bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Dual Health Care System Use for Obtaining Prescription Medications on Nonadherence in Veterans With Type 2 Diabetes
Authors: Taber David J. , Ward Ralph , Axon R. Neal , Walker Rebekah J. , Egede Leonard E. , Gebregziabher Mulugeta
Published: February 2019

Background: Dual health system use may provide increased access to physicians, medications, and other health care resources but may also increase the complexity and coordination of medication regimens. Thus, it is important to elucidate the impact of dual use on medication adherence. Objective: The objective of this study was to evaluate the impact on medication adherence for veterans with dual health care system use (VA and Medicare) when obtaining prescription antihyperglycemic medications to treat diabetes. Methods: This was a longitudinal cohort study using VA and Medicare data from 2006 to 2010. Medication adherence was estimated by calculating annualized drug class-level proportion of days covered (PDC), where PDC >80% was considered adherent. Generalized linear models were used for estimations, accounting for correlation over time. Results: In total, 254 267 veterans with diabetes were included, with 71 057 (27.9%) defined as pharmacy system dual users. Mean age was 77.5 years, and nearly all had multiple comorbidities (mean count 10.2). During follow-up, 75% of VA-only users were deemed adherent to diabetes prescriptions, compared with 63% of dual users. In adjusted models, dual prescription benefit use from VA/Medicare was associated with 39% lower odds of medication adherence (odds ratio [OR] = 0.61; 95% CI = 0.60-0.61). Medication adherence significantly worsened with each additional diabetes medication (OR = 0.65; 95% CI = 0.64-0.65) and significantly decreased over time (OR = 0.95 per year; 95% CI = 0.95-0.96). Conclusion and Relevance: These data suggest that veterans utilizing VA and Medicare to obtain diabetes prescriptions are significantly less likely to be adherent.
Lofexidine: A Newly FDA-Approved, Nonopioid Treatment for Opioid Withdrawal
Authors: Doughty Bennett , Morgenson Daralyn , Brooks Tracy
Published: February 2019

Objective: To review the pharmacology, efficacy, and safety of lofexidine for the treatment of opioid withdrawal secondary to the recent Food and Drug Administration (FDA) approval. Data Sources: A literature search using PubMed was conducted (inception to December 2018) using the terms lofexidine, opioid, opiate, and withdrawal. References from retrieved articles and the prescribing information were reviewed for any additional material. Study Selection/Data Extraction: The literature search was limited to human studies published in English that pertained to human pharmacology, pharmacokinetics, pharmacodynamics, dosing, efficacy, and safety regarding opioid withdrawal. Phase I, II, and III studies of lofexidine for opioid withdrawal were reviewed for inclusion. Data Synthesis: Lofexidine is newly FDA approved in the United States for the treatment of opioid withdrawal symptoms in adults. Several randomized controlled trials and a Cochrane review noted the effectiveness of lofexidine versus placebo for this indication. The efficacy of lofexidine has also been shown to be comparable to that of other indicated first- and second-line pharmacological agents. Relevance to Patient Care and Clinical Practice: This article examines the trials that led to lofexidine’s new FDA-approved indication as well as other recent literature published since its last major review, seeking to guide providers in the appropriate use of lofexidine for its new indication. Conclusions: Lofexidine is an effective and safe agent in treating symptoms related to opioid withdrawal in adults when compared with placebo; although it is more widely accessible than other first-line therapies, its use in practice may be limited by cost.
Impact of dosing frequency (once daily or twice daily) on patient adherence to oral targeted therapies for hematologic malignancies: a retrospective cohort study among managed care enrollees
Authors: Patel Krish , Sudhir Vinjamuri S , Kabadi Shaum , Huang Joanna C , Porwal Sanchita , Thakkar Kushan , Pagel John M
Published: February 2019

Purpose

Existing studies evaluating patient adherence to oral targeted therapies such as tyrosine kinase inhibitors focus on small populations with single malignancies. This study evaluated patterns of use of oral agents in a larger population across multiple hematologic malignancies.

Methods

Adult patients diagnosed with a hematologic malignancy and prescribed oral targeted therapy between 2011 and 2016 ( N = 18,976) were identified from the MarketScan Commercial Claims and Encounters, and Medicare Supplemental databases. Eligible patients were enrolled in monthly prescription plans 6 months before and 12 months after the index date (date of first prescription claim; n = 2442). Multivariable logistic regressions were used to determine predictors of adherence using the medication possession ratio (MPR) and persistence through prescription refill gaps.

Results

The overall median adherence was 0.9 (MPR ≥ 80%) and was comparable between once-daily (QD) and twice-daily (BID) groups. Overall, 59% of patients were persistent at 12 months. Patients on QD and BID products did not have any significant differences in adherence (fixed-interval MPR, odds ratio 0.94; 95% confidence interval (CI), 0.75–1.18) or persistence (odds ratio 0.93; 95% CI, 0.75–1.17) 12 months from index. Significant predictors of adherence and persistence included patient age, total inpatient admissions, number of adverse events, and total hospital visits.

Conclusion

Patient-specific clinical factors, rather than regimen-specific factors, were the main predictors of oral targeted therapy adherence and persistence. Adherence to oral targeted therapies appears to be similar for patients on QD and BID regimens in the real-world setting.
Remote hydrodissection
Authors: Blumenthal Eytan Z , Mimouni Michael
Published: February 2019

We describe a technique for performing hydrodissection in which the cannula tip is not advanced beyond the capsulorhexis edge, nor embedded into the cortex, but instead is placed within the capsulorhexis boundaries, pointing to the capsulorhexis edge, and angled slightly posterior to it. The fluid stream squirted from the cannula creates a cleavage plane between the capsule and cortex (hydrodissection), with a distinct wave dissecting the posterior capsule off the overlying cortex. By later rotating the angle slightly more posteriorly, hydrodelineation occurs, with the resultant “golden ring,” and often, multiple “golden rings.” The cleavage planes obtained using this technique may be more precise than when embedding the cannula tip under and beyond the capsulorhexis edge. This “remote hydrodissection” technique is easy and reproducible with soft and medium lenses, becoming more difficult to perform with harder cataracts. Hence, we recommend that this modification should initially be learned/tried on softer lenses.
Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia
Authors: Tetsunaga Tomonori , Fujiwara Kazuo , Endo Hirosuke , Tetsunaga Tomoko , Miyake Takamasa , Yamada Kazuki , Sanki Tomoaki , Ozaki Toshifumi
Published: February 2019

Introduction:

Adequate initial stability of the acetabular cup is essential for total hip arthroplasty (THA). However, changes in the alignment of the acetabular component caused by screw fixation are concerning in patients with inadequate bone stock. This study aimed to investigate the effects of screw fixation on the alignment of the acetabular component in THA patients with hip dysplasia.

Methods:

We retrospectively examined 256 hips (range 28–87 years) that underwent THA using a navigation system. Patients were divided into 2 groups based on the presence or absence of changes in the alignment of the intraoperative acetabular cup, and univariate and multivariate analyses were performed to identify factors that were predictive of changes in acetabular component alignment after screw fixation in 2 dimensions: inclination and anteversion.

Results:

Screw fixation led to a mean change in inclination of 1.6° (range 0–10°) and a mean change in anteversion of 1.4° (range 0–14°). The Crowe classification, the presence of bone cysts, and the use of an inferior quadrant screw were identified as factors that correlated with acetabular cup alignment changes in inclination (odds ratios, 6.01, 5.94 and 0.03, respectively). Only the Crowe classification was identified as a factor that correlated with intraoperative alignment changes in anteversion (odds ratio, 2.08).

Conclusions:

Screw fixation altered the acetabular cup alignment. The inclination changes were related to the extent of the dysplasia, and the risk was reduced when the inferior quadrant screw was used. Surgeons should use caution during screw fixation in THAs performed on severely dysplastic hips.
The colonization rate of needleless connector and the impact of disinfection for 15 s on colonization: A prospective pre- and post-intervention study
Authors: Devrim İlker , Demiray Nevbahar , Oruç Yeliz , Sipahi Kenan , Çağlar İlknur , Sarı Ferhat , Turgut Nuriye , Atakul Gülhan , Özdamar Nihal , Dursun Vecihe , Sorguç Yelda , Bayram Nuri , Agın Hasan
Published: February 2019

Purpose:

The optimal scrubbing time for the disinfection of the surface of needleless connectors has not been determined. The evidence for successful needleless connector decontamination with 70% isopropyl alcohol ranges from 5 to 60 s. The aim of this prospective study was to identify colonization on the external surface of needleless connectors on central venous catheters and measure the efficiency of 15 s of scrubbing with 70% alcohol.

Method:

A total of 31 patients were included. Samples were collected adhering to aseptic no-touch technique policies. Two samples were collected from the injectable surface of the needleless connector with sterile sodium chloride 0.9% moistened and a dry swab from the same site. Then the surface was scrubbed with alcohol 70% for 15 s for disinfection and second couples of samples for the cultures were taken after disinfection.

Findings:

A total of 420 swabs were obtained. The number of colonization (equal or higher than 15 CFU/plate) was present on 21 of the needleless connectors (20.0%). Coagulase-negative staphylococci was responsible for all the colonization. After disinfection for 15 s, no isolation exceeding 1 CFU/plate was present.

Conclusion:

Scrubbing for 15 s with 70% alcohol was found to be successful at elimination of colonization of the surface of needleless connector even in high microorganism counts.
‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties
Authors: Churcher Clarke Anna , Spiliadis Anastassis
Published: February 2019

As the number of young people referred to specialist gender identity clinics in the western world increases, there is a need to examine ways of making sense of the range and diversity of their developmental pathways and outcomes. This article presents a joint case review of the authors caseloads over an 18-month period, to identify and describe those young people who presented to the Gender Identity Development Service (GIDS) with gender dysphoria (GD) emerging in adolescence, and who, during the course of assessment, ceased wishing to pursue medical (hormonal) interventions and/or who arrived at a different understanding of their embodied distress. From the 12 cases identified, 2 case vignettes are presented. Implications for the development of clinical practice, service delivery and research are considered.
Transatlantic repatriation: Stigma management of second-generation Italian and Greek American women ‘returning home’
Authors: Isaakyan Irina , Triandafyllidou Anna
Published: February 2019

Based on 30 narrative-biographic interviews with second-generation Greek and Italian women who have migrated from the United States to their ‘ancestral homelands’ of Greece and Italy, our article explores nuances of their stigma management by focusing on the interaction between their pre-repatriation past and post-repatriation present and the spaces of inclusion and exclusion. Adopting the method of narrative-biographic analysis, we present three detailed case studies of repatriated women – organized as composite biographies – to illuminate from different angles the process of stigma management and the phenomenon of stigma mobility. Highlighting the dynamics of the reproduction of the diasporic patriarchy through repatriation to the ‘ancestral homeland’, we introduce and elaborate on the concept ‘nativity voucher’ in reference to ethno-cultural resources that repatriated people use to facilitate their spaces of inclusion.
Digital entrepreneurship in Taiwan and Thailand: Embracing precarity as a personal response to political and economic change
Authors: Leung Wing-Fai , Cossu Alberto
Published: February 2019

This article examines the significance of digital entrepreneurship in East Asia as informal work, based on empirical research in Taiwan and Thailand. Digital entrepreneurs in East Asia can be thought of as a new class of ‘creative workers’ who aspire to the neoliberal ideals of the West that advocate free markets and individualism. While digital entrepreneurship offers low-cost opportunities, it also represents highly precarious careers. The transition to the digital economy also means the expansion of the informal economy, which has existed in both Taiwan and Thailand. The encouragement of start-up ecosystems by respective political and economic elites serves to sweet-talk the creative class into participating in precarious work, or it may be an open bid to gain market share by incorporating informal businesses. In response to the theme of the special issue, this article discusses two contrasting cases and considers the significance of digital entrepreneurship as informalisation of work.
Real-time tracking and documentation in trauma management
Authors: Montagna Sara , Croatti Angelo , Ricci Alessandro , Agnoletti Vanni , Albarello Vittorio , Gamberini Emiliano
Published: February 2019

In trauma resuscitation, an accurate documentation is crucial to improve the quality of trauma care. Hospital emergency departments typically adopt handwritten paper records and flow sheets for acquiring data, which are often inaccurate. In this article, we describe TraumaTracker, a computer-based system for trauma tracking and documentation. Results demonstrate that completeness and accuracy of trauma documentation significantly improved using TraumaTracker, since it enables to add data and information that were not recorded in paper documentation – especially precise times and locations of events.
Toxic Toxteth: Understanding press stigmatization of Toxteth during the 1981 uprising
Authors: Butler Alice
Published: February 2019

This article investigates how the press stigmatized Toxteth during, and immediately following, the disturbances in 1981. It builds upon a body of literature on territorial stigmatization where there is a gap in understanding surrounding the production and formation of stigma. Drawing on the acceptance in literature that the media is a key contributor to territorial stigma, I delve further to understand some of the techniques that the media uses to stigmatize place. I engage in a combined quantitative and qualitative analysis of 496 newspaper articles from five British newspapers to examine how the press reports on Toxteth, and who constructs Toxteth’s identity. I show that the name of ‘Toxteth’ was largely defined by the media and that the residents of Toxteth were denied a voice in the press coverage in 1981 with fewer than 10 per cent of all articles quoting a resident. I refer to this process as ‘stranger-making’, and it underscores the way that the media denied residents an ability to construct their own identity and the identity of their area. While stranger-making involves obfuscating the unique contours of Toxteth and silencing voices, the press simultaneously impose aspects of identity from a position of power through the techniques of naming, negativity, and oppositionality.
“If it helps someone, then I want to do it”: Perspectives of persons living with dementia on research registry participation
Authors: Lee Jeanie YY , Crooks Rachel E , Pham Tram , Korngut L , Patten S , Jetté N , Smith EE , Roach Pamela
Published: February 2019

Registries are an important platform to which persons with dementia and other cognitive impairments can contribute to research studies. Registries also provide an opportunity for patients to stay informed about current studies. Engaging patients in registry development can increase sustainability of a registry and patient retention in clinical registries. We sought the perspective of persons with dementia and their accompanying family members about their registry participation experiences, barriers and facilitators to participation, and potential avenues for improvement of registry processes such as recruitment, data collection, and knowledge translation. Two semi-structured focus groups with persons with dementia and their family members ( n = 18) were conducted and analyzed using thematic content analysis. Participants were recruited from an existing patient registry made up of patients currently being seen in a dementia assessment clinic. The main themes identified included altruistic motives with regards to registry participation; and access to and privacy of personal health information. As electronic health records are becoming more common, understanding barriers and facilitators from the perspectives of people with dementia is essential to inform the future development of cognitive condition-related registries. The results from our focus groups identified engagement strategies and solutions to overcome perceived barriers for individuals experiencing progressive cognitive decline to participate in longitudinal registry projects.
Layout placement optimization methods using repeated user interface sequence patterns for client applications
Authors: Chung Jihye , Hong Seongjin , Kim Youngbin , Kang SJ , Kim Changhun
Published: February 2019

We propose a method for automatically optimizing the layout placement of user interfaces in commercial applications. The proposed method suggests an optimal user interface component placement layout for an application by considering behavior cost, repeated user interface sequences, and preferred placement area. We used the Apriori algorithm and a genetic algorithm efficiently to optimize user interface component placement based on the evaluation of a keystroke-level model. We verified the effectiveness of the proposed method using a customizable user interface for three applications, namely, Adobe Photoshop, 3DS MAX, and the massively multiplayer online role-playing game “World of Warcraft.” Our experimental results show that the proposed system can both reduce the behavioral cost of an application at the user level and enable efficient user interface usage by considering interrelationship patterns among user interface components.
Brain-Machine Interface in Chronic Stroke: Randomized Trial Long-Term Follow-up
Authors: Ramos-Murguialday Ander , Curado Marco R. , Broetz Doris , Yilmaz Özge , Brasil Fabricio L. , Liberati Giulia , Garcia-Cossio Eliana , Cho Woosang , Caria Andrea , Cohen Leonardo G. , Birbaumer Niels
Published: February 2019

Background. Brain-machine interfaces (BMIs) have been recently proposed as a new tool to induce functional recovery in stroke patients. Objective. Here we evaluated long-term effects of BMI training and physiotherapy in motor function of severely paralyzed chronic stroke patients 6 months after intervention. Methods. A total of 30 chronic stroke patients with severe hand paresis from our previous study were invited, and 28 underwent follow-up assessments. BMI training included voluntary desynchronization of ipsilesional EEG-sensorimotor rhythms triggering paretic upper-limb movements via robotic orthoses (experimental group, n = 16) or random orthoses movements (sham group, n = 12). Both groups received identical physiotherapy following BMI sessions and a home-based training program after intervention. Upper-limb motor assessment scores, electromyography (EMG), and functional magnetic resonance imaging (fMRI) were assessed before (Pre), immediately after (Post1), and 6 months after intervention (Post2). Results. The experimental group presented with upper-limb Fugl-Meyer assessment (cFMA) scores significantly higher in Post2 (13.44 ± 1.96) as compared with the Pre session (11.16 ± 1.73; P = .015) and no significant changes between Post1 and Post2 sessions. The Sham group showed no significant changes on cFMA scores. Ashworth scores and EMG activity in both groups increased from Post1 to Post2. Moreover, fMRI-BOLD laterality index showed no significant difference from Pre or Post1 to Post2 sessions. Conclusions. BMI-based rehabilitation promotes long-lasting improvements in motor function of chronic stroke patients with severe paresis and represents a promising strategy in severe stroke neurorehabilitation.
Lending a Hand to Health Care Disparities: A Cross-sectional Study of Variations in Reimbursement for Common Hand Procedures
Authors: Odom Elizabeth B. , Hill Elspeth , Moore Amy M. , Buck Donald W.
Published: February 2019

Background: Despite the role of one’s hands in human function and quality of life, financial disincentives to perform common hand procedures in patients with government-sponsored insurance plans may lead to longer wait times and decreased access to care. Here, we identify the variations in reimbursement for 4 common hand procedures as a step toward understanding these financial implications to develop safeguards to minimize effects on access to care. Methods: Billing data were collected over a 10-year period for patients undergoing carpal tunnel release (open, Current Procedural Terminology 64721; endoscopic, 29848), cubital tunnel release (64718), ganglion cyst excision (25111), and interposition arthroplasty (25447). Patients were placed into cohorts according to insurance type—private insurance, Medicare, Medicaid, or worker’s compensation—and these were directly compared. Results: A total of 3489 procedures between 2005 and 2015 were identified in this study (carpal tunnel 65.8%, cubital tunnel 28.7%, ganglion cyst excision 4.1%, and interposition arthroplasty 13.8%). In all, 54.7% of patients had private insurance; 26.3%, Medicare; 10.5%, worker’s compensation; and 8.5%, Medicaid. Reimbursement, as a percentage of charge, differed significantly by payor type for all cases and by procedure. On average, worker’s compensation plans reimbursed 65.5% of submitted charges; private insurance, 50.6%; Medicare, 25.1%; and Medicaid, 24.6%. Conclusions: We found that wide variations in reimbursement for common hand procedures exist and may preclude some surgeons from offering certain procedures to a subset of patients. Understanding these discrepancies is a key first step in minimizing a potential care delivery disparity for this patient population.
The role of structured physiotherapy in treating patients with atraumatic shoulder instability: Medium term results from a case series
Authors: Scott Martin , Sachinis Nikolaos Platon , Gooding Benjamin
Published: February 2019

Background

Consensus favours conservative treatment for atraumatic shoulder instability, but literature is scarce on the topic. We therefore prospectively assessed the results of structured physiotherapy for these patients.

Methods

Patient reported outcomes were recorded prior to physiotherapy and on discharge. Notes review identified patients re-referred for the same condition.

Results

N = 85. Review range was 12–72 months post-treatment. Median Oxford Shoulder Instability Score (OSIS) improved from 21 (range: 2–47) to 39 (11–47). Median Western Ontario Shoulder Instability Index (WOSI) improved from 1117 (range: 306–2028) to 485 (0–1569). Patients with posterior instability demonstrated better results compared with other groups (OSIS change, p = 0.025; WOSI change, p = 0.060). Quicker referral to physiotherapy gave improved outcomes (OSIS change, p = 0.004, rs = −0.4; WOSI change, p = 0.047, rs = 0.24). Twenty-one patients (24.7%) were re-referred, seven of them for repeat physiotherapy and 14 of them for surgery. Previous surgery significantly affected the possibility of a further referral ( p < 0.001), and initial diagnosis was significantly correlated with further surgery ( p = 0.032).

Discussion

Early referral to physiotherapy may produce better results. Patients with posterior instability responded better to physiotherapy. Previous surgery increased the risk of re-referral. Re-referred patients with posterior instability tended to be managed with further physiotherapy.
Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study
Authors: Gates Stephen , Sager Brian , Collett Garen , Chhabra Avneesh , Khazzam Michael
Published: February 2019

Background

The purpose of this study was to define the relationship of the axillary and radial nerves, particularly how these are affected with changing arm position.

Methods

Twenty cadaveric shoulders were dissected, identifying the axillary and radial nerves. Distances between the latissimus dorsi tendon and these nerves were recorded in different shoulder positions. Positions included adduction/neutral rotation, abduction/neutral rotation for the axillary nerve, adduction/internal rotation, adduction/neutral rotation, adduction/external rotation, and abduction/external rotation for the radial nerve.

Results

Width of the latissimus tendon at its humeral insertion was 29.3 ± 5.7 mm. Mean distance from the latissimus insertion to the axillary nerve in adduction/neutral rotation was 24.2 ± 7.1 mm, the distance increased to 41.1 ± 9.8 mm in abduction/neutral rotation. Mean distance from the latissimus insertion to the radial nerve was 15.3 ± 5.5 mm with adduction/internal rotation, 25.8 ± 6.9 mm in adduction/neutral rotation, and 39.5 ± 6.8 mm in adduction/external rotation. Mean distance increased with abduction/external rotated 51.1 ± 7.4 mm.

Conclusions

Knowing the axillary and radial nerve locations relative to the latissimus dorsi tendon decreases the risk of iatrogenic nerve injury. Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications.
A Pilot Study on a Smart Home for Elders Based on Continuous In-Home Unobtrusive Monitoring Technology
Authors: Yu Jingyu , An Ning , Hassan Tanbir , Kong Quan
Published: February 2019

Purpose:

This article reports on a pilot study of a smart home for elders (SHfE) designed to continuously monitor senior adults’ daily behaviors and the living environment of their residential homes using the application of unobtrusive sensors. SHfE users include older adults, their family members, and healthcare staff.

Background:

Globally, countries are experiencing the challenges of an increasingly aging population. A healthy environment is essential to support aging in place. By applying information and communications technology to building environments to support health, smart homes may be an option to provide a low-cost, comfortable, and user-friendly living environment for older adults.

Method:

A pilot study was conducted in a capital city in the Yangtze River Delta Agglomerations in China to verify the feasibility of the SHfE. One female older adult participated in the pilot study, which was conducted from November 2015 to January 2016.

Results:

The results indicated that the SHfE is a feasible way to analyze the behaviors (e.g., sleeping, cooking, water usage) of the elder and monitor the built environment (e.g., temperature, windows, and doors).

Conclusions:

The pilot study can be used as a baseline for further comprehensive experiments, case studies, and surveys to gain a better understanding of a smart healthy environment for older adults. On the basis of the current study, several recommendations are put forward for further implementation of the SHfE, including integrating multiple unobtrusive sensing devices; detecting fall accidents; monitoring indoor lighting, noise, and ventilation; remotely controlling electrical appliances; and developing the system with various languages. It is anticipated that the SHfE will be adopted in seniors’ residential homes in countries around the world which face an increasingly aging population.
Conceptual frameworks for social and cultural Big Data analytics: Answering the epistemological challenge
Authors: Resnyansky Lucy
Published: February 2019

This paper aims to contribute to the development of tools to support an analysis of Big Data as manifestations of social processes and human behaviour. Such a task demands both an understanding of the epistemological challenge posed by the Big Data phenomenon and a critical assessment of the offers and promises coming from the area of Big Data analytics. This paper draws upon the critical social and data scientists’ view on Big Data as an epistemological challenge that stems not only from the sheer volume of digital data but, predominantly, from the proliferation of the narrow-technological and the positivist views on data. Adoption of the social-scientific epistemological stance presupposes that digital data was conceptualised as manifestations of the social. In order to answer the epistemological challenge, social scientists need to extend the repertoire of social scientific theories and conceptual frameworks that may inform the analysis of the social in the age of Big Data. However, an ‘epistemological revolution’ discourse on Big Data may hinder the integration of the social scientific knowledge into the Big Data analytics.
Evaluating healthcare practitioners’ views on store-and-forward teledermoscopy services for the diagnosis of skin cancer
Authors: Janda Monika , Horsham Caitlin , Koh Uyen , Gillespie Nicole , Vagenas Dimitrios , Loescher Lois J , Curiel-Lewandrowski Clara , Hofmann-Wellenhof Rainer , Peter Soyer H.
Published: February 2019

Objective

The aim of the study is to evaluate healthcare practitioners’ views on and satisfaction with (i) digital image acquisition and storage and (ii) store-and-forward teledermoscopy services for the diagnosis of skin cancer in their clinical practice.

Methods

An online survey was conducted among 59 healthcare practitioners (GPs ( n=17), dermatologists ( n=22), dermatology registrars ( n=18), a dermatology research fellow ( n=1) and a plastic surgeon ( n=1)) to assess usability of digital image acquisition and storage for when the imaging process is conducted by the healthcare practitioners themselves, or by their patients. The study identifies the enablers and barriers of this emerging mode of medical practice. A thematic analysis was used to extract key themes from open-ended responses, which involved identifying themes and patterns within and across participants.

Results

Thirty-four healthcare practitioners (58%) had previously used a mobile dermatoscope within their practice. Participants most appreciated its use in their practice for lesion monitoring (59%) and record keeping (39%). Challenges reported were the increased time to support the additional workload (45%), technical issues (33%) and cost of equipment (27%). Practitioners were unsure (36%) or did not advocate teledermoscopy for direct-to-consumer use (41%). Only 23% supported the use of direct-to-consumer teledermoscopy.

Conclusion

While most practitioners are receptive to mobile teledermoscopy, there was less support for patient-initiated use, whereby the patient controls the imaging process. As technology improves rapidly it is important to evaluate practitioners’ acceptance and satisfaction of evolving telehealth services, moving forward with models of practice where healthcare practitioners and other healthcare providers will feel comfortable engaging in telehealth services.
Successful Treatment of Scedosporium Sinusitis in Two Lung Transplant Recipients: Review of the Literature and Recommendations for Management
Authors: Ference Elisabeth H. , Kubak Bernard M. , Zhang Paul , Suh Jeffrey D.
Published: February 2019

Background

Scedosporium fungal infection is an emerging disease which is difficult to diagnose and treat. Patients undergoing lung transplant may be colonized prior to transplantation and are at risk for lethal allograft infection after transplantation.

Objectives

To identify and evaluate treatment options.

Methods

This study is a retrospective review of patients treated at a tertiary academic medical center from 2007 to 2017 with positive sinonasal cultures. A review of the literature was also performed to identify additional cases.

Results

Two lung transplant patients had a positive culture for Scedosporium. The literature search resulted in 37 citations, which yielded only 2 prior cases of Scedosporium paranasal sinus colonization or infection in lung transplant recipients. Three of the 4 patients had cystic fibrosis. Two of the patients were colonized before initial transplant, while 1 patient was colonized before subsequent transplant. Three of the 4 patients survived, and all 3 had disease isolated to their sinuses and lungs treated with sinus surgery, while the fourth had disseminated disease and did not undergo sinus surgery. All patients were treated with multiple antifungals due to resistance patterns. One surviving patient cleared both sinus and lung cultures in less than 1 month, while the other 2 surviving patients achieved negative cultures after a minimum of 6 months.

Conclusions

Surgery may be especially important in patients with fungal sinus colonization or infection before or after lung transplantation. Chronic sinusitis is an important source for persistent fungal colonization and reinfection of the allograft which could be removed with surgical debridement before causing highly morbid pulmonary disease.
Bariatric Surgery and Low Back Pain: A Systematic Literature Review
Authors: Joaquim Andrei Fernandes , Helvie Peter , Patel Alpesh A.
Published: February 2019

Study Design:

Systematic literature review.

Objective:

It is estimated that one third of the world population is overweight and 20% of adults have some low back symptoms at some point of their lives. The association of obesity and low back pain and physical deterioration has been well established. We designed this study to evaluate the role of bariatric surgery (BS) for lumbar spine symptoms in obese patients.

Methods:

A systematic literature review was performed using the PubMed database identifying lumbar spine symptoms (pain, functional status, disability index) and/or complications of lumbar spine surgery before and after BS. Study quality was assessed according to the Oxford Centre for Evidence-Based Medicine.

Results:

Ten studies were identified. Nine evaluated the role of BS in low back pain and/or functional status before and after surgery: all reported that bariatric surgery had a positive impact in improving low back pain symptoms and decreasing disability in severely obese patients. One study evaluated the role of posterior lumbar surgery in patients who were obese at the time of surgery and those who had a previous bariatric procedure: bariatric surgery decreased postoperative surgical complications. The level of the evidence was low (III and IV).

Conclusions:

Bariatric surgery in severely obese patients decreases the intensity of low back symptoms and also decreases disability secondary to back problems. Additionally, bariatric surgery may be advantageous for patients who need a posterior lumbar surgery and are severely obese. Prospective studies with longer follow-up are necessary to confirm this conclusion.
A Patient With a Chronic Cough: An Unexpected Case of Calcium Pill Aspiration
Authors: Poudel Pooja , Chu Andrew , Mirchia Kanish , Paul Manju
Published: February 2019

Foreign body aspiration is a life-threatening medical condition that requires prompt action. Delayed diagnosis is associated with long-term serious complication often leading to death. In adults, it can remain undetected for a long period of time. The patient gives a long history of a cough, which clinicians often ignore. A chest radiograph is unreliable to exclude the disease as it may not show radiolucent objects. Diagnostic bronchoscopy is necessary to exclude the disease. We report a case of 70-year-old woman who had a 1-month history of a cough and was admitted for shortness of breath, and on further evaluation, we incidentally detected calcium tablets in her bronchus. The present case demonstrates the need for early bronchoscopy especially when the cause of a chronic cough is not known.
Cardiac Early Repolarization Pattern Anomalies Among Children and Adolescents With and Without Attention-Deficit Hyperactivity Disorder: A Community Observational Study
Authors: Isart Fernando A. , Ramos Faustino G. , Isart-Infante Fernando
Published: February 2019

Our research had 2 aims, first, to determine if electrocardiographic early repolarization pattern anomalies (ERPAs) were more likely present among children and adolescents diagnosed with attention-deficit hyperactivity disorder (ADHD; n = 416) when compared with non-ADHD children (n = 187), and second, to asses if ADHD patients whose parents report severe ADHD psychometric scores were more likely to have ERPA in their surface ECG (electrocardiography) when compared with other ADHD patients with mild to moderate dysfunction or no dysfunction. In our unmatched case-control study, ERPA was recognized when there was an end QRS notch (J wave) or slur on the downslope of a prominent R wave with and without ST-segment elevation and the peak of the notch or J wave (Jp) ≥0.1 mV in ≥2 contiguous leads, excluding V1-V3 anterior lead, and QRS duration (measured in leads in which a notch or slur is absent) <120 ms or ST-segment elevation >0.1 mV in ≥2 contiguous leads, excluding V1-V3, and QRS duration <120 ms. The DSM-IV ( Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used to diagnose ADHD. Our data analysis suggested a significant association between ERPA presence and ADHD (n = 603, P = .020). Our logistic regression model suggests that patients with ERPA (n = 167) were 2.778 times more likely to have a diagnosis of ADHD after controlling for age, gender, and ethnicity (95% confidence interval for odds ratio 1.087-7.100, P = .033). Multiple regression models suggested that age, P < .001; gender, P < .001; ERPA, P = .004; and ERPA leads number, P = .022, were significant predictors of global parental ADHD worry scale. Hispanic and black ethnicity were not significant predictors. Consequently, the presence of ERPA should be reported in all ECGs done in children and adolescents for prospective behavioral phenotype and/or arrhythmia risk stratification analysis.
Perceptions of What Is Important for Appetite—An Interview Study With Older People Having Food Distribution
Authors: Nordlander Marlene , Isaksson Ulf , Hörnsten Åsa
Published: February 2019

The proportion of older people in the population increases and more and more continue living in their own homes. Appetite among the elderly people is important to their nutrition and health. The increased risk of unintended weight loss and malnutrition is linked to food distribution among home-living elderly people. The aim was to describe experiences and perceptions of what matters to appetite among home-living elderly people having food distribution. The design was qualitative where interview data were collected among 13 interviewees in 2017 to 2018. Data were analyzed using qualitative content analysis. The results are presented in three domains: the food, the meal situation, and the adaptation to meal service with categories and themes responding to each domain. The six themes related to appetite among the elderly people concerned the following: eating tasty, savory, and culturally adapted food; eating healthy and sustainable food; eating alone or together with others; eating in a pleasant meal environment; having choices to make about the meal; and last, accepting disabilities and increased dependency. One conclusion is that many aspects should be taken into consideration when promoting appetites of people who also get food distribution. It is highly individual and an understanding of which aspects are relevant must be considered; consequently, person-centered care is suggested to promote appetite.
Tumoral pulmonary hypertension
Authors: Price Laura C. , Seckl Michael J. , Dorfmüller Peter , Wort S. John
Published: February 2019

Tumoral pulmonary hypertension (PH) comprises a variety of subtypes in patients with a current or previous malignancy. Tumoral PH principally includes the tumour-related pulmonary microvascular conditions pulmonary tumour microembolism and pulmonary tumour thrombotic microangiopathy. These inter-related conditions are frequently found inpost mortemspecimens but are notoriously difficult to diagnoseante mortem. The outlook for patients remains extremely poor although there is some emerging evidence that pulmonary vasodilators and anti-inflammatory approaches may improve survival. Tumoral PH also includes pulmonary macroembolism and tumours that involve the proximal pulmonary vasculature, such as angiosarcoma; both may mimic pulmonary embolism and chronic thromboembolic PH. Finally, tumoral PH may develop in response to treatments of an underlying malignancy. There is increasing interest in pulmonary arterial hypertension induced by tyrosine kinase inhibitors, such as dasatanib. In addition, radiotherapy and chemotherapeutic agents such as mitomycin-C can cause pulmonary veno-occlusive disease. Tumoral PH should be considered in any patient presenting with unexplained PH, especially if it is poorly responsive to standard approaches or there is a history of malignancy. This article will describe subtypes of tumoral PH, their pathophysiology, investigation and management options in turn.
3D printable hyaluronic acid-based hydrogel for its potential application as a bioink in tissue engineering
Authors: Noh Insup , Kim Nahye , Tran Hao Nguyen , Lee Jaehoo , Lee Chibum
Published: February 2019

Background

After recognition of 3D printing and injectable hydrogel as a critical issue in tissue/organ engineering and regenerative medicine society, many hydrogels as bioinks have been developed worldwide by using polymeric biomaterials such as gelatin, alginate, hyaluronic acid and others. Even though some gels have shown good performances in 3D bioprinting, still their performances do not meet the requirements enough to be used as a bioink in tissue engineering.

Method

In this study, a hydrogel consisting of three biocompatible biomaterials such as hyaluronic acid (HA), hydroxyethyl acrylate (HEA) and gelatin-methacryloyl, i.e. HA-g-pHEA-gelatin gel, has been evaluated for its possibility as a bioprinting gel, a bioink. Hydrogel synthesis was obtained by graft polymerization of HEA to HA and then grafting of gelatin- methacryloyl via radical polymerization mechanism. Physical and biological properties of the HA-based hydrogels fabricated with different concentrations of methacrylic anhydride (6 and 8%) for gelatin-methacryloylation have been evaluated such as swelling, rheology, morphology, cell compatibility, and delivery of small molecular dimethyloxalylglycine. Printings of HA-g-pHEA-Gelatin gel and its bioink with bone cell loaded in lattice forms were also evaluated by using home-built multi-material (3D bio-) printing system.

Conclusion

The experimental results demonstrated that the HA-g-pHEA-gelatin hydrogel showed both stable rheology properties and excellent biocompatibility, and the gel showed printability in good shape. The bone cells in bioinks of the lattice-printed scaffolds were viable. This study showed HA-g-pHEA-Gelatin gel’s potential as a bioink or its tissue engineering applications in injectable and 3D bioprinting forms.
Evaluation of compressed sensing MRI for accelerated bowel motility imaging
Authors: de Jonge C. S. , Coolen B. F. , Peper E. S. , Motaal A. G. , Nio C. Y. , Somers I. , Strijkers G. J. , Stoker J. , Nederveen A. J.
Published: February 2019

Background

To investigate the feasibility of compressed sensing and parallel imaging (CS-PI)-accelerated bowel motility magnetic resonance imaging (MRI) and to compare its image quality and diagnostic quality to conventional sensitivity encoding (SENSE) accelerated scans.

Methods

Bowel MRI was performed in six volunteers using a three-dimensional balanced fast field-echo sequence. Static scans were performed after the administration of a spasmolytic agent to prevent bowel motion artefacts. Fully sampled reference scans and multiple prospectively 3× to 7× undersampled CS-PI and SENSE scans were acquired. Additionally, fully sampled CS-PI and SENSE scans were retrospectively undersampled and reconstructed. Dynamic scans were performed using 5× to 7× accelerated scans in the presence of bowel motion. Retrospectively, undersampled scans were compared to fully sampled scans using structural similarity indices. All reconstructions were visually assessed for image quality and diagnostic quality by two radiologists.

Results

For static imaging, the performance of CS-PI was lower than that of fully sampled and SENSE scans: the diagnostic quality was assessed as adequate or good for 100% of fully sampled scans, 95% of SENSE, but only for 55% of CS-PI scans. For dynamic imaging, CS-PI image quality was scored similar to SENSE at high acceleration. Diagnostic quality of all scans was scored as adequate or good; 55% of CS-PI and 83% of SENSE scans were scored as good.

Conclusion

Compared to SENSE, current implementation of CS-PI performed less or equally good in terms of image quality and diagnostic quality. CS-PI did not show advantages over SENSE for three-dimensional bowel motility imaging.
Comparative Analysis of Durable Responses on Immune Checkpoint Inhibitors Versus Other Systemic Therapies: A Pooled Analysis of Phase III Trials
Authors: Pons-Tostivint Elvire , Latouche Aurélien , Vaflard Pauline , Ricci Francesco , Loirat Delphine , Hescot Ségolène , Sablin Marie-Paule , Rouzier Roman , Kamal Maud , Morel Claire , Lecerf Charlotte , Servois Vincent , Paoletti Xavier , Le Tourneau Christophe
Published: February 2019

PURPOSE

Immune checkpoint inhibitors (ICIs) have been demonstrated to improve overall survival (OS) in several tumor types. Durable responses have been reported with these agents in patients with melanoma and lung cancer. We aimed to quantify the proportion of patients who experience durable responses on ICIs and to compare it with other drug classes.

PATIENTS AND METHODS

We retrieved published phase III randomized trials that included at least one ICI arm in the recurrent and/or metastatic setting. A durable response to treatment was defined as a progression-free survival that exceeded three times the median progression-free survival of the whole population. The proportion of patients who experienced an OS that exceeded two times the median OS of the whole patient population also was estimated.

RESULTS

Nineteen studies involving 11,640 patients treated in 42 treatment arms (26 ICI and 16 non-ICI arms) were included. The mean proportion of patients who experienced a durable response was 2.3 times higher in those treated with an ICI compared with those treated in the control arms (25% v 11%). Durable responses were more frequent in patients treated with anti–PD-1/PD-L1 agents than in patients treated with anti–CTLA-4 agents (28% v 18%). The mean proportion of patients who had an OS that exceeded two times the median OS was also higher in those treated with ICIs than in those treated in the control arms (30% v 23%). In multivariable analysis, the effects of treatment with anti–PD-1/PD-L1 agents and of first-line treatment were statistically associated with a higher mean proportion of durable responses.

CONCLUSION

Durable responses were more frequent in patients treated with ICIs, although they also occurred in patients treated with other drug classes.