bluuebunny/crossref_metadata_2025 huggingface dataset:
White Coat Hypertension Increases Risk of Cardiovascular Events
Authors: Rosenberg Karen
Published: August 2019

According to this study:

People with white coat hypertension—but not white coat uncontrolled hypertension—are at increased risk for cardiovascular events and all-cause mortality compared with those who have normal blood pressure.

Out-of-office blood pressure monitoring is important in the diagnosis and management of hypertension.
The Art of Giving Feedback
Authors: Sherman Rose O.
Published: August 2019

For many leaders, giving positive feedback comes easily, but giving negative feedback can be more challenging. This article provides best-practice strategies for giving effective feedback—through building trust, promoting a growth mindset, and developing the courage to tackle difficult performance conversations.
Pioneering Military Burn Research
Authors: Szulecki Diane
Published: August 2019

Former Army nurse Elizabeth-Mann Salinas has improved burn care worldwide.
A Clear Small Voice
Authors: Beall Linda
Published: August 2019

One woman's truly life-changing experience of caring for a mother with cancer.
Calcinosis in scleroderma made crystal clear
Authors: Hsu Vivien , Varga John , Schlesinger Naomi
Published: August 2019

Purpose of review

Review the current state of knowledge and recent developments in the field of scleroderma-related calcinosis [systemic sclerosis (SSc)-calcinosis], focusing on emerging information related to pathophysiology.

Recent findings

Recent studies have begun to characterize that factors that regulate ectopic mineralization, and those that underlie the imbalance of promoters and inhibitors of this process in SSc.

Calcinosis cutis due to ectopic mineralization is a common and highly troublesome complication of SSc. Despite its significant prevalence and clinical impact, the pathogenesis is poorly understood and effective treatment is lacking. More research to better understand the pathophysiology is needed for the identification of novel management strategies for this severe complication of SSc.
Evaluation of Electronic Health Records on the Nursing Process and Patient Outcomes Regarding Fall and Pressure Injuries
Authors: Wu Mei-Wen , Lee Ting-Ting , Lai Shu-Mei , Huang Chi-Yi , Chang Tsai-Hsiu
Published: August 2019

Digitalizing the nursing process has become a trend in medical care. The purpose of this study was to evaluate implementation of the Standardized Computerized Nursing Process Documentation System and patient outcomes. We analyzed hospitalized patients' electronic health record database with a total of 19 659 patients in 2015. The analysis focused on nurses' selection of nursing care plans for patients with a high risk of falls or pressure injuries through admission assessments. The effectiveness of implemented nursing care plans following falls or pressure injuries was explored. The results reveal that 55% of the hospitalized patients had a risk of falling, and 27.85% of patients were at risk of pressure injuries. Patients receiving nursing care plan who experienced falls or pressure injuries were significantly higher than those without a nursing care plan (P < .001). This study could not provide direct evidence for the effect of nursing care plans on reducing the incidence of falls and pressure injuries, which may be attributable to patient characteristics. Furthermore, an analysis on data from 2007 to 2017 using a run chart revealed that the mean incidence rate for pressure injuries decreased, whereas that for falls remained stable. The results indicate that the system did not increase the occurrence of such incidences.
Developing and Pilot Testing an Integrated Technology–Moderated Institutional Health Promotion Model Using Operational Research Approach
Authors: Joseph-Shehu Elizabeth M. , Ncama Busisiwe P. , Irinoye Omolola
Published: August 2019

The study aimed to develop and pilot test an Integrated Technology–Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology–Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology–moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology.
Complications and Outcomes of Acute Respiratory Distress Syndrome
Authors: DiSilvio Briana , Young Meilin , Gordon Ayla , Malik Khalid , Singh Ashley , Cheema Tariq
Published: August 2019

Acute respiratory distress syndrome (ARDS) is a disease associated with both short- and long-term complications. Acute complications include refractory respiratory failure requiring prolonged dependence on mechanical ventilation and the subsequent need for tracheostomy and gastrostomy tubes, protracted immobilization, and lengthy stays in the intensive care unit resulting in delirium, critical illness myopathy, and polyneuropathy, as well as secondary nosocomial infections. Chronic adverse outcomes of ARDS include irreversible changes such as fibrosis, tracheal stenosis from prolonged tracheostomy tube placement, pulmonary function decline, cognitive impairment and memory loss, posttraumatic stress disorder, depression, anxiety, muscle weakness, ambulatory dysfunction, and an overall poor quality of life. The degree of disability in ARDS survivors is heterogeneous and can be evident even years after hospitalization. Although survival rates have improved over the past 4 decades, mortality remains significant with rates reported as high as 40%. Despite advancements in management, the causes of death in ARDS have remained relatively unchanged since the 1980s with sepsis/septic shock and multiorgan failure at the top of the list.
Paralytics, Sedation, and Steroids in Acute Respiratory Distress Syndrome
Authors: Leap Jennifer , Hill Jared , Patel Kaushal , Shah Arpan , Dumont Tiffany
Published: August 2019

In this article, we discuss the literature behind the use of paralytics, sedation, and steroids in acute respiratory distress syndrome. We explore the controversies and discuss the recommendations for the use of these agents.
Acute Respiratory Distress Syndrome Novel Therapies
Authors: Ma Kiet , Patel Kaushal , Naddour Mouhib , Virani Ahmed , Adurty Rajashekar , AlhajHusain Ahmad , Cheema Tariq
Published: August 2019

Acute respiratory distress syndrome (ARDS) was first described in 1967. Since then, several landmark studies have been published that have greatly influenced the way we diagnose and treat patients with ARDS. Despite extensive research and advancements in ventilator strategies, moderate-severe ARDS has been associated with high mortality rates. Current treatment remains primarily supportive with lung-protective ventilation strategies. Pharmacological therapies that reduce the severity of lung injury in vivo and in vitro have not yet translated into effective clinical treatment options. Currently, the mortality rate of severe ARDS remains in the range of 30% to 40%. To review, the mainstay of ARDS management includes mechanical ventilation with low tidal volumes to decrease barotrauma, prone ventilation, conservative fluid management, and neuromuscular blockade. ARDS survivors tend to have long-term and potentially permanent neuromuscular, cognitive, and psychological symptoms, affecting patient's quality of life posthospitalization. These long-term effects are likely secondary to prolonged hospitalizations, prolonged mechanical ventilation, utilization of prone strategies, utilization of paralytic drugs, and occasionally steroids. Therefore, several novel therapies outside the realm of advanced ventilation and prone positioning methods are being studied. In this article, we discuss a few of these novel therapies including prophylactic aspirin, inhaled nitric oxide, mesenchymal stem cells, and intravenous β-agonists. Steroids and extracorporeal membrane oxygenation have been discussed in a previous article.
Mimics of Acute Respiratory Distress Syndrome
Authors: Patel Kaushal , Baltaji Stephanie , Rabold Erica , Malik Khalid , Adurty Rajashekar , Cheema Tariq
Published: August 2019

Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as “Mimics of ARDS.” It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy.
Cardiac Dysfunction in Acute Respiratory Distress Syndrome
Authors: Fu Sheng , Thangavel Sarumathi , Ivanova Valentyna
Published: August 2019

Acute respiratory distress syndrome is a heterogenous condition with significant mortality and limited therapeutic options. Although hypoxic respiratory failure tends to be the hallmark of the disease, there can be significant cardiac compromise, particularly in the right ventricle. Echocardiography plays an important role in the early diagnosis and recognition of right ventricular dysfunction. Treatment of said dysfunction with mechanical ventilation strategies and therapies such as inhaled nitric oxide or extracorporeal membrane oxygenation remain poorly studied but offer potential salvage strategies.
Atypical Disseminated Variant of Galli–Galli Disease: A Review of the Literature
Authors: Yang Anes , Cheung Karen , Kossard Steven , Murrell Dedee F.
Published: August 2019

Galli–Galli disease (GGD) is a rare genodermatoses within the group of reticulated pigmentary disorders of the skin. Traditionally, its clinical presentation is identical to that of Dowling–Degos disease (DDD), with the additional feature of acantholysis on histopathological examination. We have reviewed the published cases of GGD to provide further support for the hypothesis that in fact, 2 phenotypes of GGD exist: the characteristic flexural GGD associated with KRT5 mutations and a disseminated variant with no mutation identified to date. A review of the literature revealed 53 reported cases of GGD. Fifteen atypical phenotype cases are described, and no KRT5 mutation has yet been identified. There is growing evidence that acantholysis is an underreported feature of DDD and that GGD and DDD are variations of the same disease, or in fact the same entity. This theory is supported by the identification of the c.418dupA missense mutation in both GGD and DDD. This review highlights that there is growing evidence that there are likely 2 clinical phenotypes of GGD with an associated genotypic correlation.
Barriers to Treatment Adherence Among College Students with Attention-Deficit/Hyperactivity Disorder
Authors: Wagoner Scott T. , Schaefer Megan R. , Rawlinson Alana Resmini , Shapiro Steven K. , Kavookjian Jan , Gray Wendy N.
Published: August 2019

Objective:

The current study sought to obtain a longitudinal perspective of and quantitatively assess barriers to medication adherence experienced by college students with attention-deficit/hyperactivity disorder (ADHD). Thus, we examined semester-long trends in barriers to adherence in addition to the relationships between barriers and medication adherence and barriers and quality of life.

Methods:

Participants were college students diagnosed with ADHD. Throughout a Fall semester, participants completed 4 sets of online questionnaires and attended 4 in-person visits, which included pill counts and written questionnaires. Participants completed measures assessing barriers to adherence and health-related quality of life, and adherence was measured via pill counts. Mean values of barriers, adherence rate, and quality of life were used for all analyses.

Results:

Of the 45 students surveyed, mean adherence rate was 56.70%, and 84.45% of participants reported at least 1 barrier. Across the semester, participants reported experiencing an average of 3.07 barriers, and a consistent barrier reported was not realizing when pills run out. Although reported barriers were unrelated to adherence, the results showed that barriers were associated with lowered quality of life, specifically lower overall quality of life in addition to lower emotional functioning, psychosocial health, school functioning, and physical functioning.

Conclusion:

Barriers to adherence appear to be common in college students with ADHD, and certain barriers are consistent with the planning difficulties observed in individuals with ADHD. Because students experiencing more barriers had lower quality of life, interventions are needed to improve students' overall illness management experience.
Pain and Bruising Levels After Lip Augmentation: A Comparison of Anterograde and Retrograde Techniques Using an Automated Motorized Injection Device. A Blinded, Prospective, Randomized, Parallel Within-Subject Trial
Authors: Galadari Hassan , Mariwalla Kavita , Delobel Patrice , Sanchez-Vizcaino Mengual Elena
Published: August 2019

BACKGROUND

Dermal fillers for lip augmentation can be injected using various techniques. Although all seem to provide acceptable results, it is not clear which technique is safer, less painful, and provides greater patient comfort.

OBJECTIVE

To compare patients' self-reported pain intensity during the injection of hyaluronic acid dermal filler for lip augmentation, with 2 different techniques, anterograde versus retrograde.

METHODS AND MATERIALS

Prospective, single-center, within-subject, single-blinded, randomized controlled trial. All subjects received injections in the lip with hyaluronic acid–based filler, each side using the anterograde or retrograde injection technique. An automated motorized injection device was used to ensure a homogeneous deposition flow of the product injected and reduce operator bias. Pain intensity was self-assessed using a 100-mm visual analog scale. Presence and severity of bruising were recorded.

RESULTS

Forty-four women (mean age 30.3 years) were randomized. Mean self-reported pain score was 53.1% lower with the anterograde technique than with the retrograde (p < .0001). The anterograde technique had lower rates of site reactions, showed a faster recovery time, and 68.2% of patients favored this technique.

CONCLUSION

This study demonstrated that the anterograde technique was less painful, and led to fewer bruising and site reactions than the retrograde technique when using an automated device.

LEVEL OF EVIDENCE

I.
Improvement of Radial Cheek Lines With Hyaluronic Acid–Based Dermal Filler VYC-17.5L: Results of the BEAM Study
Authors: Ogilvie Patricia , Fink Bernhard , Leys Christophe , Lipko-Godlewska Sylwia , Niforos François , Kelly Regina , Kerson Graeme , Silberberg Michael
Published: August 2019

BACKGROUND

Radial cheek lines (RCL) may convey an older, potentially less attractive appearance.

OBJECTIVE

To evaluate the effectiveness of hyaluronic acid–based dermal filler VYC-17.5L for correcting RCL.

MATERIALS AND METHODS

Fifty-three women (40–65 years) received injections of VYC-17.5L in both cheeks on Day 1 (optional Day 14 touch-up). Effectiveness was evaluated on Day 45 by subject-rated dynamic RCL improvement (Global Aesthetic Improvement Scale [GAIS]; primary end point) and independent, noninjecting investigator–rated GAIS; subject Self-Perception of Age (SPA); subject-assessed satisfaction with and natural look of treatment; and instrument-assessed changes in static and dynamic RCL roughness, amplitude, and texture (secondary end points). Safety assessments included injection site responses (ISRs).

RESULTS

On Day 45, 98% of subjects rated RCL as improved or much improved (investigator rated: 95%). Subjects with same or older SPA before treatment (n = 38) perceived themselves as 2.0 and 5.5 average years younger after treatment, respectively. Day 45 mean satisfaction with and natural look of treated areas was 7.9/10 and 7.2/10, respectively. Treatment significantly improved RCL roughness, amplitude, and texture (all p < .001). Most common ISRs were hematoma (35.9%), bruising (30.2%), and irregularities/bumps (22.6%); most ISRs were mild.

CONCLUSION

VYC-17.5L effectively corrected dynamic RCL, improved instrument-assessed indicators of skin quality, and resulted in younger age perception.
Pharmacologic and Nonpharmacologic Interventions for Perioperative Anxiety in Patients Undergoing Mohs Micrographic Surgery: A Systematic Review
Authors: Wan Angie Y. , Biro Mark , Scott Jeffrey F.
Published: August 2019

BACKGROUND

Perioperative anxiety is associated with negative patient outcomes in Mohs micrographic surgery (MMS). Both pharmacologic and nonpharmacologic therapies have been used to alleviate perioperative anxiety in MMS.

OBJECTIVE

To systematically evaluate the efficacy of therapies aimed at reducing perioperative anxiety in MMS.

METHODS AND MATERIALS

Eligible articles were identified using PubMed MEDLINE, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. All available studies investigating interventions to reduce perioperative anxiety during MMS were considered.

RESULTS

Of the 183 abstracts identified and screened, 5 studies met inclusion criteria. Three studies reported a postintervention reduction in patient anxiety (midazolam, educational video, and personalized music). Two studies reporting on similar interventions did not find an effect.

CONCLUSION

There is currently limited evidence to support either pharmacologic or nonpharmacologic therapy for alleviation of perioperative patient anxiety in MMS. Midazolam may provide patients a short-term benefit, though any estimate of the effect is very uncertain. Personalized music may be a promising nonpharmacologic intervention for future research.
Listening, Acting, and Learning Together to Build a Better Model of Care
Authors: Judd Marie
Published: August 2019

As a large, nationally integrated, mission-driven healthcare system, Ascension recognizes the need for a multifaceted approach to communication—one that facilitates both national alignment and local action while advancing the Quadruple Aim of enhancing the person/patient experience, improving population health, reducing costs, and improving the work life of healthcare providers.

The Ascension Person and Family Experience Model provides a framework to support a comprehensive communications strategy that encompasses our care teams, leaders, and communities. The model, which comprises a feedback loop with three steps—listen, take action, and learn together—guides both personal interactions and organizational change. It gives direction to our human-to-human connections and enables us to listen as an organization to our voice-of-the- customer data. In living the model, we take meaningful action both by developing just-in-time solutions to problems close to the person/patient and by launching systematic actions on the macro level. We also find ways to learn and innovate together through both local huddles and national conversations.

The model has been operationalized across the system with the support of a cross-discipline, cross-continuum national structure. It owes its success to a persistent focus at all levels of the organization on what matters most to those we serve and to those who serve beside us.
Preparing Occupational Therapists for Effective Family-Centered Best Practice in Early Intervention
Authors: Elenko Beth
Published: August 2019

The State University of New York (SUNY) Downstate's occupational therapy (OT) Program has worked over the last decade and a half providing advanced training in early intervention (EI) through 3 OT programs for practicing and preservice occupational therapists. There are many challenges in the preparation of entry-level practitioners to work effectively using family-centered best practices. This article describes a family partnership experience (FPE), which is part of SUNY Downstate's advanced training in EI. This article outlines the evolution of our FPE through 3 advanced training programs. In these FPEs, the OT students spend time with families who receive EI during their daily lives. Students complete assignments to identify the families' priorities and concerns, understand roles and routines, and assist families to access community resources. Through this FPE, students learn about the family's perspective. This article presents quantitative and qualitative data of the FPE through students' report in course evaluations, pre- and post–self-assessed competency, and informal interviews over the 3 higher education OT programs.
Finding a Common Lens
Authors: Bruder Mary Beth , Catalino Tricia , Chiarello Lisa A. , Mitchell Marica Cox , Deppe Janet , Gundler Darla , Kemp Peggy , LeMoine Sarah , Long Toby , Muhlenhaupt Mary , Prelock Patricia , Schefkind Sandra , Stayton Vicki , Ziegler Deborah
Published: August 2019

The Early Childhood Personnel Center (ECPC) was funded by the Office of Special Education Programs at the U.S. Department of Education to provide technical assistance to State Systems of Early Childhood Intervention and Institutions of Higher Education on issues related to personnel development. One initiative of the ECPC has been to collaborate with professional organizations to identify core cross-disciplinary competencies for all personnel serving infants and young children aged birth through 5 years with disabilities and their families. Seven national organizations representing disciplines providing services in early childhood intervention have been participating in this initiative: the American Occupational Therapy Association; the American Physical Therapy Association; the American Speech-Language-Hearing Association; the Council for Exceptional Children and the Division for Early Childhood; the National Association for the Education of Young Children; and Zero to Three. Alignments of personnel standards, practice guidelines, and competencies yielded 4 areas of competence that are common across service providers serving infants and young children with disabilities and their families. These are: Collaboration and Coordination; Family-Centered Practice; Evidence-Based Practice; and Professionalism.
Epigenetic reduction of miR-214-3p upregulates astrocytic colony-stimulating factor-1 and contributes to neuropathic pain induced by nerve injury
Authors: Liu Lian , Xu Dan , Wang Tao , Zhang Yi , Yang Xijing , Wang Xiangxiu , Tang Yuying
Published: August 2019

Emerging evidence has indicated that colony-stimulating factor-1 (CSF1) modulates neuroinflammation in the central nervous system and the development of neuropathic pain, while the underlying mechanism remains unknown. Here, we identified the increased expression of CSF1 derived from activated astrocytes in the ipsilateral dorsal horn in rats with spinal nerve ligation (SNL). Suppression of CSF1 expression alleviated neuroinflammation, neuronal hyperexcitability, and glutamatergic receptor subunit upregulation in the dorsal horn and improved SNL-induced pain behavior. We also found reduced miR-214-3p expression in the ipsilateral dorsal horn following an SNL procedure; miR-214-3p directly bound to the 3′-UTR of CSF1 mRNA and negatively regulated CSF1 expression. Intrathecal delivery of miR-214-3p mimic reversed the enhanced expression of CSF1 and astrocyte overactivity and alleviated the IL-6 upregulation and pain behavior induced by SNL. Moreover, suppression of spinal miR-214-3p increased astrocyte reactivity, promoted CSF1 and IL-6 production, and induced pain hypersensitivity in naive animals. Furthermore, SNL induced the expression of DNA methyltransferase 3a (DNMT3a) that was associated with the hypermethylation of the miR-214-3p promoter, leading to reduced miR-214-3p expression in the model rodents. Treatment with the DNMT inhibitor zebularine significantly reduced cytosine methylation in the miR-214-3p promoter; this reduced methylation consequently increased the expression of miR-214-3p and decreased the content of CSF1 in the ipsilateral dorsal horn and, further, attenuated IL-6 production and pain behavior in rats with SNL. Together, our data indicate that the DNMT3a-mediated epigenetic suppression of miR-214-3p enhanced CSF1 production in astrocytes, which subsequently induced neuroinflammation and pain behavior in SNL model rats.
Systematic review and meta-analysis of placebo/sham controlled randomised trials of spinal cord stimulation for neuropathic pain
Authors: Duarte Rui V. , Nevitt Sarah , McNicol Ewan , Taylor Rod S. , Buchser Eric , North Richard B. , Eldabe Sam
Published: August 2019

The aims of this review were to systematically identify the current evidence base of placebo (or “sham”) randomised controlled trials (RCTs) of spinal cord stimulation (SCS) for neuropathic pain and to undertake a meta-analysis to investigate the effectiveness of SCS when compared with a placebo comparator arm. Electronic databases were searched from inception until January 2019 for RCTs of SCS using a placebo/sham control. Searches identified 8 eligible placebo-controlled randomised trials of SCS for neuropathic pain. Meta-analysis shows a statistically significant reduction in pain intensity during the active stimulation treatment periods compared with the control treatment periods, pooled mean difference −1.15 (95% confidence interval −1.75 to −0.55, P = 0.001) on a 10-point scale. Exploratory study–level subgroup analysis suggests a larger treatment effect in RCTs using a placebo control (defined as studies where the device was inactive and at least one of the study procedures was different between the arms) than a sham control (defined as all study procedures being equal between arms including SCS device behaviour). Our findings demonstrate limited evidence that SCS is effective in reducing pain intensity when compared with a placebo intervention. Our analyses suggest that the magnitude of treatment effect varies across trials and, in part, depends on the quality of patient blinding and minimisation of carryover effects. Improved reporting and further methodological research is needed into placebo and blinding approaches in SCS trials. Furthermore, we introduce a differentiation between placebo and sham concepts that may be generalisable to trials evaluating surgical or medical procedures.
The Impact of Centralized Employment Structure on Community Health Work
Authors: Pothapragada Tiffany M. , Saint Onge Jarron M. , Brooks Joanna Veazey
Published: August 2019

While community health workers (CHWs) are employed in various arrangements, little is known about the association between organizational structure and CHW experiences. Seventeen in-depth interviews were conducted with CHWs, supervisors, and leadership employed in one centrally organized setting to investigate organizational structure and perceptions of CHW effectiveness. A model that hired employees but assigned them to various settings offered support and unique career advancement opportunities. Coordinated education, ongoing trainings, and persistent supervision were perceived to improve the accuracy of resource information and facilitated collaboration across the health care system with increased health care team communication, offering insights into other organizational structures.
“Connected Access”
Authors: Vigilante Kevin , Khan Mohd M.
Published: August 2019

The concept of access to health care has been dominated by the visit-based paradigm. However, with the advent of telehealth, wearables, and mobile applications, much of the information that is exchanged at the time of the provider encounter can be transmitted virtually. This calls for a reconceptualization of access that is not so heavily reliant on “the visit.” We have proposed a concept of connected access that is “dose related,” based on the expertise of the provider and the channel through which a patient and a provider communicate. Particularly relevant to chronic care, the intensity of access can be titrated according to the needs of the patient at different points in time as clinical needs change. To function optimally, this model requires value-based payment and a new care model that occurs at the intersection of team medicine, virtual care, self-care, and traditional visit-based care. Made possible through connected technologies, “Connected access” fulfills the vision articulated in the “Crossing the Quality Chasm” report (2001) that care is based on continuous healing relationships; hence, the health care system should be available at all times.
Using a Social Worker Transition Coach to Improve Hospital-to-Home Transitions for High-Risk Nonelderly Patients
Authors: Balaban Richard , Batalden Maren , Ross-Degnan Dennis , Le Cook Benjamin
Published: August 2019

High-risk hospitalized younger adults (age ≤60) have 30-day readmission rates comparable to Medicare fee-for-service patients. This younger cohort has a high incidence of comorbid mental health and substance use disorders, which increases the complexity of their postdischarge care. Although few care transition studies have enrolled younger adult patients, findings from our previous work suggest that these patients have postdischarge needs requiring different approaches than those serving elderly patients. Our current pilot study, situated in a safety-net system, targets this younger population, employing a social worker as the Transition Coach (TC). Social workers are explicitly trained to address psychosocial complexities, and we evaluated whether our TC intervention could improve hospital-to-home transitions by assisting patients with medication management, attending follow-up appointments, and addressing medical, psychiatric, and psychosocial needs. Primary outcomes were Patient Activation Measure scores on admission and 30-days postdischarge; outpatient follow-up at 7 and 30 days; and all-cause, in-network 30-, 60-, and 90-day readmissions. At 30 and 60 days, no differences were observed in the primary outcomes; at 90 days, intervention patients demonstrated a trend toward readmission reduction. A social worker–led transitional care program shows promise in reducing readmissions over 90 days among high-risk, lower socioeconomic, nonelderly adult patients.
At-home genetic testing in pediatrics
Authors: Weissman Scott M. , Kirkpatrick Brianne , Ramos Erica
Published: August 2019

Purpose of review

This review discusses the state of at-home genetic testing, including both direct-to-consumer and consumer-directed genetic testing, for children.

Recent findings

At-home genetic testing continues to increase in popularity and laboratories are starting to offer tests geared towards newborns and children. Available at-home genetic tests for children address ancestral descent, supplement newborn screening, or provide risks for childhood and adult-onset disorders as well as pharmacogenomic data. However, there are aspects of at-home testing that are unique to children that both providers and parents need to be aware of before considering this type of testing; these include issues related to motivations for testing; privacy concerns; result interpretation; ethical, legal and social implications; and impact on family relationships, among others.

This review addresses the challenges associated with at-home genetic testing in children and provides guidance for pediatricians and other health care providers who field inquiries about this type of testing or who are presented with at-home genetic test results for interpretation.
The Problematic 2014 American Academy of Pediatrics Bronchiolitis Guidelines
Authors: Mellick Larry B. , Gonzalez Juan
Published: August 2019

The 2014 American Academy of Pediatrics bronchiolitis guidelines do not adequately serve the needs and clinical realities of front-line clinicians caring for undifferentiated wheezing infants and children. This article describes the clinical challenges of evaluating and managing a heterogeneous disease syndrome presenting as undifferentiated patients to the emergency department. Although the 2014 American Academy of Pediatrics bronchiolitis guidelines and the multiple international guidelines that they closely mirror have made a good faith attempt to provide clinicians with the best evidence-based recommendations possible, they have all failed to address practical, front-line clinical challenges. The therapeutic nihilism of the guidelines and the dissonance between many of the recommendations and frontline realities have had wide-ranging consequences. Nevertheless, newer evidence of therapeutic options is emerging and forecasts hope for more therapeutically optimistic recommendations with the next revision of the guidelines.
Incidence and Prevention of Cicatricial Scleral Show in the Subciliary Access in Patients With Orbital Fractures
Authors: Fernandes Lopes Morais D’Autilio Margarida , Bottini Davide Johan , Basile Emanuela , Lovero Stefano , Sanese Giuseppe , de Angelis Barbara , Chaboki Houtan , Cervelli Valerio
Published: August 2019

Orbital fractures can involve floor, lateral and medial wall. Surgical access depends on fracture's severity, ocular trauma and patient's age. Subciliary, subtarsal, infraorbital or transconjunctival approaches are the main access to the orbit. Surgical interventions in the eyelid may induce scar tissue formation and, consequently, the cicatricial scleral show. The authors present a study with the aim to evaluate the incidence of cicatricial scleral show in patients treated for orbital fractures with or without simultaneous Tarsal Sling Canthopexy in our Plastic Surgery Department.

Methods:

The authors evaluated 50 patients divided in 2 groups: Group 1, subciliary approach and reconstruction of orbital floor without simultaneous Canthopexy Tarsal Sling; Group 2: reconstruction of orbital floor through subciliary approach with simultaneous Canthopexy Tarsal Sling.

Results:

Patients, who underwent Canthopexy Tarsal Sling, did not have any scleral show. Instead patients, who did not undergo this prevention technique, had scleral show even if a minor entity.

Discussion:

Although there was no muscle or skin removed, in our procedure, but only cutaneous incision, scleral show can appear as a complication. Canthal ligament and tarsus’ elasticity influence the incidence of post-surgical scleral show, which is more frequent in elderly patients. Therefore, the authors suggest to prevent it routinely with Tarsal Sling Canthopexy.

Conclusion:

Canthopexy Tarsal Sling is procedure that stretch tarsal structure and it may help to prevent scleral show.
Theoretical Basis for Virtual Skull Orientation According to Three-Dimensional Frankfort Horizontal Plane for Computer-Aided Surgical Simulation
Authors: Sonneveld Keith A. , Mai Peter T. , Hardigan Patrick C. , Portnof Jason E.
Published: August 2019

Purpose:

Computer-aided surgical simulation (CASS) is an evolving technology which has significantly affected surgical correction of dentofacial deformities, a key step of which is orientation of the virtual skull model to allow for analysis and treatment planning. Explored in this study is the coplanarity of a 3-dimensional Frankfort horizontal plane (3D FHP).

Materials and Methods:

The 122 17.0 cm field-of-view cone-beam computed-tomogram (CBCT) scans were oriented to a 3D FHP using right porion, right orbitale, and left orbitale. The distance between the 3D FHP and left porion was then measured. The 18 CBCT scans were found to have external fiducial markers which were used for orientation into natural head position (NHP). The distance between left porion and a true horizontal plan coincidental with the right porion was measured. Concordance reliability measures were calculated to compare NHP to 3D FHP.

Results:

The average distance of left porion to 3D FHP was found to be −0.107 mm (SD = 1.148), and the average distance from the coincidental left porion in NHP was found to be 0.846 mm (SD = 2.611). Concordance reliability calculations shows little consistency between the 2 methods of orientation (P = 0.838).

Conclusions:

The data shows coincidence between left porion and 3D FHP. Orientation of the virtual skull model according to 3D FHP offers a quick and easy method for this important step in CASS. Further study is needed for evaluation of this method in vivo.
Magnetic Susceptibility in Normal Brains of Young Adults Based on Quantitative Susceptibility Mapping
Authors: Zhao Yue , Yang Bin , Li Cairui , Zhang Ruopeng , Duan Wenshuai
Published: August 2019

Objectives:

To explore the changes of brain susceptibility of different sides and genders in healthy young adults using quantitative susceptibility mapping (QSM).

Methods:

Totally 42 healthy young right-handed adults underwent conventional brain magnetic resonance imaging and QSM scans, and the susceptibility maps were obtained by image post-processing software. Then the regions-of-interest (ROI) of bilateral frontal gray matter (FGM), frontal white matter (FWM), caudate (CA), globus pallidus (GP), putamen (PU), thalamus (TH), substantia nigra (SN), red nucleus (RN), dentate nucleus (DN), pons (PO), and corpus callosum (CC) were manually drawn to obtain magnetic susceptibility on the susceptibility maps. The magnetic susceptibility of each ROI was compared between 2 sides and genders by Wilcoxon rank sum test.

Results:

Magnetic susceptibility of bilateral ROI was the highest in GP, followed by SN, and the lowest in FWM. No statistically significant difference was found in susceptibility of bilateral FGM, FWM, CA, GP, PU, TH, SN, RN, DN, PO, or CC. Magnetic susceptibility in CA significantly different genders.

Conclusion:

Brain magnetic susceptibility measured by QSM can be used to quantitatively assess brain iron concentrations.
Botulinum Toxin Injection to Treat Masticatory Movement Disorder Corrected Mandibular Asymmetry in a Growing Patient
Authors: Cho Yu-Min , Kim Seong-Gon , Choi Dong-Soon , Jang Insan , Cha Bong-Kuen
Published: August 2019

An 8-year-old girl with masticatory movement disorder received botulinum toxin-A (BTX-A) injection and orthodontic treatment. She showed facial asymmetry with right masseter muscle hyperplasia. After BTX-A injection combined with orthodontic treatment, the transverse discrepancy between right and left maxillary dentition completely corrected. Cone-beam computed tomography images revealed that the height of the left mandibular ramus had increased by 2.3 mm, considerably more than on the right side, the discrepancy in mandibular ramus height between the left and the right decreased dramatically. In a short period, BTX-A injection combined with orthodontic treatment corrected a mandibular movement disorder with asymmetric mandibular growth in a growing patient.
Perioperative Management and Factors Associated With Transfusion in Cranial Vault Reconstruction
Authors: Hall Bradley R. , Barrientos Stephan , Flores Laura E. , Cemaj Sophie , Kugler Jane , Miller Jason J.
Published: August 2019

Background:

Bleeding is the most common adverse event in patients undergoing cranial vault reconstruction. The authors compare the transfusion rates against a national sample to determine whether the patients experience lower transfusion rates.

Methods:

The authors queried the Pediatric National Surgical Quality Improvement Program (Peds-NSQIP) for patients who underwent cranial vault reconstruction (CPT 61559) and compared them to patients who underwent cranial vault reconstruction for sagittal craniosynostosis at Children's Hospital and Medical Center (CHMC) in Omaha, Nebraska. Patients over the age of 24 months were excluded. Binary logistic regression analysis was performed using IBM-SPSS v24.0 to determine factors associated with transfusion at CHMC.

Results:

Patient demographics, preoperative hematocrit and platelet counts, readmission rates, and reoperation rates did not differ between CHMC (N = 54) and Peds-NSQIP (N = 1320) cohorts. Patients in the CHMC cohort had shorter preincision anesthesia times (47 versus 80 minutes, P < 0.001), shorter operative times (108 versus 175 minutes, P < 0.001), lower transfusion rates (50% versus 73%, P < 0.001), and smaller mean transfusion volumes (16 versus 33 mL/kg, P < 0.001); however mean length of stay was longer (4.1 versus 3.6 days, P < 0.001). Factors independently associated with transfusion at CHMC included preoperative hematocrit (odds ratio [OR] 0.423, P = 0.002), administration of an antifibrinolytic agent (OR 0.004, P = 0.001) and temperature at the time of incision (OR 0.020, P = 0.043).

Conclusion:

Patients at CHMC require less transfused blood and experience low transfusion rates. Preoperative hematocrit, administration of antifibrinolytic agents, and temperature at the time of incision are all modifiable factors associated with perioperative transfusion.
Application of a Lateral Pedicled Cranial Bone Flap for the Treatment of Secondary Zygomaticomaxillary Defects
Authors: He Wenpeng , Gong Xi , He Yang , Zheng Lei , Zhang Yi , Lai Renfa
Published: August 2019

This study aimed to evaluate the effect of laterally-based pedicled cranial bone flap (LBPCBF) for the repair of secondary zygomaticomaxillary defects. Between December 2014 and December 2016, 6 patients with unilateral zygomaticomaxillary defects were selected; of these, 5 had trauma, and 1 was exposed to titanium mesh in the infraorbital area due to radiotherapy following total maxillectomy for right maxillary squamous cell carcinoma. Preoperatively, 3 patients suffered from an intraoral vestibular groove fistula, 2 suffered from an extraoral fistula, and 1 from local exposure of titanium mesh. Surgical treatment was implemented in all 6 patients, of which, the 5 trauma patients underwent debridement, reduction, and fixation of periorbital fracture, followed by repair of the defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body with LBPCBF, and then, reconstruction of the orbital floor with titanium mesh. The other patient with exposed titanium mesh underwent repair of defects in the infraorbital margin and anterior wall of the maxillary sinus with LBPCBF after titanium mesh trimming. Postoperative review at 6 months revealed disappearance of intraoral fistula, wound healing, and improvement of facial deformity in all 6 patients, of which 2 patients demonstrated postoperative ectropion. The application of LBPCBF can simultaneously repair bone defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body, as well as, supplement the soft tissue, thereby indicating a satisfactory treatment effect.
Tick-bite–Induced Sudden Sensorineural Hearing Loss and Peripheral Facial Palsy
Authors: Gökçe Kütük Sinem
Published: August 2019

Sudden sensorineural hearing loss (SSHL) and facial paralysis are 2 important otolaryngology emergencies and diagnosing the etiology is very crucial to determine the treatment strategy. Cerebellopontin angle tumors and herpes simplex infections may lead to these situations simultaneously. Also, neurodegerative and systemic infection diseases can affect the cranial nerves VII and VII together. In this article, a patient is presented who had SSHL and facial palsy that occurred after tick bite.
Alcohol Intoxication-Related Soft Tissue Injuries in Patients With Orbital Wall Fractures
Authors: Song Yu Kwan , Kim Soon Heum , Jo Dong In
Published: August 2019

Background:

To date, involvement of alcohol intoxication (AI) in the occurrence of traumatic bone injuries has been well described in the literature. Still, however, there is a paucity of data regarding its involvement with soft tissue injuries in the oral and maxillofacial region. Considering that it is one of the significant predisposing factors that are involved in facial bone fractures in assault victims, we have speculated that they are also vulnerable to soft tissue injuries. We therefore examined the incidence, type and, pattern of soft tissue injuries in patients with trauma owing to the AI in a single-institution setting.

Materials and Methods:

A total of 488 patients underwent reconstructive surgery for orbital wall fracture at our medical institution between 2012 and 2017. Of these, 162 eligible patients were enrolled in the present study; they were divided into 2 groups (the AI group and the control group) based on a history of the AI. Then, we compared baseline and clinical characteristics, including the incidence, type, and pattern of soft tissue injury, between the 2 groups.

Results:

In our series, assault was the most common cause of traumatic injuries. We found that the patients with AI were at increased risks of preoperatively developing subconjunctival hemorrhage and diplopia and postoperatively developing infraorbital nerve (ION) hypesthesia.

Conclusions:

In conclusion, our results indicate that the AI is closely associated with the preoperative risks of subconjunctival hemorrhage and diplopia and the postoperative risks of ION hypesthesia. But further large-scale, multicenter studies are warranted to establish our results.
Using a Modified Postauricular Hemicoronal Incision to Manage Unilateral Zygomaticomaxillary Complex Fracture
Authors: Liu Min , Lv Kun , Li Zubing , Yang Xuewen
Published: August 2019

Background:

The surgical approach of the zygomaticomaxillary complex fracture is usually performed with preauricular coronal incision assisted with intraoral maxillary sulcus incision. There will be preauricular scars postoperatively.

Methods:

The authors introduce a postauricular hemicoronal incision to avoid the formation of scars in front of the ear.

Results and Discussion:

The postauricular hemicoronal incision can avoid vascular damage caused by careless operation in the preauricular approach. It eliminates the possibility of dissection or ligation of the superficial arteries and veins when preauricular approach was used. It results in no scar in front of ear, while reducing suture time and complexity.