bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and ethnic differences in self-reported telehealth use during the COVID-19 pandemic: a secondary analysis of a US survey of internet users from late March
Authors: Campos-Castillo Celeste , Anthony Denise
Published: August 2020

Objective

Widespread technological changes, like the rapid uptake of telehealth in the US during the COVID-19 pandemic, risk creating or widening racial/ethnic disparities. We conducted a secondary analysis of a cross-sectional, nationally representative survey of internet users to evaluate whether there were racial/ethnic disparities in self-reported telehealth use early in the pandemic.

Materials and Methods

The Pew Research Center fielded the survey March 19–24, 2020. Telehealth use because of the pandemic was measured by asking whether respondents (N = 10 624) “used the internet or e-mail to connect with doctors or other medical professionals as a result of the coronavirus outbreak.” We conducted survey-weighted logistic regressions, adjusting for respondents’ socioeconomic characteristics and perceived threat of the pandemic to their own health (eg, no threat, minor, major).

Results

Approximately 17% of respondents reported using telehealth because of the pandemic, with significantly higher unadjusted odds among Blacks, Latinos, and those identified with other race compared to White respondents. The multivariable logistic regressions and sensitivity analyses show Black respondents were more likely than Whites to report using telehealth because of the pandemic, particularly when perceiving the pandemic as a minor threat to their own health.

Discussion

Black respondents are most likely to report using telehealth because of the COVID-19 pandemic, particularly when they perceive the pandemic as a minor health threat.

Conclusion

The systemic racism creating health and health care disparities has likely raised the need for telehealth among Black patients during the pandemic. Findings suggest opportunities to leverage a broadly defined set of telehealth tools to reduce health care disparities postpandemic.
A phase II study of palliative radiotherapy combined with zoledronic acid hydrate for metastatic bone tumour from renal cell carcinoma
Authors: Harada Hideyuki , Shikama Naoto , Wada Hitoshi , Uchida Nobue , Nozaki Miwako , Hayakawa Kazushige , Yamada Kazunari , Nagakura Hisayasu , Ogawa Hirofumi , Miyazawa Kazunari , Katagiri Hirohisa , Nakamura Naoki
Published: August 2020

Purpose

Palliative radiotherapy is the standard of care for bone metastases. However, skeletal-related events, defined as a pathologic fracture, paraplegia, surgery or radiotherapy for local recurrence, or severe pain in previously irradiated bone with radio-resistant histology type still present high incidence. The primary objective of this study was to determine whether zoledronic acid hydrate and palliative radiotherapy could prevent local skeletal-related events.

Methods

Eligible patients with bone metastases from renal cell carcinoma were treated with zoledronic acid hydrate every 3 or 4 weeks and concurrent palliative radiotherapy of 30 Gy in 3 Gy fractions. The criteria for radiotherapy were established by the treating physician, but patients with complicated bone metastases (impending pathological fracture or spinal cord compression) which needed immediate surgery were excluded. The primary endpoint was the local skeletal-related event-free survival rate at 1 year.

Results

Twenty-seven patients were included in the study. The median age was 65 (range, 50–84) years. Radiotherapy dose was 30 Gy for all patients except 1 whose radiotherapy was terminated due to brain metastasis progression at 18 Gy. Zoledronic acid hydrate was administered in a median of 12 (range, 0–34) times. The median follow-up period was 12 months and 19 months in patients who were still alive. Of 27 patients in the efficacy analysis, the 1-year local skeletal-related event-free rate was 77.6% (80% confidence interval, 66.2–89.0). Common grade 3 toxicities were hypocalcemia (1 [4%]), sGPT level increase (1 [4%]) and sGOT level increase (1 [4%]). There was no grade 4 or 5 toxicity.

Conclusion

Zoledronic acid hydrate administration and palliative radiotherapy were a well-tolerated and promising treatment reducing skeletal-related events for bone metastases from renal cell carcinoma.
Paediatric abdominal pain in the time of COVID-19: a new diagnostic dilemma
Authors: Harwood Rachel , Partridge Roland , Minford Joanne , Almond Sarah
Published: August 2020

The diagnostic uncertainty for children with abdominal pain has increased during the COVID-19 pandemic with the additional consideration of both COVID-19 and paediatric inflammatory multisystem syndrome—temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) alongside appendicitis, mesenteric adenitis and other less common causes of abdominal pain. We describe the cases of two children who presented with severe abdominal pain, non-bilious vomiting and high temperatures during the UK’s first peak of the COVID-19 pandemic. Laboratory and abdominal ultrasound features were similar for both children but symptom progression in combination with cross-sectional abdominal imaging enabled differentiation between PIMS-TS and appendicitis with concurrent COVID-19. These cases highlight the importance of regular clinical review, multidisciplinary working and the utility of early cross-sectional imaging to determine the underlying condition.
Palmitic acid induces inflammation in placental trophoblasts and impairs their migration toward smooth muscle cells through plasminogen activator inhibitor-1
Authors: Rampersaud Amanda M , Dunk Caroline E , Lye Stephen J , Renaud Stephen J
Published: August 2020

A critical component of early human placental development includes migration of extravillous trophoblasts (EVTs) into the decidua. EVTs migrate toward and displace vascular smooth muscle cells (SMCs) surrounding several uterine structures, including spiral arteries. Shallow trophoblast invasion features in several pregnancy complications including preeclampsia. Maternal obesity is a risk factor for placental dysfunction, suggesting that factors within an obese environment may impair early placental development. Herein, we tested the hypothesis that palmitic acid, a saturated fatty acid circulating at high levels in obese women, induces an inflammatory response in EVTs that hinders their capacity to migrate toward SMCs. We found that SMCs and SMC-conditioned media stimulated migration and invasion of an EVT-like cell line, HTR8/SVneo. Palmitic acid impaired EVT migration and invasion toward SMCs, and induced expression of several vasoactive and inflammatory mediators in EVTs, including endothelin, interleukin (IL)-6, IL-8 and PAI1. PAI1 was increased in plasma of women with early-onset preeclampsia, and PAI1-deficient EVTs were protected from the anti-migratory effects of palmitic acid. Using first trimester placental explants, palmitic acid exposure decreased EVT invasion through Matrigel. Our findings reveal that palmitic acid induces an inflammatory response in EVTs and attenuates their migration through a mechanism involving PAI1. High levels of palmitic acid in pathophysiological situations like obesity may impair early placental development and predispose to placental dysfunction.
The conserved elongation factor Spn1 is required for normal transcription, histone modifications, and splicing in Saccharomyces cerevisiae
Authors: Reim Natalia I , Chuang James , Jain Dhawal , Alver Burak H , Park Peter J , Winston Fred
Published: August 2020

Spn1/Iws1 is a conserved protein involved in transcription and chromatin dynamics, yet its general in vivo requirement for these functions is unknown. Using a Spn1 depletion system in Saccharomyces cerevisiae, we demonstrate that Spn1 broadly influences several aspects of gene expression on a genome-wide scale. We show that Spn1 is globally required for normal mRNA levels and for normal splicing of ribosomal protein transcripts. Furthermore, Spn1 maintains the localization of H3K36 and H3K4 methylation across the genome and is required for normal histone levels at highly expressed genes. Finally, we show that the association of Spn1 with the transcription machinery is strongly dependent on its binding partner, Spt6, while the association of Spt6 and Set2 with transcribed regions is partially dependent on Spn1. Taken together, our results show that Spn1 affects multiple aspects of gene expression and provide additional evidence that it functions as a histone chaperone in vivo.
Funding kidney research as a public health priority: challenges and opportunities
Authors: Zoccali Carmine , Vanholder Raymond , Wagner Carsten A , Anders Hans-Joachim , Blankestijn Peter J , Bruchfeld Annette , Capasso Giovambattista , Cozzolino Mario , Dekker Friedo W , Fliser Danilo , Fouque Denis , Gansevoort Ron T , Goumenos Dimitrios , Jager Kitty J , Massy Ziad A , Oostrom Tom A J , Rychlık Ivan , Soler Maria Jose , Stevens Kate , Spasovski Goce , Wanner Christoph
Published: August 2020

Medical societies have a social responsibility to disseminate knowledge and inform health authorities on threats to public health posed by various diseases. Advocacy for health protection programmes and for medical research funding is now embedded into the missions of most scientific societies. To promote kidney research funding in Europe, the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA), rather than acting as an individual society advocating for the fight against kidney disease, has actively helped to create an alliance of national associations centred on kidney diseases, the European Kidney Health Alliance (EKHA), and joined the Biomedical Alliance (BMA). The ERA-EDTA is fully committed to supporting its working groups (WGs) and consortia of its members to allow them to produce valuable kidney research. The framing and formalization of projects, and the regulatory issues related to submission to the European Commission, are complex. To help WGs to gain expert advice from agencies with specific know-how, the ERA-EDTA has adopted a competitive approach. The best research projects proposed by WGs and consortia of other European investigators will receive seed funding to cover the costs of consultancy by expert agencies. Via its broader platforms, the EKHA and the BMA, the ERA-EDTA will strive towards broader recognition of kidney disease and related clusters of non-communicable diseases, by European and national agencies, as major threats to the qualities of life of their populations and their economies.
Estimation of the burden of shielding among a cross-section of patients attending rheumatology clinics with SLE—data from the BSR audit of systemic lupus erythematosus
Authors: Rutter Megan , Lanyon Peter C , Sandhu Ravinder , Batten Rebecca L , Garner Rozeena , Little Jayne , Narayan Nehal , Sharp Charlotte A , Bruce Ian N , Erb Nicola , Griffiths Bridget , Guest Hannah , Macphie Elizabeth , Packham Jon , Hiley Chris , Obrenovic Karen , Rivett Ali , Gordon Caroline , Pearce Fiona A
Published: August 2020

Objectives

We aimed to estimate what proportion of people with SLE attending UK rheumatology clinics would be categorized as being at high risk from coronavirus disease 2019 (COVID-19) and therefore asked to shield, and explore what implications this has for rheumatology clinical practice.

Methods

We used data from the British Society for Rheumatology multicentre audit of SLE, which included a large, representative cross-sectional sample of patients attending UK Rheumatology clinics with SLE. We calculated who would receive shielding advice using the British Society for Rheumatology’s risk stratification guidance and accompanying scoring grid, and assessed whether ethnicity and history of nephritis were over-represented in the shielding group.

Results

The audit included 1003 patients from 51 centres across all 4 nations of the UK. Overall 344 (34.3%) patients had a shielding score ≥3 and would have been advised to shield. People with previous or current LN were 2.6 (1.9–3.4) times more likely to be in the shielding group than people with no previous LN (P < 0.001). Ethnicity was not evenly distributed between the groups (chi-squared P < 0.001). Compared with White people, people of Black ethnicity were 1.9 (1.3–2.8) and Asian 1.9 (1.3–2.7) times more likely to be in the shielding group. Increased risk persisted after controlling for LN.

Conclusion

Our study demonstrates the large number of people with SLE who are likely to be shielding. Implications for clinical practice include considering communication across language and cultural differences, and ways to conduct renal assessment including urinalysis, during telephone and video consultations for patients who are shielding.
Immunoreactivity and neutralization capacity of Philippine cobra antivenom against Naja philippinensis and Naja samarensis venoms
Authors: Tan Choo Hock , Palasuberniam Praneetha , Blanco Francis Bonn , Tan Kae Yi
Published: August 2020

Background

The Philippine cobra (Naja philippinensis) and Samar cobra (Naja samarensis) are two WHO Category 1 medically important venomous snakes in the Philippines. Philippine cobra antivenom (PCAV) is the only antivenom available in the country, but its neutralization capacity against the venoms of N. philippinensis and hetero-specific N. samarensis has not been reported. This knowledge gap greatly hinders the optimization of antivenom use in the region.

Methods

This study examined the immunological binding and neutralization capacity of PCAV against the two cobra venoms using WHO-recommended protocols.

Results

In mice, both venoms were highly neurotoxic and lethal with a median lethal dose of 0.18 and 0.20 µg/g, respectively. PCAV exhibited strong and comparable immunoreactivity toward the venoms, indicating conserved venom antigenicity between the two allopatric species. In in vivo assay, PCAV was only moderately effective in neutralizing the toxicity of both venoms. Its potency was even lower against the hetero-specific N. samarensis venom by approximately two-fold compared with its potency against N. philippinensis venom.

Conclusion

The results indicated that PCAV could be used to treat N. samarensis envenomation but at a higher dose, which might increase the risk of hypersensitivity and worsen the shortage of antivenom supply in the field. Antivenom manufacturing should be improved by developing a low-dose, high-efficacy product against cobra envenomation.
The Role of Stigma in the Nursing Care of Families Impacted by Neonatal Abstinence Syndrome
Authors: Recto Pamela , McGlothen-Bell Kelly , McGrath Jacqueline , Brownell Elizabeth , Cleveland Lisa M.
Published: August 2020

Background:

The current US opioid crisis has resulted in a significant increase in opioid use disorder among pregnant and parenting women. Substance use disorders, in general, are highly stigmatized conditions. Stigma serves as a well-documented global barrier to health-seeking behaviors and engagement in healthcare. While extensive research exists on the stigma of mental illness, few studies have explored the stigma experienced by families impacted by neonatal abstinence syndrome (NAS).

Purpose:

Therefore, the purpose of this article is to explore the role of stigma in the care of families impacted by NAS.

Methods:

In this article, we present a discussion about the effects of stigma on this patient population and provide exemplars of stigma experiences from our previous research and the existing literature.

Findings/Results:

Mothers of infants with NAS faced the challenges of overcoming stigma as they were often ostracized, excluded, and shamed. Nurses who provide care for these women and their infants have reported experiencing ethical distress, moral distress, and compassion fatigue.

Implications for Practice:

Greater awareness of the impact of opioid use on the maternal–child population has resulted in numerous educational offerings for healthcare providers; however, this alone is not adequate to end stigma. Fortunately, promising tools and methods have been developed for assisting nurses with addressing stigma in a manner that can be both nonconfrontational and highly effective.

Implications for Research:

Future research is needed to explore and evaluate the efficacy of various existing strategies for counteracting harmful stigma in this patient population.
Does “Coronal Root Angle” Serve as a Parameter in the Removal of Ventral Factors for Foraminal Stenosis at L5-S1 In Stand-alone Microendoscopic Decompression?
Authors: Merter Abdullah , Shibayama Motohide
Published: August 2020

Study Design.

Prospective single-center cohort study.

Objective.

The present study aims to investigate the causes of failure of L5/S1 foraminal stenosis, and it is hypothesized that the newly defined “L5 coronal root angle (CRA)” may be a parameter in the removal of ventral pathologies.

Summary of Background Data.

Lumbar foraminal stenosis is an important cause of recurrent leg pain after central spinal stenosis surgery. Although it can be seen at all levels, L5/S1 is the level at which it is most frequently seen due to its specific characteristics, with success rate is lower than other levels after foraminal decompression.

Methods.

L5/S1 microendoscopic foraminal decompression was performed to 51 patients. According to Japanese Orthopedic Association (JOA) improvement at 12th-month follow-up, those with improvement >20% were classified as Group 1 and <20% were classified as Group 2. The patients who underwent discectomy in addition to foraminotomy formed Group 3. Lumbar lordosis angle, segmental lordosis angle, anterior disc height, pelvic tilt, pelvic incidence, sacral slope, relative disc height ratio, pedicle height/vertebral body height ratio, L5 depth, L5 CRA, and anterior disc height/ posterior disc height ratio parameters were measured with lumbar radiographic views, computed tomography (CT), and magnetic resonance imaging (MRI).

Results.

Among the parameters compared between groups, L5 CRA, posterior disc height, anterior disc height/posterior disc height, relative disc height ratio, and lumbar lordosis angle during extension were seen to be statistically significantly related with low success rate.

Conclusion.

Failure to remove the ventral pathologies when the L5 CRA is <112. 1º may lead to failed results. Besides, in cases wherein the posterior disc height is <2.85 mm or the anterior/posterior disc height ratio is >3.98, approaches to restoring disc height rather than stand-alone posterior decompression may reduce the possibility of failure.

Level of Evidence: 2
Orthosis in Thoracolumbar Fractures
Authors: Linhares Daniela , Pinto Bernardo Sousa , Ribeiro da Silva Manuel , Neves Nuno , Fonseca João A.
Published: August 2020

Study Design.

Systematic review and meta-analysis of randomized controlled trial (RCT).

Objective.

The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization.

Summary of Background Data.

Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery.

Methods.

Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed.

Results.

Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.

Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35–5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months.

Conclusion.

Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies.

Level of Evidence: 3
Lower Mortality and Morbidity with Low-Molecular-Weight Heparin for Venous Thromboembolism Prophylaxis in Spine Trauma
Authors: Neifert Sean N. , Chapman Emily K. , Rothrock Robert J. , Gilligan Jeffrey , Yuk Frank , McNeill Ian T. , Rasouli Jonathan J. , Gal Jonathan S. , Caridi John M.
Published: August 2020

Study Design.

Retrospective review of prospectively collected data.

Objective.

The objective of this study was to evaluate outcomes between patients receiving LMWH versus UH in a retrospective cohort of patients with spine trauma.

Summary of Background Data.

Although multiple clinical trials have been conducted, current guidelines do not have enough evidence to suggest low-molecular-weight heparin (LMWH) or unfractionated heparin (UH) for venous thromboembolism (VTE) prophylaxis in spine trauma.

Methods.

Patients with spine trauma in the Trauma Quality Improvement Program datasets were identified. Those who died, were transferred within 72 hours, were deemed to have a fatal injury, were discharged within 24 hours, suffered from polytrauma, or were missing data for VTE prophylaxis were excluded. A propensity score was created using age, sex, severity of injury, time to prophylaxis, presence of a cord injury, and altered mental status or hypotension upon arrival, and inverse probability weighted logistic regression modeling was used to evaluate mortality, venous thromboembolic, return to operating room, and total complication rates. E values were used to calculate the likelihood of unmeasured confounders.

Results.

Those receiving UH (n = 7172) were more severely injured (P < 0.0001), with higher rates of spinal cord injury (32.26% vs. 25.32%, P < 0.0001) and surgical stabilization (29.52% vs. 22.94%, P < 0.0001) compared to those receiving LMWH (n = 20,341). Patients receiving LMWH had lower mortality (odds ratio [OR]: 0.47; 95% CI: 0.42–0.53; P < 0.001; E = 3.68), total complication (OR: 0.92; 95% CI: 0.88–0.95; P < 0.001; E = 1.39), and VTE event (OR: 0.80; 95% CI: 0.72–0.88; P < 0.001; E = 1.81) rates than patients receiving UH. There were no differences in rates of unplanned return to the operating room (OR: 1.01; 95% CI: 0.80–1.27; P = 0.93; E = 1.11).

Conclusion.

There is an association between lower mortality and receiving LMWH for VTE prophylaxis in patients with spine trauma. A large randomized clinical trial is necessary to confirm these findings.

Level of Evidence: 3
Effect of An Online Physical Activity Promotion Program and Cardiovascular Symptoms Among Asian American Women at Midlife
Authors: Chee Wonshik , Kim Sangmi , Tsai Hsiu-Min , Liu Jianghong , Im Eun-Ok
Published: August 2020

Despite an increasing number of online programs to promote physical activity, they have rarely been evaluated for their effects on cardiovascular symptoms of racial/ethnic minority women at midlife. This study aimed to determine the preliminary efficacy of a newly developed online program for physical activity promotion on cardiovascular symptoms of Asian American midlife women. This study was a pilot repeated-measures randomized controlled trial (pretest/posttest) among 26 Asian American midlife women. The variables were measured using multiple instruments on background features, physical activity, and cardiovascular symptoms at three points of time (baseline, after 1 month, and after 3 months). Linear mixed models were used to analyze the data. The prevalence and severity of cardiovascular symptoms did not show a statistically significant group-time interaction. However, the increase in lifestyle physical activity over time was significant only among the intervention group (Δ = 0.49, P = .016). The results supported the program's preliminary efficacy on lifestyle physical activity for Asian American women at midlife, but not on cardiovascular symptoms.
Removal of Intraocular Foreign Bodies Using a Modified Flute Needle
Authors: Chan Yvonne Y. Y. , Liu Shasha , Tang Geoffrey C. H. , Cheung Janice C. C. , Liu Candice C. H. , Li Kenneth K. W.
Published: August 2020

Purpose:

To describe the construction of a novel intraocular snare and evaluate its effectiveness in intraocular foreign body (IOFB) removal.

Method:

This is a retrospective consecutive case series. Five patients underwent pars plana vitrectomy and IOFB removal using the intraocular snare constructed from modified flute needle.

Results:

All IOFBs were successfully engaged and removed with the snare on the first attempt. Three of the 5 cases (60%) enjoyed good visual outcome (0.4–1.0) postoperatively. No complication related to the use of the snare was encountered in this case series.

Conclusion:

Intraocular foreign body snare is simple, safe, and effective in IOFB removal.
Bilateral Corneal Perforation in a Patient Under Anti-PD1 Therapy
Authors: Ramaekers Anaïs , Aspeslagh Sandrine , De Brucker Nele , Van Mierlo Camille , ten Tusscher Marcel , Schauwvlieghe Pieter-Paul , Termote Karolien
Published: August 2020

Immune checkpoint inhibition has improved the clinical outcomes for numerous patients with cancer. However, the downside is a whole new spectrum of immune-related adverse events. We report a 68-year-old man with a history of nonsmall cell lung cancer presenting with a spontaneous corneal perforation in the right eye after 22 cycles of pembrolizumab. In addition, a chronic central nonhealing epithelial defect developed after performing a penetrating keratoplasty. Treatment with autologous serum drops resulted in complete healing of the corneal ulcer, where other conventional therapies had no effect. One month after reinitiating pembrolizumab therapy, our patient presented again with a corneal perforation in the fellow eye. This case describes relapsing sterile ulcerations associated with pembrolizumab use and presents an unexpected cure.
Diagnosis of COVID-19 Based on Symptomatic Analysis of Hospital Healthcare Workers in Belgium
Authors: Van Loon Nele , Verbrugghe Mathieu , Cartuyvels Reinoud , Ramaekers Dirk
Published: August 2020

Objective:

To identify early symptoms allowing rapid appraisal of infection with SARS-CoV-2 among healthcare workers of a large Belgian hospital.

Methods:

Healthcare workers with mild symptoms of an acute respiratory tract infection were systematically screened on clinical characteristics of corona virus disease 2019 (COVID-19). A nasopharyngeal swab was taken and analyzed by real-time Reverse-Transcription-Polymerase-Chain-Reaction (rRT-PCR).

Results:

Fifty percent of 373 workers tested COVID-19 positive. The symptoms cough (82%), headache (78%), myalgia (70%), loss of smell or taste (40%), and fever more than or equal to 37.5 °C (76%) were significantly higher among those infected.

Conclusion:

Where each individual symptom contributes to the clinical evaluation of possible infection, it is the combination of COVID-19 symptoms that could allow for a rapid diagnostic appraisal of the disease in a high prevalence setting. Early transmission control is important at the onset of an epidemic.
The Realities of Collaboration
Authors: Cantrell Mary Ann , Mariani Bette , Lengetti Evelyn
Published: August 2020

This article details the collaborative effort between a team of academic nurse educators with educators in a practice setting in the planning and implementation of a simulation-focused study to develop clinical judgment and clinical competency among new-to-practice nurses enrolled in a nurse residency program. Competing priorities between achieving the aims of the study and initiatives within the healthcare system are detailed, and suggestions for future joint research-focused efforts between academic and practice-based educators are offered.
Best Practice (Efficient) Immunohistologic Panel for Diagnosing Metaplastic Breast Carcinoma
Authors: Han Min , Zhang Huina , Dabbs David J.
Published: August 2020

Immunohistochemistry (IHC) plays a key role in the diagnosis of metaplastic breast carcinomas (MBCs), particularly the spindle cell variant. The most efficient immunopanel has yet to be developed. We studied the immunoprofile of 45 MBCs including 23 matrix-producing MBCs, 11 squamous cell carcinomas, 6 spindle cell carcinomas, and 5 mixed-subtypes (2 cases including spindle cell components). Representative sections from mastectomy or core biopsy specimens were subject to IHC using a list of antibodies including OSCAR, a recently developed antibody against pooled cytokeratins. The staining was interpreted as positive when >1% of tumor cells demonstrated unequivocal staining. As a result, OSCAR showed similar sensitivity to AE1/AE3 and CAM 5.2 (89.1% vs. 89.4% vs. 89.4%) for MBCs, but the former showed more diffuse pattern of staining, particularly in spindle cell carcinomas. High molecular weight cytokeratin CK14, CK5, and CK17 were positive in 91.3%, 87.2%, and 73.3% of MBCs, respectively. CK7 was much less likely to be positive in spindle cell carcinomas (37.5%) than in other variants of MBCs (97.4%). P63 and CK14 were the most useful markers for spindle cell carcinomas, positive in 87.5% and 85.7% of cases, respectively. GATA 3 was positive in 63% MBCs, and nonspecific staining for vimentin and smooth muscle actin were common. Random combination of up to 3 antibodies against keratins including p63 showed sensitivities ranging from 80.9% to 97.9%. Our results suggested the combination of OSCAR, CK14 and p63 is the most efficient panel (sensitivity 97.9%) for diagnosing MBCs.
Updated Approaches to Cardiac Electrical Stimulation and Pacing in Pediatrics
Authors: Neubrand Tara L. , Topoz Irina , Mistry Rakesh D.
Published: August 2020

Cardiac electrical stimulation is a rarely used but required skill for pediatric emergency physicians. Children who are in cardiac arrest or who demonstrate evidence of hypoperfusion because of cardiac reasons require rapid diagnosis and intervention to minimize patient morbidity and mortality. Both hospital- and community-based personnel must have sufficient access to, and knowledge of, appropriate equipment to provide potentially lifesaving defibrillation, cardioversion, or cardiac pacing. In this review, we will discuss the primary clinical indications for cardioelectrical stimulation in pediatric patients, including the use of automated external defibrillators, internal defibrillators, and pacemakers. We discuss the types of devices that are currently available, emergency management of internal defibrillation and pacemaker devices, and the role of advocacy in improving delivery of emergency cardiovascular care of pediatric patients in the community.
Rehabilitative Good Practices in the Treatment of Sarcopenia
Authors: Agostini Francesco , Bernetti Andrea , Di Giacomo Giorgio , Viva Mattia G. , Paoloni Marco , Mangone Massimiliano , Santilli Valter , Masiero Stefano
Published: August 2020

To date, rehabilitative good practices that analyze all aspects of the rehabilitation management of the patient with sarcopenia are absent in the literature. The purpose of this article is to carry out research and evaluation of the evidence, good practice, and recommendations in the literature relating to the rehabilitative treatment of disabilities associated with sarcopenia. Bibliographic research was conducted on Medline, PEDro, Cochrane Database, and Google Scholar. All articles published in the last 10 yrs were analyzed. The results of this research generated three guidelines, eight meta-analyses, five systematic reviews, a Cochrane review, 17 reviews, and seven consensus conferences. From the analysis of the literature, it seems that most of the works agree in affirming that exercise and diet supplementation are the cornerstones of rehabilitation treatment of patients with sarcopenia. The practice of an adequate lifestyle received numerous high-grade recommendations in the included guidelines. Based on the data obtained, the rehabilitation management of the patient with sarcopenia must be personalized and must include exercise and nutritional supplementation. These factors are important in increasing the autonomy of the elderly essential for safe walking without neglecting stretching exercises that are important for flexibility and balance and coordination exercises.
Essential Medical Information for Stroke Patients Undergoing Interhospital Transfer
Authors: Kim Jeoung Kun , Hau Yong Sauk , Kwak Soyoung , Chang Min Cheol
Published: August 2020

Objective

For improving the efficiency of transferring medical records for stroke patients undergoing interhospital transfer, we evaluated what is the essential medical information for physicians using the Delphi method.

Design

We set up an expert panel of 31 physiatrists, who participated in this study. The 32 preliminary items of the transferred medical information were listed by a physiatrist for the first round of the Delphi method, and degree of necessity for these 32 items was evaluated using a 3-point scale (“very necessary,” “necessary,” and “not necessary”). We considered “very necessary” and “necessary” as “agreed to its necessity.” According to the Delphi method, a satisfactory level of consensus can be achieved with the agreement of significant majority (≥80%) in the expert panel.

Results

Based on the experts’ feedback, some items were added as the preliminary items. After the second round of the Delphi method, the items confirmed to be necessary information during interhospital transfer were motor and sensory evoked potentials, Barthel Index, Mini-Mental State Examination/Global Deterioration Scale, Motor-Free Visual Perception Test, Manual Function Test, Purdue Pegboard Test, hand grip power, monofilament, 2-point discrimination test, Manual Muscle Test, Nottingham Scale, modified Brunnstrom Classification, functional ambulation category, Glasgow Coma Scale, language function test, imaging study, videofluoroscopic swallowing study, rehabilitation goal, previous medical history, comorbidity, and medication information.

Conclusions

If the previously mentioned necessary items are presented together at once during interhospital transfer, physicians who receive new stroke patients can evaluate patients’ medical information more easily and completely.
An Analytical Insight Into How Walking Speed and Spatial and Temporal Symmetry Are Related to Ankle Dysfunctions in Children With Hemiplegic Cerebral Palsy
Authors: Elnaggar Ragab K.
Published: August 2020

Objective

The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy.

Design

This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed.

Results

The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R2= 0.38,P< 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R2= 0.15,P< 0.001) and the highest portion of the variance in spatial walking symmetry (R2= 0.18,P= 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R2= 0.10,P= 0.021).

Conclusions

In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles.
Pulmonary Embolism After Acute Spinal Cord Injury and COVID-19
Authors: Pisano Thomas John , Joki Jaclyn , Hon Beverly , Cuccurullo Sara
Published: August 2020

The coronavirus virus disease 2019 is best known for its pulmonary sequelae. Understanding of the disease process is rapidly growing, and the medical community already appreciates a hypercoagulable state associated with coronavirus virus disease 2019. Acute spinal cord injury has an inherent increased risk for venous thromboembolism. In this case report, the patient presented with bilateral lower limb weakness and sensory loss secondary to thoracic disc herniation. Incidentally, at the same time as the initial presentation, the patient was also found to have coronavirus virus disease 2019 without significant respiratory symptoms. During hospitalization, the patient developed extensive bilateral lower limb deep vein thrombosis despite chemoprophylaxis. Therapeutic anticoagulation was initiated, yet several days later, he developed pleuritic chest pain. Computed tomography angiography revealed bilateral pulmonary emboli. This case highlights the need for clinicians to have elevated vigilance with regard to screening and treatment for venous thromboembolism in high-risk patients, such as spinal cord injury with a concurrent diagnosis of coronavirus virus disease 2019.
The Role of Prediagnosis Audiovestibular Dysfunction Versus Distress, Illness-Related Cognitions, and Behaviors in Predicted Ongoing Dizziness Handicap
Authors: Herdman David , Norton Sam , Pavlou Marousa , Murdin Louisa , Moss-Morris Rona
Published: August 2020

Objective

People with chronic vestibular diseases experience variable degrees of self-perceived disability. However, longitudinal data examining the predictive validity of relevant clinical variables alongside psychological variables are limited. The present study examined whether these factors predict self-reported dizziness handicap 3 months after assessment and diagnosis.

Methods

Patients were recruited from a waiting list of a tertiary neuro-otology clinic and completed standardized mood, cognitive, behavioral, and dizziness handicap questionnaires before and 3 months after their initial consultation and diagnosis. All patients were clinically assessed and underwent comprehensive audiovestibular investigations.

Results

Seventy-three percent of participants responded at follow-up (n = 135, 73% female, mean [standard deviation] age = 54.23 [17.53] years), of whom 88% were diagnosed with a neurotological condition. There were significant improvements in handicap, depression, and anxiety at 3 months. Thirty (22%) of 135 showed clinically meaningful improvement in handicap. The percentage of case-level depression and anxiety remained the same. Negative illness perceptions and symptom responses reduced, although participants still tended to view their condition negatively. Vestibular tests and type of diagnosis were not associated with self-reported handicap. Most baseline psychological variables significantly correlated with handicap at 3 months. When adjusting for baseline handicap and demographics, the baseline psychological variables only explained a significant ~3% of the variance in dizziness handicap at follow-up, with baseline handicap explaining most of the variance. All-or-nothing behavior was the most significant predictor.

Conclusions

Tertiary patients with vertigo and dizziness report negative illness perceptions and cognitive and behavioral responses to symptoms that are associated with self-reported handicap over time. Future studies are needed to investigate whether targeting these factors alongside traditional treatment approaches improves handicap in patients with chronic dizziness.
Functional Classification of Isolated Zygomatic Arch Fracture: New Proposal
Authors: Valdés Reyes José Manuel , Zapata Ocampo Sebastian
Published: August 2020

Isolated zygomatic arch fractures are common fractures in maxillofacial trauma. These fractures can trigger a functional alteration in the mouth opening and closing. Until now, there is no published classification of an isolated zygomatic arch fracture that contains the presence or not of coronoid impingement. So we propose a new classification that is easy to handle and has the largest number of scenarios that can occur in this type of fracture. The isolated zygomatic arch fracture is classified as Type I: Nondisplaced fractures, Type II: Greenstick fracture with or without coronoid impingement, Type III: Single displaced fracture with or without coronoid impingement, Type IV: Multiple displaced fracture with or without coronoid impingement, Type V: Comminuted fracture with or without coronoid impingement. We consider it to be a comprehensive classification, with general concepts of bone fractures, that can be incorporated into professional daily practice.
Complementary Effect of Maternal Sildenafil and Fetal Tracheal Occlusion Improves Lung Development in the Rabbit Model of Congenital Diaphragmatic Hernia
Authors: Russo Francesca Maria , Da Cunha Marina Gabriela Monteiro Carvalho Mori , Jimenez Julio , Lesage Flore , Eastwood Mary Patrice , Toelen Jaan , Deprest Jan
Published: August 2020

Objective:

To evaluate the effect of combining antenatal sildenafil with fetal tracheal occlusion (TO) in fetal rabbits with surgically induced congenital diaphragmatic hernia (CDH).

Background:

Although antenatal sildenafil administration rescues vascular abnormalities in lungs of fetal rabbits with CDH, it only partially improves airway morphometry. We hypothesized that we could additionally stimulate lung growth by combining this medical treatment with fetal TO.

Methods:

CDH was created on gestational day (GD)23 (n=54). Does were randomized to receive either sildenafil 10 mg/kg/d or placebo by subcutaneous injection from GD24 to GD30. On GD28, fetuses were randomly assigned to TO or sham neck dissection. At term (GD30) fetuses were delivered, ventilated, and finally harvested for histological and molecular analyses. Unoperated littermates served as controls.

Results:

The lung-to-body-weight ratio was significantly reduced in sham-CDH fetuses either (1.2 ± 0.3% vs 2.3 ± 0.3% in controls, P=0.0003). Sildenafil had no effect on this parameter, while CDH fetuses undergoing TO had a lung-to-body-weight ratio comparable to that of controls (2.5 ± 0.8%, P<0.0001). Sildenafil alone induced an improvement in the mean terminal bronchiolar density (2.5 ± 0.8 br/mm2 vs 3.5 ± 0.9 br/mm2, P=0.043) and lung mechanics (static elastance 61 ± 36 cmH2O /mL vs 113 ± 40 cmH2O/mL, P=0.008), but both effects were more pronounced in fetuses undergoing additional TO (2.1 ± 0.8 br/mm2, P=0.001 and 31 ± 9 cmH2O/mL, P<0.0001 respectively). Both CDH-sham and CDH-TO fetuses treated with placebo had an increased medial wall thickness of peripheral pulmonary vessels (41.9 ± 2.9% and 41.8 ± 3.2%, vs 24.0 ± 2.9% in controls, P<0.0001). CDH fetuses treated with sildenafil, either with or without TO, had a medial thickness in the normal range (29.4% ± 2.6%). Finally, TO reduced gene expression of vascular endothelial growth factor and surfactant protein A and B, but this effect was counteracted by sildenafil.

Conclusion:

In the rabbit model for CDH, the combination of maternal sildenafil and TO has a complementary effect on vascular and parenchymal lung development.
Medical Device–Related Pressure Injuries During the COVID-19 Pandemic
Authors: Martel Tanya , Orgill Dennis P.
Published: August 2020

BACKGROUND:

Medical device–related pressure injuries (MDRPIs) account for more than 30% of all hospital-acquired pressure injuries. The COVID-19 pandemic introduced a large population of patients at risk for MDRPIs due to prolonged intubation and prone positioning. We reviewed our experience with MDRPIs during the 2020 COVID-19 pandemic at an Academic Medical Center.

CASES:

We evaluated 30 cases of MDRPIs acquired during the peak of our pandemic, April 1 to May 31, 2020, and compared these to injuries seen over a similar time period prior to the pandemic.

CONCLUSIONS:

Our experiences with MDRPIs during this time has led the WOC team to begin development of a quality improvement project aimed at improving management of high-risk respiratory illness patients requiring intubation and prone positioning.
Skin and Mucosal Damage in Patients Diagnosed With COVID-19
Authors: Singh Charleen , Tay Jafar , Shoqirat Noordeen
Published: August 2020

Patients admitted to the intensive care unit (ICU) are at a high risk for developing pressure injuries. A patient requiring multiorgan support is at a higher risk for pressure injuries related to immobility, sedation, vasopressors, and hypoxia. To mitigate pressure injuries, our hospital utilizes a bundle approach to prevent skin injury. However, despite efforts to prevent pressure injuries, we found our patients in the ICU with the diagnosis of COVID-19 went on to develop significant pressure and mucosal injuries. This is a case report of 4 patients diagnosed with COVID-19 who developed significant skin and mucosal injuries during their ICU admissions in the month of March 2020. We found that patients developed skin conditions that were initially thought to be deep-tissue injuries (DTIs) early in the admission. The DTIs progressed over the course of the admission in the ICU and evolved to thick adherent eschar that appeared to be unstageable pressure injuries, which extended beyond the soft tissue directly over the bony prominence. We also found that skin damage to the mucosa of the nares, tongue, lips, and urethra presented first as inflammation and then progressed to thick eschar. Despite maximum pressure relief with the use of a pressure-relieving turn and position system, bordered foam dressings, fluidized positioners, specialty beds, and leadership support for twice-a-week skin checks, our patients diagnosed with COVID-19 developed extensive skin damage across the fleshy portion of the buttocks and on the mucosa of the nares, tongue, lips, and urethra during minimal exposure to pressure. Although the initial presentation of the skin damage appeared to be related to pressure, the extent of the skin damage suggests a vascular inflammatory process beyond skin damage related to pressure.