bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of Posterior Column in Displaced Acetabular Fractures Using Bone Holding Forceps
Authors: Fahmy Mahmoud , Abdelazeem Ahmed H.
Published: February 2020

Reduction of the posterior column in displaced acetabular fracture anatomically is challenging and depends on good reduction tools application. Many reduction tools have been used with some limitations in some cases. This article reports a new technique for reduction of these fractures anatomically using the large bone holding forceps. This has the advantage of other instruments, correcting displacement and rotation in one step without using an adjuvant instrument or narrowing the corridor for the plate application on the posterior surface.
Drug Exposure in Newborns: Effect of Selected Drugs Prescribed to Mothers During Pregnancy and Lactation
Authors: Rentsch Katharina M.
Published: February 2020

The number of newborns exposed to therapeutic drugs during pregnancy is growing because of the increased use of drugs during pregnancy. In recent years, advances in our understanding of drug placental transfer have augmented the likelihood of a healthy baby in mothers with chronic diseases needing drug therapy. Globally, for example, more than 1.4 million pregnancies in 2015 have been burdened with antiretroviral drugs due to an increasing number of HIV-positive women treated with these drugs, particularly in low- and middle-income countries. In most cases, the fetus is exposed to much higher drug doses in utero than the newborn nursed by the mother. Drug transfer through the placenta takes place by passive diffusion, active transport, or facilitated transport, and drug concentrations in the fetal circulation may be comparable to that in the mother's blood concentration. The excretion of drugs into breastmilk predominantly occurs by passive diffusion, allowing only the non–protein-bound fraction of the blood drug concentration to penetrate. Drug agencies in the United States and Europe highly recommend performing clinical trials in pregnant or breastfeeding women. However, only a few drugs have reported statistically sound data in these patient groups. Most available results concerning pregnancy are obtained from observational studies after birth, assessing outcomes in the newborn or by measuring drug concentrations in the mother and umbilical cord blood. In the case of the lactation period, some studies have evaluated drug concentrations in breastmilk and blood of the mother and/or infant. In this review, exposure to antiretrovirals, immunosuppressants used after solid organ transplantation, and antiepileptics during pregnancy and lactation has been discussed in detail.
Association of objectively measured sedentary behavior and physical activity levels with health-related quality of life in middle-aged women: The FLAMENCO project
Authors: Marín-Jiménez Nuria , Ruiz-Montero Pedro Jesús , De la Flor-Alemany Marta , Aranda Pilar , Aparicio Virginia A.
Published: February 2020

Objective:

The aim of the study was to analyze the association of objectively measured sedentary time and physical activity with health-related quality of life in middle-aged women.

Methods:

The present cross-sectional analyses were performed in a total of 182 middle-aged women (52.6 ± 4.6 years old) from the Fitness League Against MENopause COst (FLAMENCO) project. Sedentary time and physical activity were objectively measured through accelerometry. Participants’ health-related quality of life was assessed with the Short-Form Health Survey 36 (SF-36).

Results:

Lower sedentary time was associated with a better SF-36 emotional role (B: −0.03; 95% confidence interval: −0.07 to −0.00). Greater light physical activity was associated with a better SF-36 emotional role (B: 0.04; 95% confidence interval: 0.00-0.08). Greater moderate-vigorous physical activity was associated with a greater SF-36 physical function (B: 0.01; 95% confidence interval: 0.00-0.02) and SF-36 vitality (B: 0.02; 95% confidence interval: 0.00-0.03). Greater vigorous physical activity was associated with a better SF-36 physical function (B: 0.34; 95% confidence interval: 0.02-0.66), SF-36-bodily pain (B: 0.63; 95% confidence interval: 0.02-1.25), and the SF-36 physical component scale (B: 0.20; 95% confidence interval: 0.00-0.39). Greater total physical activity was associated with a better SF-36 emotional role (B: 0.03; 95% confidence interval: 0.00-0.07). Moderate physical activity was not associated with any SF-36 dimension (all, P > 0.05).

Conclusions:

Spending less time in sedentary behavior and greater physical activity levels, especially vigorous physical activity, are associated with better health-related quality of life in middle-aged women. Vigorous physical activity is associated with a better SF-36 physical component scale, which might mean a reduction in exercise time with similar improvements for women's quality of life.

ClinicalTrials.gov Identifier: NCT02358109. Date of registration: 05/02/2015
Dietary inflammatory index and dietary energy density are associated with menopausal symptoms in postmenopausal women: a cross-sectional study
Authors: Aslani Zahra , Abshirini Maryam , Heidari-Beni Motahar , Siassi Fereydoun , Qorbani Mostafa , Shivappa Nitin , Hébert James R. , Soleymani Mahshid , Sotoudeh Gity
Published: February 2020

Objectives:

No previous study has evaluated the association of the dietary inflammatory index (DII) and dietary energy density (DED) with menopausal symptoms and its subclasses in postmenopausal women. The aim of this study was to evaluate the association of DII score and DED with menopausal symptoms and its subtypes in Iranian postmenopausal women.

Methods:

This cross-sectional study was conducted on 393 postmenopausal women who attended health centers in the south of Tehran, Iran. The DII score was calculated using dietary factors obtained by a validated food frequency questionnaire. DED was defined as average daily energy intake (kcal) per gram of food. The Menopause Rating Scale questionnaire was used to evaluate the menopausal symptoms. The total Menopause Rating Scale score (TMRSS) was the sum of the somatic score (SS), psychological score (PS), and urogenital score. Linear regression analysis was used to assess the association of the DII score and DED with menopausal symptoms.

Results:

After adjusting for covariates, participants in the highest tertile of DII score had greater SS compared to those in the lowest tertile (βDIIt3vs1= 0.032, 95% confidence interval (CI): 0.004-0.068, P = 0.04). No significant relationship was found between DII score and PS, urogenital score or TMRSS. Furthermore, higher DED was associated with greater SS (βDIIt3vs1 = 0.071, 95% CI: 0.028-0.115, P = 0.001), PS (βDIIt3vs1 = 0.065, 95% CI: 0.012-0.121, P = 0.01) and TMRSS (βDIIt3vs1 = 0.053, 95% CI: 0.017-0.088, P = 0.004).

Conclusion:

A proinflammatory diet was associated with higher menopause-specific somatic symptoms and higher DED was positively associated with menopausal symptoms.
Accelerated progression of waist-to-hip ratio but not body mass index associated with lower socioeconomic position: a cohort study of nonobese early postmenopausal Chinese women
Authors: Chung Gary K.K. , Yu Ruby H.Y. , Woo Jean , Lai Francisco T.T. , Chung Roger Y. , Yeoh Eng-Kiong , Ho Suzanne C.
Published: February 2020

Objective:

Menopausal changes are linked to increase in body fat mass and central fat distribution; nonetheless, the impact of socioeconomic position on such changes has rarely been examined. This cohort study assessed the temporal associations of socioeconomic position with changes in body mass index (BMI) and waist-to-hip ratio (WHR) among early postmenopausal women.

Methods:

Between 2002 and 2004, 518 Hong Kong Chinese women aged 50 to 64 and within 10 years since menopause were recruited and followed up at 3 and 5 years. Weight, height, and waist and hip circumferences were measured by trained interviewers at baseline and follow-up interviews. Socioeconomic positions including educational attainment, economic activity status and household income level, and other baseline demographic characteristics, lifestyle behaviors, and mental health status were collected based on a structured questionnaire. In total, 287 and 267 women with no general and abdominal obesity, respectively, at baseline were included in multiple regression analyses.

Results:

Mean intrapersonal increases in BMI and WHR between baseline and 5-year interview were 0.46 kg/m2 and 2.80%, respectively. Women with no secondary education were 75% more likely to have a greater than-mean WHR increase than their more educated counterparts (P = 0.039). Also, having no secondary education (P = 0.041) and being a homemaker (P = 0.034) had accelerated surge in WHR. Nonetheless, baseline socioeconomic positions were not significantly associated with BMI changes.

Conclusions:

Socioeconomic patterning was observed for the progression of WHR among nonobese Chinese women soon after menopause. Early postmenopausal stage may be a critical window for prevention of abdominal obesity among women with a lower educational attainment.
Adiposity and insulin resistance as mediators between age at menarche and type 2 diabetes mellitus
Authors: Liu Dechen , Zhao Yang , Liu Yu , Sun Xizhuo , Li Honghui , Yin Zhaoxia , Li Linlin , Wang Bingyuan , Ren Yongcheng , Cheng Cheng , Liu Leilei , Chen Xu , Liu Feiyan , Zhou Qionggui , Tian Gang , Li Quanman , Guo Chunmei , Wu Xiaoyan , Han Minghui , Qie Ranran , Huang Shengbing , Zhang Ming , Hu Dongsheng , Lu Jie
Published: February 2020

Objective:

This study aimed to explore the association between age at menarche and type 2 diabetes mellitus (T2DM) and whether the association is mediated by adiposity and insulin resistance (IR) in rural Chinese women.

Methods:

This cross-sectional study analyzed data for 7,460 women (median age 56 y) from a rural Chinese area from 2013 to 2014. Data were collected by standardized interviews and anthropometric and laboratory measurements. Adiposity was measured by body mass index (BMI), and IR was measured by the homeostasis model assessment of IR (HOMA-IR) index. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% confidence limits (CLs) for the association between age at menarche and T2DM. Mediation analysis was performed to explore the contribution of BMI and HOMA-IR to the association between age at menarche and T2DM.

Results:

Among 7,460 women, 840 (11.26%) had T2DM. After adjusting for potential confounding factors, the odds of T2DM with the latest age at menarche 18 years or older versus 13 years was reduced (OR = 0.65, 95% CL: 0.47, 0.91), and age at menarche was negatively associated with T2DM (per additional year of menarche, OR = 0.95, 95% CL: 0.91, 0.99). BMI and HOMA-IR completely mediated the association between age at menarche and T2DM (total indirect effect: OR = 0.973, 95% CL: 0.961, 0.986; direct effect: OR = 0.974, 95% CL: 0.930, 1.021).

Conclusions:

Late menarche may be negatively associated with T2DM. The potential mechanism is adiposity and IR completely mediating the association between age at menarche and T2DM.
Gut microbiome and cardiovascular disease
Authors: Zhao Yongzhong , Wang Zeneng
Published: February 2020

Purpose of review

This review aims to highlight the association between gut microbiome and cardiovascular disease (CVD) with emphasis on the possible molecular mechanisms by which how gut microbiome contributes to CVD.

Recent findings

Increasingly, the roles of gut microbiome in cardiovascular health and disease have gained much attention. Most of the investigations focus on how the gut dysbiosis contributes to CVD risk factors and which gut microbial-derived metabolites mediate such effects.

In this review, we discuss the molecular mechanisms of gut microbiome contributing to CVD, which include gut microbes translocalization to aortic artery because of gut barrier defect to initiate inflammation and microbial-derived metabolites inducing inflammation-signaling pathway and renal insufficiency. Specifically, we categorize beneficial and deleterious microbial-derived metabolites in cardiovascular health. We also summarize recent findings in the gut microbiome modulation of drug efficacy in treatment of CVD and the microbiome mechanisms by which how physical exercise ameliorates cardiovascular health. Gut microbiome has become an essential component of cardiovascular research and a crucial consideration factor in cardiovascular health and disease.
A randomized placebo-controlled trial of desipramine, cognitive behavioral therapy, and active placebo therapy for low back pain
Authors: Gould Hilary M. , Atkinson Joseph Hampton , Chircop-Rollick Tatiana , D'Andrea John , Garfin Steven , Patel Shetal M. , Funk Stephen D. , Capparelli Edmund V. , Penzien Donald B. , Wallace Mark , Weickgenanta Anne L. , Slater Mark , Rutledge Thomas
Published: February 2020

This clinical trial evaluated the independent and combined effects of a tricyclic antidepressant (desipramine) and cognitive behavioral therapy (CBT) for chronic back pain relative to an active placebo treatment. Participants (n = 142) were patients experiencing daily chronic back pain at an intensity of ≥4/10 who were randomized to a single-center, double-blind, 12-week, 4-arm, parallel groups controlled clinical trial of (1) low concentration desipramine titrated to reach a serum concentration level of 15 to 65 ng/mL; (2) CBT and active placebo medication (benztropine mesylate, 0.125 mg); (3) low concentration desipramine and CBT; and (4) active benztropine placebo medication. Participants completed the Differential Description Scale and Roland Morris Disability Questionnaires before and after treatment as validated measures of outcomes in back pain intensity and disability, respectively. Participants within each condition showed significant reductions from pre-treatment to post-treatment in pain intensity (mean changes ranged from = −2.58 to 3.87, Cohen's d's = 0.46-0.84) and improvements in pain disability (mean changes = −3.04 to 4.29, Cohen's d's = 0.54-0.88). However, intent-to-treat analyses at post-treatment showed no significant differences between any condition, with small effect sizes ranging from 0.06 to 0.27. The results from this clinical trial did not support the hypothesis that desipramine, CBT, or their combination would be statistically superior to an active medicine placebo for reducing chronic back pain intensity or disability. Key limitations included recruiting 71% of the planned sample size and use of multiple inclusion/exclusion criteria that may limit generalizability to broader populations of patients with chronic back pain.
Urban-level environmental factors related to pediatric asthma
Authors: Paciência Inês , Cavaleiro Rufo João
Published: February 2020

During the 20th century, urbanization has increasing and represented a major demographic and environmental change in developed countries. This ever-changing urban environment has an impact on disease patterns and prevalence, namely on noncommunicable diseases, such as asthma and allergy, and poses many challenges to understand the relationship between the changing urban environment and the children health. The complex interaction between human beings and urbanization is dependent not only on individual determinants such as sex, age, social or economic resources, and lifestyles and behaviors, but also on environment, including air pollution, indoors and outdoors, land use, biodiversity, and handiness of green areas. Therefore, the assessment and identification of the impact of urban environment on children's health have become a priority and many recent studies have been conducted with the goal of better understanding the impacts related to urbanization, characterizing indoor air exposure, identifying types of neighborhoods, or characteristics of neighborhoods that promote health benefits. Thus, this review focuses on the role of urban environmental factors on pediatric asthma.
Safety and Efficacy of Varenicline for Smoking Cessation in Alcohol-Dependent Smokers in Concurrent Treatment for Alcohol Use Disorder
Authors: Zawertailo Laurie , Ivanova Anna , Ng Ginnie , Le Foll Bernard , Selby Peter
Published: February 2020

Background

Smoking prevalence among those with alcohol dependence is much higher than the general population. Despite this, cessation treatment in those with concurrent alcohol dependence is seldom undertaken. We conducted a randomized, placebo-controlled, double-blind pilot study, whereby patients enrolled at an addiction treatment facility in downtown Toronto, Canada, were recruited and assigned to placebo or varenicline treatment for 12 weeks. We hypothesized that varenicline would be a safe and efficacious treatment for tobacco dependence in this population.

Methods

Daily dependent smokers in treatment for alcohol dependence and interested in participating in the study were first screened over the phone and then assessed in-person. If eligible, they were randomly assigned to placebo or varenicline in a double-blind fashion. They attended weekly appointments for smoking cessation counseling and completed daily diaries for the full 12 weeks of treatment.

Results

Thirty-one subjects were randomized to either varenicline (n = 16) or placebo treatment (n = 15). Participants were predominantly male (73.3%) with a mean age of 44.6 (23–66). Only one subject in the placebo group was quit by end of treatment (7-day point prevalence abstinence), compared with 7 in the varenicline group (χ2(1) = 5.56, P = 0.037). Both groups had a significant decline in cigarettes per day (CPD) by end of treatment (varenicline = 22.1 ± 13.3 to 2.0 ± 3.0 CPD, t(10) = 4.45, P = 0.001; placebo: 14.9 ± 4.4 to 5.3 ± 6.3 CPD, t(13) = 3.61, P = 0.003).

Conclusions

The results from this pilot study indicate that varenicline is a safe and effective treatment for tobacco dependence in a sample of alcohol-dependent smokers undergoing concurrent treatment for alcohol use disorder.
Characteristics and Healthcare Needs of Women Who Are Trafficked for Sex in the United States: An Integrative Literature Review
Authors: Lepianka Christine , Colbert Alison M.
Published: February 2020

Background

Human sex trafficking is a major public health issue. The United States is the second largest market for sex-trafficked women, yet few healthcare interventions, designed for women specifically, have been identified. The purpose of this review was to present a systematic review of the literature on the characteristics and healthcare needs of women who have been trafficked for sex in the United States.

Methods

This literature review was conducted following the methodology outlined by Whittmore and Knalf and written using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Cumulative Index to Nursing & Allied Health, PsychInfo, PubMed, and Scopus databases were searched. A quality assessment tool was used to determine rigor of the studies included in this review.

Results

Nine publications met the inclusion criteria. Three studies specifically explored health. Four studies were composed solely of women born outside the United States, and two studies reported differences across many variables, including overall health, between women born outside the United States and women born within the United States. A lack of resources and an inadequate response by the health system resulted in care that was not optimal.

Conclusion

There are differences between U.S.-born and non-U.S.-born victims. Evidence on the healthcare needs of U.S.-born women trafficked for sex in the United States is extremely limited. Research focusing on the health perceptions of women survivors of human sex trafficking may shed light on how they perceive health, care, and the health system and what they identify as important for key stakeholders to understand.
Early Prelingual Auditory Development of Infants and Toddlers With Unilateral Hearing Loss
Authors: Yang Fengling , Zheng Yun , Li Gang
Published: February 2020

Objective:

To assess the influence of congenital and permanent unilateral hearing loss (UHL) on early prelingual auditory development (EPLAD) of infants and toddlers.

Study Design:

A cross-sectional and case-controlled design.

Setting:

Tertiary referral center.

Patients:

Sixty-five young children (median with interquartile ranges: 4.4 [3.3, 7.7] mo) with UHL, 70 children (6.0 [3.8, 9.0] mo) with bilateral normal hearing (BNH) and 32 children (5.8 [3.9, 12.1] mo) with bilateral mild hearing loss (BMHL) were enrolled and grouped. Children with UHL were further grouped according to the severity of impairment and the ear that was impaired.

Interventions:

Children involved were assessed by the 9-item Infant-toddler Meaningful Auditory Integration Scale (ITMAIS).

Main Outcome Measures:

1) EPLAD assessed by ITMAIS, 2) functions of sound detection, sound discrimination and identification and preverbal vocalization assessed by dividing ITMAIS into three sections, 3) trajectories of EPLAD estimated by ITMAIS.

Results:

Compared with BNH, children with UHL lagged behind in the function of sound discrimination and identification, preverbal vocalization, as well as trajectory of EPLAD. Children with severe to profound UHL exhibited more severe EPLAD handicaps than children with mild to moderate losses. The auditory functions and EPLAD trajectory of children with UHL were similar to those with BMHL.

Conclusions:

Children with congenital and permanent UHL demonstrate delays in EPLAD, which are evident soon after birth before initial development of speech and language. The ITMAIS is an appropriate tool to identify these delays both in children with unilateral and bilateral hearing impairment.
Dietary treatment of eosinophilic gastrointestinal disorders in children
Authors: Gutiérrez-Junquera Carolina , Zevit Noam
Published: February 2020

Purpose of review

To provide an overview of recent developments on dietary treatment of eosinophilic gastrointestinal disorders (EGID) in children.

Recent findings

Food antigens are the main triggers of eosinophilic esophagitis (EoE); however, currently available allergy tests cannot reliably identify eliciting antigens. Studies evaluating the six-food empiric elimination diet (6FED-milk, wheat/gluten, egg, soy/legumes, nuts and fish/seafood) have shown histological remission rates of 72%. Milk, egg, wheat/gluten, and, to a lesser extent, soy/legumes were the most frequent food triggers with only one or two culprit foods identified for most patients. A 4-food elimination strategy afforded a 64% remission rate. A step-up two-four-six food elimination diet generated a 43% remission rate at the two-food elimination stage, and similar reported rates for 4FED and 6FED. Endoscopic procedures were reduced by a 20% compared with 6FED. In a prospective study including 63 children, exclusive milk elimination has been effective in 44% of them. Controlled elimination and reintroduction with histological assessment is necessary.

Dietary therapy of EoE has evolved from more restrictive to less restrictive diets to provide better balance between efficacy vs. nutritional deficiencies and quality of life. Data on efficacy of dietary therapy in other EGIDs are very scarce.
A clinical update on vaccines: focus on determinants of under-immunization and special considerations for adolescents
Authors: Brodie Nicola , Metzenberg Gretchen E. , Silberholz Elizabeth A.
Published: February 2020

Purpose of review

The current article reviews recent literature related to pediatric and adolescent vaccination, specifically focusing on social determinants of under-immunization, expanding adolescent immunization rates, and new recommendations surrounding the meningococcal serotype B vaccine (MenB).

Recent findings

Vaccine refusals and vaccine-preventable diseases have been rising in some parts of the world, and appear to be linked to household factors, such as a family's socioeconomic status. Adolescents have lower immunization rates than younger children. Newer vaccines targeted at adolescents, such as the MenB vaccine, have yet to be widely accepted by pediatric providers, parents, and patients.

Pediatric healthcare providers should attempt to increase local immunization rates by vaccinating children at all eligible office visits and utilizing electronic health record decision-support tools. Although the number of families who choose not to vaccinate their children may be rising, providers can be innovative (e.g. incorporate digital vaccine reminder systems) and increase their familiarity with new vaccine recommendations to continue to prevent serious vaccine-preventable diseases.
Neonatal functional echocardiography
Authors: Tissot Cecile , Singh Yogen
Published: February 2020

Purpose of review

The role of echocardiography has dramatically changed over the past decade and use of functional echocardiography has become increasingly popular among neonatologists and pediatric intensivists in making clinical decisions in sick infants and children. The purpose of this review is to outline the current capabilities and limitations of functional echocardiography, best practices for its clinical application, and evidence for its utility.

Recent findings

Functional echocardiography can provide direct assessment of hemodynamics at bedside and can be used as a modern hemodynamic monitoring tool in the neonatal intensive care unit. It is now being regarded as a useful extension to the clinical examination and other monitoring tools in the critically ill infant. The anatomic, physiological, and hemodynamic information functional echocardiography provides can be used in targeting specific interventions and evaluating response to treatment.

This review article is focused on an overview of the most common applications of functional neonatal echocardiography also called targeted neonatal echocardiography or neonatologist performed echocardiography. It will review assessment of hemodynamics and cardiac function in neonatal hypotension and shock, suspected patent ductus arteriosus, suspected persistent pulmonary hypertension of the newborn with evaluation of pulmonary artery pressure and assessment of pericardial effusion. It will also emphasize the specific requirements for the practice and training of functional neonatal echocardiography.
B-Cell Precursor–Acute Lymphoblastic Leukemia With EBF1-PDGFRB Fusion Treated With Hematopoietic Stem Cell Transplantation and Imatinib: A Case Report and Literature Review
Authors: Sakurai Yukari , Sarashina Takeo , Toriumi Naohisa , Hatakeyama Naoki , Kanayama Takuyo , Imamura Toshihiko , Osumi Tomoo , Ohki Kentaro , Kiyokawa Nobutaka , Azuma Hiroshi
Published: February 2020

A 9-year-old girl was diagnosed with B-cell precursor–acute lymphoblastic leukemia (BCP-ALL). Although she entered remission after induction therapy, she relapsed 15 months after maintenance therapy cessation. Since further investigation revealed EBF1-PDGFRB fusion, her condition was treated as BCR-ABL1–like acute lymphoblastic leukemia. She was started on a tyrosine kinase inhibitor, imatinib, and chemotherapy and underwent umbilical cord blood transplantation following reduced intensity conditioning. She has remained in complete remission for 36 months after cord blood transplantation. This case demonstrates the successful use of a tyrosine kinase inhibitor to treat BCP-ALL with a fusion transcript and highlights the need for a standardized treatment protocol.
Treatment of Childhood Acute Myeloid Leukemia in Uruguay: Results of 2 Consecutive Protocols Over 20 Years
Authors: Dufort y Alvarez Gustavo , Castiglioni Mariela , Pagés Carolina , Incoronato Andrea , Simon Elizabeth , Zuccolo Silvana , Schelotto Magdalena , Morosini Fabiana , Amarillo Paloma , Pereira Inés , Giordano Hugo , Dabezies Agustín , Castillo Luis
Published: February 2020

We evaluated the outcome of 71 children with de novo acute myeloid leukemia enrolled in 2 consecutive protocols in the main pediatric hospital in Uruguay. In the LAM97 protocol (n=34), patients received, as consolidation, autologous or allogeneic hematopoietic stem cell transplantation (HSCT), depending on the availability or not of a matched sibling donor. In the LAM08 protocol (n=37), patients were stratified into risk groups, autologous HSCT was abandoned, and allogeneic HSCT was limited to intermediate-risk patients with matched sibling donor and to all patients who fulfilled the high-risk criteria. Complete remission was achieved in 91% and 92% of patients in LAM97 and LAM08, respectively. Deaths in complete remission were 9.6% and 17.6%, respectively. The incidence of relapse was significantly higher in LAM97, 35.4%, versus 12.5% in LAM08. The 5-year event-free survival and overall survival were 50.0% and 55.9% in LAM97 and 59.9% and 64.8% in LAM08. The 5-year overall survival rates in each of the risk groups were 85.7% and 100% for low risk, 50.0% and 61.2% for intermediate risk, and 42.9% and 50.0% for high risk in LAM97 and LAM08 protocols, respectively. Survival has improved over the last 2 decades, and results are comparable to those published in Europe and North America.
Magnet® Nurses of the Year Ignite Innovation
Authors: Lal M. Maureen
Published: February 2020

Innovations in patient care, nursing, and the practice environment are the hallmark of Magnet® organizations. Establishing new ways of achieving high-quality care is the result of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing. From coast to coast, clinical nurses take advantage of these opportunities to change care for the better, improve the patient experience, and drive the science of nursing forward. American Nurses Credentialing Center's National Magnet Nurse of the Year® Awards recognize and reward this work. Five outstanding clinical nurses are honored, 1 in each of the Magnet Model components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes. This month's Magnet Perspectives column spotlights the 2019 award winners and their achievements and examines how Magnet environments support and encourage their success.
Using Evidence to Create a Toolkit to Enable Sleep Among Hospitalized Patients
Authors: Oster Cynthia A. , Bernard Noreen , Manges Kirstin A.
Published: February 2020

Studies show sleep deprivation impacts patients' ability to perform physical activities and can lead to delirium, depression, and other psychiatric impairments. One of the Choosing Wisely® recommendations is “Do not wake the patient for routine care unless the patient's condition requires it.” The authors discuss the development of an evidence-based toolkit to facilitate opportunities for patients to sleep during hospitalization, exemplifying the translation of a Choosing Wisely recommendation into clinical practice.
Improving Patient Throughput With an Electronic Nursing Handoff Process in an Academic Medical Center
Authors: Sermersheim Emily Read , Moon Mark Chun , Streelman Marisa , McCullum-Smith Denina , Fromm Janine , Yohannan Stephanie , Powell Rhonda
Published: February 2020

OBJECTIVE

Rush University Medical Center nursing leadership undertook a process improvement project to revamp nursing handoff during unit transfer with the goal of improving patient throughput. The aim was to decrease assign-to-occupy time, the duration from bed assignment to bed occupancy.

BACKGROUND

There was a lengthy lag time in admitting/transferring patients, leading to delays in patient throughput and potential threats to patient safety. In fiscal year 2016, assign-to-occupy time averaged 97 minutes. The goal was to decrease that time to 60 minutes or less.

METHODS

Process improvement leaders held a rapid improvement event to determine viable solutions. A team then standardized handoff workflow; created an electronic tool, virtually eliminating verbal report; and implemented a new handoff process.

RESULTS

Assign-to-occupy time at 1 year after go-live averaged 55 minutes, and it has been staying less than 60 minutes since the implementation.

CONCLUSIONS

Key success strategies included engaging stakeholders during the rapid improvement event, imploring frontline nurses to create and promote the revised process to facilitate staff engagement, and leveraging electronic health records.
Speech of Patients With Unilateral Complete Cleft Lip and Palate: Comparison of Three Different Surgical Protocols for Primary Repair
Authors: Ahti Veera , Alaluusua Suvi , Rautio Jorma , Leikola Junnu , Hukki Jyri , Saarikko Anne
Published: February 2020

Background and Aims:

Between 1997 and 2014, 3 protocols have been used in out cleft unit for primary repair of unilateral cleft lip and palate. During the Scandcleft randomized controlled trial closing the soft palate and lip at 4 months and the hard palate at 12 months (Protocol 1) was compared with closing the entire palate at 12 months (Protocol 2). Protocol 3 comprises closure of the lip and hard palate with a vomer flap at 4 months and the soft palate at 10 months. The purpose of this study was to compare subsequent velopharyngeal competence at age of 3 and 5 years.

Patients and Methods:

The study consisted of 160 non-syndromatic patients with a unilateral cleft lip and palate. Protocol 3 was retrospectively compared with Protocols 1 and 2 within the previously published Scandcleft study.

Results:

At 3 years of age, normal or borderline competent velopharyngeal function was found in 68% of patients in Protocol 1, 74% of patients in Protocol 2, and 72% of patients in Protocol 3. At 5 years of age, the corresponding figures were 84%, 82%, and 92%. 21% of patients in Protocol 1, 4% in Protocol 2, and 23% in Protocol 3 had palatal reoperations before the age of 5 years.

Conclusion:

No significant differences emerged in velopharyngeal competence at age 3 years between the 3 protocols. Palatal reoperations were performed earlier in patient groups 1 and 3, explaining the difference in the velopharyngeal competence rate at the 5-year time-point.
Evaluation of a Pediatric Facial Paralysis Education and Family Support Day
Authors: Heinelt Martina , Zuo Kevin J. , Copeland Jocelyne , Ho Emily S. , Zuker Ronald M. , Borschel Gregory H.
Published: February 2020

Introduction:

Facial paralysis impairs the mimetic functions of the facial musculature. In pediatric patients, free functioning muscle transfer neurotized with an intact contralateral facial nerve is the gold standard for smile reanimation. In response to requests from families of children with facial paralysis, the Division of Plastic and Reconstructive Surgery at the Hospital for Sick Children hosted an inaugural “Facial Paralysis Family Day.” The objective was to create an opportunity for families to meet, exchange stories, and build support networks.

Methods:

This study was a quality improvement project to conduct a needs assessment and evaluate the feasibility and satisfaction of implementing a family support intervention for individuals living with facial paralysis.

Results:

The needs assessment demonstrated that families were most interested in advances in medicine, therapy and coping sessions and meeting other families. The post-event evaluation questionnaire indicated that attendees enjoyed the event, would attend again and found it highly valuable connecting and networking other families. It also indicated that key needs identified were addressed, with excellent ratings for the presentation discussing advances in medicine (100% rated “good” or “very good”), the therapy sessions (92% rated “good” or “very good”) and the presentations by patients and their families (100% rated “good” or “very good.”)

Discussion:

Two areas of improvement highlighted were elaborating further on medical advances and facilitating interactions between families. Overall, this event was well regarded and will likely be repeated at our institution and serve as a valuable resource for other hospitals planning to organize a similar event.
The Relationship Between Nasal Septal Deviation and Paranasal Pneumatization
Authors: Şahin Muammer Melih , Özer Hamza , Çayönü Melih , Damgaci Lale , Dinç Seçil Kayali , Boynueğri Süleyman , Taşdemir Abdülkerim , Eryilmaz Adil
Published: February 2020

Objective:

To investigate the impact of the presence and the severity of the nasal septal deviation (NSD) on the paranasal pneumatization.

Methods:

Initially, the deviated and contralateral sides was compared to evaluate the impact of the presence of NSD on pneumatization. Then, NSD classification groups were categorized according to the severity of deviation degree; 1: mild (<9°), 2: moderate (9°–15°), and 3: severe (>15°). Pneumatization of all paranasal sinuses, osteomeatal complex (OMC), frontoethmoid recess (FER) and variant structures were compared according to the NSD classification groups separately both for the deviated and the contralateral sides.

Results:

Although there was no statistically significant difference in pneumatization of the paranasal sinuses between the deviated and contralateral sides, a significant difference was observed in OMC and FER diameters. In the deviated side, there was statistically significant difference in ethmoid sinus volume, in FER and OMC diameters between NSD classification groups. In the contralateral side, FER and OMC diameters were found to be significantly different between group 1 and group 2 and between group 1 and group 3, respectively (P = 0.04 and 0.06, respectively). Both the presence and severity of the NSD did not statistically significant influence the pneumatization of variant structures, air cells and vital structures.

Conclusion:

The severity of NSD effects the ethmoid sinus volume. The relationship of FER and OMC with NSD is evident, however this may not always be in a proportional pattern. The paranasal pneumatization did not affect Keros type, bone integrity of carotid canal and optic canal.
Is Adjuvant Chemotherapy Necessary for Obstructing Stage II Colon Cancer? Results From a Propensity Score Analysis of the French Surgical Association Database
Authors: Sabbagh Charles , Manceau Gilles , Mege Diane , Abdalla Solafah , Voron Thibault , Bridoux Valérie , Lakkis Zaher , Venara Aurélien , Beyer-Berjot Laura , Diouf Momar , Karoui Mehdi
Published: February 2020

Objective:

The aim of this study was to compare the survival of patients with stage II obstructing colon cancer (OCC) who had adjuvant chemotherapy with those who did not.

Summary Background Data:

The need for adjuvant chemotherapy in stage II colon cancer is still debated.

Methods:

All consecutive patients treated for a stage II OCC in a curative intent (with primary tumor resection) between January 2000 and December 2015 were included in this retrospective, multicenter cohort study which included a propensity score analysis using an odds of treatment weighting (Average Treatment effect on the Treated, ATT). The endpoint was the comparison between the 2 groups for overall survival (OS) and disease-free survival (DFS) according to whether or not patients received adjuvant chemotherapy.

Results:

During the study period, 504 patients underwent a curative colectomy for a stage II OCC. Among these patients, 179 (35.5%) had adjuvant chemotherapy and 325 (64.5%) had no adjuvant treatment. Among the 179 patients who received adjuvant chemotherapy, 108 patients (60%) received oxaliplatin based regimen and 99 patients (55%) completed all scheduled cycles. At multivariate analysis, after weighting by the odds (ATT analysis) and adjustment, adjuvant chemotherapy after resection of a stage II OCC was associated with improvements in OS [hazard ratio (HR) = 0.42 (0.17–0.99),P= 0.0498] and DFS [HR = 0.57 (0.37–0.88),P= 0.0116].

Conclusion:

This study suggests that adjuvant chemotherapy after curative resection of stage II OCC may improve oncological outcomes.
Coagulopathy and transfusion ratios in pediatric trauma
Authors: Murphy Colin Howard , Spain David Alan , Shan Hua
Published: February 2020

BACKGROUND

Coagulopathy has been associated with poor outcomes in adult and pediatric trauma. Previous clinical trials have shown benefits with balanced transfusion ratios in trauma resuscitation in adults, but smaller retrospective studies have not established the same in pediatrics. We constructed a pediatric trauma database at a Level I trauma center for analysis.

METHODS

The institutional trauma registry was queried for all pediatric trauma activations from 2008 to 2018. Patient identifiers were used to identify laboratory data from the electronic data warehouse.

RESULTS

There were 2,769 pediatric patients with trauma identified, with 1,492 arriving direct from the scene. Of those with complete transport data available, 81% arrived within 60 minutes from time of injury. Fifty-two patients were transfused in the first 24 hours, with 25 receiving greater than an estimated 40 mL/kg of blood products. No significant difference in ratios of red cell to plasma transfused at 24 hours was observed between patients surviving to discharge (1.4; 95% confidence interval, 1.0–1.6) and deceased (1.7; 95% confidence interval, 1.4–1.9) (p = 0.087).

Among direct admissions, an abnormal prothrombin time or partial thromboplastin time taken within 2 hours of arrival was significantly associated with in-hospital mortality (p = 0.003 and <0.001), but no significant associations were seen for abnormal fibrinogen or platelet counts. Red cell to plasma transfusion ratios were not significantly associated with length of stay or ventilator days (p = 0.74 and 0.28).

CONCLUSION

There was no significant difference between transfusion ratios of surviving and deceased patients at 3- and 24-hour time points, including in a weight-adjusted highly transfused subgroup. Coagulopathy remains an important issue in pediatric trauma and may guide future multicenter studies in optimizing transfusion ratios in pediatric trauma.

LEVEL OF EVIDENCE

Retrospective comparative study, level III.
Implementation of a multidisciplinary perinatal emergency response team improves time to definitive obstetrical evaluation and fetal assessment
Authors: Smith Jennifer A. , Sosulski Amanda , Eskander Ramy , Moazzez Ashkan , Patel Neil , Putnam Brant , Kim Dennis Y.
Published: February 2020

BACKGROUND

Trauma is the leading cause of nonobstetric death during pregnancy and is associated with an increased risk of maternal and fetal mortality. In an effort to improve the delivery of care to pregnant trauma patients, we developed an institutional multidisciplinary quality initiative designed to improve response times of nontrauma specialists and ensure immediate availability of resources. We hypothesized that implementation of a perinatal emergency response team (PERT) would improve time to patient and fetal evaluation and monitoring by the obstetrics (OB) team and improve both maternal and fetal outcomes.

METHODS

We performed a 6-year (2012–2018) retrospective cohort analysis of consecutive pregnant trauma patients presenting to our university-affiliated, level I trauma center. Patients in the pre-PERT cohort (before April 2015) were compared with a post-PERT cohort. Variables analyzed included patient demographics, mechanism of injury, Injury Severity Score, and level of trauma activation. The main outcome measure was time to OB evaluation. Secondary outcomes included time to cardiotocometry, and mortality.

RESULTS

Of 92 pregnant trauma patients, there were 50 patients (54.3%) in the pre-PERT cohort and 42 (45.7%) in the post-PERT group. Blunt injuries predominated (98.9%), with the most common mechanism being motor vehicle collisions (76.1%), followed by assaults (13%) and falls (6.5%). The mean time to obstetrical evaluation was 44 minutes in the pre-PERT cohort compared with 14 minutes in the post-PERT cohort (p = 0.001). There was a significant decrease in level I (highest acuity) trauma activations pre-PERT and post-PERT (46% vs. 21%, p = 0.01), and the time to cardiotocography was significantly decreased post-PERT implementation (72 vs. .37 min, p = 0.01)

CONCLUSION

Implementation of a multidisciplinary PERT improves time to evaluation by the OB team and time to cardiotocometry in the pregnant trauma patient.

LEVEL OF EVIDENCE

Retrospective review, level IV.
The scales of recovery: Balancing posttraumatic stress with resilience in the violently injured
Authors: Wheeler Andrew , Tatebe Leah C. , Reese Carol , Jacob Beth-Anne , Pekarek Sydney , Siva Nandini Rajaram , Liesen Erik , Schlanser Victoria , Kaminsky Matthew , Messer Thomas , Starr Frederic , Mis Justin , Bokhari Faran , Dennis Andrew J.
Published: February 2020

BACKGROUND

Community violence remains a clinical concern for urban hospitals nationwide; however, research on resilience and posttraumatic growth (PTG) among survivors of violent injury is lacking. This study intends to assess survivors of violent injury for resilience and PTG to better inform mental health interventions.

METHODS

Adults who presented with nonaccidental penetrating trauma to an urban level 1 trauma center and were at least 1 month, but no more than 12 months, from treatment were eligible. Participants completed the Connor-Davidson Resiliency Scale, Posttraumatic Growth Inventory (PTGI), Primary Care Posttraumatic Stress Disorder screen, and a community violence exposure screen. Additional demographic, injury, and treatment factors were collected from medical record.

RESULTS

A total of 88 patients participated. The mean resiliency score was 83.2, with 71.1% scoring higher than the general population and 96.4% scoring higher than the reported scores of those seeking treatment for posttraumatic stress disorder (PTSD). Participants demonstrated a mean PTGI score of 78 (SD, 20.4) with 92.4% scoring above the significant growth threshold of 45. In addition, 60.5% of patients screened positive for significant PTSD symptoms, approximately eight times higher than general population. Exposure to other traumatic events was high; an overwhelming 94% of participants stated that they have had a family member or a close friend killed, and 42% had personally witnessed a homicide. Higher resilience scores correlated with PTGI scores (p < 0.001) and lower PTSD screen (p = 0.02).

CONCLUSION

Victims of violent injury experience a myriad of traumatic events yet are highly resilient and exhibit traits of growth across multiple domains. Resiliency can coexist with posttraumatic stress symptoms. Practitioners should assess for resiliency and PTG in addition to PTSD. Further investigation is needed to clarify the relational balance between resilience and posttraumatic stress.

LEVEL OF EVIDENCE

Epidemiological study type, Level II.
Predictors of swallowing outcomes in patients with combat-injury related dysphagia
Authors: Solomon Nancy Pearl , Dietsch Angela M. , Dietrich-Burns Katie
Published: February 2020

BACKGROUND

Traumatic injuries, such as those from combat-related activities, can lead to complicated clinical presentations that may include dysphagia.

METHODS

This retrospective observational database study captured dysphagia-related information for 215 US military service members admitted to the first stateside military treatment facility after sustaining combat-related or combat-like traumatic injuries. A multidimensional relational database was developed to document the nature, course, and management for dysphagia in this unique population and to explore variables predictive of swallowing recovery using Bayesian statistical modeling and inferential statistical methods.

RESULTS

Bayesian statistical modeling revealed the importance of maxillofacial fractures and soft tissue loss as primary predictors of poor swallowing outcomes. The presence of traumatic brain injury (TBI), though common, did not further complicate dysphagia outcomes. A more detailed examination and rating of videofluoroscopic swallow studies from a subset of 161 participants supported greater impairment for participants with maxillofacial trauma and no apparent relationship between having sustained a TBI and swallow functioning.

CONCLUSION

These analyses revealed that maxillofacial trauma is a stronger indicator than TBI of dysphagia severity and slower or incomplete recovery following combat-related injuries.

LEVEL OF EVIDENCE

Therapeutic/Care Management study, level IV.