bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Silicone Sheets and Paper Tape for the Management of Postoperative Scars: A Randomized Comparative Study
Authors: Lin Ying-Sheng , Ting Pei-San , Hsu Kuei-Chang
Published: May 2020

OBJECTIVE

To compare the effectiveness of silicone sheets and paper tape in the prevention of postoperative cesarean section scars.

METHODS

Patients undergoing horizontal cesarean section were included in this randomized controlled trial. Surgical wounds were divided into two halves. Patients randomly applied silicone sheets or paper tape to each side of their wound as assigned for 3 months. Wounds were assessed at 1, 3, 6, and 12 months after surgery. Researchers used the objective Vancouver Scar Scale (VSS) to evaluate the scars and the subjective visual analog scale (VAS) to evaluate itch, pain, and scar appearance.

RESULTS

No significant differences between the silicone sheet and paper tape groups were noted at postoperative follow-ups with respect to VSS scores. The silicone sheet group had significantly better VAS scores for scar appearance than the paper tape group at 6 (6.81 ± 1.47 vs 6.19 ± 1.62, P = .03) and 12 (6.88 ± 2.01 vs 6.2 ± 2.08, P = .04) months’ follow-up, respectively.

CONCLUSIONS

The silicone sheet group showed statistically significant differences in comparison with the paper tape group in terms of scar appearance as determined by the VAS. However, the differences were too small to be clinically meaningful.
The Omnipresence of Cancer
Authors: Zumstein-Shaha Maya , Lynn Cox Carol , Fawcett Jacqueline
Published: May 2020

This article aimed at describing the development of a theory of the experience of living with cancer. Secondary analysis of data from a series of studies yielded the concepts and propositions of the theory of the omnipresence of cancer. Theory construction was guided by Heidegger's ontology of dasein, whereas Newman's grand theory of health as expanding consciousness guided theory evolution. The theory includes 4 concepts—influencing factors, toward authentic dasein, mapping out the future, and living with cancer—each of which has several dimensions. Based on this theory, nursing interventions can be developed and tested to support persons with cancer.
The Contribution of Documentation Systems to How Nurses Understand Older People's Cognitive Function in Hospital
Authors: Moody Elaine , Phinney Alison , Boschma Geertje , Baumbusch Jennifer
Published: May 2020

Nurses are central to the care of older people in hospital. One issue of particular importance to the experience and outcomes of hospitalized older people is their cognitive function. This article reports findings from a focused ethnographic study demonstrating how documentation systems—documents and the social processes surrounding their use—contribute to how nurses come to understand the cognitive function of hospitalized older people. We found that documents contribute to nurses' understanding by serving as a frame of reference, by directing assessments, and by constraining communication. The findings highlight the potential to improve the documents nurses use in hospitals.
Coronavirus Disease 2019 Return to Work Guidance and Recommendations for Vestibular Clinicians
Authors: Rizk Habib G. , Strange Christine , Atallah Stephanie , Massingale Shelly , Clendaniel Richard
Published: May 2020

As states begin issuing progressive deconfinement guidelines, hospitals and institutions are starting to reopen for elective procedures and consultations. Vestibular clinicians are opening their practices to evaluate, test, or treat patients with dizziness and balance problems. The following document, requested by the American Balance Society, collates the current information about the virus, including transmission from asymptomatic carriers, decontamination, and other safety protocols, and provides a return to work guidance for clinicians caring for this population of patients, promoting provider, patient, and staff safety.
Medial patellofemoral ligament reconstruction using a central strip of the quadriceps tendon in patients with recurrent patellar instability: a prospective case series
Authors: Fadel Mohie-Eldin , Hosni Yaser
Published: May 2020

Background:

Patellar fractures and chondral injuries are serious complications after medial patellofemoral ligament (MPFL) reconstruction. Using a central strip from the quadriceps tendon avoids these complications. Moreover, this technique maintains an anatomical attachment of the tendon at the proximal patella at the position of the native MPFL. The quadriceps strip is biomechanically comparable to the intact MPFL, whereas the hamstring tendon graft is stiffer than the native MPFL.

Methods:

Thirty-four patients were involved in this study. Conservative treatment failed in all after an initial episode of patellar dislocation. Their mean age was 19.4 yr. The mean duration of symptoms was 14.3 mo. The mean follow-up period was 28.7 mo. Their preoperative visual analogue scale (VAS) was 5 and their preoperative Kujala score was 69.5. Mean Caton-Deschamps index was 1.1. Patella alta was found in seven patients. Thirteen patients had trochlear dysplasia. All had MPFL reconstruction using 10-cm long, 10-mm wide, 3 mm thick strip harvested from the central portion of the quadriceps tendon.

Results:

The mean VAS score was significantly reduced from 5 to 1. Mean Kujala score significantly improved from 69.5 to 94.8. The patellar tilt decreased significantly. There was no significant correlation between final Kujala scores and the presence of anatomical predisposing factor. All patients had negative patellar apprehension tests.

Conclusions:

Using a central strip of the quadriceps tendon in the reconstruction of MPFL in patients with recurrent patellar dislocation is an excellent option.

Level of Evidence:

Level IV.
Outcomes Following the Urgent Surgical Management of Displaced Femoral Neck Stress Fractures
Authors: Cochran Grant K. , Staeheli Gregory R. , Deafenbaugh Bradley K. , Kuhn Kevin M.
Published: May 2020

Objectives:

To review the clinical course, complication rates, and mid-term functional outcomes associated with the treatment of displaced femoral neck stress fractures (FNSFs).

Design:

Retrospective Case Series.

Setting:

Military Tertiary Referral Center.

Patients:

Twenty-one operatively treated displaced FNSFs between 2002 and 2015.

Intervention:

Urgent reduction and fixation was performed. If nonunion developed, an intertrochanteric osteotomy was performed.

Main Outcome Measurements:

Nonunion, osteonecrosis (ON) of the femoral head, conversion to arthroplasty, modified Harris Hip Score, pain score, and Hip Outcome Score (HOS).

Results:

Two (9.1%) patients developed nonunion. Both united after revision with intertrochanteric osteotomy. ON developed in one patient (4.8%) who was converted to arthroplasty. Average pain score at final follow-up was 2.0 (range 0–5). Average Modified Harris Hip Score was 84 (range 54–100). Average HOS Activities of Daily Living subscale was 80.9 (range 45.6–100). Average HOS Sport subscale was 69.8 (range 27.8–100). Larger displacement on injury films correlated with lower Modified Harris Hip Scores (P = 0.048) and lower HOS Sports Subscale Single Assessment Numeric Evaluation (P = 0.023). The need for an open reduction trended toward being a risk factor for nonunion (P = 0.081).

Conclusions:

This study represents the largest series of patients undergoing urgent surgery for displaced FNSFs. Nonunion and ON is found at a similar rate to what is reported in the young traumatic literature. Pain and outcome scores compare favorably to other hip pathology in young adults. Initial injury severity is variably correlated to final outcome scores.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Association of Perioperative Computed Tomography Hounsfield Units and Failure of Femoral Neck Fracture Fixation
Authors: Lund Erik A. , Samtani Rahul , Winston Mark , Anderson Paul A. , Whiting Paul S. , O'Toole Robert V. , Hetzel Scott , Doro Christopher J.
Published: May 2020

Objectives:

To determine whether Hounsfield units (HUs) measured on perioperative computed tomographic scans are associated with radiographic outcomes and reoperations after femoral neck fracture fixation.

Design:

Retrospective cohort study.

Setting:

Level I trauma center.

Patients:

One hundred fourteen patients age ≥18 years, who presented to a Level I trauma center, and who underwent surgical fixation of intracapsular femoral neck fracture and had perioperative computed tomographic scans and adequate follow-up.

Intervention:

None.

Main Outcome Measurements:

Screw penetration, femoral neck shortening >5 mm, and revision surgery.

Results:

A median follow-up was 23 months. An HU measurement of the femoral head was significantly associated with screw penetration and femoral neck shortening but not revision surgery. Patients with middle femoral head HU measurements <146 had 17 times (95% confidence interval: 4.32–78.9, P < 0.001) increased odds of screw penetration. Greater than 5 mm shortening was seen in patients with HUs <212.5 in the low head section by an odds ratio of 7.8 (95% confidence interval: 2.15–33.0, P = 0.014).

Conclusion:

Outcome differences regarding screw penetration and femoral neck shortening related to the HU or densities of femoral head and neck at the time of fracture are significant. These findings can help the clinician with developing a treatment plan for either arthroplasty or fixation of a femoral neck fracture based on objective bone quality measurements rather than relying on an arbitrary age recommendation.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Supramalleolar Osteotomy for Asymmetric Ankle Arthritis
Authors: Miniaci-Coxhead Sara Lyn
Published: May 2020

Supramalleolar osteotomy is a common procedure for treating patients with asymmetric, focal ankle arthritis, and distal tibia deformities. This paper discusses the history, indications, preoperative planning, surgical techniques, complications, and outcomes in relation to the supramalleolar osteotomy.
Mobile Application as a Learning Aid for Nurses and Nursing Students to Identify and Care for Stroke Patients
Authors: Baccin Camila Rosalia Antunes , Dal Sasso Grace T. Marcon , Paixão Crysttian Arantes , de Sousa Paulino Artur Ferreira
Published: May 2020

Cerebrovascular accident is a serious public health problem and requires the attention of professionals who can detect, diagnose, and provide care in a timely fashion. A quantitative quasi-experimental study was conducted using a mobile app called mSmartAVC for clinical evaluation of nursing care at the bedside. The study aimed at measuring the knowledge of nurses and nursing students in the detection and care of cerebrovascular accident. In this study, a total of 115 nurses from health services in the South of Brazil and 35 nursing students of a community university participated. The stages focused on development, modeling of clinical cases, problem-based learning, pretest (before) app use, and posttest (after) use of the app. The results of the pretest and posttest corrections showed a substantial statistical difference (P < .001), indicating a significant knowledge gain after the use of the app, particularly in terms of the detection scales and interpretation of the imaging tests. The mSmartAVC app used at the bedside supported decision-making for detection and nursing care. It was possible to confirm that the use of mobile apps plays an essential role as a learning tool for nurses and nursing students.
Maintaining Intervention Fidelity When Using Technology Delivery Across Studies
Authors: Bonar Jaime Rachelle M. , Wright Shawna , Yadrich Donna Macan , Werkowitch Marilyn , Ridder Lavonne , Spaulding Ryan , Smith Carol E.
Published: May 2020

The current standard in healthcare research is to maintain scientific fidelity of any intervention being tested. Fidelity is defined as the consistent delivery of interventions that ensures that all participants are provided the same information, guidance, and/or materials. Notably, the methods for ensuring fidelity of intervention delivery must also be consistent. This article describes our Intervention and Technology Delivery Fidelity Checklists used to ensure consistency. These checklists were completed by trained nurse observers who rated the intervention implementation and the technology delivery. Across our clinical trials and pilot studies, the fidelity scores were tabulated and compared. Intervention information and materials were delivered by a variety of devices including telehealth monitors, videophones, and/or iPads. Each of the devices allows audiovisual connections between health professionals from their offices and patients and participants in their homes. Our checklists guide the monitoring of fidelity of technology delivery. Overall checklist ratings across our studies demonstrate consistent intervention, implementation, and technology delivery approaches. Uniquely, the fidelity checklist verifies the interventionist's correct use of the technology devices to ensure consistent audiovisual delivery. Checklist methods to ensure intervention fidelity and technology delivery are essential research procedures, which can be adapted for use by researchers across multiple disciplines.
Trait specific modulatory effects of caffeine exposure on compulsive-like behaviors in a spontaneous mouse model of obsessive-compulsive disorder
Authors: Mitra Swarup , Santana Miranda Vanessa , McMillan Casey , Dykes Daniel , Mucha McKenzie , Marth Tandi E. , Poe Brooks , Basu Debarati Ghosh , Bult-Ito Abel
Published: May 2020

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by recurring intrusive thoughts and repetitive compulsive behaviors, ultimately interfering with their quality of life. The complex heterogeneity of symptom dimensions across OCD patient subgroups impedes diagnosis and treatment. The core and comorbid symptomologies of OCD are thought to be modulated by common environmental exposures such as consumption of the psychostimulant caffeine. The effect of caffeine on the expression of obsessions and compulsions are unexplored. The current study utilized mouse strains (HA) with a spontaneous, predictable, and stable compulsive-like phenotype that have face, predictive, and construct validity for OCD. We demonstrate that an acute high dose (25 mg/kg) of caffeine decreased compulsive-like nest-building behavior in the HA strains in the first hour after injection. However, nest-building scores increased in hours 3, 4, and 5 after administration finally decreasing over a 24 h period. In contrast, a high dose of chronic caffeine (25 mg/kg/d) increased nest-building behavior. Interestingly for compulsive-like digging behavior, acute exposure to a high dose of caffeine decreased the number of marbles buried, while chronic exposure had little effect. An acute high dose of caffeine decreased anxiety-like and motor activity in open field behaviors whereas chronic caffeine administration did not have any overall effect on open field activity. The results, therefore, suggest a complex role of caffeine on compulsive-like, anxiety-like, and locomotor behaviors that is dependent on the duration of exposure.
Consensus Organizing and Community-Based Participatory Research to Address Social-Structural Disparities and Promote Health Equity
Authors: Brown Mary Ellen , Stalker Katie C.
Published: May 2020

This case study illustrates the process of integrating community-based participatory research and consensus organizing in an effort to deconstruct social-structural risk factors and markers of health disparities, and build positive relationships between members of the criminal justice system and the community. Community residents, law enforcement, and other cross-sector partners engaged in an extensive planning initiative to address crime and social-structural risk factors in a majority African American community. Community-based participatory research and consensus organizing can be integrated as an effective approach to engaging and empowering communities to take action to dismantle social-structural disparities and promote a culture of health and well-being.
Correlates of Resilience in Hispanic Young Adults
Authors: Bartoszek Lauren A. , Jacobs Wura , Unger Jennifer B.
Published: May 2020

Research on health disparities among Hispanic/Latino populations has begun to look at resiliency as a key component to the health risk profile of Hispanics. However, there are still gaps in the research about the specific factors. This study sought to examine the relationship between factors in 4 primary domains—behavioral, psychological, social, and cultural—and resilience in Hispanic young adults. We used data from Project RED, which included 1503 Hispanic young adults. Results indicate that cultural factors (acculturation and cultural identity), psychological factors (depression, stress, and coping), and social connectedness are important determinants of resilience among Hispanic young adults.
Lumbar Artery Perforator Flap: Initial Experience with Simultaneous Bilateral Flaps for Breast Reconstruction
Authors: Haddock Nicholas T. , Teotia Sumeet S.
Published: May 2020

Background:

The lumbar artery perforator (LAP) flap is a useful alternative for patients who are not a candidate for breast reconstruction using the deep inferior epigastric perforator flap. Due to the positioning and concerns for prolonged ischemia time, bilateral breast reconstruction using LAP flaps is frequently performed in separate stages. We present our early experience performing simultaneous LAP flaps for bilateral breast reconstruction.

Methods:

We performed a retrospective review of all patients who underwent breast reconstruction with LAP flaps from December 2018 to September 2019. Demographics, flap data, and complication data were collected. Surgical sequence is presented.

Results:

A total of 30 simultaneous bilateral breast reconstruction were performed with LAP. We experienced 1 flap loss in an undiagnosed hypercoagulable patient. The average patient age was 52.7 years, and the average body mass index was 26.9. Most patients had a surgically absent abdominal donor site (66.7%). The average operative time was 510 minutes and ischemia time was 90.3 minutes. All flaps were performed using a composite deep inferior epigastric arterial/venous graft.

Conclusions:

The LAP flap is an innovative, yet technically challenging, choice for autologous breast reconstruction. In our experience, simultaneous bilateral breast reconstruction using LAP flaps can be safely performed in a single surgical stage; however, we recommend caution and a coordinated team approach. With simultaneously performing bilateral LAP flaps, there is an inherent prolonged ischemia time and, thus, an increased possibility for vasospasm and intraoperative revisions. This experience represents the first series of bilateral LAP flaps performed simultaneously.
Autologous Homologous Skin Constructs Allow Safe Closure of Wounds: A Retrospective, Noncontrolled, Multicentered Case Series
Authors: Mundinger Gerhard S. , Armstrong David G. , Smith David J. , Sailon Alexander M. , Chatterjee Abhishek , Tamagnini Greg , Partridge Joanna , Baetz Nicholas , Labroo Pratima , Swanson Edward W. , Sopko Nikolai A. , Granick Mark S.
Published: May 2020

An autologous homologous skin construct (AHSC) has been developed for the repair and replacement of skin. It is created from a small, full-thickness harvest of healthy skin, which contains endogenous regenerative populations involved in native skin repair. A multicenter retrospective review of 15 wounds in 15 patients treated with AHSC was performed to evaluate the hypothesis that a single application could result in wound closure in a variety of wound types and that the resulting tissue would resemble native skin. Patients and wounds were selected and managed per provider’s discretion with no predefined inclusion, exclusion, or follow-up criteria. Dressings were changed weekly. Graft take and wound closure were documented during follow-up visits and imaged with a digital camera. Wound etiologies included 5 acute and chronic burn, 4 acute traumatic, and 6 chronic wounds. All wounds were closed with a single application of AHSC manufactured from a single tissue harvest. Median wound, harvest, and defect-to-harvest size ratio were 120 cm2 (range, 27–4800 cm2), 14 cm2 (range, 3–20 cm2), and 11:1 (range, 2:1–343:1), respectively. No adverse reactions with the full-thickness harvest site or the AHSC treatment site were reported. Average follow-up was 4 ± 3 months. An AHSC-treated area was biopsied, and a micrograph of the area was developed using immunofluorescent confocal microscopy, which demonstrated mature, full-thickness skin with nascent hair follicles and glands. This early clinical experience with ASHC suggests that it can close different wound types; however, additional studies are needed to verify this statement.
The Role of Human Coronavirus Infection in Pediatric Acute Gastroenteritis
Authors: Xiong Li-Jing , Zhou Meng-Yao , He Xiao-Qing , Wu Ying , Xie Xiao-Li
Published: May 2020

Since human coronavirus (HCoV)–like particles were detected in the stool specimens of acute gastroenteritis and necrotizing enterocolitis children with electron microscopy, the relationship between HCoV and the pediatric gastrointestinal illness had been recognized. In recent years, the overall detection rates have been low and have varied by region. HCoVs have not been considered as the major pathogens in pediatric acute gastroenteritis. HCoVs detected in children with acute gastroenteritis have included 229E, OC43, HKU1, NL63, and severe acute respiratory syndrome coronavirus, Middle East Respiratory Syndrome Coronavirus and severe acute respiratory syndrome coronavirus-2 have also been associated with gastrointestinal symptoms in children. Although digestive tract has been recognized as an infection route, it has not been possible to fully investigate the association between HCoVs infection and the gastrointestinal symptoms because of the limited number of pediatric cases. Furthermore, pathologic features have not been clear. Till now, our knowledge of severe acute respiratory syndrome coronavirus-2 is limited. However, diarrhea and vomiting have been seen in pediatric cases, particularly in newborns and infants. It has been necessary to pay more attention on gastrointestinal transmission to identify the infected children early and avoid the children without apparent or mild symptoms becoming the sources of infection.
New Onset Alacrima as a Presenting Feature of a Skull Base Chondrosarcoma
Authors: Lee Hanbin , Oliphant Huw , Vundavalli Siriram , Taylor Mark , Koenig Michael , Hardwidge Carl , Bucur Sorin , Rajak Saul N.
Published: May 2020

Acquired unilateral alacrima as a presenting sign of an intracranial tumor is exceptionally rare, and only described once previously in a case of nasopharyngeal carcinoma. The authors present a 32-year-old female patient who presents with a year-long history of alacrima and arhinorrhea. She was subsequently diagnosed with a petroclival chondrosarcoma extending into Meckel’s cave and the cavernous sinus and underwent surgical debulking. To the authors' knowledge, this is the first reported case of acquired unilateral alacrima as a presenting feature of a skull base chondrosarcoma. This case serves to remind general ophthalmologists and oculoplastic surgeons alike that acquired alacrima may be the presenting feature of serious intracranial disease.
Eye-sparing Treatment of Localized Orbital Medulloepithelioma With Neoadjuvant Chemoradiation
Authors: Gallo Ryan A. , Shoag Jamie , Johnson Thomas E. , Solomon David A. , Perry Arie , Podda Antonello , Lee John Y. , Rong Andrew J.
Published: May 2020

A 9-year-old girl presented with a 3-day history of progressive proptosis accompanied by transient discomfort and blurry vision in the OD. MRI revealed a heterogeneously enhancing intraconal lesion that partially encased and displaced the optic nerve. There was no intraocular or intracranial involvement, nor were there signs of distant metastasis. Histopathologic evaluation and immunohistochemistry were consistent with orbital medulloepithelioma. The patient received 4 cycles of chemoradiation per a retinoblastoma protocol. Repeat MRI scans showed significant tumor regression, and further surgical debulking was performed. There has been no evidence of recurrence for over 14 months. Herein, the authors describe an eye-sparing, multimodal treatment of a rare case of localized orbital medulloepithelioma.
Posttraumatic Respiratory Epithelial Orbital Cyst With Intracranial Extension: A Unique Association
Authors: Theofilou Nantia-Eleni , Becker Minerva , Lombardi Tommaso , Scolozzi Paolo
Published: May 2020

Respiratory epithelial orbital cysts (REOC) are rare benign lesions that may be either congenital or acquired. Congenital REOC develop from embryological epithelial rests and are known as choristomas, whereas acquired forms develop from the sequestration of respiratory epithelium from adjacent paranasal sinuses following trauma and/or fracture repair procedures. The final diagnosis can be difficult because congenital and acquired REOC and mucoceles share the same features histologically. The involvement of the paranasal sinuses, which is the landmark of mucoceles, does not occur with REOC. Moreover, the intracranial extension, which is known for mucoceles, has never been reported for REOC. Respiratory epithelial orbital cysts warrant prompt radical surgical resection given that these lesions may lead to a progressive intracranial progression and/or recurrent infection with a potential for meningitis or cerebral abscess. The authors report a unique case of a patient with an intraorbital posttraumatic respiratory epithelial orbital cyst associated with intracranial involvement.
The transition from acute to chronic pain: dynamic epigenetic reprogramming of the mouse prefrontal cortex up to 1 year after nerve injury
Authors: Topham Lucas , Gregoire Stephanie , Kang HyungMo , Salmon-Divon Mali , Lax Elad , Millecamps Magali , Szyf Moshe , Stone Laura S.
Published: May 2020

Chronic pain is associated with persistent structural and functional changes throughout the neuroaxis, including in the prefrontal cortex (PFC). The PFC is important in the integration of sensory, cognitive, and emotional information and in conditioned pain modulation. We previously reported widespread epigenetic reprogramming in the PFC many months after nerve injury in rodents. Epigenetic modifications, including DNA methylation, can drive changes in gene expression without modifying DNA sequences. To date, little is known about epigenetic dysregulation at the onset of acute pain or how it progresses as pain transitions from acute to chronic. We hypothesize that acute pain after injury results in rapid and persistent epigenetic remodelling in the PFC that evolves as pain becomes chronic. We further propose that understanding epigenetic remodelling will provide insights into the mechanisms driving pain-related changes in the brain. Epigenome-wide analysis was performed in the mouse PFC 1 day, 2 weeks, 6 months, and 1 year after peripheral injury using the spared nerve injury in mice. Spared nerve injury resulted in rapid and persistent changes in DNA methylation, with robust differential methylation observed between spared nerve injury and sham-operated control mice at all time points. Hundreds of differentially methylated genes were identified, including many with known function in pain. Pathway analysis revealed enrichment in genes related to stimulus response at early time points, immune function at later time points, and actin and cytoskeletal regulation throughout the time course. These results emphasize the importance of considering pain chronicity in both pain research and in treatment optimization.
Prevalence and Correlates of Cost-Related Medication Nonadherence to Immunosuppressive Drugs After Heart Transplantation
Authors: Schönfeld Sandra , Denhaerynck Kris , Berben Lut , Dobbels Fabienne , Russell Cynthia L. , Crespo-Leiro Marisa G. , De Geest Sabina ,   On behalf of the BRIGHT Study Team†
Published: May 2020

Background

Cost-related medication nonadherence (CRMNA) refers to not taking medications as prescribed because of difficulties paying for them.

Objectives

The aims of this study were (1) to assess the prevalence of CRMNA to immunosuppressants in heart transplant recipients internationally and (2) to determine multilevel correlates (patient, center, and healthcare system levels) of CRMNA.

Methods

Using data from the cross-sectional international BRIGHT study, applying multistaged sampling, CRMNA was assessed via 3 self-report items in 1365 patients from 36 heart transplant centers in 11 countries. Cost-related medication nonadherence was defined as any positive answer on any of the 3 items. Healthcare system–level (ie, insurance coverage, out-of-pocket expenditures) and patient-level (ie, intention, perceived financial burden, cost as a barrier, a health belief regarding medication benefits, cost-related self-efficacy, and demographic factors) CRMNA correlates were assessed. Correlates were examined using mixed logistic regression analysis.

Results

Across all study countries, CRMNA had an average prevalence of 2.6% (range, 0% [Switzerland/Brazil] to 9.8% [Australia]) and was positively related to being single (odds ratio, 2.29; 95% confidence interval, 1.17–4.47), perceived financial burden (odds ratio, 2.15; 95% confidence interval, 1.55–2.99), and cost as a barrier (odds ratio, 2.60; 95% confidence interval, 1.66–4.07). Four protective factors were identified: white ethnicity (odds ratio, 0.37; 95% confidence interval, 0.19–0.74), intention to adhere (odds ratio, 0.44; 95% confidence interval, 0.31–0.63), self-efficacy (odds ratio, 0.54; 95% confidence interval, 0.43–0.67), and belief about medication benefit (odds ratio, 0.70; 95% confidence interval, 0.57–0.87). Regarding variability, 81.3% was explained at the patient level; 13.8%, at the center level; and 4.8%, at the country level.

Conclusion

In heart transplant recipients, the CRMNA prevalence varies across countries but is lower than in other chronically ill populations. Identified patient-level correlates are novel (ie, intention to adhere, cost-related barriers, and cost-related self-efficacy) and indicate patient-perceived medication cost burden.
Dark Purple Papule
Authors: Rimtepathip Parin , Jacob Sharon E.
Published: May 2020

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of a dark purple papule.
A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients
Authors: Droegemueller Carol J. , Kashyap Bhavani , Huna Wagner Roberta L. , Shibeshi Hannah , Clayton Mitchell W. , Fennig Mary W. , Hussein Haitham M.
Published: May 2020

BACKGROUND: The incidence rate of stroke in hospitalized patients ranges between 2% and 17% of all strokes—a higher rate than in the community. Delays in recognition and management of stroke in hospitalized patients lead to worse outcomes. At our hospital, the existing in-hospital stroke (IHS) code showed low usage and effectiveness. In a quality improvement (QI) project, we aimed to improve the identification of and the quality of care for inpatient strokes. METHODS: A nurse-driven IHS protocol was implemented, which alerted a specialized stroke team and cleared the computed tomography (CT) scanner. The protocol focused on prioritizing staff education, simplifying the process, empowering staff to activate an IHS code, ensuring adequate support and teamwork, identifying well-defined quality metrics (eg, time to CT and documentation tool use), and providing feedback communication. We analyzed 2 years of postimplementation IHS data for impact on stroke detection and outcomes. RESULTS: In the 2 years post QI, there was a more than 10-fold increase in IHS (pre-QI, n = 8; first year post QI, n = 94; second year post QI, n = 123). In the post-QI cohort, after excluding patients with missing information (n = 26), 69 cases had new stroke diagnoses (63 ischemic, 6 hemorrhagic), and 148 were stroke mimics. The mean (SD) time from IHS to CT was 18.7 (7.0) minutes. Of the 63 new ischemic stroke cases, 25 (39.7%) were treated with thrombolytic therapy and/or mechanical thrombectomy. CONCLUSION: The new IHS protocol has led to a marked increase in cases identified, rapid evaluation, and high utilization rate of acute stroke therapies.
How to Search for Orthotic Literature Using “Brace” Term?
Authors: Jafarian Fahimeh-Sadat , Rahimi Alireza , Sadeghi-Demneh Ebrahim
Published: May 2020

Introduction

The selection of appropriate search queries is a primary step to explore electronic databases for evidence-based practice. Preliminary searches revealed that no previous scientific study introduced a precise search query to identify prosthetic and orthotic studies in the electronic databases.

Objective

The aim of this study was to evaluate the effectiveness of different variations of the “brace” term for identifying the relevant studies in the orthotics field.

Study Design

This is a cross-sectional study.

Methods

A series of electronic searches in Scopus and Web of Science was carried out using all variations of “brace” term, which were previously used in published reviews in the prosthetics and orthotics field. The yields were classified into relevant and irrelevant subject areas. The rate of the relevant subject area was used to define the specificity of the free-text literature search. To define a standard search query for the “brace” term, the specificity of yields was measured while combining them with another common keyword in the same subject area (orthosis) or limiting the yields to human studies.

Results

“Brace” term was very widely used within different studies with an irrelevant subject area. Using truncation techniques with “brace” could reduce the precision of the subject area in the yields. The combination of “brace” with a synonym subject heading term increased the sensitivity of search, and refining search results through applying a filter (e.g., human studies) improved the precision of yields.

Conclusions

This study indicated that using “brace” as a free-text literature search does not have enough precision to recall relevant studies in the prosthetics and orthotics field.
Total and hidden blood loss between open posterior lumbar interbody fusion and transforaminal lumbar interbody fusion by Wiltse approach
Authors: Lei Fei , Li Zhongyang , He Wen , Tian Xinggui , Zheng Lipeng , Kang Jianping , Feng Daxiong
Published: May 2020

The purpose of this study was to calculate and compare the volume of hidden blood loss (HBL) and perioperative blood loss between open posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) by Wiltse approach.

We retrospectively analyzed 143 patients between March 2017 and December 2017, they were randomly divided into PLIF group and TLIF group. The following information were collected on admission: patient's age, gender, height, weight, body mass index (BMI), surgery levels, surgical time, duration time, disorder type, intraoperative bleeding, wound drainage, visual analog scale (VAS) scores, neurological complications, transfusion rate. Preoperative and postoperative hematocrit (Hct) were recorded in order to calculate total blood loss (TBL) according to Gross's formula. To calculate each patient's HBL, chi-square test and Student's t test were used to analyze data.

Patients in PLIF had a mean TBL of 1144 ± 356 mL, and the mean HBL was 486 ± 203 mL, 43.9 ± 16.2% of the TBL. While patients in TLIF, the mean TBL was 952 ± 303 mL, and the mean HBL was 421 ± 178 mL, 44.7 ± 17.0% of the TBL. Hence, there was significant difference in TBL and HBL between 2 groups, respectively (P = .000, P = .044). However, there was no difference in the ratio of the HBL between 2 groups (P = .797).

The volume of HBL is lower in open TLIF by Wiltse approach than that in PLIF, which may be a large proportion of TBL in posterior lumbar fusion surgery. Comprehensive understanding of HBL can contribute to keep patient safety and better to rehabilitation in perioperative.
Polypoidal choroidal vasculopathy as a complication of choroidal osteoma
Authors: Kim Doyeon , Ryu Gahyung , Sagong Min
Published: May 2020

Introduction:

Choroidal osteoma (CO) is a rare benign tumor that particularly affects young, healthy women. Its prognosis is influenced by complications, such as choroidal neovascularization (CNV), subretinal hemorrhage, subretinal fluid (SF), decalcification status, and overlying retinal pigment epithelium (RPE) atrophy. In case of CNV as the complication of CO, it is typically present in the classic form; however, reports on polypoidal choroidal vasculopathy (PCV) have been rare. Here, we report a case of an older, male patient with PCV as a complication of CO.

Patient concerns:

A 70-year-old male patient visited the hospital with vision impairment in the right eye since 2 weeks.

Diagnosis:

Fundus examination revealed a red-yellow, well-demarcated, scalloped lesion around the optic nerve in each eye; the lesions were highly reflective on ultrasound examination, and thus, CO was diagnosed. Indocyanine green fluorescence angiography and optical coherence tomography (OCT) revealed that the right eye also had PCV accompanied with SF. OCT confirmed the presence of large quiescent type 1 CNV bilaterally in decalcified areas of the lesions adjacent to the optic nerve.

Interventions:

Intravitreal bevacizumab (IB) injection was performed.

Outcomes:

Best-corrected visual acuity had improved and OCT showed a decrease in the SF, while OCT angiography showed partial regression of branching vascular network.

Conclusion:

CO can be accompanied by quiescent type 1 CNV; this should be closely monitored because it can progress to PCV. Optical coherence tomography, alongside indocyanine green fluorescence angiography, is useful for the diagnosis and monitoring of potential CNV as a complication of CO.
Effect of intraventricularly administered low-dose recombinant tissue plasminogen activator on interleukin 1-beta and transforming growth factor beta concentrations in cerebrospinal fluid of patients with primary intracerebral hemorrhage associated with intraventricular hemorrhage
Authors: Sošić Matija , Antončić Igor , Tarčuković Janja , Dunatov Siniša , Šustić Alan , Ćurko-Cofek Božena , Sotošek Vlatka
Published: May 2020

It is increasingly recognized that modulation of brain inflammation may uncover new potential therapeutic strategies for stroke. Recent studies have shifted focus from immunological implications in ischemic stroke to a more devastating form; the hemorrhagic stroke.

The aim of this study was to investigate the neuroinflammatory response in cerebrospinal fluid in patients with primary intracerebral hemorrhage (ICH) associated with intraventricular hemorrhage (IVH) in the presence of low-dose recombinant tissue plasminogen activator (rt-PA).

This retrospective study included 88 adults with primary ICH associated with IVH. Patients were divided into 2 groups: rt-PA group and non-rt-PA group, which received normal standard of care for this diagnosis. The rt-PA group was treated via catheter-based clot lysis using low-dose rt-PA injected through the external ventricular drain (EVD) system, and the non-rt-PA group was treated with saline applied to EVD system in equivalent volume. Cerebrospinal fluid samples from rt-PA were obtained from the EVD system at 4 time points: once before the drug administration, and then on day 1, 3, and 7. No attempt at randomization was made. The decision to inject rt-PA was based on the preference of the primary attending neurologist and the ability to obtain consent. Temporal interleukin-1 beta and transforming growth factor beta concentration changes were analyzed and compared between the 2 groups.

The concentration of interleukin-1 beta was significantly lower in the rt-PA group than in the non-rt-PA group on day 7. In addition, the concentration of transforming growth factor beta was significantly higher in the rt-PA group than in the non-rt-PA group on day 1. There was a significant difference in interleukin-1 beta concentration between days 0 and 1 in comparison to day 3 in the rt-PA group, and between day 0 in comparison to day 3 and 7 in the non-rt-PA group. We also observed a significant difference in transforming growth factor beta concentration between days 0 and 1 and between days 3 and 7.

The different pattern of pro- and anti-inflammatory cytokines in patients with ICH associated with IVH suggest distinct characteristics of secondary brain injury depending on the treatment modality.
Acupuncture for cancer-related hiccups
Authors: Ma Rui , Li Yan , Liu Songjiang , Zhao Wenhui
Published: May 2020

Background:

Hiccups are involuntary contractions of the diaphragm and intercostal muscles, which lead to sudden contractions of the glottis. CAM, such as acupuncture is commonly used and stimulation of the vagus nerve and interference with phrenic nerve conduction are also used to treat hiccups. However, there is little evidence on the effectiveness of acupuncture for cancer-related hiccups. We will plan to conduct a systematic review and meta-analysis of RCTs to evaluate the current evidence on the effects of acupuncture for cancer-related hiccups.

Method:

The following databases will be searched: PubMed, the Cochrane Library, Wanfang Data, China National Knowledge Infrastructure (CNKI), SinoMed, VIP, Medline, Embase, and EI. Randomized controlled trials will be included to evaluate the effect and safety of acupuncture on cancer patients with hiccups. We will set standards for the curative effect on the basis of the standard of cure and improvement for clinical disease diagnoses. The risk of bias will be assessed by the Cochrane risk of bias tool. We will conduct a meta-analysis and sensitivity analysis, as well as a subgroup analysis if high heterogeneity is present, using Revman 5.3. We will use funnel plots to identify potential reporting biases. We will test asymmetry using Egger test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to evaluate the quality of evidence.

Results:

This study will be to assess the effect and safety of acupuncture for cancer-related hiccups.

Conclusions:

This study will assess the effect of acupuncture for cancer-related hiccups and provide reliable evidence for the choice of treatments.
Oncologic safety of laparoscopic radical cholecystectomy in pT2 gallbladder cancer
Authors: Navarro Jonathan Geograpo , Kang Incheon , Hwang Ho Kyoung , Yoon Dong Sup , Lee Woo Jung , Kang Chang Moo
Published: May 2020

The role of laparoscopic radical cholecystectomy (LRC) in the surgical management of T2 gallbladder carcinoma (GBC) is still controversial.

The medical records of patients with T2 GBC treated with radical cholecystectomy were retrospectively reviewed. In this study, we compare the short- and long-term oncologic outcomes, using propensity score matching analysis, of patients with T2 GBC who underwent LRC and open radical cholecystectomy (ORC).

Among 183 patients, 86 were selected by propensity score matching (LRC = 43 and ORC = 43). The ORC group underwent more extensive surgery (liver resections and extended lymph node dissections [ELND]) than the LRC group. The LRC group had less operative blood loss, shorter length of hospital stay, fewer complications, and had the earlier start of adjuvant chemotherapy. There was no significant difference between the laparoscopic and open surgery groups in terms of 5-year overall survival rate (64.6% vs 80.4%, P = .214) and disease-free survival rate (77.1% vs 82.2%, P = .641). A subgroup analyses showed that liver resection and ELND had no survival advantage compared to no liver resection and regional lymph node dissection, respectively.

Our LRC approach is safe and effective, with long-term survival comparable to that of ORC.
Atypical replantation and reconstruction of frozen ear
Authors: Dvořák Zdeněk , Stupka Igor
Published: May 2020

Rationale:

The first successful ear replantation was performed by Pennigton in 1980 in Sydney. At least 84 ear replantations have been described in the literature over a period of 37 years since the first case. The authors have not found any previous case of frozen ear replantation in the literature.

Patient concerns:

We report the case of a 38-year-old man, who had an injury to the head while working with a machine.

Diagnosis:

The patient suffered total traumatic avulsion of the left ear. The ear was wrapped in moistened, sterile gauze and was transported on dry ice. At the time of admission to our department, the amputated ear was frozen to stiff, solid nonelastic matter.

Interventions:

We attempted replantation. Despite repeated arterial thrombosis during surgery, the ear was successfully replanted with arterial and venous anastomosis.

Outcomes:

Venous congestion occurred within 9 h of surgery and was treated using leeches. Freezing cold injury developed during reattachment. The radix and proximal parts of the helix exhibited necrosis and so were reconstructed by contralateral conchal cartilage graft, which was wrapped with a local subauricular skin flap. On completion of treatment, a satisfactory shape was achieved, although the replanted and reconstructed left auricle slightly was smaller than the contralateral auricle.

Lessons learned:

Our report confirms that the replantation of a frozen, amputated ear is possible, and we suggest that ear replantation should be the method of choice for the treatment of ear loss even under these conditions.
Comparison of laparoscopic cholecystectomy with and without abdominal drainage in patients with non-complicated benign gallbladder disease
Authors: Yang Jia , Liu Yang , Yan Peijing , Tian Hongwei , Jing Wutang , Si Moubo , Yang Kehu , Guo Tiankang
Published: May 2020

Objective:

To evaluate whether conventional postoperative drainage is more effective than not providing drainage in patients with non-complicated benign gallbladder disease following laparoscopic cholecystectomy (LC).

Methods:

A search of the electronic databases MEDLINE, EMBASE, Web of science, Cochrane Library, and Chinese Biomedical Database (CBM) was conducted for randomized controlled trials (RCTs) reporting outcomes of LC surgery with and without an abdominal drain.

Results:

Twenty-one RCTs involving 3246 patients (1666 with drains vs 1580 without) were included in the meta-analysis. There were no statistically significant differences in the rates of incidence of intra-abdominal fluid (RR: 1.10; 95% CI: 0.81–1.49; P = .54) or post-surgical mortality (RR: 0.44; 95% CI: 0.04–4.72; P = .50) between the two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (RR: 1.16; 95% CI: 0.95–1.42; P = .15) or shoulder tip pain (RR: 1.03; 95% CI: 0.76–1.38; P = .86). The abdominal drain group displayed significantly higher pain scores (MD: 1.07; 95% CI: 0.69–1.46; P < .001) than the non-drainage patients. Abdominal drains prolonged the duration of the surgical procedure (MD: 5.69 min; 95% CI: 2.51–8.87; P = .005) and postoperative hospital stay (MD: 0.47 day; 95% CI: 0.14–0.80; P = .005). Wound infection was found to be associated with the use of abdominal drains (RR: 1.97; 95% CI: 1.11–3.47; P = .02).

Conclusions:

Currently, there is no evidence to support the use of routine drainage after LC in non-complicated benign gallbladder disease. Further well-designed randomized clinical trials are required to confirm this finding.