bluuebunny/crossref_metadata_2025 huggingface dataset:
Research progress on the etiology and pathogenesis of adolescent idiopathic scoliosis
Authors: Peng Yue , Wang Sheng-Ru , Qiu Gui-Xing , Zhang Jian-Guo , Zhuang Qian-Yu
Published: January 2020

Etiology of adolescent idiopathic scoliosis (AIS), a complicated three-dimensional spinal deformity with early-onset, receives continuous attention but remains unclear. To gain an insight into AIS pathogenesis, this review searched PubMed database up to June 2019, using key words or medical subject headings terms including “adolescent idiopathic scoliosis,” “scoliosis,” “pathogenesis,” “etiology,” “genetics,” “mesenchymal stem cells,” and their combinations, summarized existing literatures and categorized the theories or hypothesis into nine aspects. These aspects include bone marrow mesenchymal stem cell studies, genetic studies, tissue analysis, spine biomechanics measurements, neurologic analysis, hormone studies, biochemical analysis, environmental factor analysis, and lifestyle explorations. These categories could be a guidance for further etiology or treatment researches to gain inspiration.
Systemic Management for Nonmetastatic Castration-resistant Prostate Cancer
Authors: Liu Zefu , Zhang Tong , Ma Zikun , Zheng Shiyang , Chen Junying , Wu Zhiming , Zheng Xia , Li Xiangdong , Liu Zhuowei
Published: January 2020

Purpose:

To indirectly compare the efficacy and safety of systemic therapies used for patients with nonmetastatic castration-resistant prostate cancer (nmCRPC).

Methods:

The relevant randomized controlled trials were retrieved from PubMed and the Cochrane Library. Network meta-analyses were used to compare multiple drugs simultaneously for the outcomes of nmCRPC. Direct evidence in trials and indirect evidence across trials were combined by the network meta-analyses to estimate the treatment efficiency.

Outcome:

Eight studies were included in our research. For prostate-specific antigen progression-free survival, the rate of progression was significantly decreased following apalutamide, enzalutamide, bicalutamide+dutasteride, and bicalutamide treatment compared with placebo. Compared with placebo treatment, metastases-free survival was significantly increased in patients who received apalutamide (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.23-0.35), enzalutamide (HR: 0.29, 95% CI: 0.24-0.35), and darolutamide (HR: 0.42, 95% CI: 0.35-0.50). Direct comparison showed significant survival benefits in patients who received second-generation anti-androgen therapy (apalutamide, enzalutamide, and darolutamide: HR: 0.74, 95% CI: 0.61-0.91) compared with patients who received placebo. With respect to metastases-free survival, based on SUCRA analysis, there was 80% and 78% probability that apalutamide and enzalutamide were preferred treatment, while darolutamide was likely to be second-best choice. Compared with placebo, all agents were not associated with significantly higher likelihood of serious adverse events and grade 3 to 4 adverse events.

Conclusion:

Our outcomes support equivalent efficacy and similar risk of adverse effects between apalutamide, enzalutamide, and darolutamide, supporting the use of these antiandrogen agents in high-risk of progression nmCRPC.
Cardiac Monitoring for Thoracic Radiation Therapy
Authors: Amin Neha P. , Desai Nina , Kim Samuel M. , Agarwal Manuj , Amin Nivee P.
Published: January 2020

Objective:

The American Society of Clinical Oncology (ASCO) 2017 guidelines on cardiac monitoring during cancer treatments identified patients receiving thoracic radiation (TRT) ≥30 Gy (heart in field) at increased risk for developing radiation-induced heart disease (RIHD). ASCO encouraged clinicians to actively screen and monitor for baseline modifiable cardiac risk factors and therapy-induced cardiotoxicity in this high-risk population. Coronary artery calcium (CAC) is an independent risk factor for adverse cardiac events that can be mitigated with preventative medical therapy. It is unclear whether radiation oncologists (ROs) are aware of ASCO guidelines or the implications of CAC observed on computed tomographic scans. We report on practice patterns, perceptions, and experiences of cardiac monitoring for patients receiving definitive TRT, excluding breast patients.

Materials and Methods:

A 28-question survey was emailed to United States ROs 3 times from September 2018 to January 2019.

Results:

There were 162 respondents from 42 states, 51% in academic practice. Most ROs (81%) were not aware of the ASCO guidelines. Only 24% agreed with the guidelines, only 27% believed symptomatic RIHD could manifest within 2 years of TRT, and 69% thought there was a lack of strong evidence for type and timing of cardiac monitoring tests. If CAC was evident on computed tomographic scans, 40% took no further action to inform the patient or referring doctor.

Conclusions:

This survey highlights a critical gap in knowledge about cardiac monitoring and potentially life-saving opportunities for preventive cardiac medical management. Future studies focusing on timing and detection of RIHD may elucidate the utility of cardiac monitoring for TRT patients.
Systemic and regional cerebral perfusion in small infants undergoing minor lower abdominal surgery under awake caudal anaesthesia
Authors: Beck Christiane E. , Sümpelmann Robert , Nickel Katja , Keil Oliver , Kuebler Jochen F. , Boethig Dietmar , Witt Lars , Dennhardt Nils
Published: January 2020

BACKGROUND

Infants undergoing general anaesthesia have an increased risk of severe respiratory and cardiovascular critical events. Awake caudal anaesthesia is an alternative for small infants undergoing minor lower abdominal surgery. While clinical experience has shown stable intra-operative haemodynamic conditions, there are no studies evaluating systemic and regional cerebral perfusion during such a procedure.

OBJECTIVES

The purpose of this study was to evaluate the effects of awake caudal anaesthesia on systemic and regional cerebral perfusion in small infants.

DESIGN

A prospective observational cohort study.

SETTING

Clinic of Anaesthesiology, University Children's Hospital, between November 2017 and June 2018.

PATIENTS

Twenty small infants (postmenstrual age 36 to 54 weeks, weight 1800 to 5700 g) scheduled for lower abdominal surgery under awake caudal anaesthesia were enrolled in this study.

INTERVENTION

Standard monitoring was expanded to include cardiac index using electrical velocimetry and regional cerebral oxygen saturation using near infrared spectroscopy. The caudal block was performed with 0.3% ropivacaine 1 ml kg−1 Hypotension was defined as mean arterial blood pressure (BP) less than 35 mmHg and regional cerebral desaturation as regional cerebral oxygen saturation less than 80% of baseline.

MAIN OUTCOMES

Mean arterial BP, cardiac index and regional cerebral oxygen saturation parameters under awake caudal anaesthesia.

RESULTS

Mean arterial BP, cardiac index and regional cerebral oxygen saturation remained above the predefined lower limits. No episodes of hypotension or regional cerebral desaturation were observed. Operation time was 35 ± 13 (range 20 to 71) min. The infants were discharged to the neonatal ward after the end of surgery, and milk was fed 22 ± 15 (range 6 to 55) min thereafter. Five preterm infants experienced self-limiting episodes of apnoea intra-operatively.

CONCLUSION

The current study shows that awake caudal anaesthesia does not impair systemic and regional cerebral perfusion in small infants.

TRIAL REGISTRATION

German registry of clinical studies (DRKS-ID: 800015742).
Goal-directed therapy with bolus albumin 5% is not superior to bolus ringer acetate in maintaining systemic and mesenteric oxygen delivery in major upper abdominal surgery
Authors: Bisgaard Jannie , Madsen Rasmus , Dybdal Lene L. , Lauridsen Jørgen T. , Mortensen Michael B. , Jensen Anders G.
Published: January 2020

BACKGROUND

Goal-directed therapy (GDT) is increasingly used in abdominal surgery. Whether crystalloids can exert the same effect as colloid, and how this may affect perfusion, is still unclear. The effect of GDT on the systemic oxygen delivery index (sDO2I) and the mesenteric oxygen delivery index (mDO2I) can be quantified by measuring cardiac index and flow in the superior mesenteric artery, respectively.

OBJECTIVE

The aim of this study was to test the hypothesis that intra-operative GDT with bolus human albumin 5% is superior to GDT with bolus ringer acetate in maintaining sDO2I and mDO2I in elective major upper gastrointestinal cancer surgery.

DESIGN

Randomised controlled double blinded trial.

SETTING

Odense University Hospital, Denmark, from May 2014 to June 2015.

PATIENTS

A total of 89 adults scheduled for elective major upper gastrointestinal cancer surgery were randomised and data from 60 were analysed. Exclusion criteria: contraindications for using the LiDCOplus system, known allergy to albumin, pre-operative renal failure, pancreatic cancer and pre-operative down staging using chemotherapy and/or radiation therapy, pregnancy.

INTERVENTIONS

Patients were randomised to intra-operative GDT with either bolus human albumin or ringer acetate 250 ml, guided by pulse pressure variation and stroke volume.

MAIN OUTCOME MEASURES

Changes in sDO2I and mDO2I. Secondary outcomes were changes in other haemodynamic variables, fluid balance, blood transfusions, fluid-related complications and length of stay (LOS) in ICU and hospital.

RESULTS

Median [IQR] sDO2I was 522 [420 to 665] ml min−1 m−2 in the ringer acetate group and 490 [363 to 676] ml min−1 m−2 in the human albumin group, P = 0.36. Median [IQR] mDO2I was 12.1 [5.8 to 28.7] ml min−1 m−2 in the ringer acetate group and 17.0 [7.6 to 27.5] ml min−1 m−2 in the human albumin group, P = 0.17. Other haemodynamic comparisons did not differ significantly. More trial fluid was administered in the ringer acetate group. We found no significant difference in transfusions, complications or LOS.

CONCLUSION

Bolus human albumin 5% was not superior to bolus ringer acetate in maintaining systemic or mesenteric oxygen delivery in elective major upper gastrointestinal cancer surgery, despite the administration of larger volumes of trial fluid in the ringer acetate group. No significant difference was seen in fluid-related complications or LOS.

TRIAL REGISTRATION

https://eudract.ema.europa.eu/ Identifier: 2013-002217-36.
Effects of oxycodone and diazepam alone and in combination on operant nociception
Authors: Leonard Michael Z. , Kangas Brian D.
Published: January 2020

Developing effective analgesics with fewer unwanted side effects is a pressing concern. Due to a lack of effective nonopioid options currently available, an alternative approach termed opioid-sparing evaluates the ability of a coadministered drug to reduce the amount of opioid needed to produce an antinociceptive effect. Opioids and benzodiazepines are often coprescribed. Although this approach is theoretically rational given the prevalent comorbidity of chronic pain and anxiety, it also has inherent risks of respiratory depression, which is likely responsible for the substantial percentage of fatal opioid overdoses that have involved benzodiazepines. Moreover, there have been no clinical trials to support the effectiveness of this drug combination nor has there been corroborative preclinical evidence using traditional animal models of nociception. The present studies examined the prescription µ-opioid analgesic oxycodone (0.003–0.1 mg/kg) and the prototypical benzodiazepine anxiolytic diazepam (0.03–1.0 mg/kg), alone and in combination, using an animal model of pain that examines the restoration of conflict-related operant behavior as evidence of analgesia. Results documented significant dose-related increases in thermal threshold following oxycodone treatment. Diazepam treatment alone did not produce significant antinociception. In combination, diazepam pretreatment shifted oxycodone functions upward in a dose-dependent manner, but the additive effects were limited to a narrow dose range. In addition, combinations of diazepam and oxycodone at higher doses abolished responding. Taken together, though intriguing, these findings do not provide sufficient evidence that coadministration of an anxiolytic will result in clinically relevant opioid-sparing for pain management, especially when considering the inherent risks of this drug class combination.
Modes of bioprosthetic valve failure: a narrative review
Authors: Koziarz Alex , Makhdoum Ahmad , Butany Jagdish , Ouzounian Maral , Chung Jennifer
Published: January 2020

Purpose of review

A thorough understanding of the modes of bioprosthetic valve failure is critical as clinicians will be facing an increasing number of patients presenting with failed bioprostheses in coming years. The purpose of this article is to review modes of bioprosthestic valve degeneration, their management, and identify gaps for future research.

Recent findings

Guidelines recommend monitoring hemodynamic performance of prosthetic valves using serial echocardiograms to determine valve function and presence of valve degeneration. Modes of bioprosthetic valve failure may be categorized as structural degeneration (calcification, tears, fibrosis, flail), nonstructural degeneration (pannus), thrombosis, and endocarditis. Calcification is the most common form of structural valve degeneration. Predictors of bioprosthetic valve failure include valves implanted in the mitral position, younger age, and type of valve (porcine versus bovine pericardial). Failed bioprosthetic valves are managed with either redo surgical replacement or transcatheter valve-in-valve implantation.

Several modes of bioprosthetic valve failure exist, which vary based on patient, implant position, and valve characteristics. Further research is required to characterize factors associated with early failure to delay structural valve degeneration and improve patient prognosis.
Blood pressure and the risk of major adverse cardiovascular events among firefighters
Authors: Noh Juhwan , Lee Chan Joo , Hyun Dae-Sung , Kim Woojin , Kim Mi-Ji , Park Ki-Soo , Koh Sangbaek , Chang Sei-Jin , Kim Changsoo , Park Sungha
Published: January 2020

Objective:

No long-term follow-up study has investigated the effect of blood pressure (BP) on cardiovascular disease mortality and morbidity in firefighters. To investigate the effects of BP on the risk of major adverse cardiovascular events (MACEs) using a national representative population-matched cohort.

Methods:

We enrolled all firefighters (N = 8242) and 28 678 referent controls aged more than 40 years who underwent baseline health examinations in 2002 and 2003. Records of hospitalization and mortality until 2015 were checked. To evaluate the causal effect of BP on MACE, subcohort analysis using a propensity score-matched (PSM) cohort with respect to job classification (firefighter vs. control) was performed.

Results:

Hypertension significantly increased the risk of MACEs compared with normal BP in both firefighters and the age--sex matched cohort, but in participants with elevated BP, significantly increased risk of MACEs [hazards ratio 1.41, 95% confidence interval (CI) 1.06–1.88] was observed only among firefighters. In the PSM cohort, firefighters had a significantly higher risk of death or hospitalization from MACEs (hazard ratio 1.29, 95% CI 1.14–1.47), myocardial infarction (hazard ratio 1.24, 95% CI 1.07–1.43), and ischemic stroke (hazard ratio 1.43, 95% CI 1.12–1.82) than controls. Firefighters with elevated BP (hazard ratio 1.58, 95% CI 1.04–2.40), stage 1 (hazard ratio 1.24, 95% CI 1.00–1.52), and stage 2 (hazard ratio 1.39, 95% CI 1.13–1.71) hypertension had higher risk of MACEs than PSM controls.

Conclusion:

Firefighters showed significantly higher cardiovascular risk than referent controls when comparing those within the same BP category, suggesting that firefighters with elevated BP and hypertension may be at high risk of adverse prognosis.
MASSIVE RETINAL NEOVASCULARIZATION IN VON HIPPEL–LINDAU DISEASE: ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR, VITRECTOMY, IMMUNOHISTOCHEMISTRY, AND OPTICAL COHERENCE TOMOGRAPHY FEATURES
Authors: Kreuz André Carvalho , Zacharias Leandro Cabral , Oliveira Raíza Dantas de Lira , Ferreira Bruno Fortaleza de Aquino , de Lima Patrícia Picciarelli , Pimentel Sérgio Luís Gianotti
Published: January 2020

Purpose:

To report a rare presentation of ocular von Hippel–Lindau disease associated with a massive epiretinal vascular proliferation over the macula removed by vitrectomy and submitted to histological analysis.

Methods:

Interventional case report.

Results:

A 13-year-old woman with von Hippel–Lindau disease reported progressive visual loss in the right eye over the preceding 6 months. Best-corrected visual acuity was 20/100 in the right eye. Fundoscopy showed retinal neovascularization (RNV) with macular traction and a small superotemporal hemangioblastoma. Spectral-domain optical coherence tomography confirmed increased macular thickness and macular traction secondary to RNV. Bevacizumab was injected intravitreally, resulting in partial regression of RNV. Five days after the injection, the patient underwent complete removal of fibrovascular proliferation via pars plana vitrectomy, followed by peripheral tumor photocoagulation. The specimen was subjected to histopathological and immunohistochemical analyses. At 2 years of follow-up, vision had improved to 20/30, and anatomical improvement was confirmed on both fundoscopy and spectral-domain optical coherence tomography.

Conclusion:

Ocular von Hippel–Lindau disease may be associated with RNV and macular traction. In such cases, RNV is likely responsive to anti–vascular endothelial growth factor and may be removed surgically along a cleavage plane between the tissue proliferation and the inner retina. In the reported case, the procedure was found to be safe and associated with macular anatomical improvement and vision recovery.
RETINAL TEARS DUE TO PICKLEBALL INJURY
Authors: Atkinson Catherine F. , Patron Mark E. , Joondeph Brian C.
Published: January 2020

Purpose:

This is the first case series of two instances of retinal tears due to an injury sustained while playing pickleball.

Methods:

Case series.

Results:

A 66-year old white man presented with a symptomatic retinal tear, localized retinal detachment, and mild vitreous hemorrhage nine days after he was hit in his left eye while playing pickleball. The patient was not wearing eye protection while playing. The patient was treated with cryotherapy, and after three weeks, the vitreous hemorrhage and retinal detachment resolved. In addition, a 60-year-old woman presented with a posterior vitreous detachment and a symptomatic retinal tear 1 month after blunt trauma to her left eye from a pickleball injury. She underwent successful laser retinopexy treatment.

Conclusion:

Proper eye protection should be strongly considered while playing pickleball, especially in the elderly population or in individuals who are at higher risk for retinal detachment.
Human induced pluripotent stem cell-derived GABAergic interneuron transplants attenuate neuropathic pain
Authors: Manion John , Khuong Thang , Harney Dylan , Littleboy Jamie B. , Ruan Travis , Loo Lipin , Costigan Michael , Larance Mark , Caron Leslie , Neely G. Gregory
Published: January 2020

Neuropathic pain causes severe suffering, and most patients are resistant to current therapies. A core element of neuropathic pain is the loss of inhibitory tone in the spinal cord. Previous studies have shown that foetal GABAergic neuron precursors can provide relief from pain. However, the source of these precursor cells and their multipotent status make them unsuitable for therapeutic use. Here, we extend these findings by showing, for the first time, that spinally transplanted, terminally differentiated human induced pluripotent stem cell-derived GABAergic (iGABAergic) neurons provide significant, long-term, and safe relief from neuropathic pain induced by peripheral nerve injury in mice. Furthermore, iGABAergic neuron transplants survive long term in the injured spinal cord and show evidence of synaptic integration. Together, this provides the proof in principle for the first viable GABAergic transplants to treat human neuropathic pain patients.
Determinants of Workplace Bullying Types and Their Relationship With Depression Among Female Nurses
Authors: KO Ying-Ying , LIU Yi , WANG Chi-Jane , LIAO Hsiu-Yun , LIAO Yu-Mei , CHEN Hsing-Mei
Published: January 2020

Background

Workplace bullying is commonly experienced by nurses worldwide.

Purpose

This study was conducted to examine the determinants of different types of workplace bullying and their relationship to depression in female nurses.

Methods

A cross-sectional correlational study was employed, and 484 female nurses from a large medical center in southern Taiwan completed the questionnaire. Data were analyzed using logistic regression analysis.

Results

Being unmarried and working in medical/surgical units were found to be the major determinants of work-related bullying, whereas being unmarried was found to be the single determinant of person-related and physical-intimidation bullying. Moreover, work-related and person-related bullying were both found to be significant determinants of depression.

Conclusions/Implications for Practice

Nursing administrators should establish workplace-bullying prevention and management strategies by setting reasonable and equal workloads for nurses, assigning tasks equitably, and building depression-related support and consultation groups.
The Smartphone Addiction Levels and the Association With Communication Skills in Nursing and Medical School Students
Authors: CELIKKALP Ulfiye , BILGIC Sebnem , TEMEL Munire , VAROL Gamze
Published: January 2020

Background

The use of smartphones among young people is quite common. However, smartphones are associated with negative effects when used excessively. It has been reported that smartphone use may adversely affect learning in the classroom, cause safety issues, and negatively affect interpersonal communications.

Purpose

The aims of this study were to determine the level of smartphone addiction among nursing and medical school students and to examine the effect of smartphone addiction level on communication skills.

Methods

This cross-sectional study was conducted with medical school and nursing students at a public university (502 participants). Data were collected using a personal information form, the Smartphone Addiction Scale–Short Version (SAS-SV), and the Communication Skills Assessment Scale.

Results

All of the participants in the study owned smartphones. Most (70.9%) were female, and 58.2% were in the nursing program. The participants used smartphones for a mean time of 5.07 ± 3.32 hours a day, primarily for messaging. The mean total SAS-SV score for the participants was 31.89 ± 9.90, and a significant difference in SAS-SV mean scores was found with regard to the variables of department, gender, daily smartphone use duration, academic success, status regarding smartphone use in the classroom, participation in sports, easy communication with patients and relatives, preferred mode of communication, health problems tied to phone use, and injury status (p < .05). In addition, a positive weak-to-moderate relationship was found between SAS-SV mean scores and the variables of daily smartphone use duration and years of smartphone use, whereas a negative weak relationship was found between SAS-SV mean scores and Communication Skills Assessment Scale scores. Daily smartphone use duration was found to be the most important predictor of smartphone addiction.

Conclusions/Implications for Practice

Higher SAS-SV scores have a negative impact on interpersonal communication and social life and reduce learning efficacy in students. Therefore, students and lecturers should be better informed regarding the benefits and risks of smartphone use in education, with precautions provided against excessive and needless use.
Improving mammography through effective screening, brief intervention, and referral to treatment at a rural health center
Authors: Percefull Julie , Butler Judith
Published: January 2020

Background:

Screening mammography rates at a rural health center were below state rates, while the countywide rate of breast cancer was above the state and national rates.

Local problem:

Only 25% of patients at the practice site received a screening mammogram within the last 2 years, and standing order usage was 25%. Evidence-based guidelines and decision aids were not used consistently. The aim was to increase the rate of screening mammograms and right care at a rural health center to 55% of eligible patients in 90 days.

Methods:

Implementation consisted of four 2-week plan, do, study, act cycles. Interventions included screening, brief intervention with patient engagement, referral to treatment with case management log tracking, and team engagement. Aggregate data were collected twice weekly.

Intervention:

An electronic health record reminder for mammography screening, a patient mammography decision aid, a case management log, and weekly quality improvement team meetings were the four core interventions used for the project.

Results:

Screening and identification improved by 40%, patient engagement improved by 30%, and case management for right care more than doubled. Overall, the combined mammography and right care rate improved by 40%. Team engagement reached 100% with survey scores for involvement rising to 78%.

Conclusions:

The results obtained indicate the tools and processes implemented effectively increased screening, patient engagement, and case management to improve mammography rates and right care.
Barriers encountered when exploring nurse practitioner postgraduate training programs
Authors: Matlick Garrett L.
Published: January 2020

With the increasing complexity of today's patients, the demand for nurse practitioner (NP) postgraduate training programs is growing. At least 70 such programs exist, yet information about these programs is limited. A sample of 52 program websites were investigated for information of importance to NPs, employers, and NP faculty. Of the postgraduate training program websites studied, information regarding at least one of the elements investigated was absent from the program website. This lack of information availability makes exploring, selecting, or recommending a postgraduate training program difficult. As the number of programs and the number of graduating NP students continue to grow, the existence and consistency of information regarding new and existing programs will be increasingly important for the accuracy of prospective trainee exploration of such programs and for researchers interested in gathering consistent data.
Sedation selection to reduce delirium risk: Why dexmedetomidine may be a better choice
Authors: Mulkey Malissa A. , Everhart D. Erik
Published: January 2020

In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk. Propofol, like benzodiazepines, causes changes in sleep patterns by suppressing the rapid eye movement sleep stage not seen with dexmedetomidine, worsening the ICU patient's already poor sleep quality. This reduction in sleep quality increases the risk of delirium. As patient advocates, advanced practice nurses play a vital role in minimizing risk of patient harm. Sedative use and management are areas of opportunity for nurses to minimize this risk. When sedatives are needed, daily sedation vacations should be conducted to re-evaluate the minimum required dose. These practices can reduce sedation risks for delirium and allow for bedside screening and early detection.
The Utility of Digital Anal Rectal Examinations in a Public Health Screening Program for Anal Cancer
Authors: Nyitray Alan G. , D'Souza Gypsyamber , Stier Elizabeth A. , Clifford Gary , Chiao Elizabeth Y.
Published: January 2020

Objectives

There are no uniform screening recommendations for anal cancer. Medical practice guidelines are now available on the use of Digital Anal Rectal Examinations (DARE) for the detection of anal cancer; however, because screening can result in more harm than benefit, our objective was to assess the evidence for use of DARE as a public health screening tool.

Materials and Methods

We conducted a current critical appraisal of anal cancer literature using World Health Organization criteria for assessing the potential utility of a public health screening program.

Results

Digital Anal Rectal Examination satisfies most, but not all, World Health Organization criteria for a public health program that seeks to detect early invasive anal cancer in populations at high risk for anal cancer, most notably HIV-positive men who have sex with men; however, DARE is not appropriate when facilities for treatment are nonexistent. In addition, there are insufficient data on DARE sensitivity and specificity.

Conclusions

The mildly invasive nature of DARE, limited likelihood of adverse procedure-related events, cost-effectiveness and patient acceptability, as well as wide availability of DARE support consideration of its integration into screening for populations at high risk of anal cancer, especially HIV-positive men who have sex with men.
Unplanned hospital readmissions after acute myocardial infarction: a nationwide analysis of rates, trends, predictors and causes in the United States between 2010 and 2014
Authors: Kwok Chun Shing , Capers Quinn , Savage Michael , Gulati Martha , Potts Jessica , Mohamed Mohamed O. , Nagaraja Vinayak , Patwala Ashish , Heatlie Grant , Kontopantelis Evangelos , Fischman David L. , Mamas Mamas A.
Published: January 2020

Background

Unplanned hospital readmissions are an important quality metric for benchmarking, but there are limited data following an acute myocardial infarction (AMI). This study aims to examine the 30-day unplanned readmission rate, predictors, causes and outcomes after hospitalization for AMI.

Methods

The USA Nationwide Readmission Database was utilized to analyze patients with a primary diagnosis of AMI between 2010 and 2014. Rates of readmissions, causes and costs were determined and multiple logistic regressions were used to identify predictors of readmissions.

Results

Of 2 204 104 patients with AMI, the 30-day unplanned readmission rate was 12.3% (n = 270 510), which changed from 13.0 to 11.5% between 2010 and 2014. The estimated impact of readmissions in AMI was ~718 million USD and ~281000 additional bed days per year. Comorbidities such as diabetes [odds ratio (OR) 1.27, 95% confidence interval (CI) 1.25–1.29], chronic lung disease (OR 1.29, 95% CI 1.26–1.31), renal failure (OR 1.38, 95% CI 1.35–1.40) and cancer (OR 1.35, 95% CI 1.30–1.41) were independently associated with unplanned readmission. Discharge against medical advice was the variable most strongly associated with unplanned readmission (OR 2.40, 95% CI 2.27–2.54). Noncardiac causes for readmissions accounted for 52.9% of all readmissions. The most common cause of cardiac readmission was heart failure (14.3%) and for noncardiac readmissions was infections (8.8%).

Conclusion

Readmissions during the first month after AMI occur in more than one in 10 patients resulting in a healthcare cost of ~718 million USD per year and ~281000 additional bed days per year. These findings have important public health implications. Strategies to identify and reduce readmissions in AMI will dramatically reduce healthcare costs for society.
A systematic review and meta-analysis of disease severity and risk of recurrence in young versus elderly patients with left-sided acute diverticulitis
Authors: van Dijk Stefan T. , Abdulrahman Nour , Draaisma Wernard A. , van Enst Wynanda A. , Puylaert Julien B.C.M. , de Boer Mark G.J. , Klarenbeek Bastiaan R. , Otte Johannes A. , Felt-Bersma Richelle J.F. , van Geloven Anna A.W. , Boermeester Marja A.
Published: January 2020

Young patients are thought to have a more severe disease course and a higher rate of recurrent diverticulitis. However, these understandings are mainly based on studies with important limitations. This review aimed to clarify the true natural history of acute diverticulitis in young patients compared to elderly patients. PubMed and MEDLINE were searched for studies reporting outcomes on disease severity or recurrences in young and elderly patients with a computed tomography-proven diagnosis of acute diverticulitis. Twenty-seven studies were included. The proportion of complicated diverticulitis at presentation (21 studies) was not different for young patients (age cut-off 40–50 years) compared to elderly patients [risk ratio (RR) 1.19; 95% confidence interval 0.94–1.50]. The need for emergency surgery (11 studies) or percutaneous abscess drainage (two studies) yielded comparable results for both groups with a RR of 0.93 (95% confidence interval 0.70–1.24) and 1.65 (95% confidence interval 0.60–4.57), respectively. Crude data on recurrent diverticulitis rates (12 studies) demonstrated a significantly higher RR of 1.47 (95% confidence interval 1.20–1.80) for young patients. Notably, no association between age and recurrent diverticulitis was found in the studies that used survival analyses, taking length of follow-up per age group into account. In conclusion, young patients do not have a more severe course of acute diverticulitis. Published data on the risk of recurrent diverticulitis in young patients are conflicting, but those with the most robust design do not demonstrate an increased risk. Therefore, young patients should not be treated more aggressively nor have a lower threshold for elective surgery just because of their age.
Elastography and serum markers of fibrosis versus liver biopsy in 1270 Egyptian patients with hepatitis C
Authors: Abdelsameea Eman , Alsebaey Ayman , Abdel-Razek Wael , Ehsan Nermin , Morad Wesam , Salama Mohsen , Waked Imam
Published: January 2020

Background

Chronic hepatitis C (CHC) is a leading cause of liver fibrosis.

Objective

To compare utility of liver transient elastography, AST-to-platelet ratio index (APRI), fibrosis-4 index (FIB4), Forns Index and Goteborg University cirrhosis index (GUCI) in predicting fibrosis stage assessed by liver biopsy in Egyptian CHC patients.

Methods

One thousand two-hundred and seventy CHC patients undergoing liver biopsy in preparation for therapy and 40 healthy potential living liver donors had transient elastography and calculation of APRI, FIB4, Forns and GUCI scores on the same day or day preceding the biopsy.

Results

Mean age was 39.89 (17–60 years) and most were males (70.7%). All donors had F0 fibrosis, most patients had F1–F2 fibrosis (n = 1011, 79.6%) and 259 (20.4%) had F3–F4 fibrosis. Patients with F3–F4 fibrosis had higher median values of APRI (0.99 vs. 0.46), FIB4 (2.15 vs. 0.95) and Forns (7.34 vs. 4.79) indices, GUCI score (1.16 vs. 0.49) and transient elastography (19.2 vs. 6.2 kPa) (all P = 0.001). For F1 discrimination, AUROC of transient elastography was higher than both Forns and GUCI scores (P = 0.001). APRI, FIB4 and GUCI had lower AUROC than transient elastography for predicting fibrosis stage in F2 and F3 patients (P = 0.001). Transient elastography had the best area under receiver operating characteristic curve for predicting fibrosis stage in F4 patients (P = 0.001). The transient elastography cutoff values (kPa) were F1 (>4.8), F2 (>8.3), F3 (>10.1) and F4 (>13.4). Age, APRI, FIB4, Forns, GUCI and transient elastography were independent predictors of F3–F4 fibrosis.

Conclusion

Liver elastography is superior to APRI, FIB4, Forns and GUCI scores in predicting fibrosis in CHC patients.
Advances in the treatment of biliary tract cancers
Authors: Uson Junior Pedro L.S. , Bogenberger James , Borad Mitesh J.
Published: January 2020

Purpose of review

To review new treatment and advances in biliary tract cancer (BTC).

Recent findings

In the prespecified per-protocol analysis of the randomized phase III trial BILCAP, adjuvant capecitabine offers overall survival (OS) benefit when compared with observation with statistical significance. In the first-line setting in metastatic BTC, gemcitabine and S-1 had noninferior OS compared with gemcitabine and cisplatin. In a separate phase III study, the triplet of gemcitabine, cisplatin and S-1 (GCS) had superior OS compared with standard gemcitabine and cisplatin. The regimen of modified FOLFOX (fluorouracil, leucovorin and oxaliplatin) regimen can be considered a potential standard option in the second-line setting for patients who failed first-line therapy with gemcitabine-based regimens. Trials in genomically selected patients indicate activity of fibroblast growth factor receptor inhibitors, mutant isocitrate dehydrogenase inhibitors and immune checkpoint inhibitors.

Capecitabine is a new option for adjuvant treatment in resected BTC. In the metastatic setting, gemcitabine and S-1 or GCS are new options for first-line therapy and modified FOLFOX regimen should be considered as a potential new empirical standard of care in genomically agnostic patients requiring second-line therapy. Future randomized trials will evaluate the role of targeted agents and immunotherapy in advanced BTC, both in monotherapy and in combination.
Novel therapies in myelodysplastic syndromes
Authors: Swoboda David M. , Gesiotto Quinto , Sallman David A.
Published: January 2020

Purpose of review

Currently, there is a rapid expansion of novel, efficacious therapies for the treatment of patients with myelodysplastic syndromes (MDS) at a rate never seen to date. In this review, we will outline new treatment strategies in MDS focusing on novel hypomethylating agents (HMA) and combinations in addition to targeted and immune-based therapies.

Recent findings

Large-scale gene sequencing and immune-based research has given us a great deal of information regarding the complexity and heterogeneity of MDS. This rapid improvement in our knowledge has provided a framework for development of novel therapies with specific gene and immune-based targets. Additionally, expanding and optimizing our current HMA-based strategies has led us to potentially not only ease administration but also improve outcomes.

Novel therapies in MDS are greatly needed is a disease state where few options are currently available, particularly in the HMA failure setting. Fortunately, through comprehensive genetic profiling, characterization of novel underlying pathogenic drivers, and understanding of the immune microenvironment, the treatment paradigm of patients with MDS is encouraging.
Driver mutations in acute myeloid leukemia
Authors: Kishtagari Ashwin , Levine Ross L. , Viny Aaron D.
Published: January 2020

Purpose of review

The mutational landscape of acute myeloid leukemia (AML) has revised diagnostic, prognostic, and therapeutic schemata over the past decade. Recurrently mutated AML genes have functional consequences beyond typical oncogene-driven growth and loss of tumor suppresser function.

Recent findings

Large-scale genomic sequencing efforts have mapped the complexity of AML and trials of mutation-based targeted therapy has led to several FDA-approved drugs for mutant-specific AML. However, many recurrent mutations have been identified across a spectrum from clonal hematopoiesis to myelodysplasia to overt AML, such as effectors of DNA methylation, chromatin modifiers, and spliceosomal machinery. The functional effects of these mutations are the basis for substantial discovery.

Understanding the molecular and pathophysiologic functions of key genes that exert leukemogenic potential is essential towards translating these findings into better treatment for AML.
An update on systemic therapy for penile cancer
Authors: Resch Irene , Abufaraj Mohammad , Hübner Nicolai A. , Shariat Shahrokh F.
Published: January 2020

Purpose of review

Whereas substantial advances have been made in systemic tumour therapy in the past decade, the prognosis of advanced squamous cell carcinoma (SCC) of the penis remains disproportionally poor. In this review, we aimed to present an update on systemic therapy of penile SCC highlighting the most recent data and future perspectives.

Recent findings

Lymph node metastases play a key role in treating and assessing the prognosis of patients with penile SCC. Data show longer overall survival with the use of adjuvant chemotherapy in patients with pelvic lymph node metastases and recent analyses lead to the development of a nomogramm predicting overall survival in connection with the use of perioperative chemotherapy. There are two pathways in the pathogenesis of penile cancer, including human papilloma virus related and unrelated, leading to many possible novel therapeutic targets. Other targeted therapies have been evaluated, which show promising results with the use of tyrosine kinase inhibitors.

Chemotherapy has shown moderate activity in advanced stages of the disease, however, the ideal timing of chemotherapy in patients with lymph node metastases is not entirely clear. Potential targets for future therapies exist, and are already being tested in other malignancies. Owing to the rarity of this condition, a robust evidence is lacking and it is of great importance to pursue further research to unveil several aspects of this disease, particularly in patients with recurrence, lymph node metastases or metastatic disease.
Role of primary retroperitoneal lymph node dissection in stage I and low-volume metastatic germ cell tumors
Authors: Heidenreich Axel , Paffenholz Pia , Nestler Tim , Pfister David , Daneshmand Siamak
Published: January 2020

Purpose of review

Early-stage testicular cancers are highly curable. Following orchidectomy, management options for stage I disease include active surveillance, nerve-sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy as recommended by the current guidelines. Primary RPLND has for decades played an integral part of treatment in patients with early-stage testicular germ cell tumors (TGCT), particularly in nonseminomatous germ cell tumors (NSGCT) with focus on reducing the long-term morbidity. We review the role of RPLND in stage I NSCGT as well as stage II A/B NSGCT and as seminoma.

Recent findings

Radiation therapy and systemic chemotherapy are established treatments for seminoma; however, long-term data has demonstrated the association of such therapies with late toxicity including secondary malignancies, hearing loss, cardiovascular disease as well as metabolic syndromes. Given the well established role of RPLND in NSGCTs, clinicians have developed an interest in utilization of surgery for low-volume retroperitoneal metastatic disease. Two prospective clinical trials (SEMS and PRIMETEST) are underway to determine the role of RPLND alone in low volume metastatic seminoma.

RPLND is a highly effective treatment for early-stage germ cell tumors but represents overtreatment in low-volume stage I disease where active surveillance is recommended. RPLND has shown a promising role in low-volume stage II seminomas. Two phase II clinical trials are underway to further determine the curative potential of this approach.
Impact of Blood Transfusion on the Prevalence of HHpgV-1, HPgV-1, and B19V Among Iranian HCV-infected Patients With Hemophilia
Authors: Agi Elnaz , Hojjatipour Samira , Namvar Ali , Bolhassani Azam
Published: January 2020

Objective:

Blood-derived products from patient with hemophilia treated by factor VIII concentrates are potential sources of transfusion-transmitted infections, including human immunodeficiency virus, hepatitis, human pegivirus-1 (HPgV-1), B19 virus, and also human hepegivirus-1 (HHpgV-1). In the current study, we investigated the impact of blood transfusion on the prevalence of HHpgV-1, HPgV-1, and B19 virus in plasma of Iranian patient with hemophilia after direct-acting antiviral treatment of hepatitis C virus (HCV) infections for the first time.

Materials and Methods:

A total of 170 patients with hemophilia who received direct-acting antivirals were enrolled in this study. Among them, 92 patients had a history of blood transfusion. The presence of HHpgV-1, HPgV-1, and B19 virus was detected by nested polymerase chain reaction analysis using the conserved primers. The plasmids harboring 5′-UTR and NS3 were used as positive controls for HPgV-1 and HHpgV-1, respectively.

Results:

Our data identified 3 individuals with HHpgV-1 viremia (1.76%), 11 individuals with HPgV-1 viremia (6.47%), and 33 individuals with B19 viremia (19.4%). All patients were negative for hepatitis B virus, human immunodeficiency virus, and HCV infections. These findings indicated lower transmissibility or higher rates of virus clearance for HHpgV-1, HPgV-1, and B19 virus as compared with other bloodborne human flaviviruses such as HCV. However, the prevalence of B19 virus was significantly higher than the other 2 viruses.

Conclusion:

In general, these findings showed that the history of blood transfusion could increase the risk of viral transmission of bloodborne viruses among patient with hemophilia.
Implementation of the m-ISHAPED Tool for Nursing Interdepartmental Handoffs
Authors: Stimpson Megan , Carlin Kristen , Ridling Debra
Published: January 2020

Background:

Handoffs can pose risks to patients.

Local Problem:

Nurses throughout a children's hospital understood patient handoffs differently, resulting in handoff errors (failures) across departments.

Methods:

Lean principles were used to modify and implement the ISHAPED (Introduction, Story, History, Assessment, Plan, Error Prevention, and Dialogue) tool.

Interventions:

The team implemented a modified ISHAPED (m-ISHAPED) tool to align the content shared and the expectations for interdepartmental handoff.

Results:

Improvements were seen in reported patient safety events from 6.84 to 1.57 per 100 patient days (P < .001) and nurse satisfaction from 81.1% to 90.6% (P < .001).

Conclusions:

A standardized process for interdepartmental nursing handoff was successfully implemented.
Quality Standards of Nursing Care for the Use of Chemical Restraints
Authors: Hupé Catherine , Larue Caroline , Gazemar Valerie , Pépin Catherine , Contandriopoulos Damien
Published: January 2020

Background:

The use of chemical restraints (CRs) in health care facilities is a complex intervention that raises questions about its effectiveness and whether it is safe and patient oriented.

Purpose:

This review aims to gather nursing quality standards for the use of CR through an innovative method of knowledge synthesis, the realist review, to support the development of a quality evaluation tool.

Methods:

A realist review method was chosen.

Results:

An operational definition of chemical restraint is proposed, a concept seen as synonymous with the management of behavioral symptoms by pharmacological agents with sedative proprieties. Twenty-eight quality standards were identified and presented in a theoretical model.

Conclusions:

These quality standards will allow the evaluation of practices from a nursing perspective for the use of CR in health care settings.