bluuebunny/crossref_metadata_2025 huggingface dataset:
Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature
Authors: Kwok Chun Shing , Bennett Sadie , Azam Ziyad , Welsh Victoria , Potluri Rahul , Loke Yoon K. , Mallen Christian D.
Published: February 2021

Background:

Despite the availability of tests to diagnose acute myocardial infarction (AMI), cases are still missed.

Methods:

We systematically reviewed the literature to determine how missed AMI has been defined, the reported rates of misdiagnosed AMI, the outcomes patients with misdiagnosed AMI have, what diagnosis was initially suspected in missed AMI cases, and what factors are associated with misdiagnosed AMI. We searched MEDLINE and EMBASE in September 2020 for studies that evaluated missed AMI. Data were extracted from studies that met the inclusion criteria and the results were narratively synthesized.

Results:

A total of 15 studies were included in this review. The number of patients with missed AMI in individual studies ranged from 64 to 4707. There was no consistently used definition for misdiagnosed AMI, but most studies reported rates of approximately 1%–2%. Compared with AMI that was recognized, 1 study found no difference in mortality for misdiagnosed AMI at 30 days and 1 year. The common initial misdiagnoses that subsequently had AMI were ischemic heart disease, nonspecific chest pain, gastrointestinal disease, musculoskeletal pain, and arrhythmias. Reasons for missed AMI include incorrect electrocardiogram interpretation and failure to order appropriate diagnostic tests. Hospitals in rural areas and those with a low proportion of classical chest pain patients that turned out to have AMI were at greater risk of missed AMI.

Conclusions:

Misdiagnosed AMI is an unfortunate part of everyday clinical practice and better training in electrocardiogram interpretation, and education about atypical presentations of AMI may reduce the number of misdiagnosed AMIs.
Droplet Digital PCR Improves IG-/TR-based MRD Risk Definition in Childhood B-cell Precursor Acute Lymphoblastic Leukemia
Authors: Della Starza Irene , Nunes Vittorio , Lovisa Federica , Silvestri Daniela , Cavalli Marzia , Garofalo Andrea , Campeggio Mimma , De Novi Lucia Anna , Soscia Roberta , Oggioni Carlotta , Mussolin Lara , Biondi Andrea , Guarini Anna , Valsecchi Maria Grazia , Conter Valentino , Biffi Alessandra , Basso Giuseppe , Foà Robin , Cazzaniga Giovanni
Published: February 2021

Minimal residual disease (MRD) is the most powerful prognostic factor in pediatric acute lymphoblastic leukemia (ALL). Real-time quantitative polymerase chain reaction (RQ-PCR) represents the gold standard for molecular MRD assessment and risk-based stratification of front-line treatment. In the protocols of the Italian Association of Pediatric Hematology and Oncology (AIEOP) and the Berlin-Frankfurth-Munschen (BFM) group AIEOP-BFM ALL2009 and ALL2017, B-lineage ALL patients with high RQ-PCR-MRD at day+33 and positive at day+78 are defined slow early responders (SERs). Based on results of the AIEOP-BFM ALL2000 study, these patients are treated as high-risk also when positive MRD signal at day +78 is below the lower limit of quantification of RQ-PCR (“positive not-quantifiable,” POS-NQ). To assess whether droplet digital polymerase chain reaction (ddPCR) could improve patients’ risk definition, we analyzed MRD in 209 pediatric B-lineage ALL cases classified by RQ-PCR as POS-NQ and/or negative (NEG) at days +33 and/or +78 in the AIEOP-BFM ALL2000 trial. ddPCR MRD analysis was performed on 45 samples collected at day +78 from SER patients, who had RQ-PCR MRD ≥ 5.0 × 10–4 at day+33 and POS-NQ at day+78 and were treated as medium risk (MR). The analysis identified 13 of 45 positive quantifiable cases. Most relapses occurred in this patients’ subgroup, while ddPCR NEG or ddPCR-POS-NQ patients had a significantly better outcome (P < 0.001). Overall, in 112 MR cases and 52 standard-risk patients, MRD negativity and POS-NQ were confirmed by the ddPCR analysis except for a minority of cases, for whom no differences in outcome were registered. These data indicate that ddPCR is more accurate than RQ-PCR in the measurement of MRD, particularly in late follow-up time points, and may thus allow improving patients’ stratification in ALL protocols.
THE NATIONWIDE INCIDENCE OF RETINAL ARTERY OCCLUSION FOLLOWING DIALYSIS AS A RESULT OF END-STAGE RENAL DISEASE
Authors: Moon Tae Hwan , Kang Minseok , Lee Seungheon , Seo Eoi Jong , Kwon Soon Kil , Kang Gilwon , Han Joung-Ho , Chae Ju Byung , Kim Dong Yoon
Published: February 2021

Purpose:

To examine the incidence and risk of retinal artery occlusion (RAO) in patients who have undergone dialysis in Korea.

Methods:

A nationwide, population-based study using South Korean national health insurance data from 2004 to 2013 was used for analysis. All patients who began dialysis between 2004 and 2013 and the same number of control subjects were selected via propensity score matching. The incidence of RAO in the dialysis and control cohorts was calculated for 2004 to 2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to evaluate the risk of developing RAO in dialysis patients. Cumulative RAO incidence curves were generated using the Kaplan–Meier method. Whether dialysis modalities influenced the incidence of RAO was also evaluated.

Results:

Seventy-six thousand seven hundred and eighty-two end-stage renal disease patients on dialysis were included in the dialysis cohort, and 76,782 individuals were included in the control cohort. During the study period, 293 patients in the dialysis cohort and 99 patients in the control cohort developed RAO. The person-years incidence of RAO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 1.1/1,000 person-years; control = 0.3/1,000 person-years;P< 0.001). The incidence of RAO was not significantly different between the two methods of dialysis (hemodialysis vs. peritoneal dialysis;P= 0.25, log-rank test).

Conclusion:

The current study provided epidemiological evidence that undergoing dialysis for end-stage renal disease was associated with an increased risk of developing RAO. The incidence of RAO rapidly increased as the duration of dialysis increased. These results strengthen the significant role of the renal function in retinal vascular disease.
Photobiomodulation therapy in age-related macular degeneration
Authors: Muste Justin C. , Kalur Aneesha , Iyer Amogh , Valentim Carolina C.S. , Singh Rishi P.
Published: February 2021

Purpose of review

To review the available data supporting the use of photobiomodulation therapy (PBT) in the treatment of age-related macular degeneration (AMD).

Recent findings

PBT might be used in treating nonexudative AMD. Limited evidence suggests that exudative AMD may also benefit from PBT.

The optimal device would deliver doses of 60 J/cm2 or more with a multiwavelength composition through the pupil over short treatment intervals. Safe upper limits have not been established. More studies are needed to evaluate the efficacy of PBT in treating exudative and nonexudative AMD.
Orbital inflammatory disorders: new knowledge, future challenges
Authors: Kahana Alon
Published: February 2021

Purpose of review

This review aims to bring together recent advances in basic, translational and clinical research on the pathogenesis and treatment of orbital inflammatory conditions.

Recent findings

Basic science studies provide mechanistic insights into why the orbit is targeted for inflammation by autoimmune inflammatory disorders. Using Graves’ disease as a test case reveals that endocrine pathways, such as the TSH and IGF1 receptor pathways play important roles in stimulating orbital inflammation. Furthermore, orbital tissues contain high concentrations of retinoids – byproducts of the visual pathway that diffuse across the sclera and can activate de novo transcription of inflammatory cytokines. Such cytokine expression places the orbit in a hyper-inflammatory ‘resting’ state, prone to respond to any additional systemic or local pro-inflammatory signals. The HIF2A--LOX pathway appears important for orbital tissue fibrosis. Lastly, bench-to-bedside studies of the IGF1R pathway have led to an FDA-approved drug, teprotumumab that represents a novel treatment approach for Graves’ orbitopathy. Unfortunately, high drug costs and misplaced insurance company ‘step-therapy’ policies may block patients from receiving therapy that can protect vision and improve quality of life.

Improved understanding of orbital inflammatory conditions has led to a new drug and promises additional breakthroughs. Translational research is successful, but requires time, resources, and patience.
Novel vitreous substitutes: the next frontier in vitreoretinal surgery
Authors: Schulz André , Januschowski Kai , Szurman Peter
Published: February 2021

Purpose of review

After removing the native vitreous during vitreoretinal surgery, an adequate substitute is required to ensure homeostasis of the eye. Current clinically used endotamponades (silicone oil, gases, semifluorinated alkanes) are effective in promoting retinal reattachment, but lead to complications such as emulsification, prolonged inflammation, blurred vision, raised intraocular pressure, cataract formation or the need for revision surgery. The aim of this review is to provide an update on novel vitreous substitutes with a focus on polymer-based systems.

Recent findings

Polymeric hydrogels provide favourable properties such as high water content, optical transparency, suitable refractive indices and densities, adjustable rheological properties, injectability, biocompatibility and their ability to tamponade the retina via viscosity and swelling pressure, comparable to the native human vitreous body. Here, vitreous replacement strategies can be divided into chemically or physically crosslinked hydrogel systems that are applied as preformed or in-situ gelling matrices.

Several hydrogel-based vitreous substitutes have already been positively evaluated in preclinical tests and have the potential to enter the clinical phase soon.
Emerging treatments for geographic atrophy in age-related macular degeneration
Authors: Mahmoudzadeh Raziyeh , Hinkle John W. , Hsu Jason , Garg Sunir J.
Published: February 2021

Purpose of review

This review describes therapeutic research programs for geographic atrophy (GA) due to age-related macular degeneration (AMD). We highlight clinical trial data from phase I, II, and III studies.

Recent findings

There are currently no treatments for GA, a form of advanced AMD that causes significant visual morbidity. Currently, therapeutic candidates are being developed to delay further progression of GA or even attempt to reverse some of the damage. The approaches to therapy range from molecular targets to cell transplantation. Studies of these novel treatment approaches have demonstrated varying degrees of success. The progress in understanding the disease pathophysiology as well as clinical trial data is reviewed.

There are promising new treatments to prevent GA progression as well as some that may reverse the disease course.
Glaucoma Publication Trends in Leading General Ophthalmology Journals During the Past Quarter Century: Where Are the Clinical Trials?
Authors: Leshno Ari , De Moraes C. Gustavo , Mezad-Koursh Daphna , Belkin Michael , Singer Reut , Jaber Wasim , Barkana Yaniv , Skaat Alon
Published: February 2021

Précis:

During the past quarter century, the rate of glaucoma-related publication in general ophthalmology journals increased due to higher representation in “experimentally oriented” journals. The rate of glaucoma randomized controlled clinical trial (RCT) articles decreased during the same time period.

Purpose:

To evaluate trends in rate of glaucoma publications in leading general ophthalmology journals over the past quarter century.

Materials and Methods:

Q1 ophthalmology journals Web sites were reviewed. Only journals not limited to certain subspecialty were considered “general” and included in the analysis. In addition we categorized journals orientation as either “clinical” or “experimental.” The PubMed search engine was used to collect publications from the selected journals between January 1, 1995 to December 31, 2019. Publications captured by “glaucoma” or “ocular hypertension” filters were considered glaucoma related. The fraction of glaucoma articles out of total number of articles within each year for each journal was calculated. A linear mixed effects model was applied to detect trends in glaucoma publication rates during the study period.

Results:

Eight journals were included: 4 “clinically oriented” and 4 “experimentally oriented.” The PubMed search yielded 72,750 publications, of which 9329 (12.8%) considered “glaucoma related.” Percentage of glaucoma publications remained stable within “clinically oriented” journals, and significantly increased within “experimentally oriented” journals (annual change of 0.3%, P<0.001). The number of glaucoma-related RCTs decreased significantly in each (annual change of −0.21% and −0.13%, respectively, P<0.05).

Conclusions:

There has been a significant rise in the rates of glaucoma publications in “experimentally oriented” journals, while their representation in “clinically oriented” journals remained stable over the past quarter century. This change might be due to the increasing efforts to develop more advanced methods for evaluation and treatment in glaucoma, although still unable to address clinical demands. The decrease in glaucoma-related RCT articles might indicate reduced funding for such research.
Lower Success in Trabeculectomies in Exfoliation Compared With Primary Open-angle Glaucoma Patients in Sweden
Authors: Ayala Marcelo
Published: February 2021

Précis:

In a Sweden-based study, a lower success rate in exfoliation than in open-angle glaucoma patients was found in a 5-year follow-up after trabeculectomy.

Purpose:

The present study aimed to compare the success of trabeculectomies in exfoliation versus open-angle glaucoma patients.

Patients and Methods:

Data were gathered through a retrospective chart review. Included patients underwent primary trabeculectomy from January 1 2009 till December 31, 2014 (6 y). All included patients were operated on at the Eye Department, Skaraborg Hospital, Sweden, and followed for at least 5 years after surgery. Included patients had primary open-angle glaucoma (POAG) or exfoliation glaucoma (EXFG). The study followed the recommendations of the World Glaucoma Association (WGA). Successful result: criterion A: eye pressure ≤18 mm Hg and pressure reduction ≥30% without medications (complete success: A1), with or without medications (qualified success: A2). Criterion B: eye pressure ≤15 mm Hg and pressure reduction ≥40% without medications (complete success: B1), with or without medications (qualified success: B2).

Results:

A total of 147 patients were included in this study, 92 in the EXFG and 55 in the POAG group. At the baseline, only 3 variables (intraocular pressure, number of medications, and the number of laser treatments) showed a significant difference between EXFG and POAG patients. Complete and qualified success for both criterion A (A1 and A2) and B (B1 and B2) were significantly lower in the EXFG compared with the POAG group (Mantel-Cox test, P<0.0001, P=0.01, P<0.001, P=0.008).

Conclusions:

Trabeculectomies in EXFG seem to have a lower success rate than in POAG patients. EXFG patients should be checked often after trabeculectomy to detect the failure of the surgery.
Outcomes of Children Born to Pregnant Women With Drug-resistant Tuberculosis Treated With Novel Drugs in Khayelitsha, South Africa: A Report of Five Patients
Authors: Acquah Rebecca , Mohr-Holland Erika , Daniels Johnny , Furin Jennifer , Loveday Marian , Mudaly Vanessa , Reuter Anja
Published: February 2021

This brief report presents a series of 5 pregnant women treated for rifampicin-resistant tuberculosis with the novel drugs bedaquiline, delamanid, and linezolid as part of an optimized backbone regimen and reviews the outcomes of the children born to them. Although the case series is small, all children had excellent birth outcomes suggesting pregnant women should not be denied access to novel therapies for RR-TB.
Neonates With SARS-CoV-2 Infection and Pulmonary Disease Safely Treated With Remdesivir
Authors: Saikia Bedangshu , Tang Julian , Robinson Simon , Nichani Sanjiv , Lawman Kelly-Beth , Katre Mahesh , Bandi Srini
Published: February 2021

We describe 2 expremature infants presenting with SARS-CoV-2-related pulmonary disease in their second and fifth week of life needing support with mechanical ventilation. Both infants’ initial presentation was with repeated apneas. These cases highlight that SARS-CoV-2 infection could present with apneas and has the potential to progress to more severe pulmonary disease in this high-risk age group of patients. Both patients were treated with remdesivir (RDV). We provide the data of 2 high-risk neonates successfully treated with RDV without observation of any described side effects. A recognition that these high-risk neonates could deteriorate and early multidisciplinary team discussion is the mainstay to the compassionate access to RDV. Our experience led us to develop a guideline on the use of RDV below 12 years of age, with particular focus on infants and young children.
Differences Between Pediatric Acute Myocarditis Related and Unrelated to SARS-CoV-2
Authors: Vukomanovic Vladislav A. , Krasic Stasa , Prijic Sergej , Ninic Sanja , Minic Predrag , Petrovic Gordana , Nesic Dejan
Published: February 2021

Background:

Acute myocarditis (AM) is defined as inflammation of the myocardium. The aim of our study is a comparative analysis of the differences between AM related and unrelated to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods:

The retrospective study included children with AM treated from January 2018 to November 2020.

Results:

The study included 24 patients; 7 of 24 had AM related to SARS-CoV-2 and they were older than 7. They were more likely to have abdominal pain (P = 0.014), headache (P = 0.003), cutaneous rash (P = 0.003), and conjunctivitis (P = 0.003), while fulminant myocarditis was commonly registered in AM unrelated to SARS-CoV-2 (P = 0.04). A multisystem inflammatory syndrome in children associated with COVID-19 was diagnosed in six adolescents. Patients with AM related SARS-CoV-2 had lower serum cardiac troponin I (cTnI) (P = 0.012), and platelets (P < 0.001), but had a higher C-reactive protein (CRP) value (P = 0.04), and N-terminal-pro hormone BNP in comparison to patients with AM unrelated to SARS-CoV-2. The patients with AM related to SARS-CoV-2 had significant reduction of CRP (P = 0.007). Inotropic drug support was used for shorter durations in patients with AM related to SARS-CoV-2, than in others (P = 0.02). Children with AM related to SARS-CoV-2 had significant improvement of left ventricle systolic function on the third day in hospital (P = 0.001). Patients with AM unrelated to SARS-CoV-2 AM had more frequent adverse outcomes (P = 0.04; three died and four dilated cardiomyopathy).

Conclusions:

In contrast to patients with AM unrelated to SARS-CoV-2, patients with AM related to SARS-CoV-2 had a higher CRP value, polymorphic clinical presentation, shorter durations of inotropic drugs use as well as prompt recovery of left ventricle systolic function.
The Developmental Benefits of Allowing Deaf Children With Cochlear Implants Early Access to Sign Language
Authors: Johnson Mckenna
Published: February 2021

This review addresses the question of how early access to sign language influences the development of deaf children with cochlear implants (CIs) by examining the literature surrounding the topic across the domains of spoken/written language development, cognitive development, and sociocultural development. Although research in the realm of language development is mixed, there appear to be few potential detriments to sign language access that may not be mediated by other aspects, such as age of implantation. Early sign language access, furthermore, shows potential to prevent developmental delays in general as well as specific cognitive functioning, and the current article speculates that claiming a Deaf identity (to which sign language is vital) may act as a protective factor against the stress of stigma surrounding hearing loss. Based on the relative insufficiency of current research to offer undisputable long-term concerns regarding the impact of sign language on development, as well as the existing evidence that suggests that early access to sign language may act as a protective factor against delays in multiple developmental domains, this review concludes that the potential benefits of allowing deaf children with CIs early and comprehensive access to sign language outweigh any possible risks.
Economic evaluations of educational, physical, and psychological treatments for fibromyalgia: a systematic review with meta-analysis
Authors: Cabral Cristina Maria Nunes , Miyamoto Gisela Cristiane , Franco Katherinne Ferro Moura , Bosmans Judith Ekkina
Published: February 2021

Nonpharmacological interventions are recommended for the treatment of fibromyalgia, but there is a lack of knowledge about the cost-effectiveness of these interventions. The aim of this study was to systematically review economic evaluations of educational, physical, and psychological interventions for the treatment of fibromyalgia. The search was performed in PUBMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, PsycINFO, EconLit, National Health Service Economic Evaluation Database, and Health Technology Assessment. Economic evaluations of educational, physical, and psychological interventions for adult patients with fibromyalgia were included. Primary outcomes were healthcare and societal costs, and quality-adjusted life-years, and secondary outcomes were any disease-specific clinical outcome. Costs and effects were pooled in a meta-analysis, when possible. Eleven studies were included, of which 7 compared a psychological intervention with another intervention or usual care/control. Over a 6-month time horizon, healthcare and societal costs of the psychological intervention were significantly lower than usual care (mean difference: $−2087, 95% confidence interval [CI]: −3061 to −1112; mean difference: $−2411, 95% CI: −3582 to −1240, respectively), and healthcare costs were significantly lower for the psychological intervention compared with a pharmacological intervention (mean difference: $−1443, 95% CI: −2165 to −721). Over a 12-month time horizon, healthcare costs for the psychological intervention were significantly lower than for usual care (mean difference: $−538, 95% CI: −917 to −158). Incremental cost-effectiveness ratios for quality-adjusted life-years and impact of fibromyalgia showed that the psychological intervention was cost-effective compared with other interventions and control conditions. There is a need of more economic evaluations conducted alongside randomized controlled trials with interventions recommended for the treatment of fibromyalgia, such as physical exercise.
Open-label placebo vs double-blind placebo for irritable bowel syndrome: a randomized clinical trial
Authors: Lembo Anthony , Kelley John M. , Nee Judy , Ballou Sarah , Iturrino Johanna , Cheng Vivian , Rangan Vikram , Katon Jesse , Hirsch William , Kirsch Irving , Hall Kathryn , Davis Roger B. , Kaptchuk Ted J.
Published: February 2021

It is commonly believed that blinding to treatment assignment is necessary for placebos to have an effect. However, placebos administered without concealment (ie, open-label placebos [OLPs]) have recently been shown to be effective in some conditions. This study had 2 objectives: first, to determine whether OLP treatment is superior to no-pill control (NPC) in irritable bowel syndrome (IBS) and, second, to compare the efficacy of OLP against double-blind placebo (DBP). In a 6-week, 3-arm, randomized clinical trial, participants were randomized in equal proportions to 3 arms: OLP, DBP, or NPC. Two hundred sixty-two adults (72.9% women), with a mean age of 42.0 (SD = 18.1) years, participated in the primary study. The mean improvement on the IBS Severity Scoring System from baseline to the 6-week end point was significantly greater in OLP compared with that in NPC (90.6 vs 52.3, P = 0.038). Open-label placebo and DBP did not differ significantly on IBS Severity Scoring System improvement (100.3 vs 90.6, P = 0.485). Standardized effect sizes were moderate for OLP vs NPC (d = 0.43) and small for OLP vs DBP (d = 0.10). Participants treated with OLP reported clinically meaningful improvements in IBS symptoms that were significantly greater than those on NPC. Open-label placebo and DBP had similar effects that did not differ significantly, suggesting that blinding may not be necessary for placebos to be effective and that OLP could play a role in the management of patients with refractory IBS.
Effect of back problems on healthcare utilization and costs in Ontario, Canada: a population-based matched cohort study
Authors: Wong Jessica J. , Côté Pierre , Tricco Andrea C. , Watson Tristan , Rosella Laura C.
Published: February 2021

We assessed the effect of back problems on healthcare utilization and costs in a population-based sample of adults from a single-payer health system in Ontario. We conducted a population-based cohort study of Ontario respondents aged ≥18 years of the Canadian Community Health Survey (CCHS) from 2003 to 2012. The CCHS data were individually linked to health administrative data to measure healthcare utilization and costs up to 2018. We propensity score-matched (hard matched on sex) adults with self-reported back problems to those without back problems, accounting for sociodemographic, health-related, and behavioural factors. We evaluated cause-specific and all-cause healthcare utilization and costs adjusted to 2018 Canadian dollars using negative binomial and linear (log transformed) regression models. After propensity score matching, we identified 36,806 pairs (women: 21,054 pairs; men: 15,752 pairs) of CCHS respondents with and without back problems (mean age 51 years, standard deviation = 18). Compared with propensity score matched adults without back problems, adults with back problems had 2 times the rate of cause-specific visits (rate ratio [RR]women 2.06, 95% confidence interval [CI] 1.88-2.25; RRmen 2.32, 95% CI 2.04-2.64), slightly more all-cause physician visits (RRwomen 1.12, 95% CI 1.09-1.16; RRmen 1.10, 95% CI 1.05-1.14), and 1.2 times the costs (women: 1.21, 95% CI 1.16-1.27; men: 1.16, 95% CI 1.09-1.23). Incremental annual per-person costs were higher in adults with back problems than those without back problems (women: $395, 95% CI $281-$509; men: $196, 95% CI $94-$300). This corresponded to $532 million for women and $227 million for men (adjusted to 2018 Canadian dollars) annually in Ontario given the high prevalence of back problems. Given the high health system burden, new strategies to effectively prevent and treat back problems and thus potentially reduce the long-term costs are warranted.
Sufficient conditions for effective psychological treatment of chronic pain: a qualitative comparative analysis
Authors: Batho Anna , Kneale Dylan , Sutcliffe Katy , Williams Amanda C de C.
Published: February 2021

Chronic pain (CP) is the leading cause of years lived with disability globally. Treatment within Western medicine is often multicomponent; the psychological element of treatment varies, yet the optimal conditions for effective reduction of pain-related outcomes remain unclear. This study used qualitative comparative analysis, a relatively new form of evidence synthesis in the field based on set theory to ascertain configurations of intervention components and processes of psychological treatment of chronic pain in adults that lead to more effective interventions. Data were extracted from 38 studies identified in a concurrent Cochrane review and were then subjected to qualitative comparative analysis. Two analyses were conducted: one to examine what is most effective for reducing disability and one to examine what is most effective for reducing distress. Analysis and comparison of the 10 treatments with best outcomes with the 10 treatments with poorest outcomes showed that interventions using graded exposure, graded exercise or behavioural rehearsal (exposure/activity), and interventions aiming to modify reinforcement contingencies (social/operant) reduced disability levels when either approach was applied but not both. Exposure/activity can improve distress levels when combined with cognitive restructuring, as long as social/operant methods are not included in treatment. Clinical implications of this study suggest that treatment components should not be assumed to be synergistic and provided in a single package.
“Here Comes the Junkies,” Opioid Replacement Therapy in Rural Australia
Authors: Opie Cynthia Ann , Wood Penelope , Haines Helen Mary , Franklin Richard C.
Published: February 2021

Background

Opioid replacement therapy (ORT) offers a harm minimization approach and is the mainstay treatment option for opioid dependence in Australia. Recovery is known to be complicated because of service access, cost, workforce availability, privacy, stigma, and discrimination. Rural living is considered to magnify each complication of recovery, yet little is understood about how opioid dependence recovery is experienced in rural Australia. This study aimed to explore the lived experience of people receiving ORT in rural Australia and describe impediments to recovery.

Methods

In this qualitative study design, all outpatients enrolled in ORT at two rural Australian sites were invited to participate. Six volunteers from each site participated in a semistructured interview (eight men, four women; mean age = 44.8 years).

Results

The participants had completed 3 years of secondary school education on average. Four major themes emerged: reinvention, restriction, employment, and reconnection. Small communities increased the likelihood of ORT participants knowing people both directly and indirectly, affecting their ability to reconstruct an identity. Lived distance from prescribers and dosing points dictated daily activity, including opportunities to seek and maintain employment. Rural ORT treatment seekers indicated that geographical displacement and separation from family, the people they needed to reconnect with, were challenging.

Conclusion

Rural people engaged in ORT require positive reinforcement from service providers, enabling identity reinvention and disconnection from the drug-seeking world. Acknowledging underlying trauma and supporting reconnection with loved ones may foster positive social connectedness.
Latent Profiles of Alcohol Consumption Among College Students Exposed to Trauma
Authors: Bountress Kaitlin E. , Hawn Sage E. , Dick Danielle M. ,   Spit for Science Working Group, Amstadter Ananda B.
Published: February 2021

Background

Alcohol use/misuse is a costly public health problem, particularly among college students in the United States. Alcohol use tends to increase during adolescence and peaks in the early/mid-20s; however, there is significant heterogeneity among alcohol use during the college years. Several studies applying a mixture modeling framework to extract latent profiles of alcohol consumption have been conducted. However, none to our knowledge has included only those exposed to trauma, a group known to be at risk for alcohol misuse. The aim of this longitudinal study (n = 1,186) was to identify profiles of alcohol consumption and their associations with demographic and trauma-related constructs.

Method

Data were collected from a larger study of college students attending a large public university. Participants in the current study were, on average, 18.46 years old at study entry, primarily female (69.6%), and of diverse racial/ethnic backgrounds (e.g., 48.8% White, 20.4% Black, 16.8% Asian).

Results

Results suggest evidence for four latent profiles. These classes include an initially high increasing, an initially high decreasing, an initially low decreasing, and an initially low increasing, the last of which had not been found. Using analyses of variance, profile membership was associated with number of traumas, probable posttraumatic stress disorder, broad drinking motives, and trauma-specific drinking-to-cope motives.

Conclusions

Results suggest that drinking motives and trauma-related factors are important correlates of these latent alcohol profiles. Work clarifying the longitudinal interrelations between profile membership and these factors is needed to help inform more effective prevention and intervention efforts.
International Nursing Collaboration to Establish the Philippine Quit Line
Authors: Fildes Elizabeth E. , Campbell Nancy J. , Ong-Cabrera Glynna , Garcia Robert
Published: February 2021

Tobacco use remains the single most preventable cause of death and disability worldwide. In the Philippines, 28.3% of the people are current tobacco smokers, which is one of the highest smoking rates in Asia. The World Health Organization estimates that 10 Filipinos die every day from cancer, stroke, and lung and heart disease caused by cigarette smoke and approximately 24 million Filipinos are exposed to secondhand smoke in the home. Although there are quit lines in all 50 U.S. states and territories, there was no access to this smoking cessation program in the Philippines before the initiation of the international collaboration described in this article. In 2012, a Filipino-American nurse with extensive quit line expertise initiated collaboration between the United States and Philippine smoking cessation experts to plan the creation of a quit line at the Lung Center of the Philippines. The Conceptual Model for Partnership and Sustainability in Global Health was used as a foundation for the planning, implementation, and evaluation of the Philippine Quit Line project, which was funded in 2017 by the World Health Organization and the Philippine Department of Health. This funding and other outcomes related to nursing education about tobacco addictions in the Philippines suggest that the Partnership and Sustainability in Global Health Model can provide a blueprint for international collaboration on health projects that are rooted in real collaborative and sustainable partnerships.
The Influence of Physical Condition on Mental Health and Quality of Life in Patients With Drug Dependence
Authors: Giménez-Meseguer Jorge , Tortosa-Martínez Juan
Published: February 2021

Background

Exercise has been proposed as a good strategy to prevent use and relapse and to improve mental health and quality of life in drug-dependent people. However, it is not known if physical condition per se influences quality of life and mental health.

Objective

The aims of this study were to analyze the relationships between physical condition, mental health, and quality of life in patients with drug dependence and to determine whether physical condition could predict levels of mental health and quality of life.

Method

Levels of physical condition (Timed Get Up and Go test, Chair Stand Test, six-minute walk test), mental health (Depression Anxiety Stress Scales [DASS-21]), and quality of life (Short Form Health Survey) were measured in a sample of 125 patients with drug dependence. A correlation analysis and a stepwise multiple linear regression analysis were performed.

Results

The physical condition tests predicted all DASS-21 variables: stress (F = 26.30, p < .001), anxiety (F = 18.33, p < .001), depression (F = 27.63, p < .001), total DASS-21 (F = 23.91, p < .001), and all the variables of the Short Form Health Survey for quality of life.

Conclusions

Physical condition can predict the levels of mental health and quality of life of patients with drug dependence.
Adolescent Girls and Alcohol Use: Increasing Concern During the COVID-19 Pandemic
Authors: Smith Tedra S. , Bryant Pamela Harris , Fogger Susanne Astrab
Published: February 2021

Adolescence is a time known for risky behaviors and often the initiation of alcohol use. Readily available, alcohol is often one of the drugs of choice for adolescents. Whereas in the past 30 years, the overall consumption of alcohol is down, the data in the past 10 years have shown more girls are binge drinking and meeting criteria for alcohol use disorder (AUD). The alarm of early alcohol use is the association with problems with the substances later in life. Historically, men and male adolescents consumed more alcohol than females. Recent studies indicate girls' alcohol use surpasses boys, whereas women now are developing AUD at the same rate as men. The consequences of early use can result in women's increased risk for multiple cancers, having a more severe form of AUD with less alcohol consumption as well as premature death. To further exacerbate this growing concern, the novel coronavirus (COVID-19) pandemic has created a perfect storm for increased use of alcohol to cope with the stress of living in an uncertain world. Normal daily activities have been halted with the uncertainty of school closures, zoom classroom sessions, and living in mandated social isolation. All nurses need to be screening for how families under their care have been managing stress. The time is opportune to educate and support parents in engaging their children in conversations around substance use. Parents can be supported to increase awareness of their own coping mechanisms and strengthen positive coping. Adolescents need support to strengthen interpersonal skills as well as make informed decisions concerning when and how they engage in alcohol consumption. This article will illuminate the growing need for all healthcare providers to assess and guide adolescents' coping skills during COVID with a focus on mental health, high-risk behavior, and alcohol use.
Substance Abuse Disorder in Nursing
Authors: Mozingo Kimberly D.
Published: February 2021

Outcome measures for individual states' nursing professional alternative-to-discipline (ATD) programs have historically ceased beyond successful fulfillment of active program monitoring, leaving a gap in affirmation of sustained postprogram efficacy. The project objective challenges the absence of profession-specific postmonitoring practice, affording qualitative evaluation of the program's impact to professional nursing. The pilot study's 8-week process improvement PICO(T) seeks validation of incorporating postprogram monitoring to validate program efficacy, conceptualizing framework guidelines established by the Federation of State Physician Health Programs' Performance Enhancement Review. Study efforts encompass identified needs assessment, current practice through outcome recommendations, and access of developed online mixed-methods appraisal with an emphasis on qualitative analysis, questioning the alumni's state of sobriety, perspective related to program participation, workforce contribution to professional practice, and intent to remain in nursing. The proposed alumni graduate status between 2 and 5 years from program completion resulted in an 11% response rate: 90% reported zero relapse since program completion; greater than 50%, willingness to participate as ATD or peer mentors; 90%, nursing licensure in good standing; and 66%, intent to remain working in profession over the next 5 years. Limitations constitute sample size, inception groundwork, and project constraints. Findings offer insight from alumni perspective, validation of literary support, and organizational interest for implementation. Contributions to nursing practice embody care of the caregiver ideology and offer future collaboration with ATD programs at state, national, and global levels to support sustained recovery of professionals affected with substance use disorder.
“Talking Around It”
Authors: DeGroot Lyndsay G. , Bidwell Julie T. , Peeler Anna C. , Larsen Luke T. , Davidson Patricia M. , Abshire Martha A.
Published: February 2021

Background

Vital components of communicating goals of care and preferences include eliciting the patient and caregiver's definition of quality of life, understanding meaningful activities and relationships, and exploring wishes for care at the end of life. Although current literature suggests framing conversations regarding end of life through the lens of meaning and quality of life, there is limited literature exploring dyadic congruence surrounding these important constructs among patients with ventricular assist devices (VADs) and their caregivers.

Objectives

The purpose of this study was to explore congruence of VAD patient and caregiver perspectives regarding end of life, definitions of quality of life, and meaning in life while managing the uncertainty of living with a VAD.

Methods

We used thematic analysis to analyze semistructured qualitative interviews of 10 patient-caregiver dyads 3 to 12 months after VAD implantation.

Results

Three major themes were identified: (1) differing trajectories of uncertainty and worry, (2) a spectrum of end-of-life perspectives, and (3) enjoying everyday moments and independence. Overall, patients and caregivers had differing perspectives regarding uncertainty and end of life. Within-dyad congruence was most evident as dyads discussed definitions of meaning or quality of life.

Conclusions

Dyadic perspectives on end of life, meaning in life, and quality of life can inform how palliative care and VAD teams approach conversations about planning for the end of life. Findings from this study can inform future shared decision-making interventions for patients living with VADs and their caregivers.
Prognostic Value of the Nutritional Risk Screening 2002 Scale in Patients With Acute Myocardial Infarction
Authors: Li Fanghui , Li Dongze , Yu Jing , Jia Yu , Jiang Ying , Chen Xiaoli , Gao Yongli , Ye Lei , Wan Zhi , Cao Yu , Zeng Zhi , Zeng Rui
Published: February 2021

Background

The Nutritional Risk Screening 2002 (NRS-2002) scale is a rapid and effective screening instrument that assesses nutritional risk among hospitalized patients.

Objective

The present study aimed to explore the prognostic value of the NRS-2002 scale in acute myocardial infarction (AMI) considering its uncertain role in this particular condition.

Methods

Patients with AMI included in the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain were investigated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to analyze the association between NRS-2002 and mortality in patients with AMI. The primary and secondary endpoints were all-cause and cardiac mortality during the follow-up period.

Results

A total of 2307 patients were enrolled, among whom 246 (10.7%) died within a median follow-up duration of 10.67 (8.04–14.33) months. Kaplan-Meier analysis revealed that patients with an NRS-2002 score of 3 or higher had poorer cumulative survival than those with an NRS-2002 score lower than 3 (P < .001). In the multivariate Cox regression analysis, patients with an NRS-2002 score of 3 or higher had more than double the risk for all-cause mortality (hazard ratio, 2.25; 95% confidence interval, 1.50–3.40; P < .001) and twice the risk for cardiac-related mortality (hazard ratio, 2.01; 95% confidence interval, 1.29–3.13; P = .002) than did patients with lower scores.

Conclusions

Our results showed that the NRS-2002 screening instrument was an independent prognostic predictor for both all-cause and cardiac mortality in patients with AMI. Nutritional risk assessment based on the NRS-2002 scale may provide useful prognostic information of early nutritional risk stratification in patients with AMI.
Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users
Authors: Gómez-Sousa María , Jiménez-Garrido Daniel F. , Ona Genís , dos Santos Rafael Guimaraes , Hallak Jaime E. C. , Alcázar-Córcoles Miguel Ángel , Bouso José Carlos
Published: February 2021

Background

In recent decades, ritualistic use of ayahuasca has spread throughout the world. Retrospective studies have suggested a good psychological safety profile, but prospective studies involving ceremony ayahuasca-naive participants are lacking.

Methods

We conducted the study using a subsample from a previous study, for which first-time ceremony ayahuasca participants were recruited. The subsample consisted of 7 subjects who experienced acute and challenging psychological reactions. The semistructured Mini-International Neuropsychiatric Interview and psychometric questionnaires were administered before participants attended the ayahuasca ceremony and at 1 and 6 months after exposure. Subjective experiences were also recorded.

Results

Seven subjects from a sample of 40 reported having experienced intense challenging psychological effects during the ayahuasca ceremony. Four of those 7 subjects met the diagnostic criteria for 1 or more psychiatric disorder before the ayahuasca ceremony. One month after the ceremony, 2 of those subjects no longer showed psychiatric symptoms, whereas the symptoms of the other 2 were reduced considerably. Those results persisted at the 6-month follow-up. Inappropriate setting/context (poor guiding skills and screening) contributed to some of the challenging reactions. Most of the participants (6 of 7) did not take ayahuasca again during the study period.

Conclusions

Based on the cases reported here, we suggest that although it is possible that participating in ayahuasca ceremonies may entail acute psychological negative reactions, those challenging experiences can also have positive long-term effects. Prospective research on the safety profile of ayahuasca and how it is affected by the context of different practices and safety strategies is therefore necessary.
Does the Starting of Clozapine Influence Coprescription of Other Medications?
Authors: Grover Sandeep , Naskar Chandrima , Chakrabarti Subho
Published: February 2021

Purpose/Background

Little is understood about the prescription load before and after the starting of clozapine. Accordingly, this study aimed to evaluate the medication load of patients receiving clozapine, just before starting clozapine and after being on clozapine for at least 1 year. Additionally, the impact of clozapine on severity of illness was evaluated.

Methods/Procedures

Two hundred seventy-seven outpatients receiving clozapine were prospectively evaluated for their prescription after at least 1 year of starting clozapine. Additionally, these patients were assessed on the Clinical Global Impression-Improvement scale to evaluate the overall clinical benefit with clozapine.

Findings/Results

They had been receiving clozapine for 6.55 (SD, 4.8; range, 1–24; median, 5) years at the time of assessment. At the start of clozapine, more than one third of the patients were receiving 2 antipsychotics. A small proportion was receiving other psychotropics, such as antidepressants, mood stabilizers, and benzodiazepines. After being on clozapine for 1 year, there was a significant reduction in the number of patients receiving two antipsychotic medications (P < 0.001), number of patients receiving antidepressants (if amitriptyline was left out), benzodiazepine (P < 0.001), and anticholinergic medications (P < 0.001). Further, there was a reduction in the mean chlorpromazine equivalent of antipsychotics (P < 0.001) and the total number of medications received by the patients (P < 0.001). However, there was an increase in the prescription rates of antihypertensive drugs (P = 0.03), anti-diabetic medications (P < 0.01), and anti-dyslipidemic medications. At follow-up, there was a significant improvement in symptoms as assessed by Clinical Global Impression-Improvement scale.

Implications/Conclusions

This study suggests that long-term use of clozapine is associated with substantial improvement in symptoms with a reduction in the medication load.