bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Decubitus Ulcer Disease Burden in European Union 15+ Countries, from 1990 to 2017
Authors: Goodall Richard , Armstrong Alexander , Hughes William , Fries Charles A. , Marshall Dominic , Harbinson Eleanor B. , Salciccioli Justin , Shalhoub Joseph
Published: January 2021

Background:

Decubitus ulcers (DU) are a common pathology with significant morbidity and financial implications for health services globally. This study aimed to compare the burden of DU across European Union (EU) 15+ countries between 1990 and 2017.

Methods:

Age-standardized incidence, mortality, and disability-adjusted life-years (DALYs) rates per 100,000 were extracted from the Global Burden of Disease Study online data repository for EU15+ countries (a group of 19 countries with comparable health expenditure, including the United States, Canada, the United Kingdom, and Australia). A joinpoint regression analysis was used to describe trends.

Results:

The incidence of DU increased between 1990 and 2017 in 15 of 19 EU15+ countries for both men and women. Mortality from DU decreased over the time period analyzed in the majority of EU15+ countries: only in Denmark, Finland, and Germany were increasing mortality rates observed. Decreasing DALY rates were generally observed, with the largest decreases observed in Ireland for men and women. Denmark and Germany were the only countries to demonstrate unfavorable trends in mortality, incidence, and DALYs between 1990 and 2017 for men and women. The United States, the Netherlands, and France were the only EU15+ countries in which improving disease burden was identified between 1990 and 2017 for all parameters assessed.

Conclusions:

Incidence of DU is increasing in EU15+ countries, whereas mortality rates and DALYs are improving. The trends in disease burden in Denmark and Germany have followed contrasting and unfavorable trends. Investigation into these trends is called for.
A Protocol for Safe Head and Neck Reconstructive Surgery in the COVID-19 Pandemic
Authors: Wong Stacy , Payton Jesse I. , Lombana Nicholas F. , Hanasono Matthew M. , Lee Gordon K. , Saint-Cyr Michel , Altman Andrew M. , Brooke Sebastian M.
Published: January 2021

The COVID-19 pandemic has had significant implications for citizens globally and for the healthcare system, including plastic surgeons. Operations of the upper aerodigestive tract, including head and neck reconstruction and craniomaxillofacial procedures, are of particularly high risk because they may aerosolize the virus and lead to severe surgeon and surgical team illness. Until the virus is eradicated or widespread vaccination occurs, we recommend certain precautions to safely perform these operations. We propose evolving algorithms for head and neck reconstruction and facial trauma surgeries to maintain provider safety. Central to these guidelines are preoperative COVID-19 testing, appropriate personal protective equipment, and operative techniques/principles that minimize operative time and aerosolization of the virus. We aim to provide efficient care to our patients throughout this pandemic, while maintaining the safety of plastic surgeons and other healthcare providers.
The Use of Local Perforator Flaps in Delayed or Secondary Breast Reconstruction
Authors: Quinn Edel Marie , O’Ceallaigh Siobhan , Highton Lyndsey , Murphy John
Published: January 2021

Local perforator flaps are used as immediate volume replacement techniques in breast conserving surgery. Here, we describe a case series of local perforator flaps used in the delayed setting to correct defects following previous breast surgery, including previous breast conservation surgery or mastectomy with reconstruction. All cases were performed in a tertiary referral breast unit between 2014 and 2020. Cases were identified using a prospectively maintained database. Indications, type of perforator flap used, immediate post-operative complications, and longer term outcomes were recorded. Fifteen cases were identified: 8 following previous breast conserving surgery and radiotherapy, 6 following mastectomy and reconstruction, and 1 for developmental breast asymmetry following childhood radiotherapy. Indications included volume deficit, contour defect, asymmetry, and capsular contracture. One patient a major complication requiring return to theater due to implant-related infection. There were no flap losses. Longer term, 2 patients underwent lipomodeling to further augment breast volume as part of a planned, staged revision. One patient subsequently elected to have bilateral breast implant exchange to increase volume. Our series shows the versatility of local perforator flaps in the correction of complex breast defects that can occur following previous breast surgery. Delayed local perforator flaps are associated with low morbidity, and further revision surgery is not commonly required.
The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania
Authors: Holler Jordan T. , MacKechnie Madeline C. , Albright Patrick D. , Morshed Saam , Shearer David W. , Terry Michael J.
Published: January 2021

Background:

Managing lower extremity fractures complicated by large soft-tissue defects is challenging for surgeons in low- and middle-income countries, and long-term quality of life (QOL) for these patients is unclear.

Methods:

We examined QOL, surgical complications, and longitudinal outcomes in 10 patients with Gustilo-Anderson Classification Type IIIB open tibia fractures seen at an orthopedic institute in Tanzania, from December 2015 to March 2017. Patients completed follow-up at 2-, 6-, 12-, 26-, and 52-week time points, and returned for qualitative interviews at 2.5 years. The primary outcome was QOL, as measured using EuroQoL-5D scores and qualitative semi-structured interview responses. The secondary outcome was rate of complication, as defined by reoperation for deep infection or nonunion.

Results:

Ten patients enrolled in the study and 7 completed 1-year follow-up. All fractures were caused by road traffic accidents and treated by external fixation. No patients received initial soft-tissue (flap) coverage of the wound. All patients developed an infected nonunion. No patients returned to work at 6 weeks, 3 months, or 6 months. EQ-5D index scores at 1 year were poor (0.71 ± 0.09). Interview themes included ongoing medical complications, loss of employment, reduced income, and difficulty with activities of daily living.

Conclusions:

Patients in low- and middle-income countries with IIIB open tibia fractures not treated with appropriate soft-tissue coverage experience poor QOL, high complication rates, and severe socioeconomic effects as a result of their injuries. These findings illustrate the need for resources and training to build capacity for extremity soft-tissue reconstruction in LMICs.
Use of the Profunda Femoris Artery Perforator Flap for Reconstruction after Sarcoma Resection
Authors: Karakawa Ryo , Yoshimatsu Hidehiko , Maeda Erisa , Shibata Tomoyoshi , Tanakura Kenta , Kuramoto Yukiko , Miyashita Hiroki , Yano Tomoyuki
Published: January 2021

Background:

Soft tissue sarcomas are rare neoplasms that can occur on any part of the body. The operative position for the resection is determined depending on the site of the soft tissue sarcomas; intraoperative repositioning may be needed for reconstruction. We present the profunda femoris artery perforator (PAP) flap harvest technique (wherein the flap can be used in any position), and suggest that the PAP flap transfer can eliminate the need for intraoperative repositioning.

Methods:

From December 2018 to January 2020, 7 patients with an average age of 68 years underwent reconstructions using a PAP flap after wide resection of STS. The mean defect size was 11.3 × 16.5 cm (range, 5.5–25 × 11–26 cm). The location of the defects was the medial thigh in 2 patients, the posterior thigh in 1, the popliteal fossa in 1, the groin in 1, and the buttock in 2. The PAP flap was elevated in the supine “frog-leg” position, the prone position, the jack-knife position, or the lateral “crisscross” position; the lateral decubitus position with the donor lower extremity on the bottom.

Results:

Of the 7 cases, the operations were performed in the supine “frog-leg” position in 3 cases, the prone position in 2 cases, the jack-knife position in 1 case, and the lateral “crisscross” position in 1 case. There were no intraoperative position changes in all cases. The mean size of the PAP flap was 8.7 × 19.9 cm (range, 6–11 × 17–24 cm). One patient had donor site dehiscence, which was treated conservatively. The PAP flaps survived completely in all cases. The mean follow-up period was 10.5 months (range, 6–17 months).

Conclusion:

Since the PAP flap elevation is feasible in every position, the PAP flap can be considered a versatile reconstruction option after sarcoma resection.
Full-thickness Skin Micro-columns within a Dermal Matrix: A Novel Method for “Donor-free” Skin Replacement
Authors: Cooper Laura , Gronet Edward , Carlsson Anders , Chan Rodney
Published: January 2021

Split-thickness skin graft has been the standard in the coverage of large full-thickness skin defects. However, donor sites can be associated with significant pain and scarring. Further, the recipient sites frequently lack some basic skin functions, such as temperature regulation, uniform texture, appropriate color, normal pliability, elasticity, and lubrication. Full-thickness skin grafts, while able to more adequately recapitulate skin function, have even greater donor site requirements. Implantation of full-thickness skin micro-columns is a relatively novel concept in which the skin is harvested orthogonally rather than tangentially. These micro-columns contain elements of full-thickness skin grafts, including reticular dermal fibroblasts, hair follicles, skin adnexa, and adipose tissue—all elements that contribute to skin function. Notably, it has been shown that the diameter of the skin micro-columns determine donor site morbidity; however, in most cases, full-thickness skin micro-column harvest results in a trivial donor site far less invasive or morbid than a traditional full-thickness skin graft or split-thickness skin graft harvest. Here, we present 2 cases in which full-thickness skin micro-columns were harvested and implanted into a bilayer dermal regeneration matrix (Integra) to achieve durable single-stage skin replacement with practically no donor site morbidity.
Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction
Authors: Jones Stacey J. , Turton Philip , Achuthan Rajgopal , Hogan Brian V. , Mckenzie Shireen N. , Kim Baek
Published: January 2021

Background:

This study sets out to compare reconstructive practice between patients undergoing immediate breast reconstruction (IBR) for cancer and those who opted for risk reduction (RR), with an emphasis on examining patterns of secondary surgery.

Methods:

Data collection was performed for patients undergoing mastectomy and IBR at a teaching hospital breast unit (2013–2016).

Results:

In total, 299 patients underwent IBR (76% cancer versus 24% RR). Implant-based IBR rate was similar in both groups (58% cancer versus 63% RR). Reconstruction loss (5.3% cancer versus 4.2% RR) and complication (16% cancer versus 12.9% RR) rates were similar. Cancer patients were more likely to undergo secondary surgery (68.4% versus 56.3%; P = 0.025), including contralateral symmetrization (22.8% versus 0%) and conversion to autologous reconstruction (5.7% versus 1.4%). Secondary surgeries were mostly planned for cancer patients (72% planned versus 28% unplanned), with rates unaffected by adjuvant therapies. This distribution was different in RR patients (51.3% planned versus 48.7% unplanned). The commonest secondary procedure was lipomodeling (19.7% cancer versus 23.9% RR). For cancer patients, complications resulted in a significantly higher unplanned secondary surgery rate (82.5% versus 38.8%; P = 0.001) than patients without complications. This was not evident in the RR patients, where complications did not lead to a significantly higher unplanned surgery rate (58.9% versus 35.2%; P = 0.086).

Conclusions:

Most of the secondary surgeries were planned for cancer patients. However, complications led to a significantly higher rate of unplanned secondary surgery. Approximately 1 in 4 RR patients received unplanned secondary surgery, which may be driven by the desire to achieve an optimal aesthetic outcome.
Successful Ocular Surface Reconstruction in Complete Ankyloblepharon With the Simple Oral Mucosal Epithelial Transplantation Technique: A Case Report
Authors: Ngowyutagon Panotsom , Prabhasawat Pinnita , Chirapapaisan Chareenun , Jaru-ampornpan Pimkwan , Pornpanich Kanograt , Ekpo Pattama , Sukon Nutchaya , Matamnan Sutthicha
Published: January 2021

Purpose:

To report an outcome of a patient with complete ankyloblepharon successfully managed with simple oral mucosal epithelial transplantation (SOMET).

Methods:

A 55-year-old woman presented with complete adhesion of both lids to the ocular surface as a complication from Stevens-Johnson syndrome. We performed 2-staged reconstructive surgeries: the first stage was to perform ankyloblepharon lysis and surface reconstruction with a mucosal graft on the palpebral area and an amniotic membrane on the bulbar area, and the second stage was to reconstruct the bulbar area with a transplantation of small pieces of oral mucosa (SOMET technique). Postoperatively, the patient was evaluated for ocular surface stability, recurrent symblepharon, in vivo confocal microscopy, and impression cytology with immunofluorescence staining.

Results:

Complete epithelialization of cornea-like epithelium was observed within 6 weeks after SOMET was performed. The ocular surface was stable over 1 year. Both fornices remained deep. In vivo confocal microscopy showed cornea-like epithelium mixed with conjunctival epithelium, as confirmed with immunofluorescence staining, which revealed cytokeratin 3, cytokeratin 7, and cytokeratin 12 positivity.

Conclusions:

SOMET is a simple modified technique using minimal oral mucosal tissue to regenerate epithelialization for complicated ocular surface reconstruction such as a complete ankyloblepharon repair. Although there was evidence of conjunctival invasion, stable ocular surface and deep fornices can be achieved for further visual rehabilitative procedure.
Prevalence of SARS-CoV-2-Antibodies in Danish Children and Adults
Authors: Rytter Maren J. H. , Nygaard Ulrikka , Mandic Ida Nikoline , Glenthøj Jonathan Peter , Schmidt Lisbeth Samsø , Cortes Dina , Smith Birgitte , Zaharov Tatjana , Søndergaard Mia Johanna , Lawaetz Marie Cecilie , Saekmose Susanne , Jensen Lise Heilmann , Schmiegelow Kjeld , Kristensen Kim
Published: January 2021

In Denmark, severe acute respiratory syndrome coronavirus 2 antibodies were assessed in a cross-sectional study among 1033 children visiting pediatric departments and 750 blood donors in June 2020, using a point-of-care test. Antibodies were detected in 17 children (1.6%) and 15 blood donors (2.0%) (P = 0.58). In conclusion, children and adults were infected to a similar low degree.
Severe Pediatric Mycoplasma pneumoniae Infection Requiring Veno-venous Extracorporeal Membrane Oxygenation
Authors: Davis Joshua , Ericson Jessica E. , Kavanagh Robert
Published: January 2021

Mycoplasma pneumoniae (MP) is an atypical bacterial pathogen that typically causes mild respiratory symptoms. Rarely, MP is associated with acute respiratory distress syndrome, a condition marked by widespread inflammation in the lungs that often requires invasive support. We report a case of severe acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation in an otherwise healthy adolescent because of MP.
Cutaneous Manifestations and Treatment Advances of Adult T-Cell Leukemia/Lymphoma
Authors: Zhang Ying , Chen Hao , Sun Jian-Fang
Published: January 2021

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive peripheral T-cell lymphoma caused by the human T lymphotropic virus type-1. The skin is affected in approximately half of ATLL patients, and skin lesions may be the first manifestation of the disease. The skin lesions of ATLL are polymorphous, and depend on the type of skin eruption, which makes it possible for doctors to predict the prognosis of the disease based on the characteristics of skin lesions. In this review article, we describe the clinical manifestations and histopathological patterns of skin lesions in ATLL, focus on its diagnostic and prognostic significance, and also summarize the advances in the treatment of ATLL.
The Impact of Hospital and Health System Leadership Development Practices on Bond Ratings
Authors: Garland Nicholas , Garman Andrew N. , O’Neil Patricia S. , Canar W. Jeffrey
Published: January 2021

EXECUTIVE SUMMARY

Shifts in healthcare policy, patient consumerism, and organizational consolidation are driving the need for hospitals and health systems to adapt if they are to achieve sustainability. Prior research has suggested that businesses with strong leadership development practices also demonstrate greater financial success and competitive performance. However, few studies have examined the impact of leadership development on organization-level outcomes, generally, or in the healthcare industry, specifically.

Our goal in this study was to examine the association between organizational leadership development practices and external perceptions of creditworthiness in the form of bond ratings. Data were drawn from the 2014 and 2016 distributions of the National Center for Healthcare Leadership’s National Health Leadership Survey; organizational credit ratings were obtained from Moody’s Investors Service and S&P Global Solutions. Spearman’s rho correlations and polynomial ranked regressions were used to determine the significance of the relationships between leadership development practices and bond ratings. Results provide preliminary evidence of associations between investing in leadership development and organizational creditworthiness. They also suggest, however, that the most financially successful health systems may de-emphasize certain kinds of leadership development practices relative to their peers. We discuss implications of these findings for organizational leaders investing in human capital as well as healthcare executives evaluating the development potential of prospective employers.
Focusing Research Efforts on the Unique Needs of Women Prosthesis Users
Authors: Major Matthew J. , Hansen Andrew H. , Russell Esposito Elizabeth
Published: January 2021

Introduction

Women with lower-limb loss represent a relevant and growing patient cohort with unique rehabilitation needs. These needs are emphasized in a growing body of literature and the most recent Veteran Affairs/Department of Defense clinical practice guidelines.

Prosthetics Challenges

Women with limb loss experience greater dissatisfaction with prosthetic fit, appearance, and types of footwear they can use. There is a lack of prosthetics solutions to accommodate the desire of women to wear different footwear varieties, including high heels. The choice to wear a variety of footwear is important to attire and hence community participation. Despite these recognized challenges, women are still underserved in prosthetics research, which limits available information to guide the rehabilitation process.

Research Initiatives

This narrative review describes considerations of lower-limb prosthesis prescription and use by women, and examples of current research to address these topics. Research efforts are beginning to explore factors that contribute to prosthetics prescription for women and to design creative prosthetics solutions to expand the range of available footwear options. Research is still needed to characterize the types of footwear women with limb loss prefer to use, and the effects of prosthesis designs, footwear, and lower-limb loss on women mobility outcomes and community participation.

Conclusions

Through targeted research initiatives, scientists and clinicians can be responsive to the specific needs of women to provide evidence-based guidelines for prosthetics prescription and improve the patient-centered care after limb loss.
Students' Perceptions of a New Doctor of Physical Therapy Curriculum Based on Constructivism and Cognitive Load Theories: A Qualitative Study
Authors: Macauley Kelly , Jette Diane U. , Brudvig Tracy J. , Callahan Janet , Levangie Pamela K.
Published: January 2021

Introduction.

In 2016, faculty at the MGH Institute of Health Professions implemented a new Doctor of Physical Therapy (DPT) curriculum based on constructivist and cognitive load theories. There is recognition that faculty too often overlook the importance of students' perceptions on the effectiveness of teaching methodologies and that student “buy-in” is particularly pivotal in curricula based on contemporary learning theories. Thus, students' perceptions have become a focus in the higher education research literature. The purpose of this article is to explore the perceptions of the first cohort of DPT students in our new curriculum across their academic studies.

Participants.

Nineteen of 70 students from the first cohort of our new curriculum participated in 1 of the 3 focus groups in year 1 (round 1) and 1 of the 2 focus groups in year 2 (round 2), with 4 students participating in both rounds.

Methods.

Qualitative thematic analysis was used to identify, summarize, and interpret students' perceptions regarding their experiences in this new curriculum.

Results.

Six themes emerging from round 1 were class preparation; plusses and minuses of group learning; usefulness of assessments; managing faculty/course differences; finding life balance; and student performance outcomes. A seventh theme emerged from round 2, namely, evolving and adapting approaches to learning.

Discussion and Conclusion.

Themes and subthemes are discussed in the context of other studies on students' perceptions of courses and curricula applying contemporary learning theories in higher education. Some of the themes emerging from our study are not unique to DPT curricula based on constructivist theories. However, our findings reflect both positive aspects of such approaches from the students' viewpoints and challenges that should be considered in supporting student engagement when designing or modifying such curricula. Findings may inform DPT programs considering similar curricular shifts toward contemporary learning practices, facilitating program curricular planning and transition processes.
Artificial intelligence to guide management of acute kidney injury in the ICU: a narrative review
Authors: De Vlieger Greet , Kashani Kianoush , Meyfroidt Geert
Published: January 2021

Purpose of review

Acute kidney injury (AKI) frequently complicates hospital admission, especially in the ICU or after major surgery, and is associated with high morbidity and mortality. The risk of developing AKI depends on the presence of preexisting comorbidities and the cause of the current disease. Besides, many other parameters affect the kidney function, such as the state of other vital organs, the host response, and the initiated treatment. Advancements in the field of informatics have led to the opportunity to store and utilize the patient-related data to train and validate models to detect specific patterns and, as such, predict disease states or outcomes.

Recent findings

Machine-learning techniques have also been applied to predict AKI, as well as the patients’ outcomes related to their AKI, such as mortality or the need for kidney replacement therapy. Several models have recently been developed, but only a few of them have been validated in external cohorts.

In this article, we provide an overview of the machine-learning prediction models for AKI and its outcomes in critically ill patients and individuals undergoing major surgery. We also discuss the pitfalls and the opportunities related to the implementation of these models in clinical practices.
Precision renal replacement therapy
Authors: Ricci Zaccaria , Tolwani Ashita , Lumlertgul Nuttha
Published: January 2021

Purpose of review

This article reviews the current evidence supporting the use of precision medicine in the delivery of acute renal replacement therapy (RRT) to critically ill patients, focusing on timing, solute control, anticoagulation and technologic innovation.

Recent findings

Precision medicine is most applicable to the timing of RRT in critically ill patients. As recent randomized controlled trials have failed to provide consensus on when to initiate acute RRT, the decision to start acute RRT should be based on individual patient clinical characteristics (e.g. severity of the disease, evolution of clinical parameters) and logistic considerations (e.g. organizational issues, availability of machines and disposables). The delivery of a dynamic dialytic dose is another application of precision medicine, as patients may require different and varying dialysis doses depending on individual patient factors and clinical course. Although regional citrate anticoagulation (RCA) is recommended as first-line anticoagulation for continuous RRT, modifications to RCA protocols and consideration of other anticoagulants should be individualized to the patient's clinical condition. Finally, the evolution of RRT technology has improved precision in dialysis delivery through increased machine accuracy, connectivity to the electronic medical record and automated reduction of downtime.

RRT has become a complex treatment for critically ill patients, which allows for the prescription to be precisely tailored to the different clinical requirements.
How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage
Authors: Rass Verena , Helbok Raimund
Published: January 2021

Purpose of review

Delayed cerebral ischaemia (DCI) complicates the clinical course of patients with subarachnoid haemorrhage (SAH) in 20--30% and substantially worsens outcome. In this review, we describe a multimodal diagnostic approach based on underlying mechanisms of DCI and provide treatment options with a special focus on the most recently published literature.

Recent findings

Symptomatic vasospasm refers to clinical deterioration in the presence of vasospasm whereas DCI constitutes multiple causes. Pathophysiologic mechanisms underlying DCI range beyond large vessel vasospasm from neuroinflammation, to microthromboembolism, impaired cerebral autoregulation, cortical spreading depolarizations and many others. The current definition of DCI can be challenged by these mechanisms. We propose a pragmatic approach using a combination of clinical examination, cerebral ultrasonography, neuroimaging modalities and multimodal neuromonitoring to trigger therapeutic interventions in the presence of DCI. In addition to prophylactic nimodipine and management principles to improve oxygen delivery and decrease the brain metabolic demand, other specific interventions include permissive hypertension, intra-arterial application of calcium channel blockers and in selected patients angioplasty.

The complex pathophysiology underlying DCI urges for a multimodal diagnostic approach triggering targeted interventions. Novel treatment concepts still have to be proven in large trials.
Protocol liver biopsies in stable long-term pediatric liver transplant recipients: risk or benefit?
Authors: Ohlsson Sinja , Kathemann Simone , Pilic Denisa , Prusinskas Benas , Baba Hideo Andreas , Theurer Sarah , Dechene Alexander , Paul Andreas , Heinold Andreas , Hoyer Peter Friedrich , Lainka Elke
Published: January 2021

Background

Follow-up after pediatric liver transplantation (LTX) is challenging and needs to be refined to extend graft survival as well as general functional health and patients´ quality of life. Strategies towards individual immunosuppressive therapy seem to play a key role. Our aim was to evaluate protocol liver biopsies (PLB) as a tool in personalized follow up after pediatric LTX.

Patients and methods

Our retrospective analysis evaluates 92 PLB in clinically asymptomatic pediatric patients after LTX between 2009 and 2019. Histological findings were characterized using the Desmet scoring system. In addition to PLB, other follow-up tools like laboratory parameters, ultrasound imaging and transient elastography were evaluated. Risk factors for development of fibrosis or inflammation were analyzed.

Results

PLB revealed a high prevalence of graft fibrosis (67.4%) and graft inflammation (47.8%). Graft inflammation was significantly (P = 0.0353*) more frequent within the first 5 years after transplantation compared to later time points. Besides conventional ultrasound, the measurement of liver stiffness using transient elastography correlate with stage of fibrosis (r = 0.567, P = <0.0001***). Presence of donor-specific anti-human leukocyte antigen antibodies in blood correlates with grade of inflammation in PLB (r = 0.6040, P = 0.0018 **). None of the patients who underwent PLB suffered from intervention-related complications. Histopathological results had an impact on clinical decision making in one-third of all patients after PLB.

Conclusion

PLB are a safe and useful tool to detect silent immune-mediated allograft injuries in the context of normal liver parameters.
Thirty-day readmission rates, reasons, and costs for gastrointestinal angiodysplasia-related bleeding in the USA
Authors: Khan Ahmad , Gupta Kamesh , Chowdry Monica , Sharma Sachit , Maheshwari Sanjay , Patel Chirag , Naseem Khadija , Pervez Hira , Bilal Mohammad , Ali Khan Muhammad , Singh Shailendra
Published: January 2021

Background

Patients with gastrointestinal angiodysplasia (GIA)-related bleeding are at high risk for readmissions, resulting in significant morbidity and an economic burden on the healthcare system.

Aim

The aim of the study was to determine the 30-day readmission rate with reasons, predictors, and costs associated with GIA-related bleeding in the USA.

Methods

We queried the National Readmission Database to identify patients hospitalized with GIA-related bleeding in the year 2016 using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Primary outcomes included the 30-day readmission rate, and secondary outcomes were in-hospital mortality and resource utilization for index and re-hospitalizations. We also performed univariate and multivariate cox regression analysis to identify predictors of readmissions.

Results

A total of 25 079 index hospitalizations for GIA-related bleeding were identified in 2016. Out of these, 5047 (20.34%) patients got readmitted within the next 30 days. The most common diagnosis associated with readmissions were related to recurrent gastrointestinal bleeding. Readmissions compared to index hospitalization has significantly higher length of stay (5.38 vs. 5.11 days, P = 0.03), but mean hospitalization charges ($52 114 vs. $49 691, P = 0.11) and mean total hospitalization costs ($12 870 vs. $12 405, P = 0.16) were similar. Patients with multiple co-morbidities, length of stay >5 days, and end-stage renal disease were found to be independent predictors for 30-day readmissions.

Conclusion

Our study shows that one in five patients hospitalized with GIA-related bleeding was readmitted within 30 days of index hospitalization, placing a heavy economic burden on the healthcare system. Further research identifying strategies to reduce readmissions in these patients is needed.
Aminotransferase-to-platelet ratio index and Fibrosis-4 index score predict hepatic fibrosis evaluated by transient hepatic elastography in hepatitis C virus-infected hemodialysis patients
Authors: Pestana Nathalia F. , Equi Claudia M.A. , Gomes Carlos P. , Cardoso Ana C. , Zumack João P. , Villela-Nogueira Cristiane A. , Perez Renata M.
Published: January 2021

Objective

This study aimed to evaluate the performance of aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) in chronic kidney disease stage 5D HCV-infected patients compared to transient hepatic elastography (TE) as the gold standard.

Methods

Hemodialysis HCV-infected patients submitted to TE (FibroScan, Echosens, Paris, France) had APRI and FIB-4 calculated. Based on the best area under receiver operating characteristic curve (AUROC) for significant fibrosis and cirrhosis, APRI and FIB-4 cutoffs were determined and their performances were compared.

Results

Seventy patients were included. Both APRI and FIB-4 showed good performance for identifying significant fibrosis [AUROC = 0.73, 95% confidence interval (CI) 0.61–0.83 and 0.79, 95% CI 0.68–0.88; P < 0.05] and cirrhosis [AUROC = 0.82, 95% CI 0.71–0.90 and 0.85, 95% CI 0.75–0.93; P < 0.05]. APRI ≤ 0.25 excluded significant fibrosis with negative predictive value (NPV) of 81.8% and APRI > 0.61 confirmed it with a positive predictive value (PPV) of 81.8%. Similarly, NPV for FIB-4 ≤ 0.60 regarding significant fibrosis was 90.9%. NPV for cirrhosis for APRI ≤ 0.42 or FIB-4 ≤ 1.40 was 97%. However, APRI > 0.73 or FIB-4 > 2.22 showed a modest PPV of 60 and 70% to confirm cirrhosis, respectively.

Conclusion

APRI and FIB-4 are simple, non-expensive scoring systems with good accuracy to assess fibrosis in HCV-infected hemodialysis patients, mainly excluding both significant fibrosis or cirrhosis and may be an alternative to TE in the evaluation of this population.
Evaluating the Impact of Glucagon-Like Peptide-1 Receptor Agonists on Metabolic Changes in Patients With Type 2 Diabetes on High-Dose Insulin
Authors: Rentsch Tiffany , Awad Magdi , Moorman John M. , Gothard Michael David
Published: January 2021

Background:

Studies involving the glucagon-like peptide-1 receptor agonist (GLP-1 RA) liraglutide have shown reductions in hemoglobin A1c (HbA1c), weight, and insulin requirements in patients with type 2 diabetes mellitus (DM2) requiring high-dose insulin therapy. The effect of the class of GLP-1 RAs on these parameters is unknown.

Data Sources:

A retrospective cohort analysis was conducted in patients with DM2 where a GLP-1 RA was added to high-dose insulin therapy. The primary composite outcome was the change from baseline to 9 months in HbA1c, weight, and insulin dose.

Results:

GLP-1 RA therapy was associated with a significant reduction in HbA1c from baseline (−0.9%; P = 0.022). Weight and insulin dose were not significantly reduced from baseline. There was a moderate effect of individual agents on these outcomes, but no significant reductions were seen due to the small sample size.

Limitations:

Generalizability of these findings may be limited by the characteristics and size of the study population.

Therapeutic Opinion:

The effect of GLP-1 RA therapy on HbA1c may be attributed to the medication class. The effect of individual agents on weight and insulin requirements needs further investigation.
Development of a Suicide Prevention Toolkit for VA Home-Based Primary Care Teams
Authors: Mlinac Michelle E. , Smith Ronald W. , Siffert Kevin J. , Richter Luis C. , Steadman-Wood Pamela L. , Wetherell Julie L.
Published: January 2021

The U.S. Department of Veterans Affairs Home-Based Primary Care program (HBPC) serves Veterans with multiple comorbid physical and psychological conditions that can increase suicide risk. HBPC teams are uniquely able to implement suicide risk assessment and prevention practices, and the team's mental health provider often trains other team members. An online suicide prevention toolkit was developed for HBPC mental health providers and their teams as part of a quality improvement project. Toolkit development was guided by a needs assessment consisting of first focus group and then data from surveys of HBPC program directors (n = 53) and HBPC mental health providers (n = 56). Needs identified by both groups included training specific to the HBPC patient population and more resources if mental health needs could not be fully managed by the HBPC team. HBPC mental health providers within integrated care teams play a key role in clinical intervention, policy development, and interprofessional team education on suicide prevention. HBPC teams have specific learning and support needs around suicide prevention that can be addressed with a feasible, easily accessible clinical and training resource.
Atrial Fibrillation
Authors: Jacek Grace A.
Published: January 2021

Atrial fibrillation is a common cardiac arrhythmia in which the atria of the heart do not beat synchronously with the ventricles. It affects 2.7 to 6.1 million people in the United States. The erratic beating of the atria can cause blood clots to form in the atria, and if released into the circulation, an embolism can travel to the brain, causing a stroke. The primary goals of care for the management of atrial fibrillation are stroke-risk reduction, control of heart rate, rhythm management, and prevention of cardiac-related morbidity and mortality. This article reviews the guideline for the management of patients with atrial fibrillation by the American College of Cardiology and American Heart Association Task Force on Clinical Practice Guidelines and provides recommendations for home healthcare clinicians.
Quality of Life, Resilience, and Related Factors of Nursing Students During the COVID-19 Pandemic
Authors: Keener Tina Antill , Hall Katherine , Wang Kesheng , Hulsey Tara , Piamjariyakul Ubolrat
Published: January 2021

Background

COVID-19 and the associated measures to mitigate the spread of the virus have significantly disrupted nursing education.

Purpose

The purpose of this study was to examine the relationship between quality of life (QoL), resilience, and associated factors among nursing students during the unprecedented COVID-19 pandemic and subsequent social distancing requirements.

Methods

A cross-sectional study using an anonymous survey with nursing students (n = 152) was conducted at a public university in rural Appalachia in April 2020. Instruments included World Health Organization Quality of Life-BREF, Connor Davidson Resilience Scale, demographics and school-related questionnaires, and an open-ended question. Data were analyzed using descriptive, bivariate, and multiple linear regression analyses.

Results

Resilience, having online experience, and being well prepared for online learning were associated with each QoL domain. Remarkably, 21% to 54% of nursing student QoL scores indicated poor QoL.

Conclusions

Cultivating resilience among nursing students may improve QoL, help with academic success, and prepare students to sustain the demands associated with the nursing profession.
Do Pediatric Emergency Physicians Comply With Guideline Recommendations in Management of Patients With Acute Urticaria?
Authors: Yiğit Ramazan Emre , Cavkaytar Ozlem , Besli Gulser Esen , Arga Mustafa
Published: January 2021

Objectives

To determine the level of knowledge and practical preferences of pediatricians regarding acute urticaria (AU) management and to assess the effects of training provided in accordance with the current urticaria guideline recommendations on pediatricians who work in the pediatric emergency department (PED).

Methods

A theoretical training was provided to pediatricians regarding the diagnosis and treatment of AU in line with current urticaria guideline recommendations. Before the training, pediatricians completed a 10-item questionnaire. This prospective study assesses their treatment approaches in patients admitted to PED because of AU during the 6-month period before and the 1-year period after training.

Results

Four hundred seventeen children in the pretraining and 1085 children in the posttraining periods were treated for AU in PED. Forty-eight pediatricians participated in the training. According to their questionnaire responses, 35% of them used only H1 antihistamine (AH) treatment, 50% used second-generation H1 AH (2nd-GAH) as AHs, 75% preferred the oral route of administration, and 85.4% did not administer systemic corticosteroid (sCS) to all patients. Comparing the practice approaches of the pediatricians in the pretraining and posttraining periods, first-generation H1 antihistamine (1st-GAH) preference rate decreased from 68.4% to 30.3% and the sCS preference rate decreased from 58.5% to 25.7%, while the 2nd-GAH preference rate increased from 31.7% to 69.7% (P < 0.001 for all). No treatments were prescribed for 10.8% of patients before the training and 3% after the training during discharge at home (P < 0.05). Comparing the home treatment choices of the pediatricians in the pretraining and posttraining periods, 1st-GAH preference rate decreased from 11.5% to 5%, while the 2nd-GAH preference rate increased from 78.7% to 91.5% (for both parameters, P < 0.001).

Conclusions

Practical treatment preferences of pediatricians in the treatment of children with AU differ considerably from both current guideline recommendations and their own theoretical knowledge, and training can enhance pediatricians' compliance with current guideline recommendations.
Physical Therapy Management of Wiedemann-Steiner Syndrome From Birth to 3 Years
Authors: Mendoza Carmel
Published: January 2021

Purpose:

To investigate Wiedemann-Steiner syndrome (WSS), its correlation to hypotonia and developmental delay, and to determine the relative intervention strategies that may be useful during early intervention from birth to 3 years.

Methods:

A literature search using PEDro and PubMed was conducted using key words “Wiedemann-Steiner syndrome,” “hypotonia,” and “developmental delay” and a case study is presented.

Results:

A 36-month-old child with WSS received PT intervention beginning at 2 months old. Addition of orthotics and treadmill walking was added at 13 and 19 months, respectively. The child progressed through developmental sequences from rolling, sitting, standing, and walking although consistently scored with motor delay of −2 SD.

Conclusions:

Fifty-seven percent of children diagnosed with WSS have hypotonia, and 90% have developmental delay. The diagnosis of WSS should require physical therapy services through early intervention programs due to its high correlation with motor developmental delay and disability. Determination of progress should be measured with achievement of function rather than norm-referenced outcome measures.

Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A292
Outcome of First-admission Depression Treated in a Specialized Mood Disorders Service
Authors: THEKISO THEKISO B. , MCLOUGHLIN DECLAN M. , HARTNETT YVONNE , CASEY SARAH , ORJI AZUBIKE , HERON ELIZABETH A. , RUSH GAVIN , KENNEDY NOEL
Published: January 2021

Objective:

Few studies have described the treatment or outcome of depression in specialized mood disorders units (MDUs). Previous studies have focused on cohorts of patients with highly treatment-resistant illness who are likely to have a poor prognosis even with intensive treatment. This study describes the treatment and medium-term outcomes of a cohort of first-admission depressed patients with less treatment-resistant illness treated in a specialized MDU.

Methods:

A cohort of 137 consecutive first-admission depressed patients, referred to an MDU over 2 years, were interviewed using standardized schedules and followed up prospectively from admission for ∼18 months to describe baseline characteristics, treatment, outcome, and predictors of outcome. Times to recovery and recurrence were evaluated using survival analyses and predictors of outcome were examined using bivariate and multivariate regression analyses.

Results:

On admission, 75% of the 137 patients had depression that had been found to be resistant to pharmacological treatment, and 34% had been chronically depressed (>2 y). Over half of the patients had likely maladaptive personality traits and one third had at least 1 comorbid psychiatric disorder. By discharge, a significantly higher proportion of the patients were being prescribed very high (P<0.01) or high doses (P<0.05) of antidepressants, augmentation therapy (P<0.001), or a combination of antidepressants (P<0.001) or were engaged in individual psychotherapy (P<0.001), compared with baseline. With intensive treatment, 62% of the patients recovered by 6 months and 76% by 12 months, with 83% overall recovering and patients found to be asymptomatic during almost 60% of the follow-up period. However, 48% suffered a recurrence over the course of the follow-up. Chronicity of mood episodes (P<0.01) and the presence of psychiatric comorbidity (P<0.05) predicted recurrence.

Conclusions:

This prospective, naturalistic, medium-term study describes better outcomes, in terms of recovery and symptomatology over time, in a cohort of first-admission depressed patients than previous first-admission studies after continuous, intensive treatment, although the proportion of patients who experienced recurrences remained high.
Role or oritavancin and dalbavancin in acute bacterial skin and skin structure infections and other potential indications
Authors: Bassetti Matteo , Labate Laura , Vena Antonio , Giacobbe Daniele R.
Published: January 2021

Purpose of review

To discuss the currently available evidence about the use oritavancin and dalbavancin for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and for other potential indications.

Recent findings

In this review, we briefly summarize the available data on efficacy (from randomized controlled trials) and on effectiveness and cure rates (from observational studies) pertaining to the use of oritavancin and dalbavancin either for ABSSSI or for other indications.

Oritavancin and dalbavancin are valid options for outpatient therapy and early discharge in patients with ABSSSI, especially when adherence to oral therapy cannot be guaranteed or no oral choices are available. Furthermore, it is worth noting that a non-negligible portion (sometimes the majority) of oritavancin and dalbavancin use in available real-life experiences is for indications other than ABSSSI, especially for Gram-positive osteomyelitis and endocarditis. The number of studies on the use of long-acting lipoglycopeptides for these currently off-label indications is rapidly increasing and will help to further optimize the use of these peculiar antibiotics in the forthcoming future.
Morphometry of Asterion and its Proximity to Dural Venous Sinuses in Northwest Ethiopian Adult Skulls
Authors: Muche Abebe
Published: January 2021

Introduction:

The asterion is a craniometric point in the norma lateralis of skull situated at the confluence of parietal, temporal, and occipital bones. The aim of this study is to determine the type and mapping of asterion and its relation with transverse-sigmoid venous sinus junction (TSSJ).

Materials and Methods:

Sixty-one dry and intact adult human skulls of unknown sex and age were used. The measurements were implemented using stainless steel sliding vernier caliper. The data were analyzed using SPSS version-20 and independentt-test analysis was implemented.P < 0.05 was considered as statistically significant.

Results:

In the study, type II was found to be the predominant asterion type. There was statistically significant difference in measurements of central thickness of right and left sides of asterion (P = 0.04, Eta squared = 0.025). Besides, the TSSJ was situated above the asterion and at the level of asterion in 39.34% and 60.66 of the cases, respectively.

Conclusions:

The Northwest Ethiopian population has a high incidence of type II asterion. In most of the cases, the TSSJ is situated at the level of the asterion. The finding of the present study may be useful to neurosurgeons to reduce the risk during posterior cranial fossa surgeries. This work may also offer worthy information to radiologists, anthropologists, anatomists, and forensic scientists.