bluuebunny/crossref_metadata_2025 huggingface dataset:
VITREOUS SEEDING OF RENAL CELL CARCINOMA IN A PATIENT RECEIVING CHECKPOINT INHIBITORS
Authors: Dajani Omar , Wong Anthony , Coleman Alyssa , Shepherd Emily A. , Wind Kenneth P. , MacCumber Mathew W.
Published: June 2022

Purpose:

To describe a case of vitreous seeding with tractional retinal detachment as a result of metastatic renal cell carcinoma in a patient on systemic checkpoint inhibitors.

Methods:

Case report.

Results:

A 44-year-old Hispanic woman with a history of renal cell carcinoma with metastases to the lungs, adrenal glands, hilar lymph nodes, and peritoneum presented with a complaint of severe floaters and blurry vision of the right eye for two months. She was found to have dense, web-like vitreous opacities and a peripheral tractional retinal detachment of the right eye. Pars plana vitrectomy, membrane peeling, endolaser, air–fluid exchange, gas injection, and vitreous biopsy were performed. The vitreous and membranes were sent for cytology with stains, including AE1/AE3, PAX-8, CK-7, CA-IX, AMACR, and S-100. Cytology revealed crowded groups of glandular cells, some in papillary-like formations. Positive stains included AE1/AE3, PAX-8, CK-7, CA-IX, and AMACR.

Conclusion:

Cytology and pathology demonstrated that vitreous seeding of metastatic renal cell carcinoma without an ocular mass lesion. It is hypothesized that the use of checkpoint inhibitors played a role in allowing for the atypical and previously unreported seeding of renal cell carcinoma to the vitreous.
OPTIC DISK PIT STUFFING—TO DO OR NOT TO DO
Authors: Anand Abhishek , Sinha Shivani , Kumari Aayushi , Mohan Nilesh , Sinha Bibhuti P.
Published: June 2022

Purpose:

Optic disk pit (ODP) is a subset of spectrum of congenital cavitary anomalies. Optic disk pit maculopathy causes progressive visual deterioration and is addressed with pars plana vitrectomy (PPV) with or without ODP stuffing.

Patient and Methods:

We report a case of progressive ODP maculopathy who was taken up for 23-G 3-port PPV, with complete vitreous removal and stuffing of the ODP with autologous sclera and sequential analysis of change in the retinal nerve fiber layer (RNFL) thickness.

Results:

Spectral-domain optical coherence tomography RNFL analysis at 1 and 12 months follow-up postoperatively showed total RNFL thickness decrease from 130 µm to 103 µm respectively. Hemiquadrant analysis showed slight reduction of superior RNFL thickness from 142 µm to 139 µm. However, in the inferior hemiquadrant, the reduction in mean RNFL thickness seems to be significant from 133 µm to 100 µm at 1 and 12 months respectively. Sector-wise analysis of the RNFL thickness showed maximum reduction in the inferotemporal quadrant and other sectors seemed to be relatively preserved corresponding to the area of scleral stuffing.

Conclusion:

Retrospective or prospective analysis of RNFL health of patients undergoing surgery for ODP-M with stuffing needs to evaluated.
Mucormycosis in Children With Hematologic Malignancies: A Case Series and Review of the Literature
Authors: Loeffen Yvette G. T. , Scharloo Fenna , Goemans Bianca F. , Heitink-Polle Katja M. J. , Lindemans Caroline A. , van der Bruggen Tjomme , Hagen Ferry , Wolfs Tom F. W.
Published: June 2022

Background:

Mucormycosis is classified as the third leading cause of invasive fungal disease in immunocompromised patients and is characterized by high morbidity and mortality (33%–56%). The aim of this study is to describe presentation, treatment and outcome of Dutch pediatric hemato-oncology patients recently diagnosed with mucormycosis and to review the literature to gain more insight specifically into contemporary outcome data.

Methods:

Ten cases were diagnosed in the Princess Máxima Center for Pediatric Oncology from 2018 to 2021 and were retrospectively reviewed. In addition, 9 case series (n = 148) were included from literature.

Results:

In our case series, 5 patients of 10 children (age 2–17 years) had disseminated invasive fungal disease. Four patients had localized pulmonary disease and 1 had a localized renal infection. One diagnosis was made postmortem. The underlying diseases were acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 2) and lymphoma (n=2). Seven patients received combination therapy comprising of a lipid amphotericin B formulation and a triazole, surgery was performed in 67%. All neutropenic patients received granulocyte transfusions and/or granulocyte colony-stimulating factor. Mucormycosis-related mortality was 20%. In the literature review, mucormycosis-related mortality was 36% for all patients and 66% for patients with disseminated disease. Survival rates were similar over the past 2 decades. The most common underlying disorder was acute lymphoblastic leukemia. Liposomal amphotericin B was the mainstay of treatment. Seventy percent of patients underwent surgery.

Conclusions:

Although survival of mucormycosis improved significantly overtime, it plateaued in the past decades. This series shows that with screening, early diagnostics and early antifungal and if possible surgical treatment, mortality is low and even disseminated disease is salvageable if approached aggressively with a combination of surgery and antifungal treatment. Further research focused on diagnostics, combination antifungal and adjunctive therapy is necessary to enhance the survival of mucormycosis in children.
Quality Assessment for Radiology Departments in Khartoum State Hospitals
Authors: Elmahdi Rania Elsadig , Khairi Malaz , Khalifa Wa'ad , Ahmed Walaa , Ali Thowiba , Ahmed Nosaiba Yusuf
Published: June 2022

Ionizing radiation is one of the most important techniques used in the diagnostic field. This research serves as a review of risk management in radiology in Sudanese governmental and private hospitals located in Khartoum State, Sudan. In addition, this research also aimed to assess the environment of workplace safety requirements in the hospitals. It investigates the potential sources of risk within radiology departments and proposes measures that may potentially mitigate these risks; 83.3% of participants considered their knowledge about radiation risks above good; 10.7% of participants do not use the protection shield, which is significant result for the poor radiation protection. According to the long distance, the distance between the radiation source and the control room is the majority from 3 to 5 m at 41.7%, giving that the typical distance recommended is at least 2 m. The risk factor in radiology department in Khartoum hospitals is basically the lack of protection tools and shield in the radiology rooms, which has a harmful effect directly on the medical staff and the patients.
Automatic Heart Sound Segmentation and Murmur Detection in Phonocardiogram
Authors: Ibrahim Afnan A. , Hassan Dina K. , Mustafa Zeinab A. , Ibraheem Banazier A. , Elmahdi Rania E.
Published: June 2022

This article aimed to design a software system for partial heart sound and define the problem to facilitate the doctor's primary job of diagnosing the normal or abnormal voice. The dataset was taken from Kaggle online site. The system was designed on several steps. The first step was to remove the noise by the use of a second-order bandpass filter, and the cutoff frequency was close to the heart sound frequency. The second step was to remove the spike by spike removal, and the final step was to use downsampling to normalize the amplitude of the signal to facilitate using the artificial neural network. The step that followed the signal processing was the segmentation and was done using Hilbert envelop, and then wavelet and PCA for feature extraction were used; finally, classification and training were done by feed forward neural network. All of these steps were implanted in MATLAB, and tests have shown that the accuracy is 97.639%. The number of data used in the training was 138 signal.
Risk Factors of Cognitive Decline in Older Caregivers With HIV: An Emerging Hypothesis
Authors: Vance David E. , Lee Yookyong , Batey D. Scott , Puga Frank , Clay Olivio J. , Byun Jun Y. , Long Alexis R. , Rafford Meghan , Xiao Chunhong , Fazeli Pariya L.
Published: June 2022

People with HIV (PWH) are living longer and healthier lives; thanks to combination antiretroviral therapy. As many PWH age, they find themselves providing care to family members and friends, just as their counterparts without HIV. The literature indicates that becoming a caregiver creates conditions that compromise one's cognitive function. Additionally, nearly 45% of all PWH experience HIV-associated neurocognitive disorder and are already vulnerable to cognitive impairment due to HIV, aging, and accompanying health conditions, and lifestyle factors. Given what is known, we assert that caregivers with HIV, especially as they age, are at additional risk for developing cognitive impairments. The purpose of this commentary was to briefly examine the juxtaposition between cognitive vulnerability of caregiving and the cognitive vulnerability of aging with HIV. Potential factors contributing to impaired cognition include stress, lack of social support, stigma, lifestyle, and comorbidities. Implications for clinical practice and research are provided.
Preferences Toward Attributes of Disease-Modifying Therapies: The Role of Nurses in Multiple Sclerosis Care
Authors: del Río-Muñoz Beatriz , Azanza-Munarriz Cristina , Becerril-Ríos Noelia , Goicochea-Briceño Haydee , Horno Rosalía , Lendínez-Mesa Alejandro , Sánchez-Franco César , Sarmiento Mònica , Bueno-Gil Guillermo , Medrano Nicolás , Maurino Jorge
Published: June 2022

BACKGROUND: Nurses play an essential role in coordinating the care of patients with multiple sclerosis (MS) throughout their disease trajectory in a complex treatment landscape. The aim of this study was to assess nurses' preferences toward different disease-modifying therapy attributes. METHODS: We conducted a multicenter, noninterventional, cross-sectional study in collaboration with the Sociedad Española de Enfermería Neurológica. Nurses actively involved in MS care were invited to participate in the study. Prevention of disability progression, preservation of cognitive function, side effect profile and safety monitoring, and method of administration were the treatment attributes tested. Conjoint analysis was used to assess preferences in 8 simulated treatment options and rank them from most to least preferred. RESULTS: A total of 98 nurses were included in the study. The mean (SD) age was 44.7 (9.8) years, and 91.8% were female with a mean (SD) time of experience in MS care of 7.5 (5.4) years. Participants prioritized preservation of cognition (38.6%), followed by preventing disability progression (35.2%) and side effect risk and safety monitoring (13.5%). Route and frequency of administration were the least preferred attributes (7.4% and 5.3%, respectively). Estimated utilities were consistent across the sample according to sociodemographic and professional practice characteristics. CONCLUSIONS: Nurses' preferences toward treatments were mainly driven by efficacy attributes. This information may support the role of nurses in the multidisciplinary management of MS facilitating shared decision making.
The Effect of Job Demands, Job Resources, and Musculoskeletal Complaints on Presenteeism Among the Dependent Self-employment Workers in Korea
Authors: Kim Jiyun , Choi Sookja
Published: June 2022

Objectives

We tested the effects of job demands on presenteeism to investigate the mediation of musculoskeletal complaints (MSCs) and the moderating effects of job resources among dependent self-employment (DSE) workers in Korea.

Methods

Using data from the fifth Korean Working Conditions Survey, we analyzed 2252 workers, and a two-step regression analysis was used to test the mediated effect of MSCs and moderated the effect of job resources on the relationship between job demand and presenteeism.

Results

Musculoskeletal complaints mediate the relationship between job demands and presenteeism. Job control moderated the relationship between MSCs and presenteeism among the job resources. However, the conditional indirect effect of job demands on presenteeism through MSCs was independent of job resource levels among DSE workers.

Conclusions

Various strategies are needed to address MSCs and enhance job resources for DSE workers, which might diminish the negative effect of job demands on presenteeism.
Examining Clinical Readiness and Performance of Students on Clinical Education Experiences: Is There an Influence From Virtual Learning?
Authors: Neely Laurie , Pabian Patrick , Darby Ashleigh-Jo , Tintor Milica , Vatansever Seher , Stock Matt
Published: June 2022

Introduction.

Peer simulation is a mechanism to enhance clinical reasoning and determine clinic readiness of Doctor of Physical Therapy students. In 2020, coursework that was traditionally face-to-face (F2F) was conducted completely online at many universities. Therefore, the purpose of this study was to examine if students who completed a stand-alone virtual simulation course presented with the same readiness and performance on their first full-time clinical education experience (CEE) as compared with students who completed the course during the previous 2 years in the traditional F2F format.

Review of Literature.

Prior to the COVID-19 pandemic, literature focused on virtual learning explored hybrid methods of delivering physical therapy education. There are limited studies exploring the impact of virtual learning on clinical performance of DPT students.

Subjects.

One hundred eight students completed their first full-time CEE during this 3-year period, with 34 having a virtual preparation and 74 having F2F coursework. Twelve of the clinical instructors (CIs) who had supervised students both virtually and in the previous 2 years were included in survey data analysis to compare cohorts.

Methods.

This study used final Clinical Performance Instrument (CPI) data to compare objective ratings of student performance from CIs as well as a standardized survey of student clinical readiness based on 22 items previously published. Both instruments were used to compare students from the class of 2022 (virtual cohort) to those from the previous 2 years (F2F cohort). Independent sample t tests were used to examine group differences in perceptions of student readiness and CPI data for compiled professional practice and patient management constructs.

Results.

Clinical Performance Instrument data revealed lower mean scores of students in all areas of performance in the virtual cohort as compared with F2F, but none of the differences reached statistical significance. For the clinical readiness survey, CIs rated students from the virtual cohort lower than prior students in overall readiness, as well as psychomotor, cognitive, and affective skill domains, including safety and accountability. However, none of the mean score differences reached statistical significance.

Discussion and Conclusion.

Although there was no statistical difference in scores on the CPI or perception of clinic readiness by CIs, students from the virtual cohort consistently scored lower on both instruments. Transition of students from F2F coursework for psychomotor skills to virtual formats should transpire with caution. As students transition back to traditional learning environments, programs should evaluate the effectiveness of various teaching methods to ensure excellence in physical therapist education.
Evaluating knowledge, confidence, and self-efficacy of NPs and PAs in the emergency department: extended focused assessment using sonography in trauma
Authors: Casey Karen O. , Pearson Tamera
Published: June 2022

Background:

Developing and translating knowledge gained in the classroom into skills that are practiced in the clinical setting is an ongoing, iterative, and dynamic process. Health care clinicians require continually evolving knowledge, ongoing education, and hands-on skills practice particular to the specialty.

Purpose:

This prospective observational study was conceived based on the existing evidence demonstrating that Point of Care Ultrasound (POCUS) is not routinely taught in nurse practitioner (NP) or physician assistant (PA) graduate programs. This study examines outcomes of an educational intervention aimed at improving knowledge, self-confidence, and self-efficacy of the Extended Focused Assessment using Sonography in Trauma (E-FAST examination) for both NPs and PAs working in emergency settings.

Methodology:

Twenty participants attended a short course including both didactic learning and hands-on learning of the E-FAST examination. Participants rated themselves using a self-assessment tool for pre- and postintervention self-evaluation. The Wilcoxon signed-rank test was used to evaluate data. A second tool used to evaluate participants’ hands-on use of the E-FAST examination is the Objective Structured Assessment of Ultrasound, in which participants were evaluated by clinical experts. These data were assessed using regression analysis.

Results:

Participants showed improvement on the pre/post course self-assessment tool. Participants also showed proficiency using ultrasound and analyzing images as evaluated by experts.

Conclusions:

A short multimodal course can improve clinicians' knowledge, confidence, and self-efficacy in the use of POCUS and the E-FAST examination.

Implications:

Hands-on education is a valuable tool for ongoing learning.
Extracorporeal Life Support Organization Guidelines for the Provision and Assessment of Nutritional Support in the Neonatal and Pediatric ECMO Patient
Authors: Lee Amy E. , Munoz Eliana , Al Dabbous Tala , Harris Elisabeth , O’Callaghan Maura , Raman Lakshmi
Published: June 2022

Disclaimer: This guideline is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge, and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biologic behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but Extracorporeal Life Support Organization (ELSO) is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.
Nutritional priorities in patients with severe COVID-19
Authors: Puthucheary Zudin A. , Rice Todd W.
Published: June 2022

Purpose of review

The COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases.

Recent findings

The current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community.

Nutritional support of patients with severe COVID-19 is essential. Given the longer duration of their critical illness, combined with hypermetabolism and energy expenditure, patients with COVID-19 are at increased risk for malnutrition during and after their hospital stay.
Short Versus Long Duration of Dual Antiplatelet Therapy After Second-Generation Drug-Eluting Stents Implantation in Patients with Diabetes
Authors: Gangwani Manesh Kumar , Aziz Muhammad , Chacko Paul , Mahmood Asif , Ali Muhammad , Priyanka Fnu , Munir Siraj , Aziz Abeer , Sagheer Shazib , Lee-Smith Wade , Parkash Om , Rai Devesh , Baibhav Bipul , Aronow Wilbert S.
Published: June 2022

Background:

Duration of dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention (PCI) remains uncertain, with increasing data suggestive of acceptable short-term duration. Metabolically accelerated atherosclerosis associated with diabetes makes it essential to study short-term DAPT in this subgroup. With limited studies determining optimal DAPT strategies after second-generation stents in this subset, we aimed to establish the optimal duration of DAPT in the diabetic population using second-generation stents.

Question:

To determine optimal DAPT duration in diabetic population undergoing PCI in 2nd generation stents

Data Sources:

We conducted an electronic database search of randomized controlled trials from PubMed/Medline, Embase, Cochrane, and Web of Science databases.

Study Design:

A meta-analysis was conducted comparing outcomes of short-term (3–6 months) DAPT therapy versus long-term (12 months) DAPT therapy in the diabetic population undergoing PCI with second-generation stents.

Results:

A total of 5 randomized controlled trials were included with a total of 3117 diabetic patients. Short-term DAPT did not show any statistical difference from long-term DAPT in achieving primary outcomes (relative ratio: 0.96, 95% confidence interval (CI) 0.68–1.35, P = 0.84). Overall mortality (OR 0.92; 95% CI, 0.52–1.63, P = 0.98), myocardial infarction [odds ratio (OR)OR 1.02; 95% CI, 0.53–1.94, P = 0.85], stent thrombosis (OR 1.20; 95% CI, 0.55–2.60, P = 0.55), target vessel revascularization (OR 1.10; 95% CI, 0.45–2.73, P = 0.74), and stroke (OR 0.50; 95% CI, 0.082–2.43, P = 0.81) did not show any statistical difference between the 2 groups. Similarly, a subgroup analysis of study population comparing 6 versus 12 months of DAPT in diabetic population did not show any difference in net primary outcomes (relative ratio: 0.86, 95% CI 0.45–1.45, P = 0.60). There was no significant heterogeneity noted between the 2 groups.

Conclusion:

This meta-analysis showed no statistically significant benefit of longer DAPT over shorter DAPT therapy in patients undergoing PCI with drug-eluting stent in patients with diabetes.
Clinical utility of bone turnover markers in patients with chronic kidney disease
Authors: Smout Dieter , Jørgensen Hanne S. , Cavalier Etienne , Evenepoel Pieter
Published: June 2022

Purpose of review

The burden of fractures is very high in patients with chronic kidney disease (CKD). It is increasingly recognized that knowledge of bone turnover is of paramount importance in guiding mineral metabolism and osteoporosis therapy in CKD. Bone histomorphometry is the gold standard to assess bone turnover, but is seldomly performed in clinical practice. Bone turnover markers (BTMs) may be the long awaited noninvasive diagnostic that may help to close the therapeutic gap in patients with advanced CKD presenting with bone fragility.

Recent findings

Mounting evidence indicates that BTMs may be useful in skeletal and nonskeletal risk stratification, in guiding mineral metabolism and osteoporosis therapy, and in monitoring the therapeutic response.

BTMs provide information that is complementary to other clinical tests. It may be envisioned that in the near future, the assessment of nonkidney cleared BTMs may become part of routine clinical evaluation and monitoring of bone health in CKD patients, integrated with clinical risk factors, imaging data and, eventually, bone histomorphometry. Panels of BTMs will likely be more informative than single markers, and the same might hold true for trends as opposed to single time point data.
When a calorie isn’t just a calorie: a revised look at nutrition in critically ill patients with sepsis and acute kidney injury
Authors: Nadamuni Mridula , Venable Andrea H. , Huen Sarah C.
Published: June 2022

Purpose of review

To discuss how nutritional management could be optimized to promote protective metabolism in sepsis and associated acute kidney injury.

Recent findings

Recent evidence suggests that sepsis is a metabolically distinct critical illness and that certain metabolic alterations, such as activation of fasting metabolism, may be protective in bacterial sepsis. These findings may explain the lack of survival benefit in recent randomized controlled trials of nutrition therapy for critical illness. These trials are limited by cohort heterogeneity, combining both septic and nonseptic critical illness, and the use of inaccurate caloric estimates to determine energy requirements. These energy estimates are also unable to provide information on specific substrate preferences or the capacity for substrate utilization. As a result, high protein feeding beyond the capacity for protein synthesis could cause harm in septic patients. Excess glucose and insulin exposures suppress fatty acid oxidation, ketogenesis and autophagy, of which emerging evidence suggest are protective against sepsis associated organ damage such as acute kidney injury.

Distinguishing pathogenic and protective sepsis-related metabolic changes are critical to enhancing and individualizing nutrition management for critically ill patients.
Prevalence and trends of urolithiasis among adults
Authors: Abufaraj Mohammad , Al Karmi Joud , Yang Lin
Published: June 2022

Purpose of review

The purpose of this article is to review and synthesize the current literature on the epidemiology of urolithiasis.

Recent findings

The global patterns of urolithiasis are changing, as the prevalence of urolithiasis appears to be increasing across the world. Geographical variation in the prevalence of urolithiasis is noted across countries and within each country. Although urolithiasis is more common among men and white race, recent data suggests a more prominent rise in the prevalence among women and African Americans. Yet, no conclusive explanations for these phenomena are reported so far.

Urolithiasis is a highly prevalent condition with an increasing prevalence among women as compared with men closing the gender gap in urolithiasis. Further studies are needed to identify the potential causes for this observation.
The Effects of Childhood Emotional and Physical Maltreatment on Adolescents' Disordered Eating Behaviors
Authors: Gioia Francesca , Boursier Valentina , Franceschini Christian , Musetti Alessandro
Published: June 2022

Over time, a complex crossroad between disordered eating behaviors (DEBs) and borderline personality features (BPFs) and their association with childhood emotional and physical maltreatment have been established. The present study aimed at evaluating the direct and indirect effect of physical and emotional abuse and neglect on DEB via BPF in a nonclinical adolescent sample. A total of 786 adolescents (48.3% male; mean age, 16.25 years; SD, 1.76) participated in the study. The mediation model suggested the pivotal predictive role of emotional maltreatment compared with the physical one. Indeed, both emotional abuse and neglect directly and indirectly predicted disordered eating via BPF (β = 0.097; p < 0.001 and β = 0.042; p < 0.01, respectively). Likely, the emotional maltreatment represents the beginning of a developmental cascade that culminates in DEB as a maladaptive coping strategy in response to negative emotions, through BPF. On the contrary, physical maltreatment seems to be less involved in the developmental cascade.
The Experience of Physical Activity in Adolescents With Cerebral Palsy
Authors: Roth Jeannine , Severtsen Billie , Hoeksel Renee , Eddy Linda
Published: June 2022

For adolescents with cerebral palsy (CP), participating in physical activity (PA) can be difficult due to functional limitations that not only affect an adolescent's ability or willingness to participate in PA but also create particular social concerns. Research in the area of PA and adolescents with CP is limited. This research study utilized hermeneutic phenomenology to gain a more comprehensive understanding of the lived experiences of 14 adolescents with CP who participated in PA. The interpretations of each participant offered common understandings and themes to be identified and warranted as valid by the interpretive team. Common understandings identified were (a) developmental tasks of typical adolescents, (b) place of friends, (c) purpose of PA, (d) importance of support, and (e) wanting to be like the primary researcher. Most of the 14 participants had similar experiences within the identified common understandings and themes. Physical activity, in part, helps adolescents find out about themselves and their place within their community. The experiences of adolescents with CP and PA show that participation in PA is a way to connect with friends, meet new people, and gain a feeling of freedom from their disability. We offer healthcare providers a starting point to talk about PA and to help adolescents with CP find activities within their community.
A Model for Delivery of Orthopaedic Perioperative Education via Telehealth
Authors: Keener Allen S. , Howell Dana M.
Published: June 2022

With orthopaedic surgery, there is a risk of poor outcomes such as pain, decreased mobility, and decreased function, particularly if patients do not receive adequate preoperative and postoperative orthopaedic education. Healthcare education delivered via telehealth can be individualized to the patient's specific situation and health literacy level and is accessible, convenient, and timely for patients and providers. The purpose of this article is to combine two models of best practice, the EDUCATE model of patient education and Bashshur's Taxonomy of Telehealth, to describe a framework for improving delivery of preoperative and postoperative orthopaedic education. This innovative model presents a patient-centered approach to orthopaedic education that can increase patient comprehension and retention and address health literacy, through consideration of three dimensions essential for effective telehealth programs: functionality, application, and technology. Applications of the model are presented.
Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature
Authors: Ringenberg Jonathan D. , Tobey Jonathan L. , Horinek Jeffrey L. , Teague David C.
Published: June 2022

Semi-extended suprapatellar intramedullary nail fixation of tibial fractures has recently been gaining popularity. Several recent studies and meta-analyses compare the outcomes of the suprapatellar approach with the traditional infrapatellar approach. Despite concerns with intra-articular placement of instruments, studies show the suprapatellar approach to be a safe alternative. Several articles conclude that the suprapatellar approach may be superior to the infrapatellar approach. This review discusses recent findings comparing suprapatellar and infrapatellar approaches for nail insertion.
Death After Poison Ivy Smoke Inhalation
Authors: Woolery Samantha , Willner Joseph , Prahlow Joseph A. , Douglas Elizabeth
Published: June 2022

Urushiol, the active antigen in poison ivy (Toxicodendron radicans), is frequently associated with type I and type III hypersensitivity reactions. These reactions most often result in cutaneous symptoms that vary in severity and may at times require medical interventions. Injuries involving other body systems associated with urushiol exposure are far less common. Here, we present 2 unrelated cases of urushiol respiratory exposure status after burning of poison ivy that resulted in cardiopulmonary arrest and ultimately death. In both cases, the history, circumstances, and autopsy findings are consistent with urushiol smoke inhalation having either caused or contributed to death. The cases are unique in that they represent the first cases of death related to poison ivy smoke exposure. Clinicians and forensic pathologists should be aware of the fact that urushiol smoke exposure may lead to morbidity and mortality.
Exploring the Preliminary Steps of One County Health Department to Manage the COVID-19 Pandemic
Authors: Fifolt Matthew , McCormick Lisa C. , Wilson Mark E. , Erwin Paul C.
Published: June 2022

This case study describes how one county health department in Alabama used the best available evidence to address the needs of its citizens during the first 6 months of the COVID-19 pandemic. The authors explore issues of scope of authority by government officials, individual freedom versus population health, and challenges of health communication during a disease outbreak. Despite the availability of vaccines, boosters, and access to vaccines by children as young as 5 years, COVID-19 cases are on the rise across the United States more than 2 years after the official news broke out of Wuhan, China. Health officials have expressed concerns that backlash against governmental public health during the pandemic will limit public health authorities from responding to the traditional challenges that were present pre-COVID-19 and will remain in a post-COVID-19 world.
Variation in State COVID-19 Disease Reporting Forms on Social Identity, Social Needs, and Vaccination Status
Authors: Lin Sunny C. , Zhen Anna , Zamora-Gonzalez Abram , Hernández José , Fiala Steven , Duldulao Aileen
Published: June 2022

To assess variation in the way state health departments collect data on social identity, social needs, and vaccination status for people testing positive for COVID-19, we reviewed all state health department Web sites for COVID-19 disease reporting forms. We located forms for 39 states and coded each one for the presence and format of fields on race, ethnicity, disability, language, sexual and gender identity, comorbidities, pregnancy status, and social needs such as housing stability, occupation, and prior COVID-19 vaccination status. We find considerable variation in both type and format of data collected. For example, 10% of state forms have fields for race and ethnicity that are more disaggregated than the 5 US Census categories, 18% have fields on mental or physical ability, 37% have nonbinary or other fields for gender identity, 28% have fields on housing stability, and 15% have fields on vaccination status. Our findings suggest that national efforts to address COVID-19 may be limited by lack of standardization of data collection methods.
Integrating Palliative Care into Physiatric Care: Perspective of the Association of Academic Physiatrists Physiatry Palliative Care Task Force
Authors: Tolchin Dorothy W. , Kaplan Naomi , Smith Sean , Barker Kim , Cheville Andrea ,   On behalf of the Association of Academic Physiatrists Physiatry Palliative Care Task Force
Published: June 2022

There are opportunities for physiatrists to apply a palliative care lens within clinical encounters across rehabilitation settings. The expanding population of patients with serious illness and injury cared for by physiatrists and the anticipated shortage of specialty palliative care clinicians make it important that physiatrists hone and apply basic palliative care skills as part of comprehensive physiatric care. In this paper, four clinical vignettes highlight relevant palliative care communication skills and demonstrate the value of integrating these skills within physiatry encounters. Resources to support physiatrists in applying basic palliative skills are provided throughout.
Assessment of Patient-Reported Physical Function in Persons with Upper Extremity Amputation: Comparison of Short Form instruments drawn from the PROMIS v2.0 Upper Extremity item bank
Authors: Resnik Linda J. , Stevens Phillip M. , Ni Pengsheng , Borgia Matthew L. , Clark Melissa A.
Published: June 2022

Objective

Compare psychometric properties of the Patient-Reported Outcomes Measurement Information System upper extremity measure (PROMIS-UE) 7-item short form with 6 and 13-item versions for persons with upper limb amputation (ULA).

Design

Telephone survey of 681-persons with ULA. Versions were scored two ways: PROMIS health measure scoring (PROMIS-UE HMSS) and sample-specific calibration (PROMIS-UE AMP). Factor analyses and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning, and reliability. Known group validity was compared for all versions.

Results

Model fit was acceptable for PROMIS-6 UE AMP and marginally acceptable for PROMIS-13 UE AMP and PROMIS-7 UE AMP. Item response categories were collapsed due to disordered categories. 91.4% of participants had PROMIS-13 UE AMP scores with reliability >0.8, compared to 70.4% for PROMIS-7 UE AMP, and 72.1% for PROMIS-6 UE AMP versions. No differences were observed by prosthesis use. Scores differed by amputation for all measures except the HMSS scored 13 and 7 item versions.

Conclusions

The PROMIS-13 UE AMP short form (SF) was superior to the HMSS scored PROMIS-7 UE or PROMIS-6 UE, and to the PROMIS-7 UE AMP and PROMIS-6 UE AMP. Issues with known group validation suggest a need for a population-specific measure of UE function for persons with ULA.
Role of NIH in the Ending the HIV Epidemic in the US Initiative: Research Improving Practice
Authors: Glenshaw Mary T. , Gaist Paul , Wilson Amber , Cregg Robert C. , Holtz Timothy H. , Goodenow Maureen M.
Published: June 2022

In 2019, approximately 1.2 M persons were living with HIV and an estimated 34,800 new HIV infections occurred in the United States (U.S.). Significant disparities in HIV burden exist among persons of color, those with male-to-male sexual contact, young people, and persons experiencing barriers to consistent uptake of HIV interventions and services. These disparities are the root of major gaps in coverage of HIV testing, linkage to prevention and treatment, adherence, and retention in services in the United States. These gaps help fuel the American HIV epidemic. The Ending the HIV Epidemic in the U.S. Initiative (EHE) is built on 4 decades of federal domestic and international responses to HIV/AIDS. As the largest health research agency in the world, the National Institutes for Health (NIH) funds extensive basic, clinical, translational, and implementation HIV research that is crucial to achieving HIV epidemic control. Addressing the gaps and meeting EHE milestones will be accomplished in part through a combination of adaptation, implementation, and scale-up of existing HIV interventions. New discoveries will also be needed to create improved and novel diagnostics, monitor viral loads, and develop new prevention and treatment tools and approaches. HIV implementation research is essential to demonstrate the most effective strategies to facilitate the adaptation, adoption, and integration of evidence-based HIV interventions in real-world settings. This article outlines current NIH research plans to reduce and identify new HIV infections, improve treatment coverage and outcomes among persons with HIV, and effectively respond to HIV transmission outbreaks in the United States.
Reducing Intersecting Stigmas in HIV Service Organizations: An Implementation Science Model
Authors: Rodriguez-Hart Cristina , Mackson Grace , Belanger Dan , West Nova , Brock Victoria , Phanor Jhané , Weigl Susan , Ahmed Courtney , Soler Jorge , McKinnon Karen , Sandfort Theo G.M.
Published: June 2022

Background:

HIV-related and intersectional stigmas are key barriers for service delivery, but best practices are nascent for addressing them in high-resource and high-burden contexts such as New York City (NYC). The Stigma Reduction and Resilience (STAR) implementation science (IS) Mapping Project in 2020 identified untested stigma reduction efforts in HIV organizations, highlighting the need for an IS framework.

Setting:

Organizations providing HIV prevention and/or care in NYC.

Methods:

An interagency team determined that IS provides a structured approach for addressing identified gaps in stigma reduction efforts, but defining existing IS concepts and adapting IS frameworks were necessary to facilitate its use. The Implementation Research Logic Model was adapted to empower HIV organizations to use IS to implement stigma reduction.

Results:

Questions, definitions, and tips were developed to guide, strengthen, and simplify the application of IS within HIV organizations to improve the reduction of HIV and intersecting stigmas. The resulting Stigma Reduction Logic Model incorporates tools for implementers who synthesize each component of the logic model (intervention, determinants, implementation strategies, mechanisms, and outcomes), including a menu of options for selecting stigma reduction interventions and implementation determinants, a checklist to assess organizational readiness for stigma reduction, and an IS terminology guide applied for stigma reduction.

Conclusions:

Stigma reduction initiatives and research can use this model to enable implementers, researchers, and HIV organization stakeholders to use the methodology of IS to build consensus for, systematically plan, implement, and evaluate stigma reduction activities relevant to the HIV epidemic. The next step is testing the model's utility.
Determinants of Implementation for HIV Pre-exposure Prophylaxis Based on an Updated Consolidated Framework for Implementation Research: A Systematic Review
Authors: Li Dennis H. , Benbow Nanette , Keiser Brennan , Mongrella Melissa , Ortiz Kasim , Villamar Juan , Gallo Carlos , Deskins Jasmine S. , Xavier Hall Casey D. , Miller Corinne , Mustanski Brian , Smith Justin D.
Published: June 2022

Background:

Delivery and use of HIV pre-exposure prophylaxis (PrEP) are suboptimal in the United States. Previous reviews of barriers and facilitators have not used an implementation science lens, limiting comprehensiveness and the link to implementation strategies. To summarize the state of the science, we systematically reviewed determinants of PrEP implementation using the updated Consolidated Framework for Implementation Research (CFIR 2.0).

Setting:

PrEP-eligible communities and delivery settings in the United States.

Methods:

In January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer-reviewed articles related to HIV/AIDS, interventions, implementation, and determinants or strategies. We identified 286 primary research articles published after 1999 about US-based PrEP implementation. Team members extracted discrete “mentioned” and “measured” determinants, coding each by setting, population, valence, measurement, and CFIR 2.0 construct.

Results:

We identified 1776 mentioned and 1952 measured determinants from 254 to 239 articles, respectively. Two-thirds of measured determinants were of PrEP use by patients as opposed to delivery by providers. Articles contained few determinants in the inner setting or process domains (ie, related to the delivery context), even among studies of specific settings. Determinants across priority populations also focused on individual patients and providers rather than structural or logistical factors.

Conclusion:

Our findings suggest substantial knowledge in the literature about general patient-level barriers to PrEP use and thus limited need for additional universal studies. Instead, future research should prioritize identifying determinants, especially facilitators, unique to understudied populations and focus on structural and logistical features within current and promising settings (eg, pharmacies) that support integration of PrEP into clinical practice.
Coverage of Big Toe Defects After Wraparound Flap Transfer With a Second-Toe Medial-Side Adjacent Toe Flap
Authors: Wang Yang , Yuan Chaoqun , Gu Jiaxiang , Pan Junbo , Liu Hongjun
Published: June 2022

Purpose

In finger reconstruction, big-toe wraparound flap (WAF) transfer provides excellent results. However, difficulty in healing and impaired function at the donor site are common. We aimed to explore an ideal method to address these complications.

Methods

This retrospective study involved 22 patients who were treated with big toe WAF transfer for finger reconstruction between 2016 and 2020. Patients were categorized into cohorts by donor site repair method: second-toe medial-side adjacent toe flap and skin graft (cohort 1) and skin graft alone (cohort 2). Functional outcomes, aesthetic appearance, and complications at the donor site were compared. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) for hallux metatarsophalangeal-interphalangeal score, Foot Function Index–Verbal Rating Scales (FFI-5 pt), and visual analog scale for pain. Aesthetic appearance was evaluated according to the adjusted question 28 in the Michigan Hand Outcome Questionnaire.

Results

The mean pain scores in AOFAS and FFI-5 pt were 38.00 ± 4.22 and 3.75 ± 2.37, and 32.50 ± 4.52 and 6.60 ± 2.14 in cohorts 1 and 2, respectively, which showed no significant differences. The method in cohort 1 can reduce the level of pain. This was further confirmed by visual analog scale scores of 3.40 ± 0.84 and 6.42 ± 7.93 in cohorts 1 and 2, respectively. The mean functional scores in AOFAS and FFI-5 pt were 38.40 ± 2.37 and 1.25 ± 1.62, and 37.92 ± 2.15 and 1.56 ± 2.11 in cohorts 1 and 2, respectively, which showed no significant differences. Eight patients developed complications: 1 patient (1/10 [10%]) in cohort 1 developed a superficial infection, and in cohort 2, 7 patients (7/12, 58.30%) developed complications, including 2 short-term complications with partial necrosis and 1 delayed healing. Long-term complications included the following: scar discomfort (2 cases), pain discomfort (1 case), and skin ulceration due to repeated wear and tear (1 case). Cohort 2 had significantly more complications than cohort 1.

Conclusions

Second-toe medial-side adjacent toe flap combined with skin graft had better aesthetic appearance, less complications, and less pain compared with skin graft alone. Hence, it can be a reliable technique for repairing the donor site after big-toe WAF transfer.