bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Preoperative Symptom Duration on Postoperative Outcomes After a Tubular Lumbar Microdiscectomy
Authors: Basques Bryce A. , Haws Brittany E. , Khechen Benjamin , Louie Philip K. , Patel Dil V. , Bawa Mundeep S. , Movassaghi Kamran , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern
Published: September 2018

Study Design:

This is a retrospective cohort study.

Objective:

This study aims to characterize the effect of preoperative symptom duration on postoperative outcomes after minimally invasive lumbar microdiscectomy (MIS LD).

Summary of Background Data:

It is unknown whether extended nonoperative treatment before MIS LD has implications for long-term clinical outcomes even after surgery is performed.

Materials and Methods:

A prospectively maintained surgical registry of patients undergoing MIS LD by a single surgeon between 2013 and 2017 was reviewed. Preoperative symptom duration was dichotomized into 2 groups (≤6 and >6 mo). Only patients with full clinical data at 6 months postoperative follow-up were included in the study. Clinical outcomes were assessed at 6, 12 weeks, and 6 months after surgery. The number of patients obtaining a minimum clinically important difference was assessed. Groups were compared with the χ2 analysis and the student t tests for categorical and continuous data, respectively.

Results:

In total, 94 patients were identified. A total of 45 patients (47.9%) had symptom duration ≤6 months. No differences in baseline characteristics were found (P>0.05). Patients with shorter symptom duration had significantly greater improvement in Oswestry Disability Index scores at 6 weeks (P=0.004), 12 weeks (P=0.022), and 6 months (P=0.005). Patients with shorter duration of symptoms also obtained minimum clinically important difference for Oswestry Disability Index at a greater rate than those with longer duration of symptoms (P=0.015).

Conclusions:

Although patients who underwent MIS LD within 6 months of symptom onset had similar baseline characteristics compared with patients who underwent surgery after 6 months of symptoms, the patients with longer preoperative symptom duration had worse functional outcomes at 6 months after surgery. These results suggest that earlier MIS lumbar microdiscectomy may provide a functional benefit for patients. Further studies should therefore evaluate the efficacy of nonoperative treatment in the setting of lumbar herniated nucleus pulposus, as prolonged conservative management may potentially impair functional recovery after surgery.
Guidelines on How to Perform a Meta-Analysis in Spine Surgery
Authors: Gendelberg David , Slattery Casey A. , Verma Kushagra
Published: September 2018

There are many questions in the literature that remain unanswered due to the paucity of available subjects or the large sample size needed to detect a difference. A meta-analysis consists of integrating together data from multiple studies into one larger data set in order to increase the subject size and power of a paper. In essence, it is a systematic review in which one uses statistical methods to summarize the results of these studies. It is important that a meta-analysis be performed in a systematic and orderly manner with the assistance of a statistician. When carried out correctly, these studies serve as powerful tools to help us better address our knowledge. Because of their complexity, they are prone to bias at multiple levels. This article will discuss the steps involved in performing a meta-analysis, select good studies, as well as explain the statistics conducted in these studies. Furthermore, we will discuss examples from the literature that demonstrate a good meta-analysis.
Establishment of a multicomponent dietary bioactive human equivalent dose to delete damaged Lgr5+ stem cells using a mouse colon tumor initiation model
Authors: Kim Eunjoo , Wright Gus A. , Zoh Roger S. , Patil Bhimanagouda S. , Jayaprakasha Guddadarangavvanahally K. , Callaway Evelyn S. , Ivanov Ivan , Turner Nancy D. , Chapkin Robert S.
Published: September 2018

Multicomponent therapy has gained interest for its potential to synergize and subsequently lower the effective dose of each constituent required to reduce colon cancer risk. We have previously showed that rapidly cycling Lgr5+ stem cells are exquisitely sensitive to extrinsic dietary factors that modulate colon cancer risk. In the present study, we quantified the dose-dependent synergistic properties of dietary n-3 polyunsaturated fatty acids (PUFA) and curcumin (Cur) to promote targeted apoptotic deletion of damaged colonic Lgr5+ stem cells. For this purpose, both heterogeneous bulk colonocytes and Lgr5+ stem cells were isolated from Lgr5-EGFP-IRES-CreERT2 knock-in mice injected with azoxymethane (AOM). Isolated cells were analyzed for DNA damage (γH2AX), apoptosis (cleaved caspase-3), and targeted apoptosis (both γH2AX and cleaved caspase-3) at 12 h post-AOM injection. Comparison of the percentage of targeted apoptosis in Lgr5+ stem cells (GFPhigh) across a broad bioactive dose-range revealed an ED50 of 16.0 mg/day n-3 PUFA + 15.9 mg/day Cur. This corresponded to a human equivalent dose of 3.0 g n-3 PUFA + 3.0 g Cur. In summary, our results provide evidence that a low dose (n-3 PUFA + Cur) combination diet reduces AOM-induced DNA damage in Lgr5+ stem cells and enhances targeted apoptosis of DNA-damaged cells, implying that a lower human equivalent dose can be utilized in future human clinical trials.
Prognosis of endoscopic surgery and traditional open resection in mucosal melanoma of the nasal cavity and paranasal sinus
Authors: Yin Gaofei , Guo Wei , Chen Xiaohong , Huang Zhigang
Published: September 2018

Mucosal melanoma of the nasal cavity and paranasal sinus is always associated with poor prognosis, and 5-year overall survival does not exceed 40%. Our study aimed to compare the intraoperative conditions and prognosis of different surgical techniques to determine the optimum surgical approach for patients with mucosal melanoma of the nasal cavity and paranasal sinus. This was a retrospective analysis of 54 patients who received treatment at Beijing Tongren Hospital between January 2004 and December 2016. The patients were divided into two groups: those who received endoscopic surgery and those who underwent traditional open resection. The study analyzed the operative methods, the intraoperative conditions, and the prognosis of the patients. SAS JMP Pro software was used for statistical analysis of the data. There were 27 patients in the endoscopic surgery group and 27 patients in the open surgery group. Each group had the same distribution in terms of AJCC staging, with seven stage III, 12 stage IVA, and eight stage IVB patients in each group. There were statistically significant differences in operative time, complications, and cosmetic effects between the two groups, but no difference in local recurrence, disease-free survival, or overall survival. In the endoscopic surgery group and open surgery group, local recurrence rates were 14.81 and 11.11%, respectively, and metastasis rates were the same in both groups (40.74%). With regard to long-term prognosis, there was no statistically significant difference between the different surgical techniques, especially in terms of survival benefit. We believe that endoscopic surgery with protection of local function can be recommended for mucosal melanoma of the nasal cavity and paranasal sinus on the basis of its advantages in terms of shorter duration of surgery and fewer complications. In addition, it achieves better postoperative cosmetic effects with minimal scarring on the face of the patient, and thus improves postoperative quality of life.
Computer-Based Video Instruction for Training Medical Students on Skin Biopsies
Authors: Cervantes Jose , Costello Collin M. , Maarouf Melody , Kurtzman Drew J.B. , Shi Vivian Y.
Published: September 2018

BACKGROUND

The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills.

OBJECTIVE

This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology.

METHODS

Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention.

RESULTS

In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p < .001, respectively). Approximately 33.3% of the students stated that the experience increased their interest in the field of dermatology.

CONCLUSION

Incorporation of CBVI into the dermatology curriculum augments medical students' procedural skills. The CBVI group performed significantly better in all 7 grading categories for shave biopsy and in 5 of 7 categories for punch biopsy. Integration of procedural laboratory tests raises students' interest in dermatology.
Epidermolysis Bullosa Patients' Perception of Surgical Wound and Scar Healing
Authors: Harris Adam G. , Saikal Samra L. , Murrell Dedee F.
Published: September 2018

BACKGROUND

There is limited evidence to suggest patients with epidermolysis bullosa (EB) have more postoperative wound complications than the general population. Despite this, the authors have noted reluctance among some surgeons to operate on these patients.

OBJECTIVE

A cross-sectional study was designed to investigate postoperative wound and scar healing outcomes in patients with EB.

METHODS

Patients were asked to complete the “Surgical Wound and Scar Healing in EB” questionnaire, and data gathered were analyzed.

RESULTS

Forty-six patients completed the questionnaire for a total of 94 different surgical procedures. Five patients reported blistering at the surgical wound site. All 5 had generalized forms of EB. Four patients reported wound infections, and 1 patient reported wound dehiscence. The postoperative scar healed with keloid or hypertrophic scarring after 26% of the reported surgical procedures.

CONCLUSION

Blistering at the postoperative site seems to be uncommon and particularly unlikely to occur in localized forms of EB. Postoperative wound infections and dehiscence are uncommon. Patients with EB may have a propensity to develop keloid or hypertrophic scarring. With these data, the authors hope clinicians have greater confidence in referring patients with EB for surgery, and surgeons more reassured about postoperative wound healing.
The Placenta Accreta Spectrum: Epidemiology and Risk Factors
Authors: CARUSI DANIELA A.
Published: September 2018

The placenta accreta spectrum has become an important contributor to severe maternal morbidity. The true incidence is difficult to ascertain, but likely falls near 1/1000 deliveries. This number seems to have increased along with the rate of risk factors. These include placenta previa, previous cesarean section, use of assisted reproductive technologies, uterine surgeries, and advanced maternal age. With increased uterine conservation, previous retained placenta or placenta accreta have become significant risk factors. Understanding placenta accreta spectrum risk factors facilitates patient identification and safe delivery planning. Patients considering elective uterine procedures or delayed childbirth should consider the impact on peripartum morbidity.
Facial nerve disorder: a review of the literature
Authors: Davies James , Al-Hassani Fawaz , Kannan Ruben
Published: September 2018

Facial nerve disorders present with varying levels of facial dysfunction. Facial nerve reinnervation techniques aim to correct this by attempting to reestablish the connection lost between the facial nerve nucleus and its distal branches, or by using donor nerves to provide an alternate neural input to the facial nerve. Many facial nerve disorders exist; however, tumors and trauma to the facial nerve are the 2 causes that most commonly result in the patient being considered for reanimation procedures, as they most often result in facial nerve discontinuity. Reinnervation techniques are the first line surgical intervention for facial paralysis when a direct connection between the facial nerve cannot be reestablished, with the XII-VII nerve transfer being the most reliable and having the most predictable outcome when compared with the alternative VII-VII procedure. However, when the reinnervation time window is missed, other techniques of reanimation must be used in an attempt to best restore the normal symmetry and function of the face. The modifications to the XII-VII nerve transfer technique have made it the most popular of all methods; however, there are still many other nerves that may be considered as donors, giving the surgeon other options in the event of the hypoglossal (XIIth) nerve being unsuitable.
Short-term Efficacy and Safety of a Latanoprost/Carteolol Fixed Combination Switched From Concomitant Therapy to in Patients With Primary Open-angle Glaucoma or Ocular Hypertension
Authors: Inoue Kenji , Shiokawa Minako , Iwasa Mayumi , Ishida Kyoko , Tomita Goji
Published: September 2018

Purpose:

We prospectively investigated the efficacy and safety of switching from concomitant latanoprost and carteolol hydrochloride (CH) to a latanoprost/carteolol fixed combination (LCFC) in patients with primary open-angle glaucoma or ocular hypertension.

Patients and Methods:

A total of 43 patients (43 eyes) who were using latanoprost (once daily in the evening) and CH (once daily in the morning) concomitantly were switched to LCFC (once daily in the morning) with no washout interval. The primary efficacy endpoint was change in intraocular pressure (IOP) between baseline (before switching) and 1 and 3 months after switching. Systemic blood pressure and pulse rate, corneal epithelial defects, and tear film break-up time (TBUT) were also compared before and 1 and 3 months after switching. A questionnaire was administered 1 month after switching to investigate ocular comfort and treatment preferences. Adverse reactions and dropouts were recorded.

Results:

There was no significant difference in IOP after switching to LCFC (15.0±2.6, 15.1±2.4, and 15.0±2.4 mm Hg at baseline and at 1 and 3 months, respectively). There was a significant decrease in corneal epithelial defects and significant increase in TBUT, without significant changes in systemic blood pressure or pulse rate. Three patients (7.3%) preferred concomitant latanoprost and CH; 33 (80.5%) preferred the LCFC. One patient each (9.3%) discontinued treatment because of foreign body sensation, blepharitis, increased IOP, or loss to follow-up.

Conclusions:

Switching from concomitant latanoprost and CH to LCFC led to similar IOP control with good safety and patient acceptance, at least in the short term.
A Case of Pseudomonas Orbital Cellulitis Following Glaucoma Device Implantation
Authors: Goldfarb Jeremy , Jivraj Imran , Yan David , DeAngelis Dan
Published: September 2018

Purpose:

Orbital cellulitis is a rare complication of aqueous tube shunt surgery. Nine cases have been described in the literature, though the microbiologic etiology is rarely reported. Management with intravenous antibiotics and/or explantation has been described.

Methods:

This is a case report and literature review.

Case:

A 64-year-old woman developed pain, periorbital swelling, limited extraocular motility, proptosis, and conjunctival injection 3 days following implantation of an Ahmed Glaucoma Valve. Computed tomography of the orbits with contrast showed soft tissue fat stranding consistent with orbital inflammation. Initial medical management with topical and intravenous ceftriaxone and vancomycin was unsuccessful. Surgical removal of the implant was performed and intraoperative cultures demonstrated florid Pseudomonas aeruginosa growth. Antibiotic coverage was changed to Piperacillin-Tazobactam for 3 days, with eventual resolution of her orbital symptoms.

Conclusions:

We report the first case of orbital cellulitis after implantation of a glaucoma device associated with P. aeruginosa. Failure of intravenous and topical antibiotics led to explantation of the valve and targeted intravenous antibiotic therapy with subsequent clinical improvement.
Metabolic Alterations Within the Primary Visual Cortex in Early Open-angle Glaucoma Patients: A Proton Magnetic Resonance Spectroscopy Study
Authors: Guo Linying , Wang Rong , Tang Zuohua , Sun Xinghuai , Wu Lingjie , Wang Jie , Zhong Yufeng , Xiao Zebin , Zhang Zhongshuai
Published: September 2018

Purpose:

To detect changes in metabolites and explore cortical plasticity at the metabolic level within the primary visual cortex through proton magnetic resonance spectroscopy in early open-angle glaucoma (OAG) patients.

Methods:

A total of 23 symmetrically bilateral early OAG patients and 21 normal controls (NC) were recruited as the early OAG group and NC group, respectively. All subjects underwent a proton magnetic resonance examination, and then, the N-acetylaspartate (NAA), glutamine-glutamate (Glx), myo-inositol (Ins), choline (Cho), and creatine (Cr) concentrations within the bilateral primary visual cortex were determined. The mean NAA/Cr ratio, mean Cho/Cr ratio, mean Glx/Cr ratio, and mean Ins/Cr ratio of the bilateral sides were compared between early OAG patients and NC using the independent samples t test.

Results:

Compared with NC, the mean Glx/Cr ratio (corrected P=0.003) in primary visual cortex was significantly higher, whereas the mean Ins/Cr ratio (corrected P=0.001) was statistically lower in early OAG patients. However, no apparent difference was found in the mean Cho/Cr ratio or mean NAA/Cr ratio between the OAG group and NC group.

Conclusions:

Abnormal metabolites were found in our study through proton magnetic resonance spectroscopy and could contribute to cortical plasticity of the primary visual cortex in early OAG patients.
Hepatitis C Genotype 4 Virus Nonstructural 3 and Nonstructural 5A Resistance-associated Substitutions in a 16-year-old Adolescent Failing Ombitasvir/Paritaprevir/Ritonavir Plus Ribavirin
Authors: Serranti Daniele , Indolfi Giuseppe , Caudai Cinzia , Bartolini Elisa , Trapani Sandra , Zazzi Maurizio , Resti Massimo
Published: September 2018

Preexistence and appearance of resistance-associated substitutions limit the efficacy of direct-acting antivirals in treatment of hepatitis C. This is the first case report of an adolescent with chronic hepatitis C virus genotype 4 infection and cirrhosis who failed treatment with ombitasvir/paritaprevir/ritonavir and ribavirin. Resistance analysis showed baseline resistance-associated substitutions M28V and Y93C and emergent D168H.
HIV Viremia During Pregnancy and Neurodevelopment of HIV-Exposed Uninfected Children in the Context of Universal Antiretroviral Therapy and Breastfeeding
Authors: le Roux Stanzi M. , Donald Kirsten A. , Kroon Max , Phillips Tamsin K. , Lesosky Maia , Esterhuyse Liza , Zerbe Allison , Brittain Kirsty , Abrams Elaine J. , Myer Landon
Published: September 2018

Background:

Elevated HIV viral load (VL) in pregnancy has been linked to increased risk of mortality, immunologic abnormalities, infectious morbidity and restricted growth among HIV-exposed uninfected (HEU) children, but little is known about effects on child development.

Methods:

HIV-infected women initiating lifelong antiretroviral therapy (ART; tenofovir + emtricitabine + efavirenz) antenatally were followed from first antenatal visit through delivery and with their breastfed infants postpartum. Cognitive, motor and expressive language development (Bayley Scales of Infant and Toddler Development-Third Edition; delay defined as score <85) were assessed on a subset of HEU infants. HIV VL was measured at ART initiation, in third trimester and around delivery. Cumulative viremia in pregnancy was expressed as log10 VL copies × year/mL [viremia copy-years (VCY)]. Relationships between VCY and development were examined after adjusting for socioeconomic, behavioral and psychosocial confounders.

Results:

Women (median pre-ART log10 VL 4.1, CD4 349 cells/mm3) commonly reported adverse social circumstances (44% informal housing, 63% unemployed, 29% risky drinking). Among 214 infants (median age, 13 months; 53% male; 13% born <37 weeks’ gestation), viremia predicted lower motor and expressive language, but not cognitive, scores in crude and adjusted analysis [per log10 VCY increase, αβ (95% confidence interval [CI]): motor, −2.94 (−5.77 to −0.11); language, −3.71 (−6.73 to −0.69) and cognitive −2.19 (−5.02 to 0.65)]. Increasing VCY also predicted higher relative odds of motor delay [adjusted odds ratio (aOR): 3.32; 95% CI: 1.36–8.14) and expressive language delay (aOR: 2.79; 95% CI: 1.57–4.94), but not cognitive delay (aOR: 1.68; 95% CI: 0.84–3.34).

Conclusions:

Cumulative maternal HIV viremia in pregnancy may have adverse implications for HEU child development.
The Changing Landscape of Childhood Tuberculosis in the United Kingdom
Authors: Mohiyuddin Tehreem , Seddon James A. , Thomas H. Lucy , Lalor Maeve K.
Published: September 2018

Background:

The epidemiology of tuberculosis (TB) is changing in the United Kingdom and globally. Childhood TB is a key indicator of recent transmission and provides a marker of wider TB control. We describe the recent epidemiology of childhood TB in the United Kingdom, how this compares to TB in adults, and document changes with time.

Methods:

TB cases notified in the United Kingdom between 2000 and 2015 were categorized as children (<15 years of age) or adults (≥15 years of age). Descriptive analyses were carried out on demographic, clinical and microbiologic data. We carried out logistic regressions to identify risk factors associated with children having no microbiologic confirmation.

Results:

In the study period, 6293 TB cases (5%) in the United Kingdom were notified in children. Childhood TB incidence declined from 487 cases in 2000 (3.4 per 100,000) to 232 cases (2.0 per 100,000) in 2015. The majority (68%) of children with TB were UK born, with a high proportion of Pakistani (24%) and Black-African (22%) ethnicity. Sixty-four percent of children had pulmonary disease. Culture confirmation was low (24%). Children who were younger, UK born and those with extrapulmonary disease were less likely to have microbiologically confirmed TB. A high proportion (87%) of children completed treatment at last-recorded outcome, with few deaths (39 cases; 0.7%).

Conclusions:

The incidence of TB in children in the United Kingdom has decreased in the past 16 years, with the majority of children completing TB treatment. Ongoing monitoring of childhood TB will provide a measure of the effectiveness of the national TB program.
Physical Therapy Management of a Critically-Ill Infant After Cardiac Surgery: A Case Report and Literature Review
Authors: Jara Ana M. , Jacobs Jeffrey P. , Reilly Margaret
Published: September 2018

Background and Purpose:

This case report describes the physical therapy management of an infant with a congenital heart defect (CHD) from prior to her first palliative surgery until her discharge. A review of the literature identifies treatment interventions after cardiac surgery for children and adults but no specific management that can guide the physical therapy management of neonates and infants.

Case Description:

A female infant with hypoplastic left heart syndrome underwent a Norwood procedure at 5 days of life with delayed sternal closure on postoperative day 2. She failed the first attempt of extubation on postoperative day 3. Physical therapy was initiated the second day of life, and the last reevaluation was performed prior to discharge at 9 weeks of age.

Outcomes:

Measurements to identify postural control stability and the infant's reactions to visual and auditory stimuli were performed at 2 days and again at 9 weeks of age. The Test of Infant Motor Performance showed an improvement in scores at the time of discharge. Testing the 2 primitive reflexes evaluated in the study showed interference of one of the reflexes with her motor abilities during hospitalization. The result of the education given to the parents was evaluated through demonstration back of developmental activities, range of motion, and handling of their baby during daily care.

Conclusion:

The physical therapy intervention program provided to this infant with hypoplastic left heart syndrome exemplifies strategies that may be applicable to infants with complex CHD. It is possible to implement individualized developmental physical therapy interventions and assist in optimizing outcomes for an infant with complex CHD and their family in the cardiovascular intensive care unit setting.
Pruritic Scalp
Authors: Limone Brittanya A. , Moncrieff Norma , Jacob Sharon E.
Published: September 2018

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of a pruritic scalp in a child.
The Many Presentations of Syphilis
Authors: Ingram Brooke
Published: September 2018

Syphilis is a sexually transmitted infection caused by a spirochete, which if left untreated, transforms through four stages. Numerous cutaneous manifestations present from the time of the initial infection and evolve as the disease systemically progresses. Syphilis has been around for centuries, and we can attribute the rise of the specialty of dermatology to its prevalence and protean nature. Syphilis is on the rise again for the first time since the advent of penicillin, making it important for healthcare providers to have knowledge of its presentation in its various stages.
Short article: Outcome of medical and surgical management for perforated jejunal diverticulitis
Authors: Garcia-Granero Alvaro , Argüelles Brenda G. , Gallardo Carmen Muniesa , Carreño Omar , Giner Francisco , Pellino Gianluca , Frasson Matteo
Published: September 2018

Objectives

Perforated jejunal diverticulitis (PJD) is rare, but it has high mortality rates. The role of nonsurgical management is debated. The aim of this study is to assess the outcomes of medical and surgical management of PJD.

Patients and methods

A single-centre study on a series of emergency patients diagnosed with PJD between 2010 and 2016 was conducted.

Results

Eleven patients with PJD were treated (seven women). Nine out of 11 were diagnosed by a computed tomography scan, and two were diagnosed at laparotomy. The initial approach was medical treatment in five patients, based on clinical and imaging findings. Four (80%) of these five patients were discharged without the need for surgical intervention. The median hospital stay was 7.5 days. Seven patients required surgery overall with a median length of hospital stay of 10.8 days. Surgical procedures consisted of segmental bowel resection and primary anastomosis in six patients and simple closure in one. There was no perioperative deaths. One patient required percutaneous drainage because of anastomotic leak, and one required reoperation owing to evisceration.

Discussion

Selected patients with PJD can be successfully managed with conservative approach, based on clinical and computed tomography findings.
Racial and Ethnic Composition of Hospitals’ Service Areas and the Likelihood of Being Penalized for Excess Readmissions by the Medicare Program
Authors: Gaskin Darrell J. , Zare Hossein , Vazin Roza , Love DeJa , Steinwachs Donald
Published: September 2018

Background:

The Hospital Readmission Reduction Program (HRRP) disproportionately penalizes hospitals serving minority communities. The National Academy of Science, Engineering, and Medicine has recommended that the Centers for Medicare and Medicaid Services (CMS) consider adjusting for social risk factors in their risk adjustment methodology. This study examines the association between the racial and ethnic composition of a hospital market and the impact of other social risk factors on the probability of a hospital being penalized under the HRRP.

Research Methods and Data:

This study analyzes data from CMS, the American Hospital Association, and the American Community Survey for 3168 hospitals from 2013 to 2017. We used logistic regression models to estimate the association between the penalty status under HRRP and the racial and ethnic composition of a hospital market, and explored whether this association was moderated by other social risk factors.

Results:

Our results indicate that the probability of being penalized increases with the percentage of black and Asian residents in the hospital service area (HSA) and decreased with the percentage of Hispanic residents in the HSA. This association was reduced and became statistically insignificant when we controlled for other social risk factors. The strongest predictors of penalty status were the hospital’s share of Medicaid patients and the percent of persons without a high school diploma in the HSA.

Conclusions:

By incorporating relevant social risk factors in the reimbursement methodology, CMS could mitigate the negative effects of HRRP on hospitals serving minority communities.
Dysregulatory syndromes: the role of signal transducers and activators of transcription
Authors: Bezrodnik Liliana , Gaillard María Isabel , Caldirola María Soledad
Published: September 2018

Purpose of review

A comparative description of dysregulatory syndromes with mutations in signal transducer and activator of transcription (STAT) genes.

Recent findings

STAT 1, 3 and 5b loss of function (LOF) and gain of function (GOF) mutations are a heterogeneous group of genetic disorders that range from immunodeficiency (ID) to autoimmune disease (AID), depending on the underlying signalling pathway defect. Between them, there are clear overlapping and differences in clinical presentation and laboratory findings.

Dysregulatory syndromes due to LOF and GOF mutations in STAT1, 3 and 5b are a particular group of primary immunodeficiencies (PIDs) in which AID may be the predominant finding in addition to infections susceptibility. STAT1 GOF mutations were described as the major cause of chronic mucocutaneous candidiasis, while activating STAT3 mutations result in early-onset multiorgan autoimmunity and ID. Human STAT5b deficiency is a rare disease that also involves ID and severe growth failure. In recent years, the identification of the genes involved in these disorders allowed to differentiate these overlapping syndromes in order to choose the most effective therapeutic options.
Three-dimensional bioprinting for organ bioengineering: promise and pitfalls
Authors: Ali Mohamed , P.R. Anil Kumar , Lee Sang Jin , Jackson John D.
Published: September 2018

Purpose of review

Loss of organ function is a critical issue that threatens a patient's life. Currently, the only available treatment is organ transplantation; however, shortage of donor organs, histocompatibility, and life-long immunosuppression present major challenges. Three-dimensional bioprinting technology holds a promising solution for treating organ failure by fabricating autologous tissues and organs for transplantation. To biofabricate a functional tissue, target-cell types are combined with an appropriate biomaterial for structural support and a bioink that supports cell function and maturation. Bioprinted structures can mimic the native tissue shape and functionality.

Recent findings

The main goal of three-dimensional bioprinting is to produce functional tissues/organs; however, whole organ printing has not been achieved. There have been recent advances in the successful three-dimensional bioprinting of numerous tissues. This review will discuss the types of bioprinters, biomaterials, bioinks, and the fabrication of various constructs for repair of vascular, cartilage, skin, cardiac, and liver tissues. These bioprinted tissue constructs have the potential to be used to treat tissues and organs that have been damaged by injury or disease.

Three-dimensional bioprinting technology offers the ability to fabricate three-dimensional tissue structures with high precision, fidelity, and stability at human clinical scale. The creation of complex tissue architectures with heterogeneous compositions has the potential to revolutionize transplantation of tissues and organs.
Causes of Treatment Failure in Children With Inflammatory Bowel Disease Treated With Infliximab
Authors: Naviglio Samuele , Lacorte Doriana , Lucafò Marianna , Cifù Adriana , Favretto Diego , Cuzzoni Eva , Silvestri Tania , Pozzi Mucelli Martina , Radillo Oriano , Decorti Giuliana , Fabris Martina , Bramuzzo Matteo , Taddio Andrea , Stocco Gabriele , Alvisi Patrizia , Ventura Alessandro , Martelossi Stefano
Published: September 2018

Objectives:

Anti‐tumor necrosis factor antibodies have led to a revolution in the treatment of inflammatory bowel diseases (IBD); however, a sizable proportion of patients does not respond to therapy. There is increasing evidence suggesting that treatment failure may be classified as mechanistic (pharmacodynamic), pharmacokinetic, or immune‐mediated. Data regarding the contribution of these factors in children with IBD treated with infliximab (IFX) are still incomplete. The aim was to assess the causes of treatment failure in a prospective cohort of pediatric patients treated with IFX.

Methods:

This observational study considered 49 pediatric (median age 14.4) IBD patients (34 Crohn disease, 15 ulcerative colitis) treated with IFX. Serum samples were collected at 6, 14, 22 and 54 weeks, before IFX infusions. IFX and anti‐infliximab antibodies (AIA) were measured using enzyme linked immunosorbent assays. Disease activity was determined by Pediatric Crohn's Disease Activity Index or Pediatric Ulcerative Colitis Activity Index.

Results:

Clinical remission, defined as a clinical score <10, was obtained by 76.3% of patients at week 14 and by 73.9% at week 54. Median trough IFX concentration was higher at all time points in patients achieving sustained clinical remission. IFX levels during maintenance correlated also with C‐reactive protein, albumin, and fecal calprotectin. After multivariate analysis, IFX concentration at week 14 >3.11 μg/mL emerged as the strongest predictor of sustained clinical remission. AIA concentrations were correlated inversely with IFX concentrations and directly with adverse reactions.

Conclusions:

Most cases of therapeutic failure were associated with low serum drug levels. IFX trough levels at the end of induction are associated with sustained long‐term response.
Rapid Progression of Acute Pancreatitis to Acute Recurrent Pancreatitis in Children
Authors: Sweeny Katherine F. , Lin Tom K. , Nathan Jaimie D. , Denson Lee A. , Husain Sohail Z. , Hornung Lindsey , Thompson Tyler , Abu‐El‐Haija Maisam
Published: September 2018

Objective:

Research is lacking on the natural history of acute pancreatitis (AP) progression to acute recurrent pancreatitis (ARP). The aim of this project was to study the progression from AP to ARP among pediatric patients with pancreatitis to better understand the presentation and natural history of pancreatitis.

Methods:

Patients presenting with AP were included in a prospective database in Research Electronic Data Capture. We enrolled 115 patients with AP from March 2013 to November 2016. Physicians completed surveys regarding clinical data for patients with first attack of AP. Patients were followed prospectively, with data on progression entered when patients presented with ARP.

Results:

The most common etiologies for the first attack of AP were idiopathic (31%), toxic/drug‐related (23%), and biliary/gallstone (18%). Twenty of the 115 patients (17%) developed ARP during the follow‐up period. Seventy percent (14/20) of patients with ARP progressed from AP to ARP within 5 months from first diagnosis. A comparison of patients who rapidly progressed to ARP within 3 months (n = 12) to those followed for >3 months without progression in 3 months (n = 97) revealed associations with a higher weight percentile for age (P = 0.045), male sex (P = 0.03), and presence of pancreatic necrosis during first AP attack (P = 0.004). Progression to ARP significantly differed by etiology group with genetics having the highest risk for ARP progression over time and patients with gallstone/biliary, viral/systemic, and obstructive (nongallstone) having the lowest risk for ARP progression over time (P = 0.02).

Conclusions:

Most patients who progressed from AP to ARP progressed within 5 months. The presence of a higher weight percentile for age, male sex, and pancreatic necrosis during the first AP attack are associated with rapid progression to ARP.
Effects of an Empowerment Program on Resilience and Posttraumatic Growth Levels of Cancer Survivors
Authors: Üzar-Özçetin Yeter Sinem , Hiçdurmaz Duygu
Published: September 2018

Background

Psychosocial empowerment of cancer survivors can help improve their psychological resilience and enhance their posttraumatic growth. However, there is a lack of research exploring the effects of such empowerment programs on resilience and posttraumatic growth of cancer survivors.

Objective

The aim of this study was to assess the feasibility of a randomized controlled trial on the effectiveness of an integrated empowerment program on cancer survivors.

Methods

We conducted a randomized controlled trial with 89 adult cancer survivors (>25 years old) from 2 oncology hospitals. Using a table of random numbers, they were assigned randomly to the experimental group (n = 45), which participated in 10 sessions of a structured empowerment program, and the control group (n = 44), which received only routine care and no further intervention. Data were collected from patients using the Posttraumatic Growth Inventory and the Resilience Scale for Adults.

Results

Posttraumatic growth and resilience levels significantly improved in the intervention group compared with the control group both at the end of and a month after the program.

Conclusion

This study's empowerment program is effective in improving posttraumatic growth and resilience levels of cancer survivors who are prone to trauma.

Implications for Practice

By enhancing resilience and posttraumatic growth of cancer survivors, the empowerment program may help restore life, and thus its application can contribute to the psychosocial well-being of cancer survivors. Nurses with training and experience can integrate this kind of program into clinical settings.
Transforming End-of-Life Care by Implementing a Patient-Centered Care Model
Authors: Dobrina Raffaella , Tenze Maja , Palese Alvisa
Published: September 2018

Patient-centered care is valued by health care professionals working in palliative care settings. However, studies have revealed the difficulty of adopting patient-centered care in daily practice and of sharing its meaning within the interdisciplinary team. The aim of this study was to report the process of transforming end-of-life care by implementing a patient-centered model of care in an Italian hospice. An action research process was conducted between June 2012 and June 2014. The following phases were performed: (a) “looking” phase: the diagnosis was established by collecting data through semistructured interviews in the field study and through the administration of the Frommelt Attitude Toward the Care of the Dying Scale Form B—Italian Version; (b) “thinking” phase: staff members, guided by a research team, redesigned practice by identifying priorities in improvements and actions through multiprofessional focus groups; (c) “acting” phase: actions identified in the previous phase were implemented; and (d) “relooking” phase: the same data collection processes used in the looking phase were applied to evaluate the outcomes achieved. Three areas of improvement have been established: (1) symptoms were intensively audited through patient self-reports by using validated tools; (2) patients' family needs were also regularly collected, documented in clinical records, and addressed; (3) patients' family members were involved in the plan of care through support and education. Inpatient hospice health carers in this study were aware of the concept of patient-centered care. However, its actual implementation was lacking. An action research approach helped them to implement expected changes.
Doctoral Education and Preparation for Nursing Faculty Roles
Authors: McNelis Angela M. , Dreifuerst Kristina Thomas , Schwindt Rhonda
Published: September 2018

Background

Despite increased enrollment in doctoral programs and the encouraging numbers of graduates intending to pursue faculty positions, lack of adequate preparedness to assume the faculty role may adversely impact retention and consequently undermine efforts to reduce the shortage.

Purpose

Understanding doctoral nursing students’ and recent graduates’ expectations of their educational experience related to preparation for an academic career is needed to inform curricular revisions and advise guidance to ensure role readiness.

Methods

A secondary analysis of 24 interviews with current PhD and doctor of nursing practice (DNP) students and recent graduates from both degree programs was performed to gain a deeper understanding of expectations and perceptions of doctoral education.

Results

Two themes emerged: (1) met and unmet expectations of programs and (2) equivocal preparation for teaching.

Conclusions

PhD and DNP curricula should include coursework on teaching, as well as research, to prepare graduates for faculty roles.
Pathologic Subtypes of Lung Adenocarcinoma Brain Metastasis Is a Strong Predictor of Survival After Resection
Authors: Casteillo François , Guy Jean-Baptiste , Dal-Col Pierre , Karpathiou Georgia , Pommier Benjamin , Bayle-Bleuez Sophie , Fournel Pierre , Vassal François , Forest Fabien
Published: September 2018

Primary lung adenocarcinoma is classified according to predominant histopathologic architecture into lepidic, papillary, acinar, solid, and micropapillary subtypes. These subtypes are related to overall survival in primary lung adenocarcinoma. The main goal of our work was to evaluate the prognostic impact of this classification on surgical resection of brain adenocarcinoma metastases in 97 patients with surgically resected brain metastases of lung adenocarcinoma from 2008 to 2017. Histopathologic subtype is associated with overall survival (P=0.0085): 30.1±5.6 months for papillary-predominant pattern, 26.5±6.3 months for acinar-predominant pattern, 13.8±1.4 months for solid pattern, 11.6±10.1 for micropapillary pattern. A “low grade” group comprising acinar and papillary-predominant pattern tumors showed a longer overall survival (28.5±4.1 mo) when compared with high-grade–predominant pattern (solid and micropapillary patterns) (13.7±1.4 mo), P=0.0011. On multivariate analysis, age below 55 years at the time of resection (hazard ratio, 3.56; 95% confidence interval, 1.12-11.31) and groups of architectural patterns (hazard ratio, 4.25; 95% confidence interval, 1.83-9.9) were related to overall survival (P=0.031 and 0.00078, respectively). Predominant architectural pattern evaluated on the surgical specimen of brain metastasis is a major prognostic factor of overall survival in metastatic lung adenocarcinoma.
Estimating the Weight of Children During Simulated Emergency Situations Using the Broselow Tape
Authors: Larose Guylaine , Levy Arielle , Bailey Benoit , Cummins-McManus Barbara , Lebel Denis , Gravel Jocelyn
Published: September 2018

Objective

The objective of this study was to evaluate whether residents can accurately estimate children's weight using the Broselow tape.

Method

We conducted a preplanned secondary analysis from an experimental trial. Participants were residents in pediatrics, family medicine, and emergency medicine rotating in the ED. Residents were randomly assigned to 2 sets of paired scenarios during 2 sessions. They were asked to estimate the weight of a manikin using the Broselow tape at the beginning of each scenario. The first scenario from the initial session and the last scenario from the second session were used for the current study. The primary analysis was the proportion of participants who accurately estimated manikin weight within a 10% margin of error.

Results

Forty residents were recruited. Thirty-two (80%) reported knowledge of the Broselow tape and 13 (32.5%) reported previous use. Weight estimation was accurate in 60% (24/40; 95% confidence interval [CI], 45%–74%) during the first scenarios. Error in weight estimation differed by greater than 25% in 28% (11/40). Error in estimation was not associated with previous knowledge (odds ratio, 6.2; 95% CI, 0.68–56) or previous use (odds ratio, 0.9; 95% CI, 0.23–3.5) of the Broselow tape. In the last scenario, 88% accurately estimated manikin weight (35/40; 95% CI, 73%–95%).

Conclusions

Although most residents reported knowledge of the Broselow tape, 40% made erroneous weight estimations by at least 10% with the first use in this simulation study. With repeated use, they improved significantly over time. Teaching appropriate use of the Broselow tape should be part of residency-training curricula and pediatric advanced life support course.
Characteristics of Children Cared for by a Physician-Staffed Helicopter Emergency Medical Service
Authors: Enomoto Yuki , Tsuchiya Asuka , Tsutsumi Yusuke , Kikuchi Hitoshi , Ishigami Koji , Osone Junpei , Togo Masahito , Yasuda Susumu , Inoue Yoshiaki
Published: September 2018

Objectives

The effectiveness of Japanese helicopter emergency medical services (HEMS) and interventions at the scene is not clear as regard children. For effective use of HEMS at the clinical scene, we need to clarify the characteristics of pediatric patients cared for by HEMS. Therefore, the objective of this study was to describe the characteristics of pediatric scene flights and to describe the procedures performed on the patients.

Methods

This was a retrospective cohort study based on the database for children aged younger than 18 years who were cared for by physician-staffed HEMS of Ibaraki prefecture, in Japan. We reviewed the database for air medical transports conducted at our institution from July 2010 to December 2016.

Results

During the 6.5-year period, the Ibaraki HEMS attended to 288 children. The median age of the children was 11 (interquartile range, 5–14) years. Of the total, 196 (68.1%) of the children had trauma-related injuries. The head was the most common site of significant injuries (12.4%). The most common cause of nontrauma incidents was seizure (9.0%). In 65.9% of the patients, the injury or illness was of mild or moderate severity at the scene. An intervention was applied at the scene in 76.0% of the cases: 75.1%, intravenous route; 6.9%, intubation; and 13.4%, drug administration. Of those patients, 29.1% were discharged from the emergency department. In-hospital mortality accounted for 1.5% (n = 2) of the cases.

Conclusions

Although the condition at the scene of most of the pediatric patients transported by the physician-staffed HEMS was not severe, an intervention was frequently applied from the scene. Improving the dispatch criteria and monitoring compliance are needed for appropriate use of HEMS.