bluuebunny/crossref_metadata_2025 huggingface dataset:
Age and leptinemia association with anxiety and depression symptoms in overweight middle-aged women
Authors: Naufel Maria Fernanda , Boldarine Valter Tadeu , Oyama Lila Missae , do Nascimento Cláudia Maria Oller , Silva dos Santos Gianni Mara , Hachul Helena , Ribeiro Eliane Beraldi
Published: October 2018

Objective:

The aim of the study was to investigate the effect of menopause and of postmenopausal stages on depression and anxiety symptoms, and whether these symptoms associate with anthropometric, metabolic, and hormonal parameters in midlife women.

Methods:

Postmenopausal women (age 50-65), either at early (EPM, n=33) or late (LPM, n = 23) postmenopause, and 23 premenopausal controls (PreM, age 40-50), matched for BMI with the PM groups, were studied. Blood biochemical and hormonal determinations, bioimpedance anthropometry, and depression and anxiety symptoms (Beck's depression [BDI] and anxiety [BAI] inventories) were conducted.

Results:

The BAI score was higher in both PM groups than in the PreM group. In contrast, only the LPM group showed a significantly elevated BDI score. All groups presented overweight and abdominal obesity, having similar BMI and waist/hip ratio values. Both PM groups showed insulin resistance, whereas only the LPM group presented decreased skeletal muscle mass and basal metabolic rate. Correlation analysis, including all 79 middle-aged women, showed age, percentage body fat, waist/hip ratio, and leptinemia to correlate positively with the anxiety and depression scores. Multivariate regression showed leptin and age to associate positively with depressive- and anxious-like symptoms.

Conclusions:

Postmenopausal women presented impaired body composition, energy expenditure, insulin sensitivity, and mental symptoms, in comparison to similarly overweight premenopausal women. Among all the overweight midlife women, these symptoms were more strongly associated with age and leptin levels than with reproductive aging itself. The data indicate that, among overweight middle-aged women with abdominal obesity, the aging process and the development of leptin resistance are associated with impairment of mental health.
Telehealth in Plastic Surgery: A Veterans Affairs Hospital Perspective
Authors: Douglas Stephanie , Geiger Erik , McGregor Andrew , Norwich Amanda , Abbate Deena , Hsia Henry , Narayan Deepak
Published: October 2018

Background:

Telemedicine is a rapidly growing tool since its invention in the 1950s. Recently, it has expanded to the field of plastic surgery. In the Connecticut VA System, there is 1 plastic surgeon at a central location for the state of Connecticut and southern Massachusetts. Our aim was to pilot a telehealth program for plastic surgery consultation within the VA to improve access to subspecialty care. We intend to discuss the value of telehealth as part of consultation services, and assess patient attitudes toward telemedicine.

Methods:

Patients in the Connecticut VA System referred for plastic surgery consultation for evaluation of nonurgent diagnoses, such as skin lesions, carpal tunnel syndrome, and chronic wounds, were invited to participate. After being appropriately consented according to Connecticut state law, patients completed a postvisit questionnaire rating their overall satisfaction, quality of interaction, and ability to communicate using a modified 10-point Likert scale. Means were calculated for numerical responses. Preference for future telehealth visits was reported as a percentage.

Results:

Forty-one of 44 eligible patients elected to participate. Of those patients, 83% (n = 34) stated they prefer telemedicine services for future visits. Patients rated overall satisfaction 9.2/10, overall quality of interaction 9.2/10, ability to communicate 9.3/10, and sound and video quality 8.6/10 and 9.0/10, respectively.

Conclusion:

Remote video telemedicine is a feasible method of plastic surgery consultation and results in high patient satisfaction. Further studies should focus on cost-effectiveness and ways to broaden the use of telehealth services in plastic surgery.
Contact Dermatitis Caused by Dermabond Advanced Use
Authors: Nakagawa Shiho , Uda Hirokazu , Sarukawa Shunji , Sunaga Ataru , Asahi Rintaro , Chi Daekwan , Yoshimura Kotaro
Published: October 2018

Background:

Dermabond Advanced (DBA) has been widely used globally; however, severe contact dermatitis (CD) can be a serious adverse effect of DBA use. In this study, we investigated the characterization and incidence rate of CD after using DBA and the safe use of DBA.

Methods:

One hundred consecutive patients who underwent skin closure with DBA were investigated. All patients were women undergoing breast reconstruction. DBA was applied to their trunk and limbs following reconstruction.

Results:

Seven patients (7%) presented with CD. Of these, 4 patients exhibited CD after the second DBA use; sensitization influence by the first DBA use was considered. One of 3 patients presenting with CD after the first DBA use was allergic to cosmetic glue, and the influence of immunological cross-reaction of acrylates was suggested.

Conclusion:

We consider that DBA use is inadequate for wounds with an improper margin and in dry and low-skin barrier areas such as the trunk and limbs because it may induce irritant CD and sensitization of DBA and subsequent allergic CD. Frequent use can also induce sensitization. If patients have a history of acrylate allergies, DBA use should be avoided because immunological cross-reaction from acetylates could result.
The Role of Antibiotics in Breast Pocket Irrigation and Implant Immersion: A Systematic Review
Authors: Frois Ashley O. , Harbour Patrick O. , Azimi Farhad , Young Jane , Chan Belinda , Mak Cindy , Warrier Sanjay
Published: October 2018

Background:

The usage of antibiotics and antiseptics to washout the breast pocket, or to soak the breast implant during surgery, has come under scrutiny in recent times. Guidelines from the Centers for Disease Control and Prevention give no recommendation for or against the usage of antibiotics in this regard. They do however offer a weak recommendation for washing tissues with iodophor. This systematic review aims to investigate the efficacy and impact of such topical antibiotic or antiseptic usage in reducing infection rates.

Methods:

A systematic electronic search was performed on the PreMEDLINE, MEDLINE, EMBASE, and CENTRAL (Cochrane) databases from inception to April 2017. Reference search was performed manually through Scopus. Results of the searches were independently screened by 2 reviewers (A.F. and P.H.). Studies involving an implant or tissue expander, with appropriate controls were included. Meta-analyses were performed where possible and data summarized when not.

Results:

Three retrospective cohort studies were found to fit the review requirements. No randomized control trials were found. These studies covered a period of 1996–2010 for a total of 3,768 women undergoing augmentative surgery. The usage of antibiotics in pocket washout or implant immersion resulted in lower infection rates (RR = 0.52; P = 0.004; 95% CI = 0.34–0.81).

Conclusions:

There is a clinical benefit in using antibiotics for breast pocket irrigation and implant immersion. However, the quality of the evidence obtained in this review is low; hence, we recommend a randomized control trial for a higher level of evidence on this important issue.
Geospatial Analysis of Risk Factors Contributing to Loss to Follow-up in Cleft Lip/Palate Care
Authors: Sharif-Askary Banafsheh , Bittar Peter G. , Farjat Alfredo E. , Liu Beiyu , Vissoci Joao Ricardo Nickenig , Allori Alexander C.
Published: October 2018

Background:

Multidisciplinary cleft care depends on follow-up at specified time points to monitor and address functional or aesthetic concerns that may arise during a child's development. However, loss to follow-up (LTFU) is common and can lead to missed opportunities for therapeutic and surgical intervention. This study explores clinical, demographic, and geographic determinants of LTFU in cleft care.

Methods:

Medical records were retrospectively evaluated for 558 pediatric patients of a single mid-volume cleft team. The primary outcome was LTFU. Spatial dependency was evaluated using variograms. The probability of LTFU was assessed using a generalized linear geostatistical model within a Bayesian framework. Risk maps were plotted to identify vulnerable communities within our state at higher risk of LTFU.

Results:

Younger age at last encounter was a strong predictor of LTFU (P < 0.0001), even when ignoring spatial dependency among observations. When accounting for spatial dependency, lower socioeconomic status [OR = 0.98; 95% CI = (0.97–0.99)] and cleft phenotype [OR = 0.55; 95% CI = (0.36, 0.81)] were significant predictors of LTFU. Distance from the cleft team and rural/urban designation were not statistically significant predictors. Cartographic representation of predicted probability of LTFU revealed vulnerable communities across our state, including in the immediate vicinity of our cleft center.

Conclusions:

Geostatistical methods are able to identify risk factors missed by traditional statistical analysis. Knowledge of vulnerable populations allow a cleft team to allocate more resources toward high-risk areas to rectify or prevent deficiencies in care.
Reconstruction and Recovery After Massive Burn
Authors: Furnas David W. , Furnas Heather J.
Published: October 2018

Background:

Forty years ago, a 33-year-old female suffered a 35% total body surface area burn after the car in which she was a passenger caught fire in a rear-end collision. She experienced second- and third-degree burns of her face, head, back, arms, and hands.

Methods:

After immediate burn resuscitation, the patient underwent approximately 40 reconstructive procedures over the course of the first 17 years after her burns.

Results:

While finding social situations difficult to endure, the patient developed tools to help her face the public.

Conclusions:

These tools included confident body language, verbal responses, and makeup application. This case report details surgical procedures the patient underwent and her own lasting contribution through establishing the first hospital-based Image Enhancement and Behavioral Skills program along with her extensive work with the Phoenix Society for Burn Survivors.
Functional Temporomandibular Joint Reconstruction in Costochondral Grafting of Micrognathia
Authors: Hirota Yuka , Ueda Koichi , Katayama Misato , Otsuki Yuki
Published: October 2018

Rib bone and costochondral complex grafting has been used to treat micrognathia classified as Pruzansky type III. To acquire more physiological joint movement, we reconstructed a temporomandibular joint with the glenoid fossa in addition to the mandibular ramus. The patient underwent a tracheostomy to correct her airway obstruction at 2 months of age. After that, no further surgical treatments were performed on the micrognathia. When she was 6 years of age and during consultation at our department, micrognathia caused by Goldenhar syndrome was confirmed. A head and neck computed tomography scan showed hypoplasia and deficit of the mandible, severe glossoptosis and airway constriction. Initially, a bilateral mandibular body distraction was performed at 6 years of age, and 15 mm of elongation was obtained. Subsequently, reconstruction of the right ramus and right temporomandibular joint fossa was performed at 8 years of age to achieve extubation. Part of her sixth rib and costochondral complex graft was used for the ramus, and costochondral graft was used for the joint fossa. Some new ideas for temporomandibular joint reconstruction were added. Postoperatively, the open mouth range was increased and improvement of the airway space narrowing was observed in a computed tomography scan. The main points of this new method are prevention of ankylosis, skull cortex thinning, and reconstructed ramus’ dislocation. This method may become an effective new treatment for cases of micrognathia with a ramus classified as Pruzansky type III.
Scratch Collapse Test for Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis
Authors: Huynh Minh N. Q. , Karir Aneesh , Bennett Alexandria
Published: October 2018

Background:

Despite the fact that carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, the diagnostic accuracy of clinical screening examinations for CTS is controversial. The scratch collapse test (SCT) is a novel test that may be of diagnostic advantage. The purpose of our study was to determine the diagnostic accuracy of the SCT for CTS.

Methods:

A literature search was performed using PubMed (1966 to April 2018); Ovid MEDLINE (1966 to April 2018); EMBASE (1988 to April 2018); and Cochrane Central Register of Controlled Trials (The Cochrane Library, to April 2018). We examined the studies for the pooled sensitivity, specificity, and likelihood ratios of the SCT. This review has been registered with PROSPERO (CRD42018077115).

Results:

The literature search generated 13 unique articles. Seven articles were included for full text screening and 3 articles met our inclusion criteria, all of which were level II evidence with low risk of bias (165 patients). Pooled sensitivities, specificities, positive likelihood ratio, and negative likelihood ratios were 0.32 [95% CI (0.24–0.41)], 0.62 [95% CI (0.45–0.78)], 0.75 [95% CI (0.33–1.67)], and 1.03 [95% CI (0.61–1.74)], respectively. The calculated area under the summary receiver operating characteristic (AUSROC) curve was 0.25, indicating a low diagnostic accuracy.

Conclusion:

The SCT has poor sensitivity; however, it is moderately specific. Based on the current literature and their variable quality of the evidence, we conclude that the SCT is not an adequate screening test for detecting CTS.
Effect of Body Weight–Supported Exercise on Symptoms of Knee Osteoarthritis: A Follow-up Investigation
Authors: Peeler Jason , Leiter Jeffrey , MacDonald Peter
Published: October 2018

Objective:

To examine the long-term effect of participation in a 12-week lower-body positive pressure (LBPP)–supported low-load treadmill exercise regime on knee joint pain, physical function, and thigh muscle strength in patients with knee osteoarthritis (OA).

Design:

Prospective, observational, repeated measures.

Setting:

Clinical orthopedic setting.

Patients:

Nineteen overweight patients with knee OA.

Intervention:

Participants exercised under low-load treadmill walking conditions 2×/week for 12 weeks using an amount of LBPP support that minimized knee pain while walking for a period of 30 minutes at a set speed of 3.1 mph at 0-degree incline.

Main Outcome Measures:

Knee pain, function, thigh muscle strength, and body anthropometry were reassessed a minimum of 6 months after completion of the initial exercise regime and compared with results from baseline and postexercise evaluation.

Results:

Data suggested that: (1) patients were able to maintain improvements in knee joint pain and symptoms; (2) patients continued to report enhanced joint function and improved quality of life; and (3) patients maintained thigh muscle strength gains. Finally, a majority of patients continued to experience significant reductions in acute knee pain during full weight-bearing treadmill walking.

Conclusions:

Data suggest that improvements in knee pain, joint function, and thigh muscle strength associated with participation in a 12-week LBPP-supported low-load exercise regime were maintained well after cessation of the program. These findings have important implications for the development and refinement of exercise strategies and interventions used in the long-term management of joint symptoms associated with knee OA in overweight patients.
Trends in Extracorporeal Membrane Oxygenation Growth in the United States, 2011–2014
Authors: Stentz Michael J. , Kelley Mary E. , Jabaley Craig S. , O’Reilly-Shah Vikas , Groff Robert F. , Moll Vanessa , Blum James M.
Published: October 2018

The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly in recent years. We sought to describe the rate of ECMO use in the United States, regional variation in ECMO use, the hospitals performing ECMO, and the primary payers for ECMO patients. Detailed data were obtained using the Healthcare Cost and Utilization Project (HCUPnet) summaries of State Inpatient Databases from 34 participating states for the years 2011–2014. The ECMO rates over time were modeled, overall and within subcategories of age group, bed size, hospital ownership, teaching status, and payer type. During the study period, the overall rate of ECMO use increased from 1.06 (1.01, 1.12) to 1.77 (1.72, 1.82) cases per 100,000 persons per year (p = 0.005). The rate of ECMO use varied significantly by region. Most ECMO patients are cared for at large hospitals, and at private, not-for-profit hospitals with teaching designation. The most common payer was private insurance; a minority of patient were uninsured. The use of ECMO increased significantly during the study period, but regional variation in the rate of ECMO use suggests that this technology is not being uniformly applied. Further research is warranted to determine why differences in ECMO use persist and what impact they have on patient outcomes.
Quality Over Quantity: Standardization of Pediatric HeartWare Ventricular Assist Device Dressing Changes
Authors: Difusco Leigh Ann , Helman Stephanie M.
Published: October 2018

Pediatric patients are unique both in their diagnosis and clinical presentation before implantation of a ventricular assist device (VAD) and in their driveline site characteristics post-implant. There is limited evidence in scholarly literature that describes complications of pediatric VAD driveline sites or approaches by which to manage them. The Cardiac Center at The Children’s Hospital of Philadelphia (CHOP) follows a standard of care for HeartWare VAD (HVAD) dressing changes in the inpatient setting with the goal of transitioning patients to weekly dressing changes by the time they are discharged to home. As a patient with an HVAD nears discharge, members of an interprofessional team collaborate with insurance providers and home care agencies to procure the appropriate supplies needed at home. Individualized plans of care are necessary for patients who are unable to transition to weekly dressings; however, customized products (such as silicone foam border dressings and antimicrobial agents) may be challenging to supply as single items from home care agencies. Between March 2014 and June 2017, 15 patients underwent HVAD implantation, and eight (53%) were discharged home. Ten patients (67%) were able to transition to weekly dressing changes. Individualized plans of care for driveline site management were required for six (40%) patients with persistent drainage. Three patients (20%) experienced a driveline site infection. This article describes how a quality improvement (QI) initiative using rapid-cycle improvement methodology was executed to standardize HVAD dressing changes in our pediatric population.
A Proof of Concept Study, Demonstrating Extracorporeal Carbon Dioxide Removal Using Hemodialysis with a Low Bicarbonate Dialysate
Authors: Cove Matthew E. , Vu Lien Hong , Ring Troels , May Alexandra G. , Federspiel William J. , Kellum John A.
Published: October 2018

Extracorporeal carbon dioxide removal (ECCO2R) devices remove CO2 directly from blood, facilitating ultraprotective ventilation or even providing an alternative to mechanical ventilation. However, ECCO2R is not widely available, whereas dialysis is available in most intensive care units (ICUs). Prior attempts to provide ECCO2R with dialysis, by removing CO2 in the form of bicarbonate, have been plagued by metabolic acidosis. We hypothesized that bicarbonate dialysis is feasible, provided the plasma strong ion difference is maintained. We used a mathematical model to investigate the effects of bicarbonate removal on pH and CO2 in plasma, and performed in-vitro experiments to test CO2 removal using three dialysates with different bicarbonate concentrations (0, 16, and 32 mmol·L−1). Our modeling predicted a reduction in partial pressures of CO2 (PCO2) and increased pH with progressive lowering of plasma bicarbonate, provided strong ion difference and plasma proteins (A
tot) were maintained. In our in-vitro experiments, total CO2 removal, scaled up to an adult size filter, was highest with our dialysate containing no bicarbonate, where we removed the equivalent of 94 ml·min−1 (±3.0) of CO2. Under the same conditions, our dialysate containing a conventional bicarbonate concentration (32 mmol·L−1) only removed 5 ml·min−1 (±4; p < 0.001). As predicted, pH increased following bicarbonate removal. Our data show that dialysis using low bicarbonate dialysates is feasible and results in a reduction in plasma PCO2. When scaled up, to estimate equivalent CO2 removal with an adult dialysis circuit, the amount removed competes with existing low-flow ECCO2R devices.
Development and Validation of a Life-Sized Mock Circulatory Loop of the Human Circulation for Fluid-Mechanical Studies
Authors: Gehron Johannes , Zirbes Julian , Bongert Markus , Schäfer Stefan , Fiebich Martin , Krombach Gabriele , Böning Andreas , Grieshaber Philippe
Published: October 2018

Mock circulatory loops (MCLs) are usually developed for assessment of ventricular assist devices and consist of abstracted anatomical structures represented by connecting tubing pipes and controllable actuators which could mimic oscillating flow processes. However, with increasing use of short-term peripheral mechanical support (extracorporeal life support [ECLS]) and the upcoming evidence of even counteracting flow processes between the failing native circulation and ECLS, MCLs incorporating the peripheral vascular system and preserved anatomical structures are becoming more important for systematic assessment of these processes. For reproducible and standardized fluid-mechanical studies using magnetic resonance imaging, Doppler ultrasound, and computational fluid dynamics measurements, we developed a MCL of the human circulation. Silicon-based life-sized dummies of the human aorta and vena cava (vascular module) were driven by paracorporeal pneumatic assist devices. The vascular module is placed in a housing with all arterial branches merging into peripheral resistance and compliances modules, and blood-mimicking fluid returns to the heart module through the venous dummy. Compliance and resistance chambers provide for an adequate simulation of the capillary system. Extracorporeal life support cannulation can be performed in the femoral and subclavian arteries and in the femoral and jugular veins. After adjusting vessel diameters using variable Hoffmann clamps, physiologic flow rates were achieved in the supraaortic branches, the renal and mesenteric arteries, and the limb arteries with physiologic blood pressure and cardiac output (4 L/min). This MCL provides a virtually physiologic platform beyond conventional abstracted MCLs for simulation of flow interactions between the human circulation and external circulation generated by ECLS.
A noninvasive indicator for the diagnosis of early hepatitis B virus-related liver fibrosis
Authors: Li BinBin , Zhang LiFen , Zhang ZhanQing , Yan GangLi , Zhu Liang , Lu Wei , Yu HongYu
Published: October 2018

Background and aims

Liver stiffness measurement (LSM) detected by FibroScan, combined with biochemical indexes, has shown potential values for assessment of liver fibrosis pathological degrees. Here we aimed to investigate a noninvasive method for hepatitis B virus-related liver fibrosis.

Patients and methods

In all, 307 patients who underwent liver biopsy and LSM measurement were included. Inflammation grades and fibrosis stages were evaluated according to METAVIR scoring system. Spearman’s rank correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curves analysis were performed to assess the factors’ role in inflammation grades/fibrosis stages.

Results

Spearman’s rank correlation analysis showed that LSM, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and AST-to-platelet ratio index were positively correlated with inflammation grades and histologic fibrosis stages; platelets showed negative correlation, and AST-to-ALT ratio was not related. Logistic regression analysis indicated that LSM and APRI were risk factors for inflammation grades; LSM was the independent risk factor for fibrosis stages, P<0.0001, odds ratio>1. ROC curve analysis found LSM cutoff values and areas under the curve for the diagnosis of fibrosis scores: 6.95 and 0.804, respectively, for the diagnosis of significant fibrosis (F≥F2); 10.35 and 0.856, respectively, for severe fibrosis (F≥F3); 11.35 and 0.897, respectively, for cirrhosis (F=F4). Considering ALT as a confounding factor, ROC analysis was repeated in patients with normal and elevated ALT separately; the results indicated that when ALT was up to 40 U/l, LSM cutoff value and areas under the curve for the diagnosis of significant fibrosis (F≥F2) were 6.55 and 0.748, respectively.

Conclusion

This study provided a noninvasive treatment and prevention indicator for early hepatitis B virus-related liver fibrosis.
Melatonin Use in Psychiatry—Quo Vadis?
Authors: Naguy Ahmed , Al-Amiri Bibi , Shoukry Tarek
Published: October 2018

Melatonin use in clinical psychiatry is currently rife, and the trend of utilization is on the rise. Efficacy coupled with safety and lack of abuse potential render melatonin an attractive therapeutic option. Data from neuroscience accrue speaking to the idea of a pluripotent molecule beyond a mere sleeping aid. Here, authors would shed some light on melatonin use in psychiatry while examining the extant evidence.
A Glutathione Precursor Reduces Oxidative Injury to Cultured Embryonic Cardiomyocytes
Authors: Peterson Darryl R. , Huang Huiya , Peresada Dmitriy , Sukowski Ernest J. , White Carl , Stefanov Gospodin , Schweig Lorene , Vazzalwar Ramesh
Published: October 2018

Background:

Newborn infants are highly vulnerable to oxidative stress. Following birth asphyxia, oxidative injury due to ischemia–reperfusion can result in significant brain and heart damage, leading to death or long-term disability.

Study Question:

The study objective was to evaluate the effectiveness of antioxidant gamma-l-glutamyl-l-cysteine (γGlu-Cys) in inhibiting oxidative injury to cultured embryonic cardiomyocytes (H9c2 cells).

Study Design:

Control and γGlu-Cys–treated (0.5 mM) H9c2 cells were incubated under 6-hour ischemic conditions followed by 2-hour simulated reperfusion.

Measures and Outcomes:

To quantify oxidative stress-induced apoptosis sustained by cardiomyocytes, lactate dehydrogenase (LDH) release and the presence of cytosolic cytochrome c were measured, as well as the number of secondary lysosomes visualized under electron microscopy.

Results:

Compared to controls, H9c2 cells coincubated with γGlu-Cys during ischemia–reperfusion exhibited a significant reduction in both LDH release into the incubation medium [23.88 ± 4.08 (SE) vs. 9.95 ± 1.86% of total; P = 0.02] and the number of secondary lysosomes [0.070 ± 0.009 (SD) vs. 0.043 ± 0.004 per μm2; P = 0.01]. Inhibition of LDH release with γGlu-Cys was the same (P = 0.67) as that of a caspase inhibitor. The significant increase in cytosolic cytochrome c (P = 0.01) after ischemia–reperfusion simulation further supports γGlu-Cys's role in apoptosis prevention.

Conclusions:

It is concluded that the glutathione precursor γGlu-Cys protects cultured embryonic cardiomyocytes from apoptosis-associated oxidative injury.
Development of a Sexually Transmitted Disease Client-friendly Unit at a Primary Care Clinic in Malaysia: Lessons Learnt
Authors: Pannir Selvam Sheela Bai , Khoo Ee Ming , Chow Suet Yin , Wong Ping Foo , Mohsin Siti Shafiatun , Abdullah Adina , Choo Wan Yuen
Published: October 2018

Management of sexually transmitted diseases and human immunodeficiency virus is challenging due to the social stigma attached. We describe the development of a client-friendly sexually transmitted disease service in a primary care clinic in Malaysia with a special focus on key populations. Challenges and key lessons learnt from its development and implementation are discussed.
Individual and Neighborhood Factors Associated With Sexual Behavior Classes in an Urban Longitudinal Sample
Authors: Green Kerry M. , Matson Pamela A. , Reboussin Beth A. , Milam Adam J. , Furr-Holden C. Debra M. , Rabinowitz Jill A. , Powell Terrinieka W. , Ialongo Nicholas S.
Published: October 2018

Background

This study aimed to increase understanding of the clustering of sexual behaviors in an urban sample of emerging adults, and the individual and neighborhood factors associated with sexual behavior patterns to provide insight into reducing the disproportionate burden of poor sexual outcomes among urban African Americans.

Methods

We draw on 2 cohorts of urban, predominantly African American youth first assessed at age 6 years and follow-up to emerging adulthood (mean age, 20 years; n = 1618). Latent class analyses by gender identified co-occurrence of sexual behavior.

Results

We found 3 classes for both males and females: high-risk (13% of males, 15% of females), low-risk (54% of males, 56% of females) and no-risk (33% of males, 29% of females). Membership in the high-risk class was associated with school dropout, a substance use disorder diagnosis, having a criminal arrest, pregnancy, and sexually transmitted diseases for both males and females. High-risk females also had higher rates of depression. Low-risk males and females also had elevated risk of pregnancy and parenthood. Neighborhood factors distinguished the high- and no-risk classes for males and females, including the neighborhood environment scale, which assessed poverty, safety, drug activity, and crime/violence in the neighborhood. Neighborhood religiosity was inversely associated with membership in the high-risk class compared with the no-risk class for females only. Neighborhood racism distinguished those in the high-risk class compared with the no-risk class for males.

Conclusions

Future work should take into account the clustering of sexual risk behaviors. Specific neighborhood factors could be addressed to reduce sexual health disparities.
Lymphogranuloma Venereum: An Increasingly Common Anorectal Infection Among Men Who Have Sex With Men Attending New York City Sexual Health Clinics
Authors: Pathela Preeti , Jamison Kelly , Kornblum John , Quinlan Tammy , Halse Tanya A. , Schillinger Julia A.
Published: October 2018

Using Chlamydia trachomatis anorectal specimens routinely tested for lymphogranuloma venereum (LGV) (2008–2011) and samples of archived specimens tested for LGV (2012–2015), we observed increased LGV positivity among men who have sex with men attending NYC Sexual Health Clinics. Using clinical data, we determined predictors of anorectal LGV that may guide clinical management.
Variability in Pediatric Ideal Body Weight Calculation: Implications for Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome*
Authors: Ward Shan L. , Quinn Carson M. , Steurer Martina A. , Liu Kathleen D. , Flori Heidi R. , Matthay Michael A.
Published: October 2018

Objectives:

No gold standard for ideal body weight determination in children exists. We aimed to compare four methods of ideal body weight calculation and determine level of agreement between methods and impact of measurement variance on tidal volumes prescribed in mechanically ventilated pediatric acute respiratory distress syndrome.

Design:

Post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies.

Setting:

Twenty-six academic PICUs.

Patients:

Five hundred eighty-nine patients.

Interventions:

None.

Measurements and Main Results:

Ideal body weight was calculated by four common methods: National Center for Health Statistics, McLaren, Moore, and body mass index, and compared in three ways: 1) determine the proportion of the cohort for which each method could successfully calculate ideal body weight; 2) compare the level of agreement between the ideal body weight methods by Bland-Altman analysis; and 3) evaluate the difference in tidal volume when 6 mL/kg ideal body weight was prescribed. We a priori defined the better method to be one that could calculate ideal body weight in most subjects, had good agreement with other methods, and led to a lower tidal volume. Only 55% could have ideal body weight measured by all four methods. National Center for Health Statistics, McLaren, and Moore methods could calculate ideal body weight in greater than or equal to 90%, whereas body mass index method was successful in only 61% because of no body mass index validation in less than 2-year-olds. In comparing each method to the others, there was great variance, particularly in greater than or equal to 10-year-olds. This variance was greatest between Moore and body mass index methods with greater than or equal to 10 kg difference in ideal body weight in some subjects. The McLaren method had the best agreement with all other methods, and yielded similar prescribed tidal volume in 2- to 10-year-olds and lower tidal volume in greater than or equal to 10 years old.

Conclusions:

There is substantial variation in calculated ideal body weight among four commonly used methods, particularly in adolescents. Since varying ideal body weight may lead to discrepancies in pediatric acute respiratory distress syndrome care, a standard approach to ideal body weight measurement is needed. We recommend the McLaren method to calculate ideal body weight in children with pediatric acute respiratory distress syndrome until a gold standard method is validated.
A Quality Improvement Bundle Including Pay for Performance for the Standardization of Order Set Use in Moderate Asthma
Authors: Conners Gregory P. , Fowler Milton A. , Lee Brian R. , Schroeder Lisa L.
Published: October 2018

Objective

In order to standardize use of our hospital's computerized asthma order set, which was developed based on an asthma clinical practice guideline, for moderately ill children presenting for care of asthma, we developed a quality improvement bundle, including a time-limited pay-for-performance component, for pediatric emergency department and pediatric urgent care faculty members.

Methods

Following baseline measurement, we used a run-in period for education, feedback, and improvement of the asthma order set. Then, faculty members earned 0.1% of salary during each of 10 successive months (evaluation period) in which the asthma order set was used in managing 90% or more of eligible patients.

Results

At baseline, the asthma order set was used in managing 60.5% of eligible patients. Order set use rose sharply during the run-in period. During the 10-month evaluation period, use of the asthma order set was significantly above baseline, with a mean of 91.6%; faculty earned pay-for-performance bonuses during 8 of 10 possible months. Following completion of the evaluation period, asthma order set use remained high.

Conclusions

A quality improvement bundle, including a time-limited pay-for-performance component, was associated with a sustained increase in the use of a computerized asthma order set for managing moderately ill asthmatic children.
A Case of Intracardiac Invasion of Hepatoblastoma Diagnosed With Point-of-Care Ultrasound
Authors: Fukuhara Shinichi , Yamaguchi Yoshimichi
Published: October 2018

Ultrasonography can be useful in the evaluation of children with abdominal complaints and may be the initial imaging modality in patients presenting with a newly recognized abdominal mass. Hepatoblastoma is an uncommon cause of acute abdominal pain in children and can rarely metastasize to the heart through vascular invasion. We report a case in which a 4-year-old girl who presented to the emergency department with abdominal pain promptly underwent point-of-care ultrasound and was subsequently diagnosed with intracardiac invasion of an abdominal tumor.
Development and Pilot Testing of a Computerized Asthma Kiosk to Initiate Chronic Asthma Care in a Pediatric Emergency Department
Authors: Kwok Maria Y. , Bakken Suzanne R. , Pusic Martin V. , York Deborah , Pahalyants Vartan , Ye Choong , Javed Kainaat , Dayan Peter S.
Published: October 2018

Objectives

Emergency department (ED) visits are an opportunity to initiate chronic asthma care. Ideally, this care should be implemented in a fashion that limits utilization of scarce ED resources. We developed, iteratively refined, and pilot tested the feasibility of a computerized asthma kiosk to (1) capture asthma information, (2) deliver asthma education, and (3) facilitate guideline-based chronic asthma management.

Methods

The following are the 4 phases of this study: (1) developing the content and structure of a computerized asthma kiosk, (2) iterative refinement through heuristic testing by human-computer interface experts, (3) usability testing with ED providers (n = 4) and caregivers of children with asthma (n = 4), and (4) pilot testing the kiosk with caregivers (n = 31) and providers in the ED (n = 18). Outcome measures for the pilot-testing phase were the proportion of ED providers who prescribed long-term controller medication (LTCM) and asthma action plans (AsAPs) and the proportion of children who took LTCMs and attended primary care providers follow-up.

Results

After kiosk development and refinement, pilot implementation resulted in LTCMs prescribing and AsAP provision for 19 (61%) of 31 and 17 (55%) of 31 patients, respectively. Before kiosk use, the proportion of the 18 ED providers who reported prescribing LTCM was 1 (5%) of 18, and providing AsAPs was 0 (0%) of 18. Eighteen (58%) of the 31 caregivers reported that their children used LTCMs after kiosk use and 13 (42%) of 31 reported following up with the primary care provider within 1 month of the ED visits.

Conclusions

A rigorously developed asthma kiosk showed promise for initiating chronic asthma care in the ED.
Physical Therapists' Use and Alteration of Standardized Assessments of Motor Function in Children
Authors: Fay Deanne , Brock Elizabeth , Peneton Samantha , Simon Rebecca , Splan Madison , Sullivan Laura , Weiler Alyce
Published: October 2018

Purpose:

This study presents survey responses of pediatric physical therapists' use and alteration of standardized assessments of motor function in children aged 2 to 10 years.

Methods:

Electronic and paper surveys were distributed to practicing physical therapists through the APTA Academy of Pediatric Physical Therapy electronic newsletter and 2 national conferences. Data were analyzed by response frequencies, qualitative responses, and χ2analyses for demographic characteristics.

Results:

A total of 497 pediatric physical therapists responded. Most (93%) reported using standardized assessments, with the majority (84%) reporting the normative scores. Almost all respondents (94%) also reported that they at least occasionally modify assessments.

Conclusion:

Standardized assessments are used by most therapists, but the high use of modifications during testing is concerning. Survey reports from therapists indicate a disconnect between standardized assessments and the needs of the child, leaving clinicians working to report required scores while maintaining validity of testing procedures.
Whole-Body Vibration Training Designed to Improve Functional Impairments After Pediatric Inpatient Anticancer Therapy: A Pilot Study
Authors: Rustler Vanessa , Prokop Aram , Baumann Freerk T. , Streckmann Fiona , Bloch Wilhelm , Daeggelmann Julia
Published: October 2018

Purpose:

To assess a whole-body vibration (WBV) intervention for children after cancer treatment.

Methods:

Eleven children after inpatient anticancer therapy participated in a 12-week supervised WBV intervention, which consisted of one 9- to 13-minute WBV session per week, with 5 to 9 minutes' overall vibration time. Feasibility was defined as the ability to participate in WBV training without reporting adverse events. The number of offered and completed training sessions, program acceptance, and measures of function were assessed.

Results:

Nine participants completed the WBV intervention without any WBV-related adverse events. The adherence rate was 87.96%. Only minor side effects were reported and there was general program acceptance. We found indications that WBV has positive effects on knee extensor strength and active ankle dorsiflexion range of motion.

Conclusions:

WBV was feasible, safe, and well received among children after inpatient anticancer therapy. No health deteriorations were observed. Positive effects need to be confirmed in future trials.
Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention
Authors: Burnfield Judith M. , Cesar Guilherme M. , Buster Thad W. , Irons Sonya L. , Pfeifer Chase M.
Published: October 2018

Purpose:

To quantify effects of motor-assisted elliptical (Intelligently Controlled Assistive Rehabilitation Elliptical [ICARE]) training on walking and fitness of a child with cerebral palsy (CP).

Key Points:

A 12-year-old boy with walking limitations due to spastic diplegic CP (Gross Motor Function Classification System II) participated in 24 sessions of primarily moderate- to vigorous-intensity ICARE exercise. Fitness improvements were evidenced clinically across sessions by the child's capacity to train for longer periods, at faster speeds, and while overriding motor's assistance. Postintervention, the child walked faster with greater stability and endurance and more rapidly completed the modified Time Up and Go test.

Conclusion:

The child's fitness and gait improved following engagement in a moderate- to vigorous-intensity gait-like exercise intervention.

Recommendations for Clinical Practice:

Integration of moderate- to vigorous-intensity motor-assisted elliptical training can promote simultaneous gains in fitness and function for children with CP.
The Struggle for Evidence in Physical and Rehabilitation Medicine
Authors: Negrini Stefano , Levack William , Gimigliano Francesca , Arienti Chiara , Villafañe Jorge Hugo , Kiekens Carlotte
Published: October 2018

Objective

The aim of the study was to evaluate the rate of publication of randomized controlled trials, systematic reviews, and meta-analysis in physical and rehabilitation medicine and its variation over time.

Design

We performed a bibliometric study and searched PubMed from inception to 2017, using National Library of Medicine 3rd level MeSH terms (“rehabilitation,” “physical therapy modalities,” and “drug therapy”) and filters (“randomized controlled trial,” “systematic reviews,” and “meta-analysis”). We used descriptive statistics, and we calculated the best-fitting regression model for all data considered.

Results

The absolute number of articles is growing in rehabilitation as much as in other treatment fields such as drug therapy. Whereas the rate of growth of publications for all studies relative to PubMed is bigger for drug therapies than for rehabilitation and physical therapy, the rate of growth of randomized controlled trials, systematic reviews, and meta-analysis is significantly greater for rehabilitation and physical therapy (P < 0.001). In 2017, 19.3% and 28.2% of the total production of scientific articles for rehabilitation and physical therapy (respectively) were for randomized controlled trials and systematic reviews versus 11.3% for drug therapy.

Conclusions

Production of the highest form of research evidence (randomized controlled trials, systematic reviews, and meta-analysis) is continuously increasing in physical and rehabilitation medicine at a higher rate than in other treatment fields such as drug therapy. The quality and results of this evidence should be evaluated in future studies.
Clinical Feasibility of Gadoxetic Acid–Enhanced Isotropic High-Resolution 3-Dimensional Magnetic Resonance Cholangiography Using an Iterative Denoising Algorithm for Evaluation of the Biliary Anatomy of Living Liver Donors
Authors: Kang Hyo-Jin , Lee Jeong Min , Ahn Su Joa , Bae Jae Seok , Kannengiesser Stephan , Kiefer Berthold , Suh Kyung-Suk
Published: October 2018

Objectives

The aim of this study was to evaluate the clinical feasibility of gadoxetic acid–enhanced isotropic high-resolution (IHR) 3-dimensional (3D) T1-weighted (T1W) magnetic resonance cholangiography (MRC) using an iterative denoising (ID) algorithm for evaluation of the biliary anatomy of living liver donors in comparison with conventional 3D multislice T2-weighted (T2W) MRC.

Materials and Methods

In this institutional review board–approved retrospective study, a total of 75 living liver donors who underwent conventional 3D multislice T2W-MRC and IHR-3D-T1W-MRC on a 3 T scanner and subsequent right hepatectomy for liver donation were included. Isotropic high-resolution T1W-MRCs were obtained in both axial and coronal planes using the 3D VIBE Dixon sequence and an ID algorithm implemented with wavelet thresholding of 3D complex-valued data of the noise level, g-factor, and k-space filtering. Thereafter, 3 board-certified radiologists independently reviewed the examinations for visibility and sharpness of the bile ducts (BDs), as well as overall image quality on a 5-point scale. For diagnostic performance, anatomic variations of the BD, length of right hepatic duct, and the expected number of BD openings at right hepatectomy were also recorded. As the reference standard, BD variation was determined by surgeons in consensus using intraoperative real-time fluorescent cholangiography.

Results

Mean acquisition times of 3D-T2W-MRC and IHR-T1W-MRC were 367 seconds and 17 seconds (P < 0.001), respectively. Compared with 3D-T2W-MRCs, IHR-T1W-MRCs yielded significantly improved visibility and sharpness of all evaluated intrahepatic bile ducts (all Ps < 0.05), and higher overall image quality (P < 0.01). The IHR-T1W-MRCs also demonstrated significantly higher agreement in BD variation (87.6% vs 81.3%, P = 0.03) and expected BD openings (76.9% vs 70.2%, P = 0.006) than 3D-T2W-MRC compared with the reference standard. Interobserver agreement in estimating the length of right hepatic duct, IHR-T1W-MRC showed excellent interobserver agreement (intraclass correlation coefficient, 0.94), whereas 3D-T2W-MRC showed good interobserver agreement (intraclass correlation coefficient, 0.78).

Conclusions

Isotropic high-resolution T1W-MRCs with ID provided significantly improved BD image quality and more accurate depiction of the BD anatomy and BD openings at right donor hemihepatetomy than 3D-T2W-MRC.