , Senarathna Hasalanka S , Gunaratna Hasun U , Bandara Praneeth M , Horadigala Chathura J
Published: August 2023

Amongst many interventional procedures performed in a cardiac catheterisation laboratory, the coronary angiography (CAG) is the most frequently performed cardiac interventional procedure. A diagnostic reference level (DRL) is an effective tool to optimise the radiation exposure to patients and staff whilst maintaining the adequate diagnostic image quality. The aim of the study was to establish institutional DRLs for the CAG procedures performed at a selected private hospital in Colombo, Sri Lanka. A total of 325 CAG procedures were selected for this study from two C-arm machines. The institutional DRLs of cumulative dose length product (DAP) and fluoroscopic time for the CAG procedure were calculated. The established institutional DRL for accumulated DAP and fluoroscopic time are 10 610 mGycm2 and 2.31 min, respectively. As this study conducted at only one institute we recommend to develop national DRLs for mostly performing interventional procedures in Sri Lanka by considering all influencing factors to optimise the patient dose.
Fun and less fun funding: the experiential affordances of research grant conditions
Authors: Stage Andreas Kjær , Utoft Ea Høg
Published: August 2023

The conditions of mainstream research funding constrain risky, novel research. However, alternative grants are emerging. We study grantees of a double-blinded funding scheme targeting risky, novel research: The Villum Experiment (VE). Without prompting, scientists juxtaposed the experience of performing research under these conditions with that of performing research funded by mainstream grants: fun and less fun. The conditions of VE felt less intrusive and appealed to their self-perceptions and idealized views of scientific work, which shaped how they conducted the funded research. This paper makes three contributions: (1) it reaffirms that how researchers experience grant conditions affects whether a scheme affords what it intends, (2) it highlights that the affordances of research funding are relative to other concurrent funding options, and (3) it shows that small, more broadly allocatable grants can afford scientists a protected space for autonomous research, usually associated with elusive tenure positions or European Research Council (ERC) grants.
Rehabilitation Following a Triceps Branch to Axillary Motor Nerve Transfer—A Pragmatic Therapy Guide
Authors: O’Sullivan Joel , Jeffrey Jack , Miller Caroline , Power Dominic
Published: August 2023

Peripheral motor nerve transfer surgery is a technique that may be used to restore motor function to paralyzed muscles. Motor nerve transfer involves harvesting an expendable motor nerve branch, and transfer to the motor branch of the denervated target muscle, using microsurgical coaptation. To date, a standardized rehabilitation protocol does not exist. The 6 stages of rehabilitation after motor nerve transfer surgery were outlined by colleagues in the Birmingham Peripheral Nerve Injury service in 2019. This article aims to provide a practical therapy perspective on the rehabilitation stages of motor nerve transfer surgery outlined in that paper, focusing on the radial to axillary nerve transfer. Timeframes for each stage along with exercise prescription and rationale are provided.
Optimizing Pharmacist Team-Integration for ICU Patient Management: Rationale, Study Design, and Methods for a Multicentered Exploration of Pharmacist-to-Patient Ratio
Authors: Keats Kelli , Sikora Andrea , Heavner Mojdeh S. , Chen Xianyan , Smith Susan E. ,   on behalf of the OPTIM Investigator Team
Published: August 2023

BACKGROUND:

The workload of healthcare professionals including physicians and nurses in the ICU has an established relationship to patient outcomes, including mortality, length of stay, and other quality indicators; however, the relationship of critical care pharmacist workload to outcomes has not been rigorously evaluated and determined. The objective of our study is to characterize the relationship of critical care pharmacist workload in the ICU as it relates to patient-centered outcomes of critically ill patients.

METHODS:

Optimizing Pharmacist Team-Integration for ICU patient Management is a multicenter, observational cohort study with a target enrollment of 20,000 critically ill patients. Participating critical care pharmacists will enroll patients managed in the ICU. Data collection will consist of two observational phases: prospective and retrospective. During the prospective phase, critical care pharmacists will record daily workload data (e.g., census, number of rounding teams). During the retrospective phase, patient demographics, severity of illness, medication regimen complexity, and outcomes will be recorded. The primary outcome is mortality. Multiple methods will be used to explore the primary outcome including multilevel multiple logistic regression with stepwise variable selection to exclude nonsignificant covariates from the final model, supervised and unsupervised machine learning techniques, and Bayesian analysis.

RESULTS:

Our protocol describes the processes and methods for an observational study in the ICU.

CONCLUSIONS:

This study seeks to determine the relationship between pharmacist workload, as measured by pharmacist-to-patient ratio and the pharmacist clinical burden index, and patient-centered outcomes, including mortality and length of stay.
Pediatric Acute Respiratory Distress Syndrome and Tracheal Injury in a Patient Requiring Extracorporeal Membrane Oxygenation Following Cement Aspiration: A Case Report
Authors: Böhrer Madeleine , Long Cai , Thompson Adrienne , Veroukis Stasa , Khaira Gurpreet
Published: August 2023

BACKGROUND:

Ingestion and aspiration of caustic substances is a common problem in pediatrics and carries the risk of associated aspiration pneumonitis, laryngeal injury, and esophageal injury. Extracorporeal membrane oxygenation (ECMO) has been used to support adults with acute respiratory distress syndrome (ARDS) from aspiration of cement dust, however, literature outlining pediatric management in cases of alkali lung and airway injuries is lacking.

CASE SUMMARY:

A 6-year-old boy presented with ARDS from cement aspiration requiring high-pressure ventilation. He had further complications of tracheal injury with subsequent pneumomediastinum secondary to the alkali burn. He required ECMO to facilitate repeat bronchoscopy for cement particle washout and to enable recovery from ARDS and tracheal injury.

CONCLUSION:

This case highlights the need to perform early bronchoscopy and gastrointestinal endoscopy for injury assessment and foreign body removal in alkali burns. It also emphasizes the value of ECMO support for respiratory failure and facilitating bronchoalveolar lavage when it is not otherwise tolerated.
Fasting-mimicking diet: a metabolic approach for the treatment of breast cancer
Authors: Ligorio Francesca , Provenzano Leonardo , Vernieri Claudio
Published: August 2023

Purpose of review

Metabolic reprogramming is a new and potentially targetable hallmark of cancer. In recent years, fasting and fasting-mimicking diets (FMDs) have been tested as anticancer strategies both in preclinical experiments and in clinical trials. In this review, we aim at summarizing the available evidence about the antitumour activity of these approaches in preclinical breast cancer models, as well as results from clinical trials investigating fasting/FMD in breast cancer patients.

Recent findings

Preclinical evidence demonstrated that nutrient deprivation boosts the antitumor activity of chemotherapy, immunotherapy or targeted therapies in triple-negative breast cancer (TNBC) and HR+/HER2 models through both cell-autonomous antitumour effects in cancer cells and favourable modifications in intratumor immune cells. Several clinical experiences demonstrated that fasting/FMD is feasible and well tolerated in combination with standard treatments in BC patients, and that it could reduce chemotherapy-related toxicities. Finally, despite the absence of randomized trials demonstrating the antitumor activity of fasting/FMD in breast cancer patients, preliminary clinical reports suggest that this experimental nutritional strategy may enhance chemotherapy activity. Randomized clinical trials are ongoing to validate these results at a larger scale.

Fasting/FMD is a promising therapeutic approach in patients with breast cancer; ongoing and future trials will confirm their role in improving breast cancer care.
Serum 25-hydroxyvitamin D, genetic susceptibility, and the risk of incident type 2 diabetes: A prospective cohort in East China
Authors: Sun Ying , Zhang Haojie , Wang Bin , Wang Yuying , Chen Chi , Chen Yi , Lu Yingli , Wang Ningjian
Published: August 2023

Background:

The serum vitamin D level varies widely by population, and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus (T2DM). However, the relationship is inconsistent and the impact of vitamin D on T2DM among East Chinese adults is unclear. The study aimed to investigate the association between serum 25-hydroxyvitamin D (25[OH]D) levels and the risk of T2DM and evaluated whether the association is modified by genetic predisposition.

Methods:

In the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) cohort, 1862 participants free of T2DM at baseline were included. A weighted genetic risk score was calculated with 28 variants associated with T2DM. Hierarchical logistic models were used to examine the association of serum 25(OH)D and genetic risk with T2DM.

Results:

After a 5-year follow-up, 132 cases of T2DM were documented. We observed no significant association between quartiles of serum 25(OH)D and T2DM risk after multivariable adjustment (χ2 = 0.571, P
for trend = 0.426). Compared to those in the lowest quartile of 25(OH)D, the odds ratios (ORs) (95% confidence interval [CI]) for participants with increased quartiles were 1.29 (0.74–2.25), 1.35 (0.77–2.36), and 1.27 (0.72–2.24), respectively. We observed a positive association of glycated hemoglobin (HbA1c) with 25(OH)D at baseline (β = 1.752, P = 0.001) and after follow-up (β = 1.385, P = 0.003), and a negative association of ln conversion homeostasis model assessment (HOMA)-β with 25(OH)D at baseline (β = -0.982, P = 0.021). There was no significant interaction between 25(OH)D and diabetes genetic predisposition on the risk of T2DM (χ2 = 2.710, P
for interaction = 0.100). The lowest OR (95% CI) of T2DM was among participants with low genetic risk and the highest quartile of 25(OH)D (0.17 [0.05–0.62]).

Conclusion:

Serum 25(OH)D may be irrelevant to the risk of incident T2DM among East Chinese adults regardless of genetic predisposition.
Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments
Authors: Wang Juncheng , Liu Hanning , Yue Chao , Yang Limeng , Yang Kai , Zhao Yan , Ren Huan , Zhang Ying , Zheng Zhe
Published: August 2023

Background:

Patients who undergo coronary artery bypass grafting (CABG) are known to be at a significant risk of experiencing long-term adverse events, emphasizing the importance of regular assessments. Evaluating health-related quality of life (HRQoL) serves as a direct method to gauge prognosis. Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary (PCS) and Mental Component Summary (MCS) derived from the Short-Form 36 (SF-36) health survey in CABG patients.

Methods:

The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013. SF-36 assessments were conducted during both the hospitalization period and follow-up. The primary endpoint of the study was all-cause mortality, while the secondary outcome was a composite measure including death, myocardial infarction, stroke, and repeat revascularization. We assessed the relationships between the PCS and MCS at baseline, as well as their changes during the first 6 months after the surgery (referred to as ΔPCS and ΔMCS, respectively), and the observed outcomes.

Results:

The patients were followed for an average of 6.28 years, during which 35 individuals (35/433, 8.1%) died. After adjusting for clinical variables, it was observed that baseline MCS scores (hazard ratio [HR] for a 1-standard deviation [SD] decrease, 1.57; 95% confidence interval [CI], 1.07–2.30) and ΔMCS (HR for a 1-SD decrease, 1.67; 95% CI, 1.09–2.56) were associated with all-cause mortality. However, baseline PCS scores and ΔPCS did not exhibit a significant relationship with all-cause mortality. Notably, there was a dose-response relationship observed between ΔMCS and the likelihood of all-cause mortality (HRs for the 2nd, 3rd and 4th quartiles compared to the 1st quartile, 0.33, 0.45 and 0.11, respectively).

Conclusions:

Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG. Better mental health status and recovery indicated better prognosis.
Correlation of Lung Immune Prognostic Index With Efficacy of PD-1/PD-L1 Inhibitor Combined With Chemotherapy and Prognosis in Patients With Advanced Non–Small Cell Lung Cancer
Authors: Zhu Zhongxiu , Zhang Aixia
Published: August 2023

Objective:

Non–small cell lung cancer (NSCLC) is a devastating but universal class of lung carcinoma with an unfavorable prognosis. This paper mainly investigated the correlation between lung immune prognostic index (LIPI) score and combined treatment of immune checkpoint inhibitor and chemotherapy (CHT) in patients with advanced NSCLC.

Methods:

Totally, 301 advanced NSCLC patients with programmed death-ligand 1 (PD-L1) expression ≥1% were assigned into good LIPI group (N=113), intermediate LIPI group (N=101), and poor LIPI group (N=87) based on LIPI scoring system, followed by treatment of CHT plus programmed cell death-1 (PD-1)/PD-L1 inhibitor. The differences in clinical parameters between subgroups of NSCLC patients were analyzed by χ2 test, 1-way analysis of variance, and Kruskal-Wallis H test. All patients were followed up until June 30, 2022, and objective response rate, disease control rate, progression-free survival (PFS), and overall survival (OS) were recorded. The independent associations of LIPI score with PFS and OS were assessed via the Cox regression model.

Results:

There were evident differences in clinical stage and lymphocyte among the 3 subgroups of NSCLC patients. The efficacy of PD-1/PD-L1 inhibitor combined with CHT was better in patients with good LIPI score, manifested by higher objective response rate and disease control rate. Moreover, LIPI score was an independent factor influencing PFS and OS in patients with advanced NSCLC, with longer PFS and OS in patients with good LIPI score.

Conclusion:

LIPI score has a predictive value for combination therapy of PD-1/PD-L1 blockade and CHT in advanced NSCLC patients.
Examining the association between urinary triclosan levels and menopausal status: results from the National Health and Nutrition Examination Survey, 2003 to 2016
Authors: Beroukhim Gabriela , Kayani Jehanzeb , Taylor Hugh S. , Pal Lubna
Published: August 2023

Objective

To examine the association between urinary levels of triclosan (TCS), a ubiquitous endocrine disrupter, and menopausal status using the National Health and Nutrition Examination Survey.

Methods

A retrospective cross-sectional study from 2003 to 2016 was conducted among US female participants who completed the reproductive health questionnaire and provided TCS-level measurements. Exposure was assessed by urinary TCS levels adjusted for urinary creatinine; levels were log-transformed to achieve normal distribution for parametric analyses. Menopausal status was based on participants' responses to: “What is the reason that you have not had a period in the past 12 months?” Multivariable linear regression analyses examined the association between creatinine-adjusted urinary TCS levels and menopausal status after adjusting for age at survey completion, body mass index, race, ethnicity, and smoking exposure.

Results

Of the final sample of female participants (n = 6,958), 40% identified as postmenopausal, of whom 60% had experienced natural menopause, and of these, 11% had become menopausal at under 40 years of age. Triclosan levels correlated positively with advancing age (r = 0.09, P < 0.001) and inversely with body mass index (r = −0.09, P < 0.001). Smoking exposure was associated with significantly lower TCS levels (P < 0.001). Compared with premenopausal women, postmenopausal women had significantly higher log-transformed, creatinine-adjusted TCS levels (mean, −1.22 ± 1.79 vs −1.51 ± 1.79 ng/mg creatinine; P < 0.001). Triclosan levels were unrelated to the duration of menopause and did not differ between women who underwent natural versus surgical menopause, and premature menopause versus menopause at 40 years or older. In unweighted multivariate linear regression analyses, menopausal status was independently associated with higher urinary TCS levels after adjusting for covariates (β coefficient, 0.17; 95% CI, 0.020-0.323; P = 0.026).

Conclusions

In a nationally representative sample, postmenopausal status was associated with higher urinary TCS levels, observations that merit further investigation into potential exposures and health consequences.
Association of menopausal vasomotor symptom severity with sleep and work impairments: a US survey
Authors: DePree Barbara , Shiozawa Aki , King Deanna , Schild Arianne , Zhou Mo , Yang Hongbo , Mancuso Shayna
Published: August 2023

Objective

Menopausal vasomotor symptoms commonly disrupt sleep and affect daytime productivity. This online survey evaluated associations between vasomotor symptom severity and perceived sleep quality and work productivity.

Methods

Participants were perimenopausal or postmenopausal US women aged 40 to 65 years with ≥14 vasomotor symptom episodes per week for ≥1 week in the past month. The women, who were recruited from Dynata panels via email invitation and categorized by vasomotor symptom severity based on the Menopause Rating Scale, were surveyed about sleep and work productivity and completed the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b (primary outcome) and Sleep-Related Impairment Short Form 8a, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire.

Results

Among 619 respondents (mean age, 53 y; White, 91%; perimenopausal, 34%; postmenopausal, 66%; 57.5% were never treated for vasomotor symptoms), vasomotor symptoms were mild in 88, moderate in 266, and severe in 265. A majority (58% overall) were employed, including 64.8%, 49.6%, and 64.2% of women with mild, moderate, and severe VMS, respectively. Of the 90.8% who reported that vasomotor symptoms affect sleep (81.8%, 86.8%, and 97.7% of those with mild, moderate, and severe VMS), 83.1% reported sleep-related changes in productivity (75.0%, 73.2%, and 94.2%, respectively). Patient-Reported Outcomes Measurement Information System Sleep Disturbance Short Form 8b mean T scores in the mild (T score, 53.5), moderate (57.3), and severe (59.8) VMS cohorts indicated more sleep disturbance than in the general population (T score, 50; overall P < 0.001 before and after controlling for confounding variables). Sleep-Related Impairment 8a results were similar. Vasomotor symptom severity was positively associated with Pittsburgh Sleep Quality Index mean scores, presenteeism, absenteeism, overall work impairment, and impairment in general activities.

Conclusions

Greater vasomotor symptom severity was associated with more sleep disturbance, more sleep-related impairment, worse sleep quality, and greater impairment in daytime activities and work productivity.
Less Complex Contact Lens Required for a Patient With Keratoconus After Topography-Guided Photorefractive Keratectomy
Authors: Roll Elizabeth H. , Gelles John D. , Hersh Peter S. , Yu Austin S. , Su Becky , Greenstein Steven A.
Published: August 2023

In this report, we discuss contact lens (CL) fitting in a patient with a history of keratoconus (KC), before and after undergoing topography-guided photorefractive keratectomy (TG PRK). Before TG PRK, the patient failed multiple CL modalities and reported difficulty with his habitual CLs and inadequate spectacle-corrected visual acuity to perform his activities of daily living. In this case, a collaborative, comprehensive approach to visual management in a patient with KC was used, and after TG PRK was performed to improve his corneal contour and symmetry, our patient was fit with a standard soft CL and additionally had improved spectacle-corrected visual acuity.
A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain
Authors: Simons Laura E. , Harrison Lauren E. , Boothroyd Derek B. , Parvathinathan Gomathy , Van Orden Amanda R. , O'Brien Shannon F. , Schofield Deborah , Kraindler Joshua , Shrestha Rupendra , Vlaeyen Johan W.S. , Wicksell Rikard K.
Published: August 2023

Graded exposure treatment (GET) is a theory-driven pain treatment that aims to improve functioning by exposing patients to activities previously feared and avoided. Combining key elements of GET with acceptance-based exposure, GET Living (GL) was developed for adolescents with chronic pain (GL). Based on robust treatment effects observed in our single-case experimental design pilot trial of GL (NCT01974791), we conducted a 2-arm randomized clinical trial comparing GL with multidisciplinary pain management (MPM) comprised of cognitive behavioral therapy and physical therapy for pain management (NCT03699007). A cohort of 68 youth with chronic musculoskeletal pain (M age 14.2 years; 81% female) were randomized to GL or MPM. Owing to COVID-19 restrictions, 54% of participants received zoom video delivered care. Assessments were collected at baseline, discharge, as well as at 3-month and 6-month follow-up. Primary outcomes were self-reported pain-related fear and avoidance. Secondary outcomes were child functional disability and parent protective responses to child pain. As hypothesized, GL improved in primary and secondary outcomes at 3-month follow-up. Contrary to our superiority hypothesis, there was no significant difference between GL and MPM. Patients reported both GL and MPM (in person and video) as credible and were highly satisfied with the treatment experience. Next steps will involve examining the single-case experimental design data embedded in this trial to facilitate an understanding of individual differences in treatment responses (eg, when effects occurred, what processes changed during treatment within the treatment arm). The current findings support GET Living and MPM for youth with chronic pain.
Information is power: a qualitative study exploring the lived experiences of patients with degenerative cervical radiculopathy
Authors: Plener Joshua , Mior Silvano , Atkinson-Graham Melissa , Hogg-Johnson Sheilah , Côté Pierre , Ammendolia Carlo
Published: August 2023

Degenerative cervical radiculopathy (DCR) can lead to severe pain, paraesthesia, and/or motor weakness, resulting in significant morbidity, disability, and reduced quality of life. Typically, individuals suffer from prolonged symptoms, with time to complete recovery spanning months to years. Little is known about the impact DCR has on peoples' lives. Therefore, this study aimed to explore the everyday experiences of individuals living with DCR. A qualitative study was conducted through an interpretivist lens exploring the experiences of participants. Participants were purposefully recruited and interviewed with 2 research team members. Transcripts were independently analyzed by 2 reviewers and coding was finalized by consensus. Analysis was performed using an interpretative phenomenological approach, with emergent themes mapped onto the 5 domains of the International Classification of Functioning, Disability and Health framework. Eleven participants were interviewed between December 2021 and April 2022. Three themes emerged: the biopsychosocial impact of DCR, role of the health care provider, and uncertainty surrounding DCR. Pain and paraesthesia were the most common symptoms experienced by participants, leading to significant psychological distress and impact to daily activities, most notably driving, housecleaning, sleep, and ability to work. Participants described the uncertainty they experienced as a result of the unpredictable nature of DCR and the important role that health care providers play in their journey with DCR. Health care providers were seen acting as either a facilitator or a barrier to their recovery. The findings from this study can be used by clinicians providing patient-centered care to better understand the experiences of people with DCR.
Associations between patient-reported functional disability and measures of physical ability in juvenile fibromyalgia
Authors: Gibler Robert C. , Peugh James L. , Pfeiffer Megan , Thomas Staci , Williams Sara E. , Beasley Katie , Bonnette Scott , Collins Sara , Beals-Erickson Sarah E. , Ounpuu Sylvia , Briggs Matthew , Stinson Jennifer N. , Myer Gregory D. , Kashikar-Zuck Susmita ,   for the FIT Teens Trial Study Group
Published: August 2023

Juvenile fibromyalgia (JFM) is a chronic condition characterized by symptoms of pain and fatigue and is associated with sedentary behavior and functional disability. Adults with fibromyalgia exhibit deficits in physical fitness as evidenced by lower aerobic capacity and physical endurance, but it is unknown whether these impairments are apparent in adolescents with JFM. Furthermore, the extent to which functional disability and pain interference relate to measures of physical fitness has not been investigated in a pediatric pain population. During a baseline assessment for a clinical trial, 321 adolescents with juvenile fibromyalgia (Mage = 15.14, 85.2% female) completed measures of pain intensity, fatigue, JFM symptom severity, functional disability, and pain interference. They also completed 2 validated fitness tasks: (1) the Harvard step test, which assesses aerobic fitness, and (2) the 6-minute walk test, a simple submaximal test of endurance. We examined associations among self-report measures and fitness assessments using bivariate correlations. We then employed hierarchical regression analyses to determine the unique contributions of physical fitness assessments to self-reported functional disability and pain interference. Results indicated that youth with JFM exhibited deficits in aerobic capacity and physical endurance. However, physical fitness explained negligible variance in functional disability and pain interference beyond that accounted for by pain, fatigue, and JFM symptom severity. Scores on available functional disability measures may reflect perceived difficulties in coping with symptoms during physical tasks rather than actual physical capability. Rigorous and sensitive assessments of physical fitness and endurance are needed to determine whether rehabilitation interventions for pediatric pain improve physical functioning.
Managers’ Influence on the Prevention of Common Mental Disorders in the Workplace
Authors: Hultqvist Jenny , Zhang Peiran , Staland-Nyman Carin , Bertilsson Monica
Published: August 2023

Objective

To investigate the association among managers’ attitudes toward subordinates with common mental disorders (CMDs), self-confidence in supporting these subordinates, and managerial preventive actions (MPAs).

Methods

A cross-sectional study was conducted among Swedish managers (n = 2988) and two types of MPAs: reviewing assignments and work situation (MPA-review), and talking about CMD at the workplace (MPA-talk). Binary logistic regression models were applied and adjusted for individual and organizational covariates.

Results

Managers with negative attitudes toward subordinates with CMD were less likely to have done both MPAs. Managers with higher self-confidence in supporting these subordinates were more likely to have done both MPAs compared with managers with lower self-confidence.

Conclusions

Managerial negative attitudes toward CMD and self-confidence in supporting subordinates with CMD have a role in MPAs and should be addressed in manager training programs to encourage preventive actions.
Effect of Work-Related Behavior and Experience Patterns on Sleep Quality in Emergency Medical Service Personnel
Authors: Schnell Julia , Thielmann Beatrice , Schumann Heiko , Böckelmann Irina
Published: August 2023

Objective

The aim of this study was to examine the influence of work-related behavior and experience patterns on sleep quality in emergency medical service personnel.

Methods

From the total sample of 508 emergency medical service workers who took part in the Germany-wide online survey, 368 respondents completed the questionnaires on sleep characteristics (Pittsburgh Sleep Quality Index [PSQI]) and work-related behavior and experience pattern. Three hundred sixty-seven of the 368 participants also finished the Regensburg Insomnia Scale.

Results

Based on their work-related behavior and experience pattern results, individuals were categorized into one of the four following patterns: two risk patterns (A, B) and two healthy behavior and experience patterns (G, S). Participants that were classified into risk-pattern A and B (33.85%) scored significantly higher in both PSQI and Regensburg Insomnia Scale overall score and all PSQI components implicating a poorer sleep quality. A total of 78.5% of the individuals with pattern A and B were considered bad sleepers whereas only 43.4% of individuals with pattern G and S were scored as bad sleepers.

Conclusions

Work-related behavior and experience patterns showed a strong association to sleep characteristics and may therefore be used to identify appropriate preventative measures.
Pediatric Surgical Nurses as Advocates for Immigrant Latinx Children: A Case Report
Authors: Tenemaza-Rojas Katherine Marilyn , Roney Linda Nancy
Published: August 2023

Latinx children represent over a quarter of the child population in the United States and are cared for by pediatric nurses in various settings across the care continuum. In the clinical setting, medical interpretation resources help pediatric nurses interact with their patients and their families, yet significant barriers to therapeutic communication remain. A case study will illustrate critical points for nurses to consider as they strive to provide the best care for their Latinx pediatric patients and their families. Although most support resources are community based, nurses who better understand the social and legal implications of immigration support higher levels of advocacy at the bedside.
The genetics of autosomal dominant familial hypercholesterolemia
Authors: Anderson Sharon , Botti Christina
Published: August 2023

Familial hypercholesterolemia (FH) is one of the most common genetic conditions. Affected individuals are unable to metabolize cholesterol due to inherited changes in the low-density lipoprotein (LDL) receptor, which impairs the ability to metabolize cholesterol, resulting in extremely high levels of cholesterol that leads to premature coronary artery disease. Autosomal dominant FH is caused by variants in several genes, which may present as heterozygous FH (less severe) or homozygous FH (more severe). Clinical diagnosis may be more likely when there is a family history of two or more first-degree relatives with total and LDL-cholesterol (LDL-C) level elevations, a child is identified, or the affected individual or close relatives have tendon xanthomas and/or progressive atherosclerosis. This article provides an overview of autosomal dominant FH, including disease prevalence, clinical diagnostic criteria, genetic variants, diagnostic testing, pathognomonic findings, and treatment options. It also shares a brief case, which highlights challenges associated with genetic test interpretation and the importance of including experienced providers in the diagnosis and treatment of this underdiagnosed and often untreated or undertreated genetic condition.
Results of a Novel, Nonsurgical Bone-Conduction Hearing Aid for the Treatment of Conductive Hearing Loss in Australian Children
Authors: Marino Roberta , Eager Katrise , Kuthubutheen Jafri , Kadhim Latif , Távora-Vieira Dayse
Published: August 2023

Objective

To determine and compare the benefits a novel adhesive bone-conduction system and a conventional bone-conduction hearing aid (BCHA) on a softband for children with conductive hearing loss.

Study Design

Prospective, single-subject randomized, crossover trial.

Setting

Tertiary referral center in Australia.

Participants

Eight children aged from 4 to 17 years with conductive hearing loss.

Intervention

Rehabilitative with participants using the novel adhesive bone-conduction aid and a BCHA.

Main Outcome Measures

Aided thresholds, as well as speech perception in quiet, unaided and aided with the novel adhesive bone-conduction aid and BCHA on a softband. For the six older children, speech in noise testing was also conducted.

Results

The mean unaided four frequency average hearing levels was 48 dB HL for air conduction, 10.5 dB HL for bone conduction, with a mean air-bone gap in the aided ear of 37.5 dB HL.

Four-frequency average hearing level aided thresholds were 20.2 dB for the novel device and 19.8 dB for the BCHA, with no significant difference between the devices. Aided monosyllabic word scores improved from an average of 45% in the unaided condition to 81.6 and 85% for the novel adhesive and BCHA devices, respectively. Aided speech in noise performance improved, on average, by 1.6 dB SNR when wearing the BCHA and the novel adhesive device, with no significant difference in performance between the two devices.

Conclusions

The novel device provided equivalent performance to the BCHA on all measures and can be considered as an alternative device for pediatric patients with conductive hearing loss.
Cognitive Performance, Sociodemographic Factors, Pure-Tone Audiometry, and their Association with Speech Discrimination: A Prospective Population-Based Study of 1,061 Older Adults
Authors: Marinelli John P. , Reed Nicholas S. , Lohse Christine M. , Fussell Wanda L. , Petersen Ronald C. , Machulda Mary M. , Vassilaki Maria , Carlson Matthew L.
Published: August 2023

Objective

Hearing loss is increasingly recognized as a chronic disease state with important health sequelae. Although considered a central component of routine audiometric testing, the degree to which various patient factors influence speech discrimination is poorly characterized to date. The primary objective of the current work was to describe associations of cognitive performance, sociodemographic factors, and pure-tone audiometry with speech discrimination in older adults.

Study Design

Prospective study.

Setting

Olmsted County, Minnesota.

Patients

There were 1,061 study participants 50 years or older at enrollment in the population-based Mayo Clinic Study of Aging between November 2004 and December 2019 who underwent formal audiometric and cognitive testing included in the current investigation.

Main Outcome Measures

The primary outcome measure was word recognition scores (WRSs; measured as <100% vs 100% as well as continuous), with pure-tone averages (PTAs; 0.5, 1, 2, and 3 kHz), age, sex, years of education, state area deprivation index (ADI) quintiles, and global cognitionzscores as explanatory features.

Results

The mean (SD) age among the 1,061 participants was 76 (9) years with 528 (50%) males. Participant age [OR (95% CI) for a 10-year increase of 1.8 (1.4–2.3),p< 0.001], male sex [OR = 2.6 (1.9–3.7),p< 0.001], and PTA [OR for a 10-dB hearing loss increase of 2.4 (2.1–2.8),p< 0.001] were all significantly associated with <100% WRSs, with the greatest explanatory ability attributable to the PTA. Years of education (p= 0.9), state ADI quintile (p= 0.6), and global cognitive performance (p= 0.2) were not associated with WRS. The multivariable model demonstrated strong predictive ability for less than perfect WRSs, with acindex of 0.854. Similar results were seen for WRSs analyzed as continuous, with the multivariable model resulting in anR2value of 0.433.

Conclusions

Although PTA exhibited the greatest influence on speech discrimination, advancing age and male sex both independently increased the likelihood of having worse speech discrimination among older adults, even after accounting for years of education, neighborhood-level socioeconomic disadvantage, and cognitive function. These findings help identify patient factors that can be instrumental when designing screening programs for adult-onset hearing loss.
Development and Chinese Cross-Cultural Adaptation of the Cochlear Implant Quality-of-Life Survey
Authors: Fan Caleb J. , Mavrommatis Maria A. , Kaul Vivian F. , McRackan Theodore R. , Wanna George B. , Cosetti Maura K.
Published: August 2023

Objective

To conduct the Chinese cross-cultural adaptation of the Cochlear Implant Quality of Life-10 Global (CIQOL-10 Global) instrument.

Patients

Bilingual Chinese American cochlear implant users.

Intervention

Chinese cross-cultural adaptation of the CIQOL-10 Global.

Main Outcome Measure

Description of the process of Chinese cross-cultural adaptation of the CIQOL-10 Global and pilot testing of the Chinese CIQOL-10 Global in the target patient population.

Results

The CIQOL-10 Global was cross-culturally adapted into Chinese. Ten participants were recruited for pilot testing. There was wide representation from across the target population in terms of age (mean, 44.8 yr; range, 20.2–80.3 yr), sex (5 were male, 5 were female), education, and socioeconomic factors. All participants were able to easily read, comprehend, and fill out the Chinese CIQOL-10 Global.

Conclusions

The Chinese version of the CIQOL-10 Global is now available to provide an overall assessment of quality of life of Chinese-speaking cochlear implant users.
A Perplexing Case of a Germ Cell Tumor: A Case Report
Authors: Rajan Priyank , Misra Ruchira , Mushrif Sujata , Kandalkar Bhuvaneswari , Parikh Ruchi , Shah Rasiklal , Kurkure Purna
Published: August 2023

Germ cell tumors (GCTs) are associated with pure gonadal dysgenesis or Swyer syndrome. Swyer syndrome usually presents with primary amenorrhea, streak ovaries, and mixed GCT. However, our patient presented with secondary amenorrhea, normal female external genitalia, and a mixed GCT. Constitutional karyotype was suggestive of 46,XY. Management comprised chemotherapy, followed by surgery. Histopathology was suggestive of dysgerminoma complicating a gonadoblastoma. The purpose of reporting this case is its rarity and the importance of diagnosing an XY karyotype, as the incidence of GCTs is higher in these patients.
A Pediatric Case of Extraneural Subcutaneous Metastasis of Ependymoma
Authors: Ueno Chika , Tanaka Masayuki , Yamazaki Ayako , Yamamoto Shuichi
Published: August 2023

Ependymoma is the third most common brain tumor in children. Extracranial metastases of ependymomas are uncommon. A 21-month-old Japanese boy was diagnosed to be brain dead due to a posterior fossa (PF) brain tumor. Surgical resection of the tumor was not performed. Twenty-seven months later, he developed a truncal subcutaneous tumor, which was pathologically diagnosed as PF ependymoma group A. We observed the intracranial recurrence of the brain tumor, an invasion to the left orbit, and a neoplasm in his liver before he died. This case suggests that PF ependymoma group A can metastasize extracranially to various organs.
A “SURFin’ Leukemia”: Acute Lymphoblastic Leukemia Masquerading as a Syndrome of Undifferentiated Recurrent Fever
Authors: De Nardi Laura , D’Agostin Martina , Naviglio Samuele , Trombetta Andrea , De Martino Eleonora , Tommasini Alberto , Rabusin Marco
Published: August 2023

Periodic fever is not uncommon in childhood and is often ascribed to autoinflammatory conditions; however, it may be present also in children with cancer. We here describe the case of a 3-year-old boy with acute lymphoblastic leukemia who initially presented with a 4-month history of recurrent, stereotyped episodes of fever and localized joint pain, separated by completely symptom-free intervals. These symptoms were initially interpreted as a possible syndrome of undifferentiated recurrent fever until more signs of leukemia became apparent. Our report confirms that acute lymphoblastic leukemia can rarely present with periodic fever, thus possibly leading to diagnostic errors unless a high index of suspicion is maintained.
Creating a Legacy of Leadership
Authors: Drenkard Karen
Published: August 2023

Every nurse leader knows there are challenges that face us as we lead in complex organizations. This column will focus on the sage advice and insights of 5 nurse leaders, who have chosen to share an authentic legacy of lessons learned, successes, challenges, and their reflections on leadership through the creation of a book about organizationally minded nurse leaders. Catherine Gilliss, Bobbie Berkowitz, Jean Johnson, Paula Milone-Nuzzo, and Pat Reid Ponte have worked together to write a book titled Organizationally Minded Nursing Leadership.
Achieving a Diverse, Equitable and Inclusive Environment Using the Pathway to Excellence® Framework as a Model
Authors: Powell Tiffany , Bischoff Joy , Reddy Kathleen , Nagy Sarah E. , Lawrence Tonya M. , Bates Melissa , McCright Maggie
Published: August 2023

Diversity, equity, inclusion, and belonging (DEIB) are essential in building effective healthcare teams to provide quality patient care. Striving to achieve a DEIB culture in the healthcare setting presents challenges and opportunities, and using a framework facilitates this important work. This article details how 2 Pathway to Excellence® (Pathway) designated organizations used the Pathway framework foundations around leadership, shared decision-making, professional development, safety, quality, and well-being to build and support their DEIB structures.