bluuebunny/crossref_metadata_2025 huggingface dataset:
End-of-Life Care Terminology
Authors: Rahemi Zahra , Fasolino Tracy
Published: November 2020

The purpose of this scoping review is to present an overview of terms found in publications associated with end-of-life care management that can impact decision making by patients, health care providers, and researchers. Connotative terminology and syntax can influence the decision-making approach and process. We examined 49 publications for positive, negative, and neutral connotations. We consistently found negative terminology in the publications. To advance the development of nursing knowledge regarding end-of-life care, researchers should be aware of their biases of terminology and syntax use. We propose modifications to language used in end-of-life care planning models and literature can improve care congruency.
A Conceptual Framework of Self-advocacy in Women With Cancer
Authors: Thomas Teresa H. , Donovan Heidi S. , Rosenzweig Margaret Q. , Bender Catherine M. , Schenker Yael
Published: November 2020

Researchers define self-advocacy as the ability of an individual with cancer to overcome challenges in getting their preferences, needs, and values met. While imperative in all health care settings, self-advocacy is especially important in cancer care. The goal of this article is to present a conceptual framework for self-advocacy in cancer. We review foundational studies in self-advocacy, define the elements of the conceptual framework, discuss underlying assumptions of the framework, and suggest future directions in this research area. This framework provides an empirical and conceptual basis for studies designed to understand and improve self-advocacy among women with cancer.
Influence of Depressive Symptoms on the Outcome of Lumbar Spine Fusion—A 5-year Follow-up Study
Authors: Toivonen Leevi , Häkkinen Arja , Pekkanen Liisa , Salonen Anne , Kautiainen Hannu , Neva Marko H.
Published: November 2020

Study Design.

Prospective follow-up study.

Objective.

The aim of this study was to assess whether depressive symptoms change the outcome of lumbar spine fusion (LSF) surgery at a 5-year follow-up.

Summary of Background Data.

Previous reports of the influence of depressive symptoms on the results of spine surgery are controversial, but the patient characteristics and indications for surgery varied widely between the studies. The influence of depressive symptoms on the 5-year outcome of LSF has not been studied.

Methods.

The study was based on data from a local LSF database from two hospitals comprising 392 consecutive patients (mean age 61 years, 277 women) who underwent an instrumented LSF and fulfilled the 5-year follow-up. At the 5-year follow-up, the patients were compared with a control group from the general population (n = 477, age-, sex-, and residential area-matched) extracted from Official Statistics of Finland. The prevalence of depressive symptoms was evaluated using the Depression Scale (DEPS; 0–30) and disability was evaluated by the Oswestry Disability Index (ODI; 0–100%). A DEPS score ≥12 was considered to indicate depressive symptoms.

Results.

Before surgery, 35% of the patients had depressive symptoms. The proportion diminished to 13% at 3 months postoperatively and increased to 24% at 5 years. In the population, the prevalence was 11% at baseline and 10% at the 5-year follow-up. The preoperative ODI was 54 in the patients with depressive symptoms, and it was 41 in the patients with no depressive symptoms. The changes at 5-year follow-up were −20 and −18, correspondingly. The same congruence was preserved when analyzing short and long fusions separately. These changes were statistically and clinically significant. In the control population, the ODI remained around 24 in depressive people and 10 in nondepressive people.

Conclusion.

Our data suggest that patients with and without depressive symptoms may benefit equally well from LSF.

Level of Evidence:

3
Comparison of Morphometric Measurements of Traditional Posterior Cervical Screw and Paravertebral Foramen Screw in Chinese Population
Authors: Chen Xi , Yang Qing , Kalisi Kupu Uluakimata Mei Muli , Yuan Suomao , Tian Yonghao , Liu Xinyu
Published: November 2020

Study Design.

A morphometric measurement study.

Objective.

To measure the length and angle parameters of the screw paths of pedicle screws (PS), lateral mass screws (LMS), and paravertebral foramen screws (PVFS) of subaxial cervical spine in Chinese population.

Summary of Background Data.

Aramomi proposed a novel internal fixation technology, named PVFS, as an alternative to LMS and PS for subaxial cervical vertebrae (C3-C7).

Methods.

This study measured the length and medial angles of screw paths on the three-dimensional reconstruction model of cervical computerized tomography data of 50 patients (25 men and 25 women) in our hospital from January 2018 to June 2018.

Results.

In general, the optimum length and medial angle of the PVFS in Chinese population were 10.65 mm and 21.12° at C3; 10.12 mm, 22.62° at C4; 9.82 mm, 23.66° at C5; 9.19 mm, 24.13° at C6; and 9.10 mm, 27.54° at C7. The optimum axial length and medial angle of PS in Chinese population were 30.94 mm, 33.92° at C3; 30.50 mm, 34.95° at C4; 31.92 mm, 33.42° at C5; 30.50 mm, 31.94° at C6; and 29.87 mm, 31.01° at C7. The optimum lengths of LMS paths in Chinese population were C3, 14.84 mm; C4, 15.33 mm; C5, 15.44 mm; C6, 14.74 mm; and C7, 14.06 mm.

Conclusion.

Although the length of PVFS is limited, it still can be used as an effective substitute for LMS and PS. The PVFS does not have the risk of directly injuring the vertebral artery, its safety angle of insertion is larger than that in PS, and it has higher surgical safety.

Level of Evidence: 3
Greater Socioeconomic Disadvantage Is Associated with Worse Symptom Severity at Initial Presentation in Patients Seeking Care for Lumbar Disc Herniation
Authors: Bernstein David N. , Merchan Nelson , Fear Kathleen , Rubery Paul T. , Mesfin Addisu
Published: November 2020

Study Design.

Retrospective, observational study.

Objective.

To determine the association of patient socioeconomic disadvantage, insurance type, and other characteristics on presenting symptom severity in patients with isolated lumbar disc herniation.

Summary of Background Data.

Little is known of the impact of socioeconomic disadvantage and other patient characteristics on the level of self-reported symptom severity when patients first seek care for lumbar disc herniation.

Methods.

Between April 2015 and December 2018, 734 patients newly presenting for isolated lumbar disc herniation who completed the Patient-Reported Outcomes Measurement Information System Physical Function (PF), Pain Interference (PI), and Depression Computer Adaptive Tests (CATs) were identified. Socioeconomic disadvantage was determined using the Area Deprivation Index, a validated measure of socioeconomic disadvantage at the census block group level (0–100, 100 = highest socioeconomic disadvantage). Bivariate analyses were used. Multivariable linear regression was used to determine if there was an association between socioeconomic disadvantage, insurance type, and other patient factors and presenting patient-reported health status.

Results.

Significant differences in age, insurance type, self-reported race, marital status, and county of residence were appreciated when comparing patient characteristics by socioeconomic disadvantage levels (all comparisons, P < 0.01). In addition, significant differences in age, insurance type, marital status, and county of residence were appreciated when comparing patient characteristics by self-reported race (all comparisons, P < 0.01). Being in the most socioeconomically disadvantaged cohort was associated with worse presenting Patient-Reported Outcomes Measurement Information System scores (Physical Function: β = -3.27 (95% confidence interval [CI]: -4.89 to -1.45), P < 0.001; Pain Interference: β = 3.20 (95% CI: 1.58–4.83), P < 0.001; Depression: β = 3.31 (95% CI: 1.08–5.55), P = 0.004.

Conclusion.

The most socioeconomically disadvantaged patients with symptomatic lumbar disc herniations present with worse functional limitations, pain levels, and depressive symptoms as compared to patients from the least socioeconomically disadvantaged cohort when accounting for other key patient factors.

Level of Evidence: 3
Growth of the Digital Footprint of the Society of Critical Care Medicine Annual Congress: 2014–2020
Authors: Carroll Christopher L. , Szakmany Tamas , Dangayach Neha S. , DePriest Ashley , Duprey Matthew S. , Kaul Viren , Kleinpell Ruth , Tegtmeyer Ken , Kudchadkar Sapna R.
Published: November 2020

Objectives:

Since 2014, the Society of Critical Care Medicine has encouraged “live-tweeting” through the use of specific hashtags at each annual Critical Care Congress. We describe how the digital footprint of the Society of Critical Care Medicine Congress on Twitter has evolved at a time when social media use at conferences is becoming increasingly popular.

Design:

We used Symplur Signals (Symplur LLC, Pasadena, CA) to track all tweets containing the Society of Critical Care Medicine Congress hashtag for each annual meeting between 2014 and 2020. We collected data on the number of tweets, tweet characteristics, and impressions (i.e., potential views) for each year and data on the characteristics of the top 100 most actively tweeting users of that Congress.

Setting:

Twitter.

Subjects:

Users tweeting with the Critical Care Congress hashtag.

Interventions:

Not applicable.

Measurements and Main Results:

The Critical Care Congress digital footprint grew substantially from 2014 to 2020. The 2014 Critical Care Congress included 1,629 tweets by 266 users, compared with 29,657 tweets by 3,551 participants in 2020; average hourly tweets increased from 9.7 to 177. The percentage of tweets with mentions of other users and tweets with visual media increased. Users attending the conference were significantly more likely to compose original tweets, whereas those tweeting from afar were more likely to retweet Critical Care Congress content. There was a yearly increase in content-specific hashtags used in conjunction with Critical Care Congress hashtags (n = 429 in 2014 to n = 22,272 in 2020), most commonly related to pediatrics (18% of all hashtags), mobility/rehab (9%), sepsis (7%) social media (6%), and ICU burnout (1%).

Conclusions:

There has been significant growth in live-tweeting at the Critical Care Congress, along with the increased use of content-specific hashtags and visual media. This digital footprint is largely driven by a proportion of highly engaged users. As medical conferences transition to completely or partially online platforms, understanding of the digital footprint is crucial for success.
Postural Orthostatic Tachycardia Syndrome and Disordered Eating: Clarifying the Overlap
Authors: Benjamin Julia , Sim Leslie , Owens Michele Tsai , Schwichtenberg Andrea , Harrison Tracy , Harbeck-Weber Cindy
Published: November 2020

Objective:

Postural orthostatic tachycardia syndrome (POTS) is estimated to occur in up to 1% of adolescents, with symptoms of dizziness, fatigue, and pain impacting daily functioning. However, many risk factors and symptoms for POTS overlap with those of youth with disordered eating, and adolescents with POTS may be at increased risk for developing eating disorders. Therefore, the present study sought to better understand this overlap. We hypothesized that patients with POTS would have higher than expected rates of weight change, restrictive eating patterns, and food sensitivities.

Methods:

We conducted a retrospective chart review of 96 adolescents and young adults diagnosed with POTS who were participating in a 3-week intensive interdisciplinary pain rehabilitation program. We conducted descriptive and correlational statistical analyses on data from self-report measures, biomarkers of nutritional status, and abstracted information about eating and weight concerns from medical notes.

Results:

Nearly 3 quarters of participants described engaging in restrictive eating, and more than half of them described experiencing weight loss. They also endorsed experiencing food allergies, celiac disease, and eating disorder at higher rates than would be expected in the general population. One-fifth of the sample had experienced invasive interventions to correct for nutritional imbalances, such as having a feeding tube.

Conclusion:

Weight and eating are clear areas of risk for patients with orthostatic intolerance. It is essential that treatment team members thoroughly screen for eating disturbances and make recommendations that support regular and balanced eating habits.
Prednisolone and Prednisone Pharmacokinetics in Adult Renal Transplant Recipients
Authors: Skauby Ragnhild H. , Gustavsen Marte T. , Andersen Anders M. , Bjerre Anna , Åsberg Anders , Midtvedt Karsten , Vethe Nils T. , Bergan Stein
Published: November 2020

Background:

Prednisolone (PL) is a standard component of most immunosuppressive protocols after solid organ transplantation (Tx). Adverse effects are frequent and well known. The aim of this study was to characterize the pharmacokinetics (PKs) of PL and prednisone (PN), including cortisol (CL) and cortisone (CN) profiles, after PL treatment in renal Tx recipients in the early post-Tx phase.

Methods:

This single-center, prospective, observational study included stable renal Tx recipients, >18 years of age, and in the early postengraftment phase. Blood samples were obtained predose and during a 24-hour dose interval [n = 26 samples per area under the curve (AUC0–24)], within the first 8 weeks post-Tx. PL, PN, CL, and CN concentrations were measured using high-performance liquid chromatography−tandem mass spectrometry.

Results:

In renal Tx recipients (n = 28), our results indicated a relatively high PL exposure [median, range AUC0–24 = 3821 (2232–5382) mcg h/L], paralleled by strong suppression of endogenous CL profile, demonstrated by a low CL evening-to-morning ratio [median, range 11 (3–47)%]. A negative correlation (r = −0.83) between PL AUC0–24 and morning CL levels was observed. The best single PK variable to predict PL AUC0–24 was PL C6 (r
2 = 0.82). An algorithm based on 3 PK sampling time points: trough, 2, and 4 hours after PL dosing, predicted PL AUC0–24 with a low percentage prediction error (PPE = 5.2 ± 1.5%) and a good correlation of determination (r
2 = 0.91). PL AUC0–24 varied 3-fold among study participants, whereas CL AUC0–24 varied by 18-fold.

Conclusions:

The large interindividual variability in both PL exposure and suppression of endogenous CL implies a possible role for therapeutic drug monitoring. An abbreviated profile within the first 4 hours after PL dosing provides a good prediction of PL exposure in renal Tx recipients. The strong negative correlation between PL AUC0–24 and morning CL levels suggests a possible surrogate marker for drug exposure for further evaluation.
Toxicology Screening Testing in Patients Undergoing Spine Surgery: A Prospective Observational Pilot Study
Authors: Clavijo Claudia F. , Oliva Anthony M. , Dingmann Colleen , Kaizer Alexander , Christians Uwe , Burger Evalina , Patel Vikas , Kleck Christopher J. , Vogel Scott A. , Scott Benjamin K. , Janik Daniel J. , Jameson Leslie C. , Ginde Adit A.
Published: November 2020

Background:

Chronic opioid use and polypharmacy are commonly seen in chronic pain patients presenting for spine procedures. Substance abuse and misuse have also been reported in this patient population. Negative perioperative effects have been found in patients exposed to chronic opioid, alcohol, and recreational substances. Toxicology screening testing (TST) in the perioperative period provides useful information for adequate preoperative optimization and perioperative planning.

Methods:

We designed a pilot study to understand this population's preoperative habits including accuracy of self-report and TST-detected prescribed and unprescribed medications and recreational substances. We compared the results of the TST to the self-reported medications using Spearman correlations.

Results:

Inconsistencies between TST and self-report were found in 88% of patients. Spearman correlation was 0.509 between polypharmacy and intraoperative propofol use, suggesting that propofol requirement increased as the number of substances used increased.

Conclusions:

TST in patients presenting for spine surgery is a useful tool to detect substances taken by patients because self-report is often inaccurate. Discrepancies decrease the opportunity for preoperative optimization and adequate perioperative preparation.
PARACENTRAL ACUTE MIDDLE MACULOPATHY IN CENTRAL RETINAL VEIN OCCLUSION COMPLICATING AMYLOID LIGHT-CHAIN AMYLOIDOSIS
Authors: Parodi Maurizio B. , Arrigo Alessandro , Rajabian Firuzeh , Tecilazich Francesco , Giustina Andrea , Bandello Francesco , Jampol Lee M.
Published: November 2020

Purpose:

To describe a case of paracentral acute middle maculopathy associated with central retinal vein occlusion in a patient affected by amyloid light-chain amyloidosis.

Methods:

One patient with confirmed diagnosis of amyloid light-chain amyloidosis, displaying paracentral acute middle maculopathy and central retinal vein occlusion, was recruited. The patient underwent complete ophthalmologic examination and multimodal imaging, including: fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography.

Results:

Fundus autofluorescence showed a ferning pattern, corresponding to linear hypofluorescence in late-phase indocyanine green angiography and delayed venous filling, detected by fluorescein angiography. Structural optical coherence tomography revealed a hyper-reflective line located in the outer plexiform layer, corresponding to the prominent middle limiting membrane, along with several placoid lesions. Optical coherence tomography angiography found that the superficial capillary plexus was preserved, whereas vessel density was reduced in both the deep capillary plexus and the choriocapillaris. After 1 year of follow-up, the patient achieved an almost complete morphological recovery.

Conclusion:

Multimodal imaging described in depth the morphological features of a case of combined paracentral acute middle maculopathy and central retinal vein occlusion in a patient affected by amyloid light-chain amyloidosis.
Visual Rehabilitation With Contact Lenses Following Open Globe Trauma
Authors: Scanzera Angelica C. , Dunbar Grace , Shah Vidhi , Cortina Maria Soledad , Leiderman Yannek I. , Shorter Ellen
Published: November 2020

Objectives:

To describe visual outcomes with various contact lens modalities in patients with a history of ocular trauma who underwent surgical open globe repair.

Methods:

Records of all patients with a history of open globe injury and repair at a tertiary care hospital between January 1, 2010, and December 31, 2016, were reviewed. Demographics, type of injury, and visual acuity were assessed before and after contact lens evaluation.

Results:

Of 214 patients who underwent open globe repair, 29 (13.6%) were evaluated with a contact lens. Visual acuity improved in 97% (28 of 29) of patients from 1.47±0.75 to 0.67±0.71 logarithm of the minimal angle of resolution (logMAR) with manifest refraction to 0.28±0.45 logMAR with contact lenses (n=29; P<0.0001). Corneal opacity was the most common clinical indication (20 of 29) for fitting followed by aphakia (13 of 29). A range of contact lens modalities, including corneal rigid gas-permeable (12 of 28), soft (9 of 28), hybrid (3 of 28), scleral gas-permeable (2 of 28), and piggyback (2 of 28) lenses were prescribed.

Conclusion:

In this study, patients with a history of trauma and open globe repair with good neurosensory visual potential had improvements in visual acuity with contact lens greater than manifest refraction. Soft and gas-permeable lenses were used to improve visual acuity in patients with a history of open globe repair and corneal scarring, aphakia, iris abnormalities, or other ocular sequelae. Although corneal rigid gas-permeable lenses were prescribed most often, additional consideration should be given to other contact lens modalities, including soft, piggyback, hybrid, and scleral gas-permeable lenses.
Oral Mucosal Epithelial Transplantation and Limbal-Rigid Contact Lens: A Therapeutic Modality for the Treatment of Severe Ocular Surface Disorders
Authors: Sotozono Chie , Inatomi Tsutomu , Nakamura Takahiro , Ueta Mayumi , Imai Kojiro , Fukuoka Hideki , Komai Seitaro , Ishida Gaku , Kitazawa Koji , Yokoi Norihiko , Koizumi Noriko , Kimura Yasuko , Go Masahiro , Fukushima Masanori , Kinoshita Shigeru
Published: November 2020

Stevens–Johnson syndrome, ocular cicatricial pemphigoid, and severe thermal or chemical injury are considered severe ocular surface disorders (OSDs) because they affect the entire ocular surface, including corneal and conjunctival epithelial stem cells. In patients with severe OSDs, the long-term prognosis for limbal transplantation is poor, and the related corneal opacity and cicatrization lead to devastating visual impairment. To date, there is no standardized treatment to improve vision in cases with severe OSD. Investigating novel treatment methods for severe OSDs, our group began cultivated oral mucosal epithelial transplantation in 2002 and developed a limbal-supported rigid-type contact lens that can be applied as a nonsurgical treatment. When used in combination, these treatment methods make it possible to successfully restore vision in cases with severe OSDs.
Treatment of a Large Multiloculated Liver Abscess with Intra-Abscess Antibiotic Instillation
Authors: Steele Russell W.
Published: November 2020

This report describes a 15-year-old with an 11.1 × 8.2 × 8.4 cm multiloculated liver abscess caused by methicillin-sensitive Staphylococcus aureus who failed extensive catheter drainage and intravenous antibiotics. Daily intra-abscess oxacillin was instilled for 7 days with rapid clinical improvement and sterilization of the abscess. One month later, an ultrasound of the abdomen revealed a normal liver.
Viral Meningitis Associated With COVID-19 in a 9-year-old Child: A Case Report
Authors: Yousefi Koroush , Poorbarat Salar , Abasi Zohre , Rahimi Sajad , Khakshour Ali
Published: November 2020

We report first viral meningitis associated with coronavirus disease 2019 (COVID-19) in a patient hospitalized at Imam Hassan Hospital in Bojnurd. The patient was a 9-year-old child with no history of internal disease who referred to the emergency with a complaint of fever, headache and low back pain, about 3 days after the onset of symptoms. finally, viral meningitis was diagnosed with COVID-19.
Safety and efficacy of incisional goniotomy as an adjunct with phacoemulsification in primary angle-closure glaucoma
Authors: Gupta Shikha , Sethi Anin , Yadav Suresh , Azmira Kishan , Singh Abhishek , Gupta Viney
Published: November 2020

Purpose:

To evaluate the intraocular pressure (IOP)—lowering efficacy and safety of incisional goniotomy as an adjunct to phacoemulsification in primary angle-closure glaucoma (PACG) patients.

Methods:

Consecutive patients with PACG (high or borderline IOP) deemed fit for phacoemulsification were enrolled. After phacoemulsification, incisional goniotomy was performed with or without goniosynechialysis. Patient demographic profile, clinical data, and adverse events, if any, were analyzed during at least a 6-month follow-up period. Success was defined as IOP of 18 mm Hg or lesser with or without medications.

Setting:

Tertiary care Ophthalmic hospital.

Design:

Prospective interventional case series.

Results:

Of 46 eyes (38 patients) included, 69.6% eyes were classified as having advanced glaucoma. The mean treated IOP decreased by 7.3 ± 1.0 (SE) mm Hg (95% CI, 5.2-9.3) from 21.4 ± 6.6 to 14.2 ± 3.7 mm Hg at a mean duration of 11.7 ± 5.5 months (6-22 months) postoperatively (P < .001, paired t test). There was 66.6% reduction in median number of hypotensive medications (P < .001, Wilcoxon signed-rank test). Observed complications included hyphema (13 eyes [28%]), IOP spike (3 eyes [6.5%]), and cyclodialysis (1 eye [2.17%]). High treated IOP and number of medications were significantly associated with failure in univariate analysis (P < .05, Fisher exact test). The cumulative survival probability for qualified success at 22 months was 87.8% ± 0.07 (95% CI, 0.65-0.96).

Conclusions:

Incisional goniotomy as an adjunct with phacoemulsification resulted in a significant and sustained reduction in IOP along with decrease in number of glaucoma medications in chronic PACG eyes, irrespective of the disease stage.
Refractive growth variability in the Infant Aphakia Treatment Study
Authors: McClatchey Scott K. , McClatchey Thaddeus S. , Cotsonis George , Nizam Azhar , Lambert Scott R. ,   for the Infant Aphakia Treatment Study Group
Published: November 2020

Purpose:

Prediction of refraction after cataract surgery in children is limited by the variance in rate of refractive growth (RRG3). This study compared RRG3 in aphakic and pseudophakic eyes with their fellow, normal eyes in the Infant Aphakia Treatment Study.

Setting:

Twelve clinical sites in the United States.

Design:

Randomized clinical trial.

Methods:

Infants randomized to unilateral cataract extraction had RRG3 calculated based on biometric data (axial length and keratometry) at cataract surgery and at 10 years of age, for both the normal and cataract eyes. Subjects were included if complete biometric data from both eyes were available both at surgery and at 10 years. Variance in RRG3 was compared between the groups with Pitman test for equality of variance between correlated samples.

Results:

Longitudinal biometric data were available for 103 of the 114 patients enrolled. RRG3 was −15.00 diopters (D) (3.00 D) for normal eyes (reported as mean [SD]), −17.70 D (6.20 D) for aphakic eyes, and −16.70 D (6.20 D) for pseudophakic eyes (P < .0001 for comparison of variances in RRG3 between normal and all operated eyes). Further analysis found differences in the variance in axial length growth (P < .0001) between operated and normal eyes; the variance in keratometry measurement change did not reach significance.

Conclusions:

The standard deviation in the RRG3 of normal eyes in our study was half of that found in eyes that underwent cataract surgery.
Accuracy of a universal theoretical formula for power calculation in pediatric intraocular lens implantation
Authors: Eppley Sarah E. , Arnold Benjamin F. , Tadros Dina , Pasricha Neel , de Alba Campomanes Alejandra G.
Published: November 2020

Purpose:

To compare the accuracy of Barrett Universal II formula with other formulas (Holladay 2, Hoffer Q, and SRK/T formulas) in the prediction of postoperative refraction for pediatric intraocular lens implantation.

Setting:

Academic medical center/children’s hospital, San Francisco, California.

Design:

Retrospective case series.

Methods:

Children aged 16 years or younger who underwent cataract extraction and IOL implantation (2012 to 2019) and had refraction assessed at 3 to 16 weeks postoperatively were included. Prediction error (PE) was calculated as postoperative mean spherical equivalent minus the target refraction. Mean, median, and standard deviation was calculated for PE and absolute PE. Performance across covariables (axial length, age, biometry type, keratometry, etc.) was studied, and a multivariate regression analysis was performed using a single prediction model for each formula.

Results:

Sixty-four eyes of 64 patients, aged 1.5 to 15.5 years, were included. Barrett Universal II formula had the lowest mean PE (−0.22 diopters [D]), SD (1.18 D), median PE (−0.26 D), and median absolute PE (0.71) compared with those of the other formulas. Holladay 2 formula performed similarly to Barrett Universal II formula, and SRK/T formula had the greatest mean PE (−0.50 D) and SD (1.22 D). Barrett Universal II formula predictions were stable across all variables.

Conclusions:

Barrett Universal II formula demonstrated similar or superior performance when compared with other formulas in this pediatric study. Holladay 2 formula performed similarly to Barrett Universal II formula, and SRK/T formula had the least reliable performance, across several key biometric characteristics. Although PEs can be highly variable in pediatric populations, this study supports Barrett Universal II formula as a reasonable and reliable option for lens power calculation in children, including those with extreme biometric measurements.
Visual image quality after small-incision lenticule extraction compared with that of spectacles and contact lenses
Authors: Gyldenkerne Anders , Ivarsen Anders , Nisted Ivan , Hjortdal Jesper
Published: November 2020

Purpose:

To assess the influence of small-incision lenticule extraction (SMILE) for high myopia on the visual image quality assessed by the logarithm of the visual Strehl ratio (logVSX) and put this into a clinical context by pairwise comparing the logVSX of postoperative eyes with those of myopic controls wearing spectacles and/or contact lenses.

Setting:

University hospital.

Design:

Prospective and cross-sectional clinical study.

Methods:

Patients with a myopic spherical equivalent of at least 6.00 diopters treated with SMILE aimed at emmetropia and correspondingly myopic controls corrected with spectacles and/or contact lenses were included. The logVSX calculation was divided into habitual logVSX based on the wavefront aberration measurement directly and optimal logVSX calculated in a theoretical through-focus experiment to obtain the best-achievable logVSX.

Results:

A total of 117 eyes of 61 patients and 64 eyes of 34 myopic controls were included. SMILE did not affect the habitual logVSX but worsened the optimal logVSX (P < .001). The postoperative habitual logVSX was statistically significantly worse compared with contact lenses (P = .002). The postoperative optimal logVSX was significantly worse compared with both spectacles (P < .01) and contact lenses (P = .003). There was no statistically significant difference in habitual or optimal logVSX between spectacles and contact lenses.

Conclusions:

SMILE for high myopia does not affect the habitual logVSX but decreases the optimal logVSX slightly. The postoperative habitual logVSX is worse than for contact lenses but not spectacles, and the postoperative optimal logVSX is worse than for both contact lenses and spectacles. There is no statistically significant difference in either habitual or optimal logVSX between spectacles and contact lenses.
A randomized, controlled trial of a β2-agonist in painful polyneuropathy
Authors: Gillving Mimmi , Demant Dyveke , Holbech Jakob V. , Gylfadottir Sandra Sif , Bach Flemming W. , Jensen Troels S. , Finnerup Nanna B. , Sindrup Søren H.
Published: November 2020

Experimental data have suggested that in neuropathic pain, tricyclic antidepressants may work solely through a β2-agonist action. The aim of this study was to test if the β2-agonist terbutaline relieves painful polyneuropathy. The study was a randomized, double-blind, placebo-controlled and active-controlled, 3-way, cross-over trial among patients with painful polyneuropathy. The treatment periods were of 5 weeks' duration and were preceded by 1 week for washout and 1 week for baseline observations. The patients received terbutaline (5-15 mg), imipramine (30-150 mg), or placebo in a random order. Drug doses depended on age and metabolizer status. The change in total pain recorded from ratings in diaries (numeric rating scale [NRS] 0-10) was the primary outcome, and the change in rating of specific pain symptoms (NRS 0-10), patient global impression of change, and sleep disturbance were secondary outcomes. Forty-seven patients were randomized. The median score for total pain changed from NRS 6.4 to 6.1 from baseline to week 5 on terbutaline with an average effect during the treatment period as compared with placebo of 0.13 (95% confidence interval −0.12 to 0.38, P = 0.32). The median score for total pain on imipramine changed from NRS 6.6 to 4.8 with an average effect as compared with placebo of −1.17 (95% confidence interval −1.42 to −0.92, P < 0.001). Secondary outcomes were also unaltered by terbutaline but improved by imipramine. The β2-agonist terbutaline has no effect in painful polyneuropathy. β2-agonism seems not to be an important mechanism of action of tricyclic antidepressants in neuropathic pain.
Cervical Screening Practices and Outcomes for Young Women in Response to Changed Guidelines in Calgary, Canada, 2007–2016
Authors: Sayed Sayeeda Amber , Naugler Christopher , Chen Guanmin , Dickinson James A.
Published: November 2020

Objective

The aim of the study was to describe temporal trends in screening and outcomes for women, after changes in guidelines in Alberta, Canada, that raised starting age to 21 years, then to 25 years of age, and reduced frequency to 3 yearly.

Materials and Methods

Calgary Laboratory Information System data were used to examine screening rates, follow-up procedures, and cancer among women 10–29 years from 2007 to 2016 in the whole population of Calgary. Interrupted time-series analyses were used to assess changes in screening and subsequent diagnostic procedures over the 10-year period.

Results

Annual screening rates dropped by approximately 10% at all ages older than 15 years after the 2009 Alberta cervical cancer screening guidelines, followed by a steady decrease. Further change continued subsequent to minimal apparent effect of the 2013 Canadian Task Force on Preventive Health Care guidelines. The rates of abnormal test results decreased in concert with decreased screening. No increases in cervical intraepithelial neoplasia 1, cervical intraepithelial neoplasia 2/3, or invasive cervical cancer rates were observed after reduced testing.

Conclusions

The largest decrease in screening and follow-up procedures occurred in the period immediately after implementation of 2009 Alberta screening guidelines. The number of consequent procedures also decreased in proportion to decreased screening, but there was no increase in cancer rates. Starting screening at the age of 25 years and reducing intervals seem to be safe.
Anal Cancer and Anal Cancer Screening Knowledge, Attitudes, and Perceived Risk Among Women Living With HIV
Authors: Rodriguez Serena A. , Higashi Robin T. , Betts Andrea C. , Ortiz Cynthia , Tiro Jasmin A. , Luque Amneris E. , Barnes Arti
Published: November 2020

Objectives

The aims of the study were (1) to describe anal cancer knowledge, perceived risk, screening barriers, and acceptability of sample self-collection among women living with HIV (WLWH) at an integrated safety-net system and (2) to describe differences in demographic and psychosocial variables among a subsample of WLWH with a history of abnormal cervical cytology results versus those with normal results.

Materials and Methods

We conducted telephone surveys with English- and Spanish-speaking WLWH (N = 99) and used electronic health record data to extract insurance type, CD4+ cell count, RNA viral load, and cervical cytology results. We calculated descriptive statistics for participant demographics, HIV laboratory results, and psychosocial variables. Among the subsample of women who completed a recent cervical Pap, we used Fisher exact test to assess differences in demographic variables, CD4+ counts, RNA viral loads, knowledge, awareness, acceptability, and perceived risk by cervical cytology results.

Results

Most participants (70%) reported knowing nothing about anal cancer; 28% correctly responded that HIV increases one’s chance of getting anal cancer. Most (68%) never heard of an anal Pap test. Forty percent would get an anal Pap if they could self-collect the sample, whereas 59% were neutral or disagreed. The 2 most commonly cited barriers to obtaining an anal Pap were “I do not know enough about it” (n = 15) and “It might hurt” (n = 9).

Conclusions

This study highlights a gap in knowledge and awareness among WLWH regarding their heightened risk for anal cancer. It indicates the need for health education and suggests an opportunity for a self-collection intervention.
Association Between Vulvar Squamous Intraepithelial Lesions and Psychiatric Illness
Authors: Bell Sarah G. , Kobernik Emily K. , Haefner Hope K. , Welch Kathryn C.
Published: November 2020

Objectives

The aims of the study were to describe and to compare demographics and the prevalence of psychiatric disorders among patients with low- and high-grade vulvar squamous intraepithelial lesions.

Methods

A retrospective chart review was performed for patients presenting to a vulvar diseases clinic between 1996 and 2019 (N = 2,462). Intake questionnaire data were entered into a deidentified database. Results were compared between 80 patients with biopsy-confirmed high-grade squamous intraepithelial lesions (HSILs) and 48 patients with biopsy-confirmed low-grade squamous intraepithelial lesions (LSILs). Bivariate analysis was performed to compare demographics and psychiatric treatment and outcomes across HSIL and LSIL groups.

Results

Among 128 patients with vulvar disease, 80 (62.5%) had HSILs and 48 (37.5%) had LSILs. Patients with HSILs were significantly older (HSIL median [interquartile range] = 49.0 (39.0–61.0) vs LSIL = 36.0 [29.0–53.0], p = .006). There were no significant differences between groups across race/ethnicity, education, marital status, or self-reported household income categories. Forty percent of HSIL patients reported depression compared with 20.8% of LSIL patients (p = .03), whereas 31.3% of HSIL patients and 8.3% of LSIL patients reported anxiety (p = .002). Bipolar disorder was reported in 3.8% of HSIL patients and no LSIL patients (p = .29). There were no differences in the proportion of patients receiving psychiatric counseling, medications, or hospitalizations between groups.

Conclusions

Squamous intraepithelial lesions of the vulva are associated with psychiatric disorders above age-matched national averages; these disorders are more prominent in the HSIL group. Combining mental health services with ongoing disease treatment seem to be part of a comprehensive approach to caring for this patient population.
Cytokine Adsorption in Severe Acute Respiratory Failure Requiring Veno-Venous Extracorporeal Membrane Oxygenation
Authors: Rieder Marina , Duerschmied Daniel , Zahn Timm , Lang Corinna , Benk Christoph , Lother Achim , Biever Paul , Bode Christoph , Wengenmayer Tobias , Staudacher Dawid , Supady Alexander
Published: November 2020

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a last resort treatment option for patients with acute respiratory failure (acute respiratory distress syndrome [ARDS]). Cytokine adsorption has been incorporated in the management of some of these patients on an individual basis to control the imbalance of danger-associated molecular patterns and proinflammatory cytokines. However, little is known about the combination of V-V ECMO and cytokine adsorption as earlier reports contained mixed patient cohorts in terms of disease and mode of ECMO, veno-venous and veno-arterial. We here report single-center registry data of nine all-comers with severe ARDS treated with V-V ECMO and cytokine adsorption using the CytoSorb adsorber compared with a control group of nine propensity score matched patients undergoing V-V ECMO support without cytokine adsorption. Even though Respiratory ECMO Survival Prediction and PRedicting dEath for SEvere ARDS on V-V ECMO scores predicted a higher mortality in the cytokine adsorption group, mortality was numerically reduced in the patients undergoing V-V ECMO and cytokine removal compared with V-V ECMO alone. The need for fluid resuscitation and vasopressor support as well as lactate levels dropped significantly in the cytokine adsorption group within 72 hours, whereas vasopressor need and lactate levels did not decrease significantly in the control group. Therefore, our data suggest that cytokine adsorption might be beneficial in patients with severe ARDS requiring V-V ECMO support.
Usefulness of HVAD Waveforms as Diagnostic Assistance for Cardiac Tamponade
Authors: Nakamura Makiko , Imamura Teruhiko , Hori Masakazu , Yokoyama Shigeki , Doi Toshio , Fukahara Kazuaki , Kinugawa Koichiro
Published: November 2020

We experienced a 39-year-old male patient who converted paracorporeal left ventricular assist device to HeartWare ventricular assist device (HVAD; Medtronic, Framingham, MA) as bridge-to-transplant indication. On the 10th postoperative day, the HVAD flow waveform presented periodical low pulsatility pattern. Significant pericardial hematoma was observed on the imaging studies, and he showed pulsus paradoxus. He was highly suspected of cardiac tamponade and performed thoracotomy. HVAD waveform might be a useful tool to monitor and early suspect of postoperative cardiac tamponade to consider more intensive examinations and thoracotomy before hemodynamic deterioration, although further large-scale studies are warranted to strengthen our hypothesis.
Simple and Effective Blood Salvage Technique for Extracorporeal Membrane Oxygenation Circuit
Authors: Suzuki Yota , Roach Jay , Leyva Yolanda R. , DeAnda Abe , Levy Gal
Published: November 2020

Return of circuit blood after discontinuing extracorporeal membrane oxygenation (ECMO) is an important blood conservation strategy for reducing the need for blood transfusion. This follows the current standard of circuit blood salvaging after cardiopulmonary bypass (CPB). There is a variety of strategies and techniques of blood salvage described associated with CPB but not with ECMO. We describe a simplified technique to salvage the blood in the ECMO circuit that requires no special equipment, is safe, and maximizes blood salvage.
Autoimmune Liver Disease in Patients With Sickle Cell Disease
Authors: Waisbourd-Zinman Orith , Frenklak Rachel , Hakakian Odelia , Hilmara Didja , Lin Henry
Published: November 2020

Objective:

Hepatic and biliary tract diseases are common in sickle cell disease (SCD) patients, likely due to sickling, hemosiderosis, viral hepatitis, or cholelithiasis. Literature is lacking on associations between SCD, autoimmune hepatitis (AIH), and/or sclerosing cholangitis (SC)-together, autoimmune liver disease (AILD). We aimed to better understand the relationship of these diseases in pediatric patients.

Materials and Methods:

A retrospective analysis of patients with SCD and AILD at the Children’s Hospital of Philadelphia (January 2008 to August 2015).

Results:

Seven patients, ages 8 to 23 years (3 males), were identified. Three had AIH, 2 SC, and 2 AIH/SC overlap, known as autoimmune SC. All patients with AIH treated with azathioprine significantly improved their liver enzymes. One patient with SC and inflammatory bowel disease underwent successful bone marrow transplant. Two SC patients died from SCD complications.

Conclusions:

In this cohort, there seems to be an association between SCD and AILD; SC in this population was severe. Physicians should be aware of this and evaluate patients with SCD and elevated liver enzymes for AILD.
A Subset of Intrahepatic Cholangiocarcinomas Express Albumin RNA as Detected by In Situ Hybridization
Authors: Avadhani Vaidehi , Cohen Cynthia , Siddiqui Momin T. , Krasinskas Alyssa
Published: November 2020

Intrahepatic cholangiocarcinomas (ICCs) show morphologic diversity, ranging from tumors composed of nonmucinous small ducts to mucin-producing large duct tumors to tumors with mixed hepatocellular carcinoma features. Diagnosing ICCs can be difficult, especially on biopsy, not only because of the morphologic diversity, but also because metastatic tumors are often in the differential diagnosis. Recently, branched DNA-based albumin RNA in situ hybridization (ISH) has been shown to be a potential sensitive and specific marker for ICC with 99% sensitivity. Using a different RNA ISH technology, we evaluated the expression of albumin RNA ISH in ICC. We performed RNA ISH for albumin using RNAscope on 43 ICCs in a triplicate tissue microarray. Albumin RNA ISH was positive in 18 of 43 (42%) ICCs. Five of the 6 (83%) combined hepatocellular carcinoma-CC were positive in the CC component. None of the tumors with mucin production were positive (0/9). In our cohort, albumin RNA ISH showed a sensitivity of 42% in ICCs, supporting the morphologic diversity of ICCs. Albumin RNA ISH does not appear to be a highly sensitive marker for ICC and hence cannot be used as a stand-alone marker for ICC.
Incorporating a Trauma-Informed Care Protocol Into Pediatric Trauma Evaluation
Authors: Beaulieu-Jones Brendin R. , Bingham Sarah , Rhynhart Kurt K. , Croitoru Daniel P. , Singleton Marcy N. , Rutman Maia S. , Baertschiger Reto M.
Published: November 2020

Objectives

Trauma evaluation in the emergency department (ED) can be a stressful event for children. With the goal of minimizing pain, anxiety, and unneeded interventions in stable patients, we implemented the Pediatric PAUSE at our level 1 adult/level 2 pediatric trauma center. The Pediatric PAUSE is a brief protocol performed after the primary survey, which addresses Pain/Privacy, Anxiety/IV Access, Urinary Catheter/Rectal exam/Genital exam, Support from family or staff, and Explain to patient/Engage with PICU team. The aim was to assess whether performing the PAUSE interfered with timeliness of emergent imaging in pediatric patients and their disposition.

Methods

We identified all patients aged 0 to 18 years evaluated as trauma activations at our institution after the Pediatric PAUSE was implemented (October 1, 2016–March 31, 2017) as well as 2 analogous 6-month pre-PAUSE periods. Patient demographics, time to imaging studies, and time to ED disposition were analyzed.

Results

One hundred seventy-two patients met the study criteria, with a mean age of 10.9 years and mean injury severity score of 10.6. One hundred fifteen participants (68.5%) were transferred from other hospitals, and 101 (87.8%) had ≥1 imaging study performed before arrival. The Pediatric PAUSE was performed for 41 (25%) of 163 study participants. There was no difference in time to first imaging study in participants for whom the PAUSE was performed (18.4 vs 15.0 minutes, P = 0.09).

Conclusions

The PAUSE is a practice intervention designed to address the psychosocial needs of pediatric trauma patients and their families to help prevent posttraumatic stress symptoms. Implementation did not interfere with the timeliness of first imaging in pediatric trauma patients.