bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardized nursing management of enzyme replacement therapy for late-onset Pompe disease
Authors: Tang Shan , Ma Jiachu , Meng Huaxing , Guo Junhong , Cao Shuyan , Wang Binquan
Published: January 2021

Pompe disease or glycogen storage disease type II is a rare autosomal recessive disorder caused by a deficiency of the lysosomal enzyme a-glucosidase. Although enzyme replacement therapy (ERT) with 2 weekly intervals following was considered an effective treatment for Pompe disease in 2006, few patients can afford to receive treatment in China because of the high cost. This study aimed to examine the standard management of enzyme replacement therapy for late-onset Pompe disease among patients over the age of 14 years from a nursing perspective in order to assess operating procedures. ERT injection fluid dispensing and infusion procedures using different methods were analyzed and compared in 3 patients with advanced Pompe disease for forming standard operation procedures. In addition, the impact of different methods on time consumption was analyzed by 1-way analysis of variance. There were significant differences in time consumption between different dispensing and infusion methods. The time of dispensing and infusing the injection fluids using the cooperative method was 15.97 minutes shorter than that using the conventional method (95% CI: 4.51–27.43, P = .012); the time using the modified method was 20.93 minutes shorter than that using the conventional method (95% CI: 9.47–32.39, P = .012); and there was no significant difference between the cooperative and modified methods (P = .431). Enzyme replacement therapy entails frequent treatment and strict nursing requirements related to the intravenous infusion process. In this context, a standard operating procedure can be used to control nursing times and labor costs effectively while ensuring a safe and effective infusion process.
Alterations of functional connectivity in auditory and sensorimotor neural networks
Authors: Gwak Dae-Won , Park Eunhee , Park Jin-Su , Kim Eunji , Kang Min-Gu , Kim Ae-Ryoung , Lee Jae-Eun , Jung Seung-Hwan , Jeong Jae-Gyeong , Lee Kyu-Yup , Chang Yongmin , Jung Tae-Du
Published: January 2021

Rationale:

Cortical deafness is a rare auditory dysfunction caused by damage to brain auditory networks. The aim was to report alterations of functional connectivity in intrinsic auditory, motor, and sensory networks in a cortical deafness patient.

Patient concerns:

A 41-year-old woman suffered a right putaminal hemorrhage. Eight years earlier, she had suffered a left putaminal hemorrhage and had minimal sequelae. She had quadriparesis, imbalance, hypoesthesia, and complete hearing loss.

Diagnoses:

She was diagnosed with cortical deafness. After 6 months, resting-state functional magnetic resonance imaging (rs-fMRI) and diffuse tensor imaging (DTI) were performed. DTI revealed that the acoustic radiation was disrupted while the corticospinal tract and somatosensory track were intact using deterministic tracking methods. Furthermore, the patient showed decreased functional connectivity between auditory and sensorimotor networks.

Interventions:

The patient underwent in-patient stroke rehabilitation therapy for 2 months.

Outcomes:

Gait function and ability for activities of daily living were improved. However, complete hearing impairment persisted in 6 months after bilateral putaminal hemorrhagic stroke.

Lessons:

Our case report seems to suggest that functional alterations of spontaneous neuronal activity in auditory and sensorimotor networks are related to motor and sensory impairments in a patient with cortical deafness.
The efficacy and safety of Xuefu Zhuyu Decoction combined Mifepristone in the treatment of Uterine leiomyoma
Authors: Shi Shasha , Ye Qiaobo , Yu Chenghao , Peng Fu
Published: January 2021

Background:

Uterine leiomyoma (UL) is a common severe gynecological issue. In China, Xuefu Zhuyu Decoction (XFZYD), combined with Mifepristone, is widely used in the treatment of UL. However, their combined effectiveness and safety for this purpose have not yet been explored.

Objective:

This systematic review aims to evaluate the effectiveness and safety of XFZYD combined with Mifepristone as a method of treatment for UL.

Methods:

We searched the following 7 databases: 3 English medical databases (PubMed, EMBASE, Cochrane Library), and 4 Chinese medical databases (Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and the Wanfang database). The primary outcome was the effect of XFZYD combined with Mifepristone on the effective rate, uterine leiomyoma volume (ULV), and uterine volume (UV) of uterine leiomyoma. Bias risk was assessed using the Cochrane risk of bias tool. The software RevMan5 was used to evaluate the quality of the included studies and process the data.

Results:

This study will evaluate the efficacy and safety of XFZYD combined with Mifepristone in the treatment of uterine fibroids by evaluating the effective rate, Uterine Leiomyoma volume, and uterine volume, the incidence of estradiol, luteinizing hormone, and other indicators.

Conclusion:

This study will provide reliable evidence-based evidence for Xuefu Zhuyu Decoction Combined with Mifepristone in the treatment of uterine fibroids.

Ethics and dissemination:

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/YADN3
Involuntary movement in stiff-person syndrome with amphiphysin antibodies
Authors: Xie Yin-yin , Meng Hong-mei , Zhang Feng-xiao , Maimaiti Buajieerguli , Jiang Ting , Yang Yu
Published: January 2021

Rationale:

Stiff-person syndrome (SPS) is a rare neurological immune disorder characterized by progressive axial and proximal limb muscle rigidity, stiffness, and painful muscle spasms. Amphiphysin antibodies are positive in approximately 5% of SPS patients. To date, there have been no relevant reports on involuntary movement in cases of SPS with amphiphysin antibodies.

Patient concerns:

We describe the case of a 69-year-old man with a 2-year history of progressive stiffness in the neck, bilateral shoulders, and chest muscles, and a more-than-a-year history of dyspnea accompanied by mandibular involuntary movement. The patient was a vegetarian and had good health in the past. The family's medical history was unremarkable.

Diagnoses:

He was diagnosed with SPS based on the progressive muscle stiffness, the amphiphysin antibody seropositivity, the continuous motor activity on electromyography, and the effective treatment with benzodiazepines.

Interventions:

The patient was orally administered clonazepam and baclofen, and corticosteroid IV followed by prednisone orally.

Outcomes:

In the hospital, after treatment with methylprednisolone, clonazepam, and baclofen, the patient's rigidity, stiffness, and dyspnea significantly improved. The involuntary movement of the mandible persisted throughout the treatment process. Currently, under oral treatment with baclofen and clonazepam, the patient's symptoms of muscle stiffness and dyspnea exist, and follow-up is continued.

Lessons:

We report a rare and novel case of involuntary movement in SPS with amphiphysin antibodies. The present report explores the relationship between SPS and involuntary movement and expands the spectrum of clinical manifestations of SPS.
The occult nodal metastasis rate of early tongue cancer (T1–T2)
Authors: Choi Kyu Young , Park Sang Chul , Kim Jin Hwan , Lee Dong Jin
Published: January 2021

Objectives:

In this study, a meta-analysis was conducted to evaluate the occult lymph node metastasis rate in patients with early-stage (T1–T2) oral tongue squamous cell carcinoma. Also, the correlation between occult lymph node metastasis rate and T2 ratio among T1–T2 or the reported year of each study was analyzed to adjust other confound variables.

Study Design:

Literature search.

Methods:

A systematic computerized search of the electronic databases was carried out for articles published between January 1, 1980, and December 31, 2018, which reported occult nodal metastasis rate in T1 and T2 (separately) tongue cancer patients. Statistical analysis was performed using Comprehensive Meta Analysis version 3.3.070. Publication bias was assessed by the Egger test and Begg funnel plot method. The correlation between occult nodal metastasis rate and T2 ratio or reported year, respectively, was assessed by meta-regression analysis.

Results:

From 19 studies, a total of 1567 cases were included in the meta-analysis. By random effects model, the mean occult cervical lymph node metastasis was 24.4% (95% confidence interval; 0.205–0.248). The meta-regression revealed that the T2 ratio and the reported year of the studies did not have a significant effect on the occult metastasis rate (correlation coefficient = 0.531 and 0.002, respectively, and P = .426 and 0.921, respectively).

Conclusion:

The meta-analysis revealed that the early-stage oral tongue squamous cell carcinoma had a rate of 24.4% for occult nodal metastasis. The occult nodal metastasis rate was not significantly affected by neither T2 ratio among T1–T2 nor reported year of the studies.
Early versus late tracheotomy in ICU patients
Authors: Deng Hongsheng , Fang Qiang , Chen Kun , Zhang Xiaoling
Published: January 2021

Background:

This study aimed to quantitatively analyze the available randomized controlled trials (RCTs) and investigate whether early tracheotomy can improve clinical endpoints compared with late tracheotomy in critically ill patients undergoing mechanical ventilation.

Methods:

The electronic databases of PubMed, Embase, and the Cochrane library were systematically searched in August 2019. The investigated outcomes were calculated using relative risks (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) through the random-effects model for categories and continuous data, respectively.

Results:

The electronic searches yielded 2289 records, including 15 RCTs comprising a total of 3003 patients and found to be relevant for the final quantitative analysis. The summary RRs that indicated early versus late tracheotomy were not associated with the risk of short-term mortality (RR: 0.87; 95% CI: 0.74–1.03; P = .114) and ventilator-associated pneumonia (RR: 0.90; 95% CI: 0.78–1.04; P = .156). Moreover, early tracheotomy was associated with shorter intensive care unit (ICU) stay (SMD: –1.81; 95% CI: –2.64 to –0.99; P < .001) and mechanical ventilation duration (SMD: –1.17; 95% CI: –2.10 to –0.24; P = .014). Finally, no significant difference was observed between early and late tracheotomy for hospital stay (SMD: –0.42; 95% CI: –1.36–0.52; P = .377).

Conclusions:

The present meta-analysis suggests that early tracheotomy can reduce the length of ICU stay and mechanical ventilation duration, but the timing of the tracheotomy was not associated with the short-term clinical endpoints in critically ill patients undergoing mechanical ventilation.
Detailed comparison of the da Vinci Xi and S surgical systems for transaxillary thyroidectomy
Authors: Yu Da Young , Chang Young Woo , Lee Hye Yoon , Kim Woo Young , Kim Hoon Yub , Lee Jae Bok , Son Gil Soo
Published: January 2021

Robotic surgical systems have evolved over time. The da Vinci Xi system was developed in 2014 and was expected to solve the shortcomings of the previous S system. Therefore, we conducted this study to compare these 2 systems and identify if the Xi system truly improves surgical outcomes.

In this retrospective study, a total of 86 patients with unilateral papillary thyroid carcinoma without central lymph node involvement underwent gasless transaxillary hemithyroidectomy using 2 robotic systems, the da Vinci S and Xi. Forty patients were in the da Vinci S group and 46 patients were in the da Vinci Xi group. All surgeries were performed by 1 surgeon (YWC). All surgery video files were analyzed to compare the duration of each surgical step.

The total operation time was significantly shorter in the Xi group than in the S group (153.0 minutes vs 105.7 minutes, P < .01). Time for robot docking was shorter in the Xi group (19.8 minutes vs 10.6 minutes, P < .01), and all procedures performed in the console also required a shorter time in this group. The overall complication rate did not differ significantly (P = .464).

The da Vinci Xi system made robotic thyroidectomy easier and faster without increasing the complication rate. It is a safe and valuable system for robotic thyroidectomy.
Hypertrophic spinal pachymeningitis caused by ANCA-associated vasculitis revealed by 18F-FDG PET/CT
Authors: Wu Meiqi , Ren Jingyun , Luo Yaping
Published: January 2021

Rationale:

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can involve the central nervous system in estimatedly 15% of patients. Hypertrophic pachymeningitis causes inflammatory hypertrophy of the cranial or spinal dura mater and patients present with various neurological deficits. ANCA-associated hypertrophic spinal pachymeningitis has rarely been reported in literature. We report a case of AAV presenting with hypertrophic spinal pachymeningitis detected by 18F-FDG PET/CT.

Patient concerns:

A 66-year-old woman diagnosed with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis developed back pain, bilateral lower limb weakness, dysuria, and dysporia 1 month ago.

Diagnosis:

Contrast-enhanced MRI showed thickening and enhancement of the dura mater in the thoracic cord. Intraspinal hypermetabolism in the corresponding region was observed on 18F-FDG PET/CT. The patient was finally diagnosed with ANCA-associated hypertrophic spinal pachymeningitis.

Interventions:

The patient was treated with a higher dose of prednisone and cyclophosphamide.

Outcomes:

After 2-week treatment, the patient's neurological symptoms improved rapidly and laboratory findings were ameliorated. A repeated contrast-enhanced MRI showed partial improvement of the disease in the thoracic cord.

Lessons:

18F-FDG PET/CT and contrast-enhanced MRI can aid in the clinical diagnosis and surveillance in AAV-associated hypertrophic spinal pachymeningitis and potentially facilitate early recognition and intervention to prevent irreversible neurological impairment.
A rare intraocular lens surface foreign body during phacoemulsification surgery
Authors: Li Chen , Lu Peirong
Published: January 2021

Rationale:

Only a few cases of intraocular lens (IOL) opacification during phacoemulsification surgery have been reported in the literature; intraoperative emergency due to IOL surface foreign body is even rarer.

Patient concerns:

A 76-year-old woman underwent uncomplicated cataract surgery in her right eye. A triangular transparent seemingly foreign body tightly attached to the posterior surface of the IOL was found during IOL implantation; the IOL surface foreign body prevented the patient from obtaining satisfactory visual acuity after surgery.

Diagnosis:

IOL surface foreign body.

Interventions:

After confirmation of the surface foreign body by swept-source optical coherence tomography (IOL Master 700), the surface foreign body was removed in a second surgery. After surgery, the IOL was still well centered.

Outcomes:

Fortunately, the patient achieved distinctly improved vision without any visual disturbances in her right eye. To identify the material of the foreign body, it was examined by Fourier-transform infrared spectroscopy (FTIR).

Lessons:

This case suggests that surgeons should carefully observe IOLs before implantation. In addition, effective preoperative planning and skillful surgery can remove foreign bodies smoothly and improve patient vision.
Chinese herbal medicine Du-Huo-Ji-Sheng-decoction for knee osteoarthritis
Authors: Cao Ji-hui , Feng Da-gang , Wang Yan-zhi , Zhang Hai-yan , Zhao Yu-dong , Sun Zai-hui , Feng Shu-gui , Chen Yi , Zhu Ming-shuang
Published: January 2021

Background:

As a classic prescription for treating knee osteoarthritis, Du-Huo-Ji-Sheng-decoction has been widely recognized for its clinical efficacy. The purpose of this systematic review and meta-analysis is to evaluate the effectiveness and safety of Du-Huo-Ji-Sheng-decoction in the treatment of knee osteoarthritis.

Methods:

The following databases will be searched from January 2011 to December 2020: PubMed, Embase, Web of Science, Cochrane Library, Chinese Biomedical Medical Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang Database. Statistical analysis will be processed by RevMan V.5.3 software.

Results:

This study will provide an assessment of the current state of DHJSD in the treatment of KOA, aiming to show the efficacy and safety of DHJSD.

Conclusion:

This study will provide evidence to judge whether DHJSD is an effective intervention for KOA.
A study on the perception of hand washing and health status in Korean adults
Authors: Park Soohee
Published: January 2021

This study aimed to investigate the perception about hand washing and health status among Koreans using the data from the Community Health Survey.

We examined the differences in the perceptions about hand washing and health statuses of 220,440 participants of the 2017 community health survey. The sample was divided into groups based on demographic variables, perceptions about hand washing, and prevalence of metabolic diseases. Participants’ demographic characteristics were analyzed using frequency, and perceptions about hand washing and subjective health status-related parameters were analyzed using t tests. The prevalence of metabolic disorder was analyzed with χ2 tests.

There were significant differences in subjective health status, subjective oral health status, and perceived obesity in the positive and negative hand washing perception groups (P < .01). The prevalence rate of hypertension and diabetes mellitus significantly differed in the positive and negative hand washing perception groups (P < .01), but no differences were observed for hyperlipidemia (P < .01).

This study showed that positive hand washing perception is associated with good health care practices. The perceptions of hand washing, which are formed during early childhood, were closely associated with health status. This finding could be useful evidence for developing programs focusing on major health behaviors and levels of health.
The Effect of Supervision Waivers on Practice
Authors: O’Reilly-Jacob Monica , Perloff Jennifer
Published: January 2021

Background:

While optimal utilization of the nurse practitioner (NP) workforce is an increasingly popular proposal to alleviate the growing primary care shortage, federal, state, and organizational scope of practice policies inhibit NPs from practicing to the full extent of their license and training. In March of 2020, NP state-specific supervisory requirements were temporarily waived to meet the demands of the coronavirus disease 2019 (COVID-19) pandemic in Massachusetts.

Objective:

The objective of this study was to examine the impact of temporarily waived state practice restrictions on NP perception of care delivery during the initial surge of the COVID-19 pandemic in Massachusetts.

Research Design:

Mixed methods descriptive analysis of a web-based survey of Massachusetts NPs (N=391), conducted in May and June 2020.

Results:

The vast majority (75%) of NPs believed the temporary removal of practice restriction did not perceptibly improve clinical work. Psychiatric mental health NPs were significantly more likely than other NP specialties to believe the waiver improved clinical work (odds ratio=6.68, P=0.001). NPs that experienced an increase in working hours during the pandemic surge were also more likely to report a positive effect of the waiver (odds ratio=2.56, P=0.000).

Conclusions:

Temporary removal of state-level practice barriers alone is not sufficient to achieve immediate full scope of practice for NPs. The successful implementation of modernized scope of practice laws may require a collective effort to revise organizational and payer policies accordingly.
Family Caregiver Training Needs and Medicare Home Health Visit Utilization
Authors: Burgdorf Julia G. , Stuart Elizabeth A. , Arbaje Alicia I. , Wolff Jennifer L.
Published: January 2021

Background:

Medicare home health providers are now required to deliver family caregiver training, but potential consequences for service intensity are unknown.

Objective:

The objective of this study was to assess how family caregiver training needs affect the number and type of home health visits received.

Design:

Observational study using linked National Health and Aging Trends Study (NHATS), Outcomes and Assessment Information Set (OASIS), and Medicare claims data. Propensity score adjusted, multivariable logistic, and negative binomial regressions model the relationship between caregivers’ training needs and number/type of home health visits.

Subjects:

A total of 1217 (weighted n=5,870,905) National Health and Aging Trends Study participants receiving Medicare-funded home health between 2011 and 2016.

Measures:

Number and type of home health visits, from Medicare claims. Family caregivers’ training needs, from home health clinician reports.

Results:

Receipt of nursing visits was more likely when family caregivers had medication management [adjusted odds ratio (aOR): 3.03; 95% confidence interval (CI): 1.06, 8.68] or household chore training needs (aOR: 3.38; 95% CI: 1.33, 8.59). Receipt of therapy visits was more likely when caregivers had self-care training needs (aOR: 1.70; 95% CI: 1.01, 2.86). Receipt of aide visits was more likely when caregivers had household chore (aOR: 3.54; 95% CI: 1.82, 6.92) or self-care training needs (aOR: 2.12; 95% CI: 1.11, 4.05). Medication management training needs were associated with receiving an additional 1.06 (95% CI: 0.11, 2.01) nursing visits, and household chores training needs were associated with an additional 3.24 total (95% CI: 0.21, 6.28) and 1.32 aide visits (95% CI: 0.36, 2.27).

Conclusion:

Family caregivers’ activity-specific training needs may affect home health visit utilization.
Achieving Population Health Impacts Through Health Promotion Programs Offered by Community-based Organizations
Authors: Brewster Amanda L. , Wilson Traci L. , Curry Leslie A. , Kunkel Suzanne R.
Published: January 2021

Background:

Evidence-based health promotion programs can help older adults manage chronic conditions and address behavioral risk factors, and translating these interventions to population-scale impact depends on reaching people outside of clinical settings. Area Agencies on Aging (AAAs) have emerged as important delivery sites for health promotion programs, but the impacts of their expanded role in delivering these interventions remain unknown.

Objective:

The objective of this study was to test whether evidence-based health promotion programs implemented by AAAs from 2008 to 2016 influenced health care use and spending by older adults and to examine how agencies’ organizational capacity for implementation influenced these population-level impacts.

Research Design:

We used panel regression models to examine how the expansion of health promotion programs offered by AAAs over the course of 2008–2016 was associated with a change in health care use and spending by older adults in counties served by the AAAs. We examined impact separately for high capacity and low capacity agencies.

Results:

Across the full sample of AAAs, beginning to offer any health promotion program in the AAA was associated a with 0.94% percentage point reduction in potentially avoidable nursing home use in counties covered by the AAA (95% confidence interval=−1.58, −0.29), equivalent to a 6.5% change. Expanding the breadth of programs offered by the AAA was also associated with a significant reduction in potentially avoidable nursing home use. Stratified analysis showed that reductions in potentially avoidable nursing home use were evident only in places where the AAA had high implementation capacity. Expansion of health promotion programs offered by AAAs was not associated with the change in county-level hospital readmission rates, ambulatory care sensitive hospitalizations, or Medicare spending per beneficiary.

Conclusions:

AAAs are an example of community-based organizations that can contribute to health care policy goals such as cost containment. Organizational development support may be needed to extend their ability to effect change in more regions of the country.
Mandated Copayment Reductions in Medicare Advantage
Authors: Keohane Laura M. , Thomas Kali S. , Rahman Momotazur , Trivedi Amal N.
Published: January 2021

Objectives:

To address concerns that postacute cost-sharing may deter high-need beneficiaries from participating in Medicare Advantage (MA) plans, the Centers for Medicare and Medicaid Services have capped cost-sharing for skilled nursing facility (SNF) services in MA plans since 2011. This study examines whether SNF use, inpatient use, and plan disenrollment changed following stricter regulations in 2015 that required most MA plans to eliminate or substantially reduce cost-sharing for SNF care.

Design:

Difference-in-differences retrospective analysis from 2013 to 2016.

Setting:

MA plans.

Participants:

Thirty-one million MA members in 320 plans with mandatory cost-sharing reductions and 261 plans without such reductions.

Measurements:

Mean monthly number of SNF admissions, SNF days, hospitalizations, and plan disenrollees per 1000 members.

Results:

Mean total cost-sharing for the first 20 days of SNF services decreased from $911 to $104 in affected plans. Relative to concurrent changes in plans without mandated cost-sharing reductions, plans with mandatory cost-sharing reductions experienced no significant differences in the number of SNF days per 1000 members (adjusted between-group difference: 0.4 days per 1000 members [95% confidence interval (95% CI), −5.2 to 6.0, P=0.89], small decreases in the number of hospitalizations per 1000 members [adjusted between-group difference: 0.6 admissions per 1000 members (95% CI, −1.0 to −0.1; P=0.03)], and small decreases in the number of SNF users who disenrolled at year-end [adjusted between-group difference: −16.8 disenrollees per 1000 members (95% CI, −31.9 to −1.8; P=0.03)].

Conclusions:

Mandated reductions in SNF cost-sharing may have curbed selective disenrollment from MA plans without significantly increasing use of SNF services.
Model Homes
Authors: Saynisch Philip A. , David Guy , Ukert Benjamin , Agiro Abiy , Scholle Sarah H. , Oberlander Tyler
Published: January 2021

Background:

The patient-centered medical home (PCMH) model has been widely adopted, but the evidence on its effectiveness remains mixed. One potential explanation for these mixed findings is variation in how the model is implemented by practices.

Objective:

To identify the impact of different approaches to PCMH adoption on health care utilization in a long-term, geographically diverse sample of patients.

Design:

Difference-in-differences evaluation of PCMH impact on cost and utilization.

Subjects:

A total of 5,314,284 patient-year observations from the HealthCore Integrated Research Database, and 5943 practices which adopted the PCMH model in 14 states between 2011 and 2015.

Intervention:

PCMH adoption, as defined by the National Committee for Quality Assurance.

Measurements:

Six claims-based utilization measures, plus total health care expenditures. We employ hierarchical clustering to organize practices into groups based on their PCMH capabilities, then use generalized difference-in-differences models with practice or patient fixed effects to estimate the effect of PCMH recognition (overall and separately by the groups identified by the clustering algorithm) on utilization.

Results:

PCMH adoption was associated with a >8% reduction in total expenditures. We find significant reductions in emergency department utilization and outpatient care, and both lab and imaging services. In our by-group results we find that while the reduction in outpatient care is significant across all 3 groups, the reduction in emergency department utilization is driven entirely by 1 group with enhanced electronic communications.

Conclusion:

The PCMH model has significant impact on patterns of health care utilization, especially when heterogeneity in implementation is accounted for in program evaluation.
The J-IDEA Pandemic Planner
Authors: Christen Paula , D’Aeth Josh C. , Løchen Alessandra , McCabe Ruth , Rizmie Dheeya , Schmit Nora , Nayagam Shevanthi , Miraldo Marisa , Aylin Paul , Bottle Alex , Perez-Guzman Pablo N. , Donnelly Christl A. , Ghani Azra C. , Ferguson Neil M. , White Peter J. , Hauck Katharina
Published: January 2021

Background:

Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for coronavirus disease 2019 (COVID-19), while retaining capacity for other emergency conditions, is one of the most challenging tasks faced by health care providers and policymakers during the pandemic. Health systems must be well-prepared to cope with large and sudden changes in demand by implementing interventions to ensure adequate access to care. We developed the first planning tool for the COVID-19 pandemic to account for how hospital provision interventions (such as cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affect the capacity of hospitals to provide life-saving care.

Methods:

We conducted a review of interventions implemented or considered in 12 European countries in March to April 2020, an evaluation of their impact on capacity, and a review of key parameters in the care of COVID-19 patients. This information was used to develop a planner capable of estimating the impact of specific interventions on doctors, nurses, beds, and respiratory support equipment. We applied this to a scenario-based case study of 1 intervention, the set-up of field hospitals in England, under varying levels of COVID-19 patients.

Results:

The Abdul Latif Jameel Institute for Disease and Emergency Analytics pandemic planner is a hospital planning tool that allows hospital administrators, policymakers, and other decision-makers to calculate the amount of capacity in terms of beds, staff, and crucial medical equipment obtained by implementing the interventions. Flexible assumptions on baseline capacity, the number of hospitalizations, staff-to-beds ratios, and staff absences due to COVID-19 make the planner adaptable to multiple settings. The results of the case study show that while field hospitals alleviate the burden on the number of beds available, this intervention is futile unless the deficit of critical care nurses is addressed first.

Discussion:

The tool supports decision-makers in delivering a fast and effective response to the pandemic. The unique contribution of the planner is that it allows users to compare the impact of interventions that change some or all inputs.
Membranous nephropathy: current understanding of various causes in light of new target antigens
Authors: Ronco Pierre , Debiec Hanna
Published: January 2021

Purpose of review

Membranous nephropathy is an autoimmune disease caused by antibodies mostly directed to podocyte antigens. PLA2R and THSD7A antigens were described in 2009 and 2014 using classical immunochemical techniques. In the last 2 years, thanks to the combination of laser microdissection of glomeruli and mass spectrometry of solubilized digested proteins, several antigens associated with various causes have been described in patients with membranous nephropathy. The purpose of this review is to report on those “new” antigens and to analyse the clinicopathological correlations that make each of this antigen unique.

Recent findings

This article covers the literature of the last 2 years devoted to the description of those new antigens and biomarkers including NELL-1 and Semaphorin 3B in primary membranous nephropathy, and exostosins 1 and 2 and NCAM in lupus class V membranous nephropathy, which will be compared with the previously described antigens. These findings will lead to propose a new classification of membranous nephropathy based on serology and tissue antigen identification that could/should substitute for the classical distinction between primary and secondary membranous nephropathy.

The discovery of the latest antigens has major implications for the care of patients with membranous nephropathy as they drive the etiologic investigations and provide invaluable markers for treatment monitoring.
Compound Heterozygous Mutations in the F7 Gene in 2 Unrelated Families With Congenital Factor VII Deficiency
Authors: Ma Cui , Wang Yue , Gao Haidi , Xue Lu , Wu Shuangshuang , Xu Xijing , Zhang Huichao , Li Chunhuai
Published: January 2021

Factor VII (FVII) deficiency is a rare bleeding disorder normally caused by homozygous and compound heterozygous mutations in the F7 gene. Whole-exome sequencing was performed to identify F7 mutations in 3 individuals from 2 unrelated families who were diagnosed with FVII deficiency. Four compound heterozygous mutations were identified and validated in these 3 probands with FVII deficiency. Among the 4 identified mutations, NM_000131.4:c.572-1_581del, NM_000131.4:c.1250A>G (p.Tyr417Cys), and NM_000131.4:c.647G>T (p.Gly216Val) were novel. All 3 novel mutations were predicted to be likely pathogenic by the American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines.
Management of Hyperhemolysis in β-thalassemia With Multiple Immunosuppressives, Including Complement Blockade
Authors: Zanetti Richard C. , Vasta Lauren M. , Romanelli Kristen , Newton Thomas C.
Published: January 2021

Hyperhemolysis is a life-threatening condition of exaggerated hemolysis of red blood cells which occurs in patients receiving chronic transfusion therapy. We present a 19-year-old male with the β-thalassemia major with an episode of hyperhemolysis. Hemolysis was initially unresponsive to immunosuppression but responded after the addition of eculizumab. Several weeks after stabilization, hemolysis returned; which was also managed with immunosuppression and eculizumab. Hyperhemolysis presents significant challenges in β-thalassemia due to the underlying dysfunctional erythropoiesis and transfusion dependence. Aggressive immunosuppression combined with eculizumab successfully slowed the hemolysis and allowed for the resumption of transfusions.
Vision Outcomes for Pediatric Patients With Optic Pathway Gliomas Associated With Neurofibromatosis Type I: A Systematic Review of the Clinical Evidence
Authors: Thirunavu Vineeth M. , Mohammad Laila M. , Kandula Viswajit , Beestrum Molly , Lam Sandi K.
Published: January 2021

Children with neurofibromatosis type I (NF1) have a higher predisposition for low-grade astrocytomas of the optic pathway, commonly referred to as optic pathway gliomas (OPGs). OPGs can result in visual deterioration. Treatment outcomes in OPG-NF1 management are often reported around tumor stabilization. We sought to compare vision outcomes associated with different OPG treatment strategies to inform about this important functional metric. A meta-analysis exploring the different modalities to treat children with OPG-NF1 was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using multiple databases. Of the 113 articles identified in the search, 23 full text articles, representing 564 patients, were included for review. These articles included retrospective, prospective, and randomized controlled studies on observation (n=9), chemotherapy (n=19), radiation therapy (n=6), and surgery (n=7). Of the patients undergoing observation, 87% (60/69) demonstrated stable acuity. In the chemotherapy studies, 27.3% (72/264) demonstrated improved acuity/visual field and/or visual-evoked potential amplitudes, 39.4% (104/264) stable acuity, and 33.3% (88/264) deterioration. Both the radiation and surgical treatments reported worsening acuity at 90.9% (10/11) and 73.3% (11/15), respectively. Causal associations are not known. Indications for and timing of treatment choice warrant larger scale study to provide further understanding.
Anxiety Due to COVID-19 in Different Palliative Care Settings in Germany
Authors: Trianti Stavroula Myrto , Soßalla Lukas , Schmitzer Ina
Published: January 2021

Epidemics exert significant psychological impact. We conducted a survey in different palliative care settings focusing on anxiety caused by coronavirus disease 2019 (COVID-19). A questionnaire was given from April 1 through May 8, 2020, to 154 patients in 3 distinct populations: (1) hospice patients, (2) patients under ambulatory palliative care, (3) as controls, patients visiting a general practitioner (GP) practice. Items captured were age, anxiety caused by COVID-19 on a visual analog scale from 0 to 10, influence on everyday life, insomnia, and appetite loss. Palliative care patients were older than GP visitors (median [interquartile range], 72 [61-78] years in the hospice, 76 [67-83] years in ambulatory palliative care, and 62 [56-74] years in GP practice, P < .001). Anxiety scores were 0 (0-2) in the hospice, 3 (0-6) in ambulatory palliative care and 4.5 (2-6) in the GP practice (P = .004 for hospice vs GP practice, P = .177 for ambulatory palliative care vs GP practice). Age did not correlate with anxiety (P = .063). Anxiety-caused insomnia ranged from 0% to 12%. Patients' everyday life was influenced in 15% to 31% in the 3 groups (P = .480). Patients in ambulatory palliative care experienced comparable anxiety caused by COVID-19 with other patients, whereas anxiety was negligible in hospice patients. Addressing the psychological impact of the pandemic should be considered in management of palliative patients.
The Differential Diagnosis of Intrahepatic Ductular Reaction in Medical Liver Biopsy
Authors: Jain Richa , Clark Ian
Published: January 2021

Intrahepatic ductular reaction is a pathologic proliferation of phenotypical biliary channels. Ductular reactions aim to restore compromised physiological function after liver injury and are one of the archetypal responses of the liver to a wide variety of etiologies, among them are parenchymal loss, biliary tract disease, neoplasms, after liver transplantation, and several pediatric liver diseases. The types and extent of ductular reactions can vary, according to the etiological insult. In this review, the authors will first consider the different mechanisms for ductular reactions and their relevance for liver regeneration. After, the authors will discuss our approach to differential diagnosis for ductular reactions in different patient groups, taking into account clinical history and potential pitfalls. The authors provide an algorithmic approach for practicing pathologists and trainees when confronted by a ductular reaction in a liver biopsy.
Mindfulness-Based Intervention Effects on Substance Use and Relapse Among Women in Residential Treatment: A Randomized Controlled Trial With 8.5-Month Follow-Up Period From the Moment-by-Moment in Women’s Recovery Project
Authors: Amaro Hortensia , Black David S.
Published: January 2021

Objective

We tested the efficacy of Moment-by-Moment in Women’s Recovery (MMWR), a mindfulness training program adapted for ethnoculturally diverse women with complex social and clinical histories in residential treatment for substance use disorder, on substance use and relapse outcomes.

Methods

Participants were randomized to MMWR (n = 100; 60% Hispanic/Latina, 18% non-Hispanic Black) or the attention control condition, Neurobiology of Addiction (n = 100; 56% Hispanic/Latina, 21% non-Hispanic Black). Substance use outcomes (days until first use, days of use, and relapse status: abstained, lapsed, relapsed) were obtained from interviewer-assisted timeline followback for an 8.5-month follow-up period spanning the intervention start through the 6-week intervention period and 7 months after the intervention ended.

Results

An intent-to-treat survival analyses showed that time delay to first marijuana use favored MMWR (hazard ratio = 0.44, 95% confidence interval = 0.20–0.98, p = .049) with a medium-to-large effect size. In negative binomial hurdle models, the MMWR group showed fewer days of marijuana use at 3.5 months (B = −1.71, SE = 0.79, incidence rate ratio = 0.18, p = .030) and a trend at 7 months after the intervention (B = −0.90, standard error = 0.55, incidence rate ratio = 0.41, p = .10). For marijuana, mindfulness practice time during the intervention predicted time delay to first use (B = 0.28, p = .006) and total abstinence days (B = 0.34, p = .002) across the 7 months after MMWR. No other substance use outcomes showed differential response to MMWR relative to controls. Only in MMWR, number of study intervention sessions attended (dose) correlated with a greater length of time to alcohol intoxication (r = .48, p < .001), fewer days of alcohol intoxication (r = −.24, p = .020), and greater improvement in mindfulness skills (r = .61, p < .01).

Conclusions

MMWR added to an ongoing intensive residential treatment program serving vulnerable women is protective against marijuana use but no other substance use outcomes. Mindfulness practice time predicted a delay in time to first marijuana use. MMWR class attendance, an indicator of intervention dose, appears protective of alcohol intoxication at follow-up; thus, extended MMWR exposure might be useful.
Dispositional Mindfulness and Acute Heat Pain: Comparing Stimulus-Evoked Pain With Summary Pain Assessment
Authors: Mischkowski Dominik , Stavish Caitlin M. , Palacios-Barrios Esther E. , Banker Lauren A. , Dildine Troy C. , Atlas Lauren Y.
Published: January 2021

Objective

Dispositional mindfulness is associated with reduced pain in clinical and experimental settings. However, researchers have neglected the type of pain assessment, as dispositional mindfulness may have unique benefits for reduced pain sensitivity when relying on summary pain assessments, in contrast to assessing the pain of each noxious stimulus. Here, we test the association between dispositional mindfulness and pain using both trial-by-trial pain assessments and overall summary ratings after acute pain tasks.

Methods

One hundred thirty-one healthy adult volunteers (mean age = 29.09 [8.00] years, 55.7% female) underwent two experimental thermal pain paradigms. We tested whether dispositional mindfulness measured with the Mindful Attention Awareness Scale was related to a) heat-evoked pain sensitivity, as measured by pain threshold, pain tolerance, average pain, trial-by-trial ratings, and heat-evoked skin conductance response, and b) summary judgments of sensory and affective pain assessed using the McGill Pain Questionnaire (MPQ).

Results

Mindful Attention Awareness Scale ratings were associated with decreased pain on the MPQ sensory (B = −0.18, SE = 0.05, 95% confidence interval = −0.29 to −0.07, t = −3.28, p = .001) and affective (B = −0.11, SE = 0.03, 95% confidence interval = −0.18 to −0.05, t = −3.32, p = .001) dimensions but not with experimental thermal pain assessments, including threshold, tolerance, heat-evoked pain, or skin conductance response (p values ≥ .29).

Conclusions

In this study, dispositional mindfulness mitigated acute thermal pain only when pain was assessed using the MPQ. These findings may reflect differences in immediate versus retrospective judgments or the type of pain assessed by each measure. Future research should examine regulation processes that may explain these differential analgesic benefits, such as attention, rumination, or reappraisal.
The Daily Dose-Response Hypothesis of Mindfulness Meditation Practice: An Experience Sampling Study
Authors: Levi Karin , Shoham Adi , Amir Iftach , Bernstein Amit
Published: January 2021

Objective

Because of fast-growing interest in the applications of mindfulness to promote well-being and mental health, there are field-wide efforts to better understand how mindfulness training works and thereby to optimize its delivery. Key to these efforts is the role of home practice in mindfulness-based intervention (MBI) outcomes. Despite its centrality in MBIs, recent reviews have documented limited and mixed effects of home practice on MBI outcomes. However, methodological issues regarding monitoring and quantifying home practice and focus on cumulative or additive effects may limit our understanding of it. Temporally proximate, more transient, and contextually circumscribed effects of mindfulness mediation practice have not been examined.

Methods

We applied intensive experience sampling to measure daily practice and levels of targeted proximal outcomes (state mindfulness, decentering, emotional valance, and arousal) of training over the course of a 21-day MBI among a community-based sample of 82 meditation-naive adults.

Results

Despite intensive experience sampling, we found no evidence of cumulative or additive effects of total mindfulness meditation practice on outcomes at postintervention for mindfulness, decentering, emotional valence, or emotional arousal. However, we found that that daily dose of mindfulness meditation home practice significantly predicted same-day levels of state mindfulness (B = 0.004, SE = 0.001, t = 3.17, p = .000, f
2 = 0.24), decentering (B = 0.004, SE = 0.001, t = 2.757, p = .006, f
2 = 0.05), and emotional valence (B = 0.006, SE = 0.003, t = 2.015, p = .044, f
2 = 0.01) but not daily levels of emotional arousal. Daily dose-response practice effects did not carry over to next-day levels of monitored outcomes.

Conclusions

Findings show that effects of daily home mindfulness meditation practice dose on state mindfulness, decentering, and positive emotion are reliable but transient and time-limited. Findings are discussed with respect to the proposed daily dose-response hypothesis of mindfulness meditation practice.
Selecting Health Care Improvement Projects: A Methodology Integrating Cause-and-Effect Diagram and Analytical Hierarchy Process
Authors: Testik Özlem Müge , Shaygan Amir , Dasdemir Erdi , Soydan Guray
Published: January 2021

Objectives:

It is often vital to identify, prioritize, and select quality improvement projects in a hospital. Yet, a methodology, which utilizes experts' opinions with different points of view, is needed for better decision making.

Methods:

The proposed methodology utilizes the cause-and-effect diagram to identify improvement projects and construct a project hierarchy for a problem. The right improvement projects are then prioritized and selected using a weighting scheme of analytical hierarchy process by aggregating experts' opinions. An approach for collecting data from experts and a graphical display for summarizing the obtained information are also provided.

Results:

The methodology is implemented for improving a hospital appointment system. The top-ranked 2 major project categories for improvements were identified to be system- and accessibility-related causes (45%) and capacity-related causes (28%), respectively. For each of the major project category, subprojects were then ranked for selecting the improvement needs.

Conclusion:

The methodology is useful in cases where an aggregate decision based on experts' opinions is expected. Some suggestions for practical implementations are provided.