bluuebunny/crossref_metadata_2025 huggingface dataset:
Impaired Fasting Glucose Is the Major Determinant of the 20‐Year Mortality Risk Associated With Metabolic Syndrome in Nondiabetic Patients With Stable Coronary Artery Disease
Authors: Younis Arwa , Goldkorn Ronen , Goldenberg Ilan , Geva Diklah , Tzur Boaz , Mazu Anna , Younis Anan , Fisman Zvi , Tannenbaum Alexander , Klempfner Robert
Published: October 2017

Background

We wanted to explore the association of metabolic syndrome (MetS) versus its individual components with 20‐year all‐cause mortality among patients with stable coronary artery disease.

Methods and Results

The cohort comprised 12 403 nondiabetic patients with stable coronary artery disease who were enrolled in the Bezafibrate Infarction Prevention Registry between February 1990 and October 1992 and followed up through December 2014. The study cohort was divided into 4 groups: patients without MetS or impaired fasting glucose (
IFG
), patients with
IFG
but without MetS, patients with MetS but without
IFG
, and patients with both MetS and
IFG
. Kaplan‐Meier survival analysis showed that at 20 years of follow‐up, the rates of all‐cause mortality were the highest among patients with both MetS and
IFG
(66%). Patients with
IFG
without MetS experienced a significantly higher mortality rate compared with those with MetS without
IFG
(61% versus 56%; log‐rank
P
<0.001). Multivariable Cox proportional hazard analysis showed that the final Cox model demonstrated that the additive effect of MetS (hazard ratio, 1.13; 95% confidence interval, 1.1–1.16;
P
=0.02) and
IFG
(hazard ratio, 1.54; 95% confidence interval, 1.46–1.62;
P
<0.001) on 20 years mortality was nonsignificant (hazard ratio, 1.01; 95% confidence interval, 0.93–1.11;
P
=0.69).
IFG
was associated with the most pronounced increase in mortality risk among the individual components (hazard ratio, 1.22; 95% confidence interval, 1.14–1.3;
P
<0.001).

Conclusions

Our findings suggest that
IFG
alone is a major independent predictor of long‐term mortality among patients with stable coronary artery disease versus other components of the MetS.
Endothelial Progenitor Cell Biology and Vascular Recovery Following Transradial Cardiac Catheterization
Authors: Mitchell Andrew , Fujisawa Takeshi , Mills Nicholas L. , Brittan Mairi , Newby David E. , Cruden Nicholas L. M.
Published: October 2017

Background

Transradial catheterization is associated with radial artery injury and vasomotor dysfunction and represents an accessible model of acute vascular injury in humans. We characterized vascular injury and functional recovery to understand the role of circulating endothelial progenitor cells in vascular repair.

Methods and Results

In 50 patients (aged 64±10 years, 70% male) undergoing transradial cardiac catheterization, radial artery injury was assessed by optical coherence tomography and examination of explanted vascular sheaths. Flow‐ and nitrate‐mediated dilatation of the radial artery was assessed in both arms at baseline, at 24 hours, and at 1, 4, and 12 weeks. Circulating endothelial progenitor cell populations were quantified using flow cytometry. Late endothelial outgrowth colonies were isolated and examined in vitro. Optical coherence tomography identified macroscopic injury in 12 of 50 patients (24%), but endothelial cells (1.9±1.2×10
4
cells) were isolated from all arterial sheaths examined. Compared with the noncatheterized radial artery, flow‐mediated vasodilatation was impaired in the catheterized artery at 24 hours (9.9±4.6% versus 4.1±3.1%,
P
<0.0001) and recovered by 12 weeks (8.1±4.9% versus 10.1±4.9%,
P
=0.09). Although the number of
CD
133
+
cells increased 24 hours after catheterization (
P
=0.02), the numbers of
CD
34
+
cells and endothelial outgrowth colonies were unchanged. Migration of endothelial cells derived from endothelial outgrowth colonies correlated with arterial function before catheterization but was not related to recovery of function following injury.

Conclusions

Transradial cardiac catheterization causes endothelial denudation, vascular injury, and vasomotor dysfunction that recover over 12 weeks. Recovery of vascular function does not appear to be dependent on the mobilization or function of endothelial progenitor cells.

Clinical Trial Registration

URL
:
https://www.clinicaltrials.gov
. Unique identifier:
NCT
02147119.
Comparative Risk of Cardiovascular Outcomes Between Topical and Oral Nonselective NSAIDs in Taiwanese Patients With Rheumatoid Arthritis
Authors: Lin Tzu‐Chieh , Solomon Daniel H. , Tedeschi Sara K. , Yoshida Kazuki , Kao Yang Yea‐Huei
Published: October 2017

Background

Topical
NSAID
s have less systemic absorption than oral
NSAID
s. We examined the risk of cardiovascular events associated with nonselective topical NSAIDs versus oral NSAIDs among patients with rheumatoid arthritis in Taiwan.

Methods and Results

We conducted a retrospective cohort study that included patients with incident rheumatoid arthritis who were newly starting therapy with nonselective topical NSAIDs or oral NSAIDs. We used the Taiwan National Health Insurance Research Database (
NHIRD
). The first date patients received either type of
NSAID
was defined as the index date.
NSAID
exposures continued until there was a treatment gap of >30 days. The main outcome was composite cardiovascular events, including myocardial infarction, unstable angina, heart failure, stroke, or revascularization. Follow‐up was censored at treatment discontinuation, switch or addition of other
NSAID
category, cardiovascular outcome, death, or the end of the study. Propensity score weighted Cox regression models were used to compare the risk of cardiovascular events between topical NSAIDs and oral NSAIDs. There were 10 758 and 78 056 treatment episodes for topical and oral
NSAID
s identified. After weighting by propensity score, the cohorts were well balanced over all covariates. The crude cardiovascular event rate was 1.87 per 100 person‐years for topical
NSAID
s and 2.14 per 100 person‐years for oral
NSAID
s. Results of propensity score weighted Cox regression found the topical NSAID group had 36% lower risk for cardiovascular events compared with the oral NSAID group (hazard ratio, 0.64; 95% confidence interval, 0.43–0.95).

Conclusions

We found topical NSAID users experienced a reduced risk of cardiovascular events compared with oral NSAID users. If future studies with a larger sample size and longer follow‐up confirm these results,
NSAID
prescribing might change accordingly.
Thoracic Epidural Anesthesia Can Be Effective for the Short‐Term Management of Ventricular Tachycardia Storm
Authors: Do Duc H. , Bradfield Jason , Ajijola Olujimi A. , Vaseghi Marmar , Le John , Rahman Siamak , Mahajan Aman , Nogami Akihiko , Boyle Noel G. , Shivkumar Kalyanam
Published: October 2017

Background

Novel therapies aimed at modulating the autonomic nervous system, including thoracic epidural anesthesia (
TEA
), have been shown in small case series to be beneficial in treating medically refractory ventricular tachycardia (
VT
) storm. However, it is not clear when these options should be considered. We reviewed a multicenter experience with
TEA
in the management of
VT
storm to determine its optimal therapeutic use.

Methods and Results

Data for 11 patients in whom
TEA
was instituted for
VT
storm between July 2005 and March 2016 were reviewed to determine the clinical characteristics, outcomes, and role in management. The clinical presentation was incessant
VT
in 7 (64%), with polymorphic
VT
in 3 (27%) and monomorphic
VT
in 8 (73%). The underlying conditions were nonischemic cardiomyopathy in 5 (45%), ischemic cardiomyopathy in 3 (27%), and hypertrophic cardiomyopathy, Brugada syndrome, and cardiac lipoma in 1 (9%) each. Five (45%) had a complete and 1 (9%) had a partial response to
TEA
; 4 of the complete responders had incessant
VT
. All 4 patients with a documented response to deep sedation demonstrated a complete response to
TEA
.

Conclusions

More than half of the patients with
VT
storm in our series responded to
TEA
.
TEA
may be effective and should be considered as a therapeutic option in patients with
VT
storm, especially incessant
VT
, who are refractory to initial management. Improvement in
VT
burden with deep sedation may suggest that sympathoexcitation plays a key role in perpetuating
VT
and predict a positive response to
TEA
.
Gender Differences in the Reporting of Vocal Fatigue in Teachers as Quantified by the Vocal Fatigue Index
Authors: Hunter Eric J. , Banks Russell E.
Published: October 2017

Objectives:

Occupational voice users report higher instances of vocal health problems. Women, who are more likely than men to report voice problems, are the largest members of some occupational voice users, such as teachers. While a common complaint among this population is vocal fatigue, it has been difficult to quantify. Therefore, the goal of this study is to quantify vocal fatigue generally in school teachers and investigate any related gender differences.

Methods:

Six hundred forty (518 female, 122 male) teachers were surveyed using an online questionnaire consisting in part of the Vocal Fatigue Index (VFI), an index specifically designed to quantify vocal fatigue.

Results:

Compared to vocally healthy adults, the teachers surveyed were 3 times as likely to report vocal tiredness or vocal avoidance and over 3 times as likely to report physical voice discomfort. Additionally, female teachers were more likely to have scores approaching those with dysphonia.

Conclusions:

The VFI quantified elevated levels of vocal fatigue in teachers, with a significant prevalence of symptoms reported among females compared to males. Further, because the VFI indicated elevated complaints (between normal and dysphonic) in a population likely to be elevated, the VFI might be used to identify early indications of voice problems and/or track recovery.
Bipolar Radiofrequency Ablation (Coblation) of External Auditory Canal Lymphatic Malformation and Other Soft Stenoses
Authors: Gu Alex , Bauman Nancy M.
Published: October 2017

Introduction:

Soft tissue occlusion of the external auditory canal (EAC) can cause intense pruritis, recurrent foul smelling otorrhea, recurrent otitis externa, and conductive hearing loss. Occlusion of the EAC can be challenging to treat as the area is prone to circumferential scarring.

Methods:

We describe the novel use of serial bipolar radiofrequency ablation (coblation) to treat 3 children with complete EAC occlusion from congenital and acquired conditions including lymphedema (1), microcystic lymphatic malformation (1), and venolymphatic malformation (1).

Results:

Patients underwent a mean of 3 procedures with postoperative EAC stenting (7 days) and antibiotic and steroid aural preparations (10 days). Otologic symptoms resolved in all patients, and their EACs remained patent 14 months after last procedure (range, 4-32 months). One patient experienced a pinpoint tympanic membrane perforation that healed spontaneously 2 weeks later.

Conclusions:

Coblation of soft tissue stenosis of the EAC can be an effective treatment for this problematic condition.
Ubuntu and the Quest for Conflict Resolution in Africa
Authors: Akinola Adeoye O. , Uzodike Ufo Okeke
Published: October 2017

Many postcolonial African states have experienced violent conflicts, prompting the quest for viable approaches to conflict resolution and peace-building. Certain groups’ desire to control power and resources at the expense of others lies at the heart of the racism, civil wars, armed insurrections, terrorism, ethnic conflict, genocide, xenophobia, and intracommunity and domestic conflict prevalent in Africa, particularly in countries that experienced prolonged foreign domination. The quest for peace and security led to the resurgence of Ubuntu, an African humanist ideology, as an indigenous approach to conflict resolution and peace-building. This article explores the place of Ubuntu in the continent’s peace and security projects. Despite the utility of Ubuntu’s principles in a few postconflict societies, the article highlights the difficulties involved in its adoption by state institutions, mainly due to the complex interactions exemplified by the modern state. However, adherence to the principles of Ubuntu by state and nonstate actors would drastically reduce threats to peace and security in Africa.
Simulation and validation of air flow and heat transfer in an autoclave process for definition of thermal boundary conditions during curing of composite parts
Authors: Bohne Tobias , Frerich Tim , Jendrny Jörg , Jürgens Jan-Patrick , Ploshikhin Vasily
Published: October 2017

Aerospace carbon fibre-reinforced components are cured under high pressure (7 bar) and temperature in an autoclave. As in an industrial environment, the loading of an autoclave usually changes from cycle to cycle causing different thermal masses and airflow pattern which leads to an inhomogeneous temperature distribution inside the carbon fiber-reinforced plastic part. Finally, the overall process can be delayed and the part quality can be compromised. In this paper, the heat transfer in a small laboratory autoclave has been investigated using calorimeter measurements and a fluid dynamic model. A complex turbulent flow pattern with locally varying heat transfer coefficient has been observed. Especially, the pressure and the inlet fluid velocity have been identified as sensitive process parameters. Further finite element simulations with adjusted boundary conditions provide accurate results of the curing process inside of the components for selective process control. The heat transfer coefficient has been found to be almost stationary during the observed constant pressure autoclave process allowing a separated investigation of the heat transfer coefficient and the curing of the components. The presented method promises therefore a detailed observation of the autoclave process with reduced computational effort.
The Role of Stressful Life Events and Cultural Factors on Criminal Thinking Among African American Women Involved in the Criminal Justice System
Authors: Link Tanja C. , Oser Carrie B.
Published: October 2017

African American women are positioned at the intersection of multiple disadvantaged statuses and disproportionately affected by criminal justice policies, as evinced by their increased likelihood of incarceration. Yet they continue to be overlooked in mainstream criminological research. Using data from 418 African American women in the B-WISE (Black Women in a Study of Epidemics) project, the present study investigates the relationship between several prominent stressors occurring in five social contexts and criminal thinking as a coping strategy. Findings indicate that criminal thinking may be one maladaptive coping mechanism to manage stressors, such as gendered racism, financial stress, and network loss, that occur across these multiple social contexts for African American women in prison and on probation. Spirituality, on the other hand, seems to operate as a buffer. Implications for practice include promoting programs that strengthen a sense of collective identity in the community, as well as hiring more African American women who could provide additional culturally competent behavioral health services in criminal justice professions.
A Mindful Approach to Diabetes Self-Management Education and Support for Veterans
Authors: DiNardo Monica , Saba Shaddy , Greco Carol M. , Broyles Lauren , Terhorst Lauren , Chasens Eileen R. , Bair Brandi , Charron-Prochownik Denise , Cohen Susan
Published: October 2017

Purpose

The purpose of this study is to determine feasibility, satisfaction, and preliminary effects of Mindful Stress Reduction in Diabetes Education (Mind-STRIDE), a mindfulness-based intervention for veterans.

Methods

The study used a single-group pretest-posttest repeated-measures design. The 90-minute Mind-STRIDE training, adapted from Mindfulness Based Stress Reduction (MBSR), was provided as the final component of a half-day diabetes self-management education class at a Veterans Affairs (VA) outpatient diabetes clinic. Following initial training, participants were asked to practice mindfulness at home for 10 minutes each day during the 3-month study. Study recruitment and retention were calculated as rates. Veteran and diabetes educator satisfaction were assessed by rating scales and open-ended comments. Psychosocial-behavioral and metabolic outcomes were assessed at baseline and 3 months after initial training. Bivariate correlations were performed to describe relationships between mindfulness and other outcome variables. Gain scores and Wilcoxon matched-pair signed rank tests were used to assess pre to post changes; Cohen’s d was applied to estimate the magnitude of effects.

Results

Twenty-eight of 49 eligible veterans (57%) enrolled in the study. Of those, 11 veterans (39%) demonstrated participation in home practice, and 20 veterans (71%) completed the study. Overall, participants and diabetes educators were highly satisfied with the Mind-STRIDE intervention. Significant improvements were found in diabetes distress, diabetes self-efficacy, diabetes self-management behaviors, mindful-describing, and A1C.

Conclusion

Results suggest feasibility, satisfaction, and positive preliminary effects. Efficacy testing by randomized controlled trial with analysis of covariance structures is warranted.
Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes in a Safety-Net Clinic
Authors: Belyeu Brittaney , Chwastiak Lydia , Russo Joan , Kiefer Meghan , Mertens Kathy , Chew Lisa , Jackson Sara L.
Published: October 2017

Purpose

The purpose of the study was to evaluate patient factors associated with nonengagement in a Diabetes Collaborative Care Team (DCCT) program in a safety-net clinic.

Methods

The first 18 months of a multidisciplinary care, team-based diabetes care management program in a safety-net primary care clinic were studied. Nonengagement was defined as fewer than 2 visits with a team member during the 18 months of the program. Patients who did not engage in the program were compared with those who did engage on demographics, comorbid medical and psychiatric diagnoses, and cardiovascular risk factors, using univariate and multivariable analyses.

Results

Of the 151 patients referred to the DCCT, 68 (45%) were nonengaged. In unadjusted analyses, patients who did not engage were more likely to be female and have higher baseline A1C values; they were less likely to have major depressive disorder, anxiety disorder, any depression diagnosis, and hyperlipidemia. Female gender and chronic pain were independently associated with nonengagement after multivariable adjustment.

Conclusions

The findings suggest that among patients with uncontrolled diabetes in an urban safety-net primary care clinic, there is a need to address barriers to engagement for female patients and to integrate chronic pain management strategies within multicondition collaborative care models.
Review: Jussi Parikka, Digital Contagions: A Media Archaeology of Computer Viruses
Authors: Whitson Roger
Published: October 2017

The second edition of Jussi Parikka’s Digital Contagions: A Media Archaeology of Computer Viruses is both a welcome reissue of a canonical text in media archaeology and an important intervention into contemporary techno-political crises like cyberwarfare. Parikka’s book shows how viruses are central to the history of networked computing, while articulating their social connections to political, medical, and cultural discourses. For him, the notion of contagion in digital networks is inseparable from the rise of the computing security industry and the spread of what he calls ‘viral capitalism’: a system of value that leverages viral methodologies to colonize new markets and appropriate revolutionary impulses. Against the purity and commercialism of contemporary consumer electronics, Digital Contagions instead looks to the experiments of early viral programming as offering alternative histories of digital media.
An Interview with Wendy Brown: Redoing the Demos?
Authors: Burgum Samuel , Raza Sebastian , Vasquez Jorge
Published: October 2017

The following discussion with philosopher and political scientist Wendy Brown seeks to apply her provocative and indispensable ideas to recent political events and problems, in particular focusing on her work in Undoing the Demos (2015) and returning briefly to consider Politics Out of History (2001) in today’s context. The questions were collectively authored and the interview itself was conducted by Sebastian Raza via Skype on 23 May 2017. We would like to thank Wendy Brown for the generous contribution of her time and for answering the questions so directly and clearly.
Transitioning From Successful Aging: A Life Course Approach
Authors: Cooney Teresa M. , Curl Angela L.
Published: October 2017

Objective: The life course perspective and representative U.S. data are used to test Rowe and Kahn’s Successful Aging (SA) conceptualization. Four sets of influences (childhood experiences, social structural factors, adult attainments, and later life behaviors) on SA transitions are examined to determine the relative role of structural factors and individual behaviors in SA. Method: Eight waves of Health and Retirement Study data for 12,108 respondents, 51 years and older, are used in logistic regression models predicting transitions out of SA status. Results: Social structural factors and childhood experiences had a persistent influence on transitions from SA, even after accounting for adult attainments and later life behaviors—both of which also impact SA outcomes. Discussion: The findings on sustained social structural influences call into question claims regarding the modifiability of SA outcomes originally made in presentation of the SA model. Implications for policy and the focus and timing of intervention are considered.
Assessing strategic policy transfer in Romanian Public Management
Authors: Common Richard , Gheorghe Irina
Published: October 2017

The notion of strategic policy transfer builds upon existing accounts of policy transfer that assume selectivity in terms of what governments choose to learn from abroad. This article analyses the case of public administration in Romania, which, at first glance, appears to have embraced policy transfer as part of the process of Europeanisation and other modernisation initiatives emanating from international institutions such as the World Bank. Based on interviews with policy elites in Romania, the authors establish that those elites were not interested in learning about administrative improvements from abroad because they were self-evidently workable but because it satisfied key external actors. Furthermore, the high degree of politicisation of the Romanian bureaucracy, which remains a legacy of its Communist past, continues to act as a barrier to change, and may result in the reversal of reforms now EU membership is fully established.
Numerical and experimental investigations of pressure fluctuations in single-channel pumps
Authors: Tan Linwei , Shi Weidong , Zhang Desheng , Zhou Ling , Wang Chuan
Published: October 2017

To elucidate the characteristics and generation mechanism of pressure fluctuations in single-channel pumps, the unsteady flow in three single-channel pumps with the same impeller equipped with a spiral volute (model 1), a circular volute (model 2), and a torus (model 3) were analyzed by computational fluid dynamics. Experiments on global performance characteristics in the volute of model 1 were performed, and fast response pressure sensors were installed in the spiral volute to measure pressure fluctuations. The results indicate that the numerical results are in good agreement with the experimental results. This study shows that a phase delay exists between different volute monitoring points and the pressure fluctuations in the volute are mainly caused by the potential interactions between the impeller blade and volute wall. Comparison of the pressure fluctuations amplitude of the impeller outlet shows that pressure fluctuation amplitude of model 3 is one order of magnitude lower than those of the others and the wake at the impeller outlet played an important role in pressure fluctuations. The standard deviation of pressure was introduced to describe the pressure fluctuations strength. It shows that the pressure fluctuation strength of the pressure surface is apparently higher than that of the suction surface, and the maximum pressure fluctuation strength in the blade is consistent with the flow separation area, indicating that flow separation is also an important factor for pressure fluctuations in single-channel pumps.
“Hold Me Tight So I Can Go It Alone”: Developmental Themes for Young Adults With Autism Spectrum Disorder
Authors: Mattys Laura , Noens Ilse , Evers Kris , Baeyens Dieter
Published: October 2017

Although research shows that young adults with autism spectrum disorder (ASD) struggle with higher rates of depression, anxiety, and other co-occurring psychiatric disorders, their psychological development through emerging adulthood remains understudied. To explore relevant developmental themes for young adults with ASD while subscribing to a social-constructionist epistemology, we interviewed young adults with ASD and their mental health care professionals individually, and organized focus groups with their parents in a multiperspective design. Developmental themes were identified using interpretative phenomenological analysis. Despite a substantial body of research considering lack of social motivation, a central ASD characteristic, narratives were remarkably socially oriented. This article discusses the overarching themes of (a) searching for balance and negotiating ASD and (b) searching for suitable surroundings in different areas of life, as well as their implications for clinical practice.
Integrating Mathematics and Children’s Literature for Young Children With Disabilities
Authors: Green Katherine B. , Gallagher Peggy A. , Hart Lynn
Published: October 2017

Math skills are critical for children’s future success in school, as school-entry math knowledge is the strongest predictor of later academic achievement. Although there is a recent increase of literature on math with young children, there is a scarcity of research related to young children with disabilities. This quasi-experimental study with 50 preschool aged children with disabilities examined the effects of an intervention that integrated mathematics and literature on early numeracy skills. The intervention was conducted 3 days per week for 6 weeks, and consisted of an interactive shared storybook reading including mathematical content through scripted questioning and discussions and story-related mathematical activities after the reading of the story. Children who received the intervention scored significantly higher than the comparison group in total math ability, quantity comparison, one-to-one correspondence counting, and oral counting as measured by scores on the Test of Early Mathematics Ability, Third Edition (TEMA-3) and the Individual Growth & Development Indicators Early Numeracy (IGDIS-EN).
Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model
Authors: Marr T. David , Pinelli Nicole R. , Jarmul Jamie A. , Waldron Kayla M. , Eckel Stephen F. , Cicci Jonathan D. , Bates Jill S. , Amerine Lindsey B.
Published: October 2017

Background: Pharmacy practice models that foster pharmacists’ accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. Objective: The objective of this study was to evaluate the impact of a CMM practice model in the acute care setting on organizational, patient, and financial outcomes. Methods: Three adult service lines focused on at-risk patients identified using internal risk stratification methodology were implemented. Core CMM elements included medication reconciliation, differentiated clinical pharmacy services, inpatient MTM consultations, discharge services, and documentation. Mixed methods compared the effect of the CMM model before and after implementation. Historical patients served as comparative controls in an observational design. Pharmacists completed a 60-minute interview regarding their experiences. Qualitative data were analyzed using thematic coding to characterize perception of the model. Results: Three pharmacists implemented the model on cardiology, hematology/oncology, and surgery transplant services and provided services to 75 patients during the study. A total of 145 medication-related problems were identified and resolved. CMM was associated with a nonsignificant reduction of 8.8% in 30-day hospital readmission rates ( P = 0.64) and a 24.9% reduction in 30-day hospital utilization ( P = 0.41) as well as a significant reduction of 86.5% in emergency department visits ( P = 0.02). Patients receiving discharge prescriptions from our outpatient pharmacies increased by 21.4%, resulting in an 11.3% increase in discharge prescription capture and additional revenue of $5780. Themes identified from qualitative interviews included CMM structure, challenges, value, and resources. Conclusion: This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.
An Interprofessional Evaluation of Health Literacy Communication Practices of Physicians, Pharmacists, and Nurses at Public Hospitals in Penang, Malaysia
Authors: Rajah Retha , Hassali Mohamed Azmi , Lim Ching-Jou
Published: October 2017

Background: Health care practitioners carry a tremendous responsibility to differentiate the varying need of information and customized communication according to a patient’s health literacy (HL) level. Objectives: To assess and compare the HL communication practices among physicians, pharmacists, and nurses serving at public hospitals in Penang, Malaysia. Methods: A pretested, self-administered questionnaire was used to collect data from study participants of 6 public hospitals using stratified sampling. Descriptive and inferential statistics used to analyze the data with level of significance was set at P < 0.05. Results: Of 600 distributed questionnaires, 526 (87.6%) were adequately filled and returned. Almost 19.0% (n = 98) of the respondents admitted that they did not frequently use simple language and avoid medical jargon during communication with patients. Only about half of the respondents reported frequently using other HL communication practices that include handing out education material to patients (52.2%, n = 275), asking the patient to repeat information (58.9%, n = 310), and asking patients’ caregivers to be present during explanation (57.4%, n = 302). Comparatively, drawing pictures to ease patients’ understanding (40.1%, n = 211) was the less-frequently practiced HL communication techniques. Health practitioners in the age group >41 years ( P = 0.046), serving 10 years and more ( P = 0.03) and those who have heard the term or concept of HL ( P = 0.004) have statistically significantly higher mean score of HL communication practices than other groups. Conclusions: The gap in the HL communication practices among physicians, pharmacists, and nurses warrants educational intervention, and standardized HL communication techniques guidelines are needed in the near future.
Impact of a Combination Antibiotic Bag on Compliance With Surviving Sepsis Campaign Goals in Emergency Department Patients With Severe Sepsis and Septic Shock
Authors: Lorenzo Michael P. , MacConaghy Lindsay , Miller Christopher D. , Meola Gregory , Probst Luke A. , Pratt Brian , Steele Jeff , Seabury Robert W.
Published: October 2017

Background: Severe sepsis and septic shock represent common presentations in the emergency department (ED) and have high rates of mortality. Guideline-recommended goals of care have been shown to benefit these patients, but can be difficult to provide. Objective: To determine whether the use of a premixed bag consisting of 2 g cefepime and 1 g vancomycin in 1000 mL of normal saline increases the probability of patients receiving Surviving Sepsis Campaign (SSC) recommendations for the initiation of antimicrobials and fluid challenge. Methods: This was a 6-month retrospective analysis conducted to determine the impact of an intervention on time to antimicrobials and fluid administration in patients with severe sepsis and septic shock. Patients presenting to the ED who received a diagnosis of severe sepsis or septic shock and were administered 2 antibiotics were eligible for inclusion. The primary outcome assessed was compliance with SSC recommendations for antibiotic and fluid goals within 3 hours of ED arrival. Results: A total of 160 patients were included. In the intervention group, 63.8% of patients met the primary outcome compared with 22.5% in the historical group (odds ratio = 2.32; 95% CI = 1.67-3.23). Time to administration of antibiotics was less with the combination antibiotic bag (CAB: median (IQR) = 72 (48-115) minutes; non-CAB: median (IQR) = 135 (102-244) minutes; P ≤ 0.001). Conclusion: This intervention significantly increased the proportion of patients provided with SSC goals of care. Such interventions have not been reported previously and could be meaningful in the management of severe sepsis and septic shock.
Role of Extra-articular Tibiotalocalcaneal Arthrodesis and Posterior Approach in Highly Complex Cases
Authors: Eckholt Sergio , Garcia-Elvira Ruben , Fontecilla Nicolás , Fernandez-Reinales Alvaro , Poggio Daniel
Published: October 2017

Background:

Tibiotalocalcaneal (TTC) arthrodesis is a procedure commonly used as salvage surgery for various pathologic processes that compromise the ankle and subtalar joints. It is a reasonably standardized procedure when performed as a primary surgery in advanced stages of TTC arthritis. For such cases, there are several alternative approaches, fixation materials, and bone substitutes that can be used. Most represent valid options with similar results in the literature. However, in highly complex cases requiring TTC arthrodesis, the options for the approach and fixation material can be limited. Understanding the alternative approaches and techniques is of great help to the surgeon when faced with highly complex cases, such as patients with multiple previous operations, lack of bone stock, severe deformities, or compromise of associated soft tissues. In this article, we describe the role of the posterior approach with some technical variation that allows extra-articular arthrodesis in highly complex cases, and we present a series of patients with tibiotalocalcaneal arthrodesis who were operated on using this technique.

Methods:

Retrospective review of all patients who underwent tibiotalocalcaneal arthrodesis via posterior approach between 2008 and 2016. The surgeries were performed by 2 different surgeons with the same technique (posterior approach with sliding graft) but 2 different fixation methods. Radiographs and computed tomographic (CT) studies were reviewed and patient satisfaction was rated using the Coughlin scale. Mean follow-up was 38 months. We identified 20 patients. The mean age was 51.2 years; 11 patients had post-traumatic arthritis whereas the others had other causes of arthritis (inflammatory disease, neurologic deformity, etc).

Results:

The arthrodesis was performed using a tibiotalocalcaneal plate in 9 patients and retrograde intramedullary nail in 11 patients. Radiographic fusion was observed at an average of 3.1 months. Four patients had complications and 15 reported good or excellent results after surgery.

Conclusion:

Our study found a fusion rate comparable to other studies in highly complex cases. There were no operative wound complications. We observed that the posterior approach, with an extra-articular fusion procedure, was a valid option for salvage surgery in highly complex cases that require tibiotalocalcaneal fusion.

Level of Evidence:

Level IV, retrospective case series.
Subcutaneous metastasis from recurrent basaloid squamous cell carcinoma of the esophagus
Authors: Puri Sonam , Holle Lisa M , Forouhar Faripour A , Clement Jessica M
Published: October 2017

Background

Esophageal cancer is the 11th most common cause of cancer mortality in the United States. It is aggressive in nature and has an ability to spread rapidly through direct extension, lymphatic spread, or hematogenously. With an estimated incidence of 1%, cutaneous metastases from esophageal cancer are extremely rare.

Case presentation

In this case study and review, we describe a case of recurrent esophageal basaloid squamous cell carcinoma presenting as multiple, rapidly progressing and tender subcutaneous nodules. A 69-year-old male with history of basaloid squamous cell carcinoma of the esophagus treated with concurrent chemoradiation, presented to his oncologist with complaints of a large, painful nodule at the nape of his neck approximately two years after completing treatment. On further examination, he was noted to have multiple, well circumscribed, solid, tender nodules on his abdominal wall along with a painful nodule on the pulp of his index finger. Histopathology from all sites revealed skin infiltration by high-grade invasive basaloid subtype of squamous cell carcinoma, similar to patient’s prior known and treated primary esophageal cancer. Further imaging work up showed extensive metastatic disease involving lung, liver, and brain.

Conclusion

Esophageal squamous cell carcinoma rarely metastasize to the skin. Subcutaneous nodules can be the first presentation of recurrent disease. The lesions are commonly confused with skin infections and treated inappropriately with antibiotics, leading to delay in diagnosis of recurrent disease. Early biopsy of suspicious lesions should be performed, especially in patients with history of cancer, such that prompt diagnosis and treatment can occur to maximize patient outcomes.
A clinical pharmacy pilot within a Precision Medicine Program for cancer patients and review of related pharmacist clinical practice
Authors: Arnall Justin R , Petro Robin , Patel Jai N , Kennedy LeAnne
Published: October 2017

Purpose

The implementation, benefits, and challenges of clinical pharmacist services within a Precision Medicine Program for cancer patients are described. By relating the practice model that was developed, this report may further encourage pharmacists at cancer centers nationally to be involved and lead precision-based care in the oncology setting.

A clinical pharmacist was integrated into a Precision Medicine Program for oncology patients using somatic testing to identify actionable mutations and apply targeted therapy to malignancies. This pharmacist served as a drug resource for the program’s molecular tumor board and oncologists seeking precision-based oncologic strategies. The pharmacist was a facilitator of drug assistance and dispensing in collaboration with the specialty pharmacy and provided care to 14 oncology patients receiving precision-based therapies. The clinical pharmacist was readily accepted as an addition to the team by both oncologists and patients and the experience served as an important learning opportunity.

Conclusion

The success of integrating this precision medicine pharmacist into a newly formed Precision Medicine Program and the model it can serve as may be considered for other cancer centers that may or may not have easily accessible pharmacogenomic experts and resources. This service highlights the importance of pharmacist care in such a program and the various opportunities for integration. Oncology clinical pharmacists should seek to integrate into Precision Medicine Programs and systems directing this care and develop their knowledge and understanding of genomics to continue providing the highest level of cancer care as a pivotal member of the cancer care team.
Early Bill-of-Quantities Estimation of Concrete Road Bridges: An Artificial Intelligence-Based Application
Authors: Dimitriou Loukas , Marinelli Marina , Fragkakis Nikolaos
Published: October 2017

Accurate cost estimation in the preliminary stages of project development is critical for making informed planning decisions. However, such early estimates are typically restricted by limited information. In this article, the widely recognized intelligence of feed-forward artificial neural networks (FFANNs) is used to process actual data from 68 concrete road bridges and provide a surrogate model for the accurate estimation of the bill-of-quantities (BoQ). Specifically, two FFANNs are trained to estimate the superstructure and piers concrete and steel-based on the construction method and the bridge dimensions. As the relevant metrics demonstrate, the FFANNs capture very well the complex interrelations in the data set and produce highly accurate estimates. Furthermore, their generalization capability is superior to the capability of respective linear regression models. As the data used to train the FFANNs are normally available early in the project lifecycle, the proposed model enables early, yet accurate cost estimates to be obtained.
A Treatment Algorithm for Moderate to Severe Atopic Dermatitis in Adults
Authors: Lynde Charles W. , Bourcier Marc , Gooderham Melinda , Guenther Lyn , Hong Chih-ho , Papp Kim A. , Poulin Yves , Sussman Gordon , Vender Ronald
Published: October 2017

Background:

Atopic dermatitis (AD) is a common and chronic inflammatory skin disease. Approximately 10% of adults with AD do not respond adequately to topical therapies and require phototherapy and/or systemic therapy.

Objective:

To provide a patient-focused approach to the identification and management of adults with AD who require systemic treatment.

Methods:

A working group of clinicians experienced in managing AD was convened to review and discuss current evidence on the identification and clinical management of adults with moderate to severe AD.

Results:

We propose a set of simple and practical clinical criteria for selecting candidates for systemic treatment of AD based on their response to first-line topical therapy and 4 clinical measures that are easily incorporated into routine practice. We also suggest a framework for evaluating systemic treatments according to attributes that are important from both a clinician’s and a patient’s perspective. An algorithm was developed proposing a pathway for treatment of moderate to severe AD in adults.

Conclusion:

Adults with moderate to severe AD that does not respond adequately to topical therapies currently have few safe and effective treatment options. A clinical algorithm could help guide treatment decisions.
The use of telemedicine for delivering healthcare in Japan: Systematic review of literature published in Japanese and English languages
Authors: Ito Jun , Edirippulige Sisira , Aono Takeshi , Armfield Nigel R
Published: October 2017

Background

In common with other countries, Japan has an ageing population and geographical impediments to healthcare access. The role of telemedicine within the Japanese health system may be of wide interest, yet it has not been comprehensively explored and documented. Thus, the aim of this study was to systematically review the Japanese and English language literature relating to the clinical use of telemedicine in Japan.

Methods

For studies published in Japanese, we searched Ichushi and CiNii. For English language publications, we searched Cochrane Library, PubMed, Embase, and Web of Science. All peer-reviewed articles describing the clinical use of telemedicine and published between 2007 and 2016 were included. Data on clinical area, study type, technology used, and type of communication were extracted. Studies were categorised by prevention, screening, diagnosis, surveillance, and treatment.

Results

The search yielded 1476 records; 26 Japanese language and 15 English language articles were selected for review. A wide range of clinical areas were represented; however, home care and life-style related studies were dominant. More than 50% of studies were related to prevention and early diagnosis. The majority of Japanese studies involved doctor-to-doctor consultation. Smartphones and remote monitoring systems were the main types of technology used.

Conclusions

Most studies of telemedicine in Japan are published in the Japanese language and are thus relatively inaccessible to the rest of the world; for the first time, this study has provided an overview of the clinical use of telemedicine in Japan. The clinically related papers reflect the Japanese cultural focus on disease prevention.
Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme
Authors: Bagot Kathleen L , Cadilhac Dominique A , Kim Joosup , Vu Michelle , Savage Mark , Bolitho Les , Howlett Glenn , Rabl Justin , Dewey Helen M , Hand Peter J , Denisenko Sonia , Donnan Geoffrey A , Bladin Christopher F
Published: October 2017

Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.
Epilepsy, digital technology and the black-boxed self
Authors: Roach Rebecca
Published: October 2017

This article traces the history of epilepsy’s affinities with new media. It draws on interviews with people with epilepsy (PWE) and wider instances of the condition’s representation in the socio-cultural imaginary to demonstrate the degree to which epilepsy has been heavily technologized in the second half of the 20th century. Thanks to common analogies made between the seizing brain and the faulty electrical circuit, the PWE has been increasingly conceived within cybernetic terms: in particular, these subjects have long been ‘black boxed’ by the medical establishment. Tracking this connection across the rise of so-called ‘Surveillance Medicine’ and new digital health technologies reveals, I argue, suggestive parallels between the stigmatized PWE and the data-driven subject of today’s digital environment.