bluuebunny/crossref_metadata_2025 huggingface dataset:
Telehealth Capability Among Substance Use Disorder Treatment Facilities in Counties With High Versus Low COVID-19 Social Distancing
Authors: Cantor Jonathan , Stein Bradley D. , Saloner Brendan
Published: October 2020

Objective:

To quantify the availability of telehealth services at substance use treatment facilities in the U.S. at the beginning of the COVID-19 pandemic, and determine whether telehealth is available at facilities in counties with the greatest amount of social distancing.

Methods:

We merged county-level measures of social distancing through April 18, 2020 to detailed administrative data on substance use treatment facilities. We then calculated the number and share of treatment facilities that offered telehealth services by whether residents of the county social distanced or not. Finally, we estimated a logistic regression that predicted the offering of telehealth services using both county- and facility-level characteristics.

Results:

Approximately 27% of substance use facilities in the U.S. reported telehealth availability at the outset of the pandemic. Treatment facilities in counties with a greater social distancing were less likely to possess telemedicine capability. Similarly, nonopioid treatment programs that offered buprenorphine or vivitrol in counties with a greater burden of COVID-19 were less likely to offer telemedicine when compared to similar facilities in counties with a lower burden of COVID-19.

Conclusions:

Relatively few substance use treatment facilities offered telehealth services at the onset of the COVID-19 pandemic. Policymakers and public health officials should do more to support facilities in offering telehealth services.
Identification of Typologies of Cocaine Use Based on Quantity, Frequency, and Duration of Use: A Latent Profile Analysis
Authors: Liu Yiyang , Vaddiparti Krishna , Cheong JeeWon , Cottler Linda B.
Published: October 2020

Objectives:

We identified the patterns of cocaine use during individuals’ heaviest use period by considering quantity, frequency, and duration simultaneously and examined the correlates and risk profile for these patterns.

Methods:

Latent profile analysis was conducted among the 3117 individuals who reported lifetime use of cocaine in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) with quantity, frequency, and duration used as indicators. Logistic regression analyses examined factors associated with subtype membership based on patterns of cocaine use and the relationships between these patterns and cocaine use disorder (CocUD) and its severity.

Results:

Four patterns were identified: a “low use” class (72.6%), a “moderate use” class (8.2%), a “daily use” class (17.9%), and a “very high quantity use” class (1.3%). Relative to non-Hispanic White and the “low use” class, non-Hispanic Black was associated with increased odds to be in the “moderate use” and “daily use” classes. Higher prevalence of smoking crack cocaine and poly-route use was observed among the “very high quantity use” class relative to other classes; increased risk of using other substances was associated with the “daily use” class. Higher levels of cocaine use were associated with higher risks of CocUD and worse severity compared to the “low use” class.

Conclusions:

People who use cocaine are heterogeneous with different patterns of use and risks of CocUD. Reducing cocaine smoking and poly-route of use should be placed as the same priority as decreasing very high quantity of use in interventions.
Unmet Mental Health Care Needs and Illicit Drug Use During Pregnancy
Authors: Pfeifer Lyndsie R. , Haile Zelalem T.
Published: October 2020

Objectives:

The prevalence of drug use is at alarmingly high levels in the United States. Of particular concern is prenatal drug use, which exposes the underdeveloped organ systems of the fetus to harsh chemicals. Identifying factors associated with illicit drug use during pregnancy is critical to identify and treat at-risk pregnant women and improve maternal and infant health outcomes. The goal of this study was to examine the association between unmet mental health care needs and substance use during pregnancy.

Methods:

The present cross-sectional study analyzed secondary data from the 2002 to 2014 National Survey on Drug Use and Health (n = 10,516). The main outcome of interest was self-reported illicit drug use in the last 30 days. The independent variable was unmet mental health care needs in the last 12 months.

Results:

Overall, 6.4% of the participants reported a history of unmet mental health care needs and 4.5% used a substance during pregnancy. The odds of illicit drug use during pregnancy were higher among women who had an unmet mental health care needs compared to women without a history of unmet mental health care needs, multivariable-adjusted odds ratio (95% CI) 4.06 (3.01 to 5.48; P < 0.001). The observed association between unmet mental health care needs and illicit drug use persisted in subgroup analyses by age, race/ethnicity and education.

Conclusion:

In a nationally representative cross-sectional sample of pregnant women, having unmet mental health care needs was positively associated with illicit drug use during pregnancy after adjusting for potential confounders.
Development of an Interprofessional Policy on the Use of Human Milk and Breastfeeding for Pain Relief
Authors: Graf Tori , Duffey Emily , Spatz Diane
Published: October 2020

Background:

Infants are subjected to painful procedures as part of routine care. Evidence suggests human milk (HM) has pain-relieving qualities; however, nurses may not be aware of this evidence.

Purpose:

This article presents the evidence for HM and breastfeeding for pain management, as well as describes using the evidence to create an interprofessional enterprise-wide policy on the topic.

Methods/Search Strategy:

Cochrane, PubMed, CINAHL, and Medline were searched for full-length articles published in peer-reviewed journals between 2012 and 2020. Articles using HM as an independent variable during a painful procedure, or discussing benefits of HM for pain management, were analyzed.

Findings/Results:

Ten articles were selected for evaluating use of HM for pain relief in term and preterm infants. There is statistically significant evidence that expressed HM has pain-relieving abilities, especially when combined with other soothing interventions such as rocking. HM reduces crying time, and lowers pain scores during painful procedures. Seven articles recommend breastfeeding for effective pain management. Breastfeeding reduces crying time, heart rate, and pain scores compared with oral sucrose, holding, nonnutritive sucking, swaddling, and topical anesthetics.

Implications for Practice:

Breastfeeding and HM should be offered as primary pain management options. Having an interprofessional enterprise-wide policy for the use of breastfeeding and HM for pain management during painful procedures, such as vaccination, will provide safe, effective pain management.

Implications for Research:

Further understanding of effective HM dosing for pain management and use of pasteurized donor HM in place of expressed HM is required.
A Quality Improvement Approach to Perineal Skin Care
Authors: Rogers Sue , Thomas Micaela , Chan Belinda , Hinckley Spencer K. , Henderson Carol
Published: October 2020

Background:

Diaper dermatitis (DD) causes discomfort and emotional distress and creates possible sources of infection among newborn intensive care unit infants. Diaper dermatitis remains prevalent despite studies documenting an understanding of prevention and treatment modalities. Standardizing perineal skin care guidelines could reduce DD.

Purpose:

Implement perineal skin care guidelines, while introducing novel diaper wipes, to decrease the incidence of DD by 20% within a 1-year period.

Methods:

Our unit reviewed evidence-based literature to develop a standardized perineal care guideline for prevention and treatment, encompassing the use of novel, preservative-free diaper wipes with grapefruit seed extract. The outcome measures were the incidence and duration of DD. Process compliances were monitored. The balancing measure was the rate of fungal skin infection while using preservative-free wipes.

Findings:

Between July 2017 and March 2019, 1070 infants were admitted for 1 or more days, with 11% of those being born at less than 30 weeks of gestational age. After guideline implementation in January 2018, the incidence of DD decreased by 16.7%. The incidence of severe cases dropped by 34.9%, with 3.5 days per 100 patient-days shortened duration. Process compliance was achieved. Neonates tolerated the novel wipes without increased fungal skin infection.

Implications for Practice:

The Perineal Skin Care Guidelines could reduce the rate and duration of DD. Newborn intensive care unit infants tolerated the novel diaper wipes.

Implications for Research:

Additional research on wipes containing other types of extracts or ingredients.
NICU Fathers
Authors: LeDuff Lawrence D. , Carter Brigit M. , Cunningham Craig A. , Braun Lisa A. , Gallaher Keith J.
Published: October 2020

Background:

Parental support in the neonatal intensive care unit (NICU) is critical; yet, the nursing staff may struggle to provide optimal support to NICU fathers. Generally, fathers are not viewed as equally competent caregivers when compared with mothers, and fathers often impart these beliefs on themselves. Increasing the nursing staff's knowledge and understanding of paternal support can change attitudes and foster positive behavior changes, enhancing the perception of support received by NICU fathers.

Purpose:

To implement a needs assessment and educational intervention for the nursing staff designed to increase the perception of nursing support received by NICU fathers.

Methods:

The Nurse Parents Support Tool (NPST) was administered to the clinical nursing staff and fathers in a pre/posttest design comparing support given by nurses with the fathers' perception of received support. Data from the preintervention assessment was used to design an educational intervention on improving fathers' support. Following the intervention, a postintervention NPST was administered to fathers to determine whether there was an improvement in support perception.

Findings/Results:

Improvement in the NICU fathers' perception of nursing staff support was noted between father groups. In addition, the NPST can be used to assess paternal support needs and develop staff education.

Implications for Practice:

Support provided to NICU fathers can enhance the father's perception of himself as an equal and competent caregiver, leading to improved father–infant bonding as the child ages. Educational interventions targeting father support should be a routine part of nursing staff training.

Implications for Research:

Future research should examine the long-term effects of early paternal support on psychosocial, cognitive, and developmental outcomes of NICU infants.
The Feasibility of Kangaroo Care and the Effect on Maternal Attachment for Neonates in a Pediatric Cardiac Intensive Care Unit
Authors: Broge Mary Jane , Steurer Lisa M. , Ercole Patrick M.
Published: October 2020

Background:

As survival rates in neonates with congenital heart disease have improved, research has shown they are at an increased risk for brain injury and neurodevelopmental delay. One intervention shown to have a positive impact on the development in premature and full-term newborns, as well as a positive impact on mother–infant relationship, is kangaroo care (KC). There is limited evidence to support the use of KC in infants with congenital heart disease, some of who may also be premature.

Purpose:

The purpose of this study was to examine the safety and feasibility of introducing KC for neonates with congenital heart disease in the pediatric cardiac intensive care unit.

Methods:

A descriptive observational feasibility study was employed to evaluate the safety and efficacy of KC for this population.

Results:

There were 25 neonates included with 60 sessions of KC. There were no adverse events including line and tube dislodgments and physiological instability related to the use of KC.

Implications for Practice:

This study found KC to be safe and feasible for neonates with KC.

Implications for Research:

This is the first study examining the feasibility and safety of KC in this vulnerable population of neonates. Further research should be conducted using a quasi-experimental design to investigate neurodevelopmental outcomes with a larger sample of patients.
Engaging Mothers to Implement Nonpharmacological Care for Infants With Neonatal Abstinence Syndrome
Authors: Shuman Clayton J. , Weber Ashley , VanAntwerp Katherine , Wilson Roxanne
Published: October 2020

Background:

Little is known about nurse perceptions regarding engagement of mothers in implementation of nonpharmacological care for opioid-exposed infants.

Purpose:

This study was designed to describe perinatal and pediatric nurse perceptions of (1) engaging mothers in the care of opioid-exposed infants and (2) facilitators and barriers to maternal engagement.

Methods:

This study used a qualitative descriptive design to interview perinatal and pediatric nurses in one Midwest United States hospital. Interviews were conducted via telephone using a semistructured interview guide and audio recorded. Audio files were transcribed verbatim and thematically analyzed using the constant comparative method.

Results:

Twenty-one nurses participated in the study, representing a family birth center, neonatal intensive care unit, and pediatric unit. Five major themes resulted from analysis: (1) vulnerability and bias; (2) mother–infant care: tasks versus model of care; (3) maternal factors affecting engagement and implementation; (4) nurse factors affecting engagement and implementation; and (5) recommendations and examples of nursing approaches to barriers. Minor themes supported each of the major themes.

Implications for Practice:

Nurses must engage mothers with substance use histories with empathy and nonjudgment, identify and promote maternal agency to care for their infants, and engage and activate mothers to deliver nonpharmacological care during the hospital stay and following discharge.

Implications for Research:

Findings suggest interventions are needed to improve (1) nursing education regarding maternal substance use and recovery, (2) empathy for substance-using mothers and mothers in treatment, and (3) identification and support of maternal agency to provide nonpharmacological care to withdrawing infants.
Ticagrelor prevents tumor metastasis via inhibiting cell proliferation and promoting platelet apoptosis
Authors: Meng Xingjun , Liu Weisheng , Yang Hui , Cao Zhihui , He Hui , Zheng Kai , Chen Yonghua , Su Jiang , Lv Jun , Sun Jiantong , Li Ping , Ding Shuai , Ahmad N. , Qian Jun , Zhou Yuanshuai
Published: October 2020

Tumor cells can activate platelets, which in turn facilitate tumor cell survival and dissemination. Platelets inhibition or blocking platelet–tumor cell interactions has become a strategy to suppress tumor progression. In this study, we investigated the effect of ticagrelor, a new antiplatelet drug, on tumor cell proliferation and metastasis. Our results show that ticagrelor not only inhibits the proliferation, migration, and invasion of B16F10 and Lewis lung carcinoma cells but also induces platelet apoptosis. In addition, we find that apoptosis of the platelet cells is dose dependent. Further, the result of in-vivo experiments proved that ticagrelor treatment decreased the tumor metastasis. The results of this study demonstrate that ticagrelor may be a potential anti-tumor agent for tumor metastasis.
Sepsis Epidemiology Across the International Classification of Diseases, 9th Edition, to International Classification of Diseases, 10th Edition, Chasm—A Direct Application of the Institute for Health Metrics and Evaluation Case Definition to Hospital Discharge Data*
Authors: Jordan Kempker A. , Rudd Kristina E. , Wang Henry E. , Martin Greg S.
Published: October 2020

Objectives:

Describe the epidemiology of sepsis across the transition from the International Classification of Diseases, 9th Edition, and International Classification of Diseases, 10th Edition, coding systems, evaluating estimates of two previously published International Classification of Diseases, 10th Edition, coding strategies.

Design:

Serial cross-sectional analysis.

Setting:

Healthcare Utilization Project’s annual Nationwide Inpatient Sample of U.S. hospital discharges, 2012–2017.

Patients:

Discharges greater than or equal to 18 years old, which met one of the three case definitions for sepsis. For the records using International Classification of Diseases, 9th Edition, we used previously published modified Angus criteria, and for records using International Classification of Diseases, 10th Edition, we deployed a case definition used by the Centers for Medicare & Medicaid Services and a case definition developed by the Institute for Health Metrics and Evaluation.

Interventions:

None.

Measurements and Main Results:

During the study period, there were discontinuities in the sepsis incidence estimates using the modified Angus International Classification of Diseases, 9th Edition, criteria in 2014 and either Centers for Medicare & Medicaid Services or Institute for Health Metrics and Evaluation International Classification of Diseases, 10th Edition, criteria in 2016. In 2014, there were an estimated 1,009 cases (95% CI, 989–1,030) of modified Angus sepsis per 100,000 persons, whereas in 2016, there were 709 cases (95% CI, 694–724) of Centers for Medicare & Medicaid Services sepsis and 1,498 cases (95% CI, 1,471–1,092) of Institute for Health Metrics and Evaluation sepsis per 100,000 persons. Furthermore, the Institute for Health Metrics and Evaluation definition identified a sepsis cohort with similar hospital characteristics but a younger age distribution, higher proportion of women, lower severity of illness, and lower hospital mortality.

Conclusions:

The Institute for Health Metrics and Evaluation International Classification of Diseases, 10th Edition, coding strategy for identifying sepsis may capture a larger patient population within administrative datasets that are different from those identified with previously deployed International Classification of Diseases-based methods. Further work is required to determine the optimal International Classification of Diseases, 10th Edition, coding strategy for use in hospital discharge data.
Development and validation of radiomics model built by incorporating machine learning for identifying liver fibrosis and early-stage cirrhosis
Authors: Qiu Qing-Tao , Zhang Jing , Duan Jing-Hao , Wu Shi-Zhang , Ding Jia-Lin , Yin Yong
Published: October 2020

Background:

Liver fibrosis (LF) continues to develop and eventually progresses to cirrhosis. However, LF and early-stage cirrhosis (ESC) can be reversed in some cases, while advanced cirrhosis is almost impossible to cure. Advances in quantitative imaging techniques have made it possible to replace the gold standard biopsy method with non-invasive imaging, such as radiomics. Therefore, the purpose of this study is to develop a radiomics model to identify LF and ESC.

Methods:

Patients with LF (n = 108) and ESC (n = 116) were enrolled in this study. As a control, patients with healthy livers were involved in the study (n = 145). Diffusion-weighted imaging (DWI) data sets with three b-values (0, 400, and 800 s/mm2) of enrolled cases were collected in this study. Then, radiomics features were extracted from manually delineated volumes of interest. Two modeling strategies were performed after univariate analysis and feature selection. Finally, an optimal model was determined by the receiver operating characteristic area under the curve (AUC).

Results:

The optimal models were built in plan 1. For model 1 in plan 1, the AUCs of the training and validation cohorts were 0.973 (95% confidence interval [CI] 0.946–1.000) and 0.948 (95% CI 0.903–0.993), respectively. For model 2 in plan 1, the AUCs of the training and validation cohorts were 0.944, 95% CI 0.905 to 0.983, and 0.968, 95% CI 0.940 to 0.996, respectively.

Conclusions:

Radiomics analysis of DWI images allows for accurate identification of LF and ESC, and the non-invasive biomarkers extracted from the functional DWI images can serve as a better alternative to biopsy.
Single-arm Trials with Historical Controls
Authors: Suissa Samy
Published: October 2020

Background:

Regulatory agencies now recognize single-arm trials with external historical controls, particularly common in oncology, to assess promising treatments for rare or specific indications. When a new treatment indication depends on events over time, such as treatment failures, this design can introduce time-related biases in comparisons with external controls.

Methods:

We describe two potential biases resulting from calendar time and choice of time zero. We illustrate these biases using simulated data, emulating those from a single-arm trial of the effectiveness of blinatumomab in treating relapsed or refractory acute lymphoblastic leukemia on the outcome of mortality.

Results:

The trial compared 189 patients treated with blinatumomab with 1112 external historical control patients. First, calendar time was not concurrent, with the blinatumomab arm diagnosed during 2010–2014 and the control cohort during 1990–2013. The median survival under blinatumomab was 6.1 months compared with 3.3 months in the control arm, though for the latter it increased from 2.4 to 4.2 months over the 24-year period. Second, using the latest line of salvage treatment as cohort, entry for the control cohort introduces selection bias. The corresponding hazard ratio of death with blinatumomab compared with control was 0.56 (95% CI = 0.47, 0.67) but became 0.98 (95% CI = 0.83, 1.15) after redefining cohort entry by the matched line of salvage treatment rather than the latest line.

Conclusion:

While single-arm trials with external historical controls are gaining recognition, a proper understanding of time-related sources of bias is essential if such trials will be used to provide valid evidence for drug approval from regulatory agencies.
Time Since Infection and Risks of Future Disease for Individuals with Mycobacterium tuberculosis Infection in the United States
Authors: Menzies Nicolas A. , Swartwood Nicole , Testa Christian , Malyuta Yelena , Hill Andrew N. , Marks Suzanne M. , Cohen Ted , Salomon Joshua A.
Published: October 2020

Background:

Risk of tuberculosis (TB) declines over time since Mycobacterium tuberculosis infection, but progression to clinical disease is still possible decades later. In the United States, most TB cases result from the progression of latent TB infection acquired over 2 years ago.

Methods:

We synthesized evidence on TB natural history and incidence trends using a transmission-dynamic model. For the 2020 US population, we estimated average time since infection and annual, cumulative, and remaining lifetime risks of progression to TB, by nativity and age.

Results:

For a newly infected adult with no other risk factors for progression to TB, estimated rates of progression declined from 38 (95% uncertainty interval: 33, 46) to 0.38 (0.32, 0.45) per 1000 person–years between the first and 25th year since infection. Cumulative risk over 25 years from new infection was 7.9% (7.0, 8.9). In 2020, an estimated average age of individuals with prevalent infection was 62 (61, 63) for the US-born population, 55 (54, 55) for non-US-born, and 57 (56, 58) overall. Average risks of developing TB over the remaining lifetime were 1.2% (1.0, 1.4) for US-born, 2.2% (1.8, 2.6) for non-US-born, and 1.9% (1.6, 2.2) for the general population. Risk estimates were higher for younger age groups.

Conclusions:

Our analysis suggests that, although newly infected individuals face appreciable lifetime TB risks, most US individuals with latent TB infection were infected long ago, and face low future risks of developing TB. Better approaches are needed for identifying recently infected individuals and those with elevated progression risks.
Risk Factors for Contact Lens–Related Microbial Keratitis and Associated Vision Loss in a South Indian Population
Authors: Konda Nagaraju , Garg Prashant , Sharma Savitri , Willcox Mark D. P.
Published: October 2020

Objectives:

To identify risk factors associated with contact lens–related microbial keratitis (CL-MK) and subsequent vision loss in a south Indian population.

Methods:

A retrospective study of medical records at the LV Prasad Eye Institute in Hyderabad, India, of patients diagnosed with CL-MK and of controls who had no history of corneal inflammation during contact lens wear was undertaken. Variables such as demographic data, contact lens wear details, duration of the event, visual acuity, epithelial defect and infiltrate size, and microbiology of the cornea during the event were collected. Differences between cases and controls were analyzed using parametric and nonparametric tests. Logistic regression was used to calculate the odds ratio (OR) and associated 95% confidence intervals in univariate and multivariate analyses for cases vs. controls and for factors associated with vision loss.

Results:

One hundred sixty-seven cases of CL-MK and 153 controls were included in the analyses. Risk factors associated with the greatest increased OR for CL-related MK were: being in professional employment vs. a student (OR=3.9), disposing lenses yearly versus monthly or biweekly (OR=2.2), and any overnight wear (OR=2.8). Risk factors associated with vision loss were: high myopia (OR=3.6), severe vs. mild severity (OR=16.0), and hypopyon (OR=4.3).

Conclusions:

Identification of these risk factors may help inform safe contact lens wear habits and management strategies.
Clinical Outcome of Hybrid Contact Lenses in Keratoconus
Authors: Kloeck Dave , Koppen Carina , Kreps Elke O.
Published: October 2020

Objectives:

To report the clinical outcome of hybrid contact lens fitting in keratoconus.

Methods:

A retrospective chart review was performed of keratoconus patients who had been fitted with hybrid contact lenses in one or both eyes. Patients with a history of previous intraocular surgery (except for corneal crosslinking) and relevant concurrent ocular disease limiting visual outcome were excluded. The outcome data at 6-month follow-up included hybrid lens-corrected visual acuity, wearing time, and lens discontinuation.

Results:

Fifty-four keratoconus patients (102 eyes) were included. Mean visual acuity with habitual correction before hybrid lens fitting was 0.63±0.29 (decimal Snellen). Eyes were fitted with Eyebrid lenses (LCS Laboratories, Caen, France) and SynergEyes lenses (SynergEyes Inc., Carlsbad, CA). Refits were necessary in 13 eyes, because of poor fitting (76.9%) or suboptimal refraction (23.1%). Visual acuity had significantly improved with hybrid lenses (0.93±0.14; P<0.0001). In 37 eyes (37.8%), hybrid lens wear was discontinued within 6 months after lens fitting. Reported issues were discomfort in 27 eyes (73%), handling difficulties in 14 eyes (37.8%) and poor vision in 1 eye (2.7%). Success rate of lens fitting was significantly correlated to cone morphology (P=0.01).

Conclusions:

New generation hybrid lenses are an appropriate, safe therapeutic option for keratoconus patients. Excellent visual outcomes are achieved in successful fittings, yet a dropout rate of 37.8%—mainly occurring in sagging, more peripheral, cones - still limit their clinical success.
The Relationship Between Vision and Comfort in Contact Lens Wear
Authors: Diec Jennie , Naduvilath Thomas , Tilia Daniel , Bakaraju Ravi C.
Published: October 2020

Objective:

Understand relationship between vision and comfort in contact lens (CL) wear.

Methods:

Retrospective analysis of five trials using similar protocols with nonpresbyopic (NP) myopes or presbyopic participants (Px) wearing various simultaneous-image designs (SM) and single-vision (SV) CL (NP only). Questionnaires (vision satisfaction, vision clarity: distance/intermediate/near, comfort) on 1 to 10 scale were administered 1 week after fitting. Vision/comfort relationship was analyzed using linear mixed model and presented as regression coefficient with 95% confidence intervals (CIs).

Results:

Vision ratings correlated with comfort ratings, although this varied depending on type of vision rating and Px category. Vision satisfaction influenced comfort for the NP-SV group (slope: 0.8; 95% CI: 0.58–1.01, P≤0.001), but was significantly lower in the presbyopic group (slope: 0.38; 95% CI: 0.33–0.42; P≤0.001). Controlling for lens material obtained similar results. In the reverse relationship, comfort had a significant impact on vision satisfaction, although again at varying levels for each Px group. NP-SV demonstrated the weakest relationship (slope: 0.47; 95% CI: 0.35–0.59, P≤0.001) in comparison to NP-SM and P-SM groups.

Conclusion:

Vision and comfort in CL wear are inter-related. Consideration of Px characteristics, visual stimulus, and CL comfort needs to be accounted for when assessing overall CL experience.
Descemet Membrane Endothelial Keratoplasty in Toxic Anterior Segment Syndrome: A Case Series
Authors: Necip Kara , Oltulu Refik , Levent Dogan , Osman Gundogan Ali
Published: October 2020

Purpose:

To evaluate the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with toxic anterior segment syndrome (TASS).

Methods:

Thirteen eyes of 13 patients who underwent DMEK for endothelial decompensation secondary to TASS were retrospectively reviewed. A comprehensive ocular examination including best-corrected visual acuity (BCVA), slitlamp biomicroscopy, intraocular pressure measurement, fundus evaluation, and measurement of central corneal thickness were performed in all patients at preoperatively and postoperatively.

Results:

There were 8 men and 5 women, with an average age of 56 ± 19 years. The mean follow-up was 8.7 ± 3.5 months. The time interval between the onset of TASS and DMEK was 4.9.±6.6 months (range, 1.5–26 months). Twelve of 13 grafts were clear at last visit. The mean preoperative BCVA was 20/666 (range, hand motion to 20/200), and the mean BCVA was 20/36 (range, hand motion to 20/20) at the postoperative last visit (P = 0.003). The decrease in mean pachymetry from preoperative (768 ± 69 μm) to postoperative last visit (523 ± 71 μm) was statistically significant (P < 0.001).

Conclusions:

DMEK seems to be a safe and an effective treatment option in eyes with TASS-related endothelial decompensation.
Effect of Anticoagulant Therapy on the Outcome of Descemet Membrane Endothelial Keratoplasty
Authors: Loreck Niklas , Geries Carla , Schrittenlocher Silvia , Siebelmann Sebastian , Matthaei Mario , Bachmann Björn , Hayashi Takahiko , Cursiefen Claus
Published: October 2020

Purpose:

To analyze the effect of anticoagulant therapy (ACT) for systemic diseases on the outcome of Descemet membrane endothelial keratoplasty (DMEK).

Methods:

Consecutive eyes with Fuchs endothelial dystrophy that underwent DMEK between August 4, 2011, and July 15, 2016, were retrospectively analyzed. Data were obtained from the Cologne DMEK database at the University of Cologne, Germany. Best spectacle-corrected visual acuity (logMAR), endothelial cell density (at baseline and postoperatively up to 12 months), and rebubbling rates were compared between patients receiving ACT (ACT group) and those with no anticoagulant treatment (NCT group).

Results:

In this study, 329 eyes of 329 patients were included (ACT group n = 97, NCT group n = 232; mean age 69.9 ± 9.1 years). Bleeding was more common in the ACT group (P < 0.001). Preoperative best spectacle-corrected visual acuity was 0.59 ± 0.44 and 0.48 ± 0.35 logMAR for the ACT and NCT groups, respectively, which improved to 0.13 ± 0.08 and 0.08 ± 0.16 logMAR, respectively, at 12 months postoperatively. No significant difference in endothelial cell density loss at 12 months was found between the groups (ACT group 36.2% ± 14.7%, NCT group 38.5% ± 15.1%; P = 0.467). Rebubbling rate was 19.6% in the ACT group and 28.9% in the NCT group (P = 0.08).

Conclusions:

Although ACT increases the risk for preoperative and intraoperative bleeding in DMEK, there seems to be no negative effect on DMEK outcome. Thus, it is not advisable to stop ACT for DMEK surgery.
Use of Panel-Reactive Antibody Testing in the Planning and Management of Ocular Surface Stem Cell Transplantation
Authors: Jeffrey Joseph H. , Denny Matthew R. , Cheung Albert Y. , Sarnicola Enrica , Wright Elizabeth , Govil Amit , Holland Edward J.
Published: October 2020

Purpose:

Panel-reactive antibody (PRA) testing has been widely adopted in solid organ transplantation for risk assessment in potential allograft recipients but has not been studied in the context of ophthalmic transplantation. The purpose of this study is to evaluate outcomes in patients undergoing ocular surface stem cell transplantation (OSST) for limbal stem cell deficiency (LSCD) relative to preoperative PRA level.

Methods:

This is retrospective chart review of all eyes with documented PRA level that underwent OSST for LSCD between May 2000 and March 2019 at a single institution. Eyes with stable ocular surface but <1 year of follow-up and eyes without updated PRA before repeat OSST were excluded. Eyes were grouped by PRA <80% and ≥80%. The primary outcome was ocular surface failure, whereas the secondary outcome was clinical allograft rejection.

Results:

Sixty-nine surgeries met inclusion criteria, consisting of 54 living-related conjunctival limbal allografts, 5 keratolimbal allografts, and 10 combined living-related conjunctival limbal allografts/keratolimbal allografts (Cincinnati procedure). The most common etiologies for LSCD were aniridia (33%), chemical/thermal injury (28%), and contact lens associated (14%). Surface failure occurred in 5 of 12 eyes (58%) with PRA ≥80% versus 12 of 57 eyes (21%) with PRA <80% (P = 0.01). The relative risk for surface failure with PRA ≥80% was 2.8 [confidence interval (CI), 1.38–5.55]. There was no significant difference in acute rejection (P = 1).

Conclusions:

Pretransplant PRA level is an important prognostic factor for ocular surface stability in eyes undergoing OSST for LSCD, with implications for donor selection, perioperative management, and systemic immunosuppression.
Pilot Study of Videos to Deliver Mindfulness-Based Art Therapy for Adults With Multiple Sclerosis
Authors: Newland Pamela , Miller Rebecca , Bettencourt B. Ann , Hendricks-Ferguson Verna
Published: October 2020

BACKGROUND: Mindfulness-based art therapy (MBAT) has been shown to provide a strategy for adults with multiple sclerosis (MS) to self-manage their symptoms. There is a need for the use of an MBAT intervention that can be delivered in any setting for adults with MS. The purpose of this pilot feasibility study was to test the feasibility and acceptability of an MBAT intervention delivered via videoconference. METHODS: We developed an MBAT intervention to be delivered by videoconference to adults with MS recruited from an academic center registry. We also conducted phone interviews to collect acceptability data. RESULTS: Most of the participants (n = 5) were very positive about the MBAT video sessions and stated content as clear and easy to follow and understand. The time and delivering method were acceptable. CONCLUSION: Mindfulness-based art therapy sessions delivered through videoconference are acceptable and feasible for adults with MS.
Caregiver Burden and Associated Factors Among Informal Caregivers of Stroke Survivors
Authors: Achilike Saviour , Beauchamp Jennifer E. S. , Cron Stanley G. , Okpala Munachi , Payen Samuel S. , Baldridge Lyric , Okpala Nnedinma , Montiel Tahani Casameni , Varughese Tina , Love Mary , Fagundes Christopher , Savitz Sean , Sharrief Anjail
Published: October 2020

BACKGROUND: Informal caregiving of stroke survivors often begins with intensity compared with the linear caregiving trajectories in progressive conditions. Informal caregivers of stroke survivors are often inadequately prepared for their caregiving role, which can have detrimental effects on their well-being. A greater depth of understanding about caregiving burden is needed to identify caregivers in most need of intervention. The purpose of this study was to examine caregiver burden and associated factors among a cohort of informal caregivers of stroke survivors. METHODS: A cross-sectional study of 88 informal caregivers of stroke survivors was completed. Caregiver burden was determined with the Zarit Burden Interview, caregiver depressive symptoms were measured with the Patient Health Questionnaire-9, and stroke survivor functional disability was assessed with the Barthel Index. Ordinal logistic regression was used to identify independent factors associated with caregiver burden. RESULTS: Forty-three informal caregivers (49%) reported minimal or no caregiver burden, 30 (34%) reported mild to moderate caregiver burden, and 15 (17%) reported moderate to severe caregiver burden. Stroke survivor functional disability was associated with informal caregiver burden (P = .0387). The odds of having mild to moderate caregiver burden were 3.7 times higher for informal caregivers of stroke survivors with moderate to severe functional disability than for caregivers of stroke survivors with no functional disability. The presence of caregiver depressive symptoms was highly correlated with caregiver burden (P < .001). CONCLUSION: Caregivers of stroke survivors with functional disabilities and caregivers experiencing depressive symptoms may have severer caregiver burden. Trials of interventions aimed at decreasing informal caregiver burden should consider the potential impact of stroke survivors' functional disability and the presence of depressive symptoms.
“Mushroom” Autologous Partial Ossicular Replacement Prosthesis: Long-term Results
Authors: Malhotra Manu , Priya Madhu , Bhardwaj Abhishek , Tyagi Amit Kumar , Kumar Amit , Varshney Saurabh , Malhotra Rashmi
Published: October 2020

Objective:

Evaluate a new autologous mushroom-shaped cortical bone partial ossicular replacement prosthesis (MPORP) for cost-effective and sustainable hearing results.

Study Design:

Prospective study.

Setting:

Tertiary care center.

Patients:

Forty-two patients suffering from chronic otitis media with intact superstructure of the stapes and partially or completely eroded incus.

Interventions:

Group-1 (n = 24) underwent only tympanoplasty with MPORP; group-2 (n = 18) underwent intact canal wall mastoidectomy (ICW) with MPORP.

Main Outcome Measures:

Hearing results were evaluated using a four frequency average (measured at 0.5, 1, 2, 3 kHz) pure tone air conduction (PTA), air-bone gap (ABG), and word recognition scores (WRS) after 3, 6, and 12 months and compared with preoperative results.

Results:

Overall, successful rehabilitation of ABG to 20 dB or less was achieved in 92% of patients. Mean postoperative ABG was 15.35 ± 4.18 dB showing mean improvement of 23.89 ± 5.95 dB. In group-1, mean postoperative ABG was 18.47 ± 3.65 dB, showing an improvement of 25.92 ± 5.3 dB. In group-2, mean postoperative ABG was 18.47 ± 3.65 dB showing an improvement of 20.14 ± 4.96 dB. Hearing improvement in all the cases together and both the groups checked separately was statistically significant (paired t test, p < 0.001). Group 1 had, on average, 5 dB better hearing than group 2 (unpaired t test, p > 0.05).

Conclusion:

The MPORP is obtainable from the local site, easily constructed, bio-compatible, cost-effective, less bulky, adequately rigid for sound transmission, magnetic resonance imaging (MRI) compatible, and provides sustainable hearing gain because it has better chances of integration with the head of stapes.
Using Digital Storytelling to Reduce Unplanned Health Care Encounters
Authors: Lacey Susan R. , Craighead Debra V.
Published: October 2020

Background:

There is a growing body of literature establishing digital storytelling as an efficacious strategy to improve hypertension outcomes. The purpose of this nurse-led project was to explore the use of digital storytelling to reduce unplanned health care encounters and to determine whether the approach was feasible.

Problem:

Half of adults in the United States have hypertension. However, only 1 in 4 has his or her condition under control. In addition, the annual economic burden is more than $51 billion.

Approach:

Digital storytelling was employed with residents in northeast Louisiana. Videos of individuals with well-managed hypertension shared success stories with less well-managed individuals over a 16-month long program.

Outcomes:

The study found that 55 (93%) of listeners had no unplanned provider visits, 57 (94.9%) had no emergency department room visits, and 57 (94.9%) were not hospitalized over the study period.

Conclusions:

Digital storytelling reduced unplanned encounters, and the program was deemed feasible.
The Relationship Between Preoperative Feeding Exposures and Postoperative Outcomes in Infants With Congenital Heart Disease
Authors: Kataria-Hale Jasmeet , Cognata Acacia , Hagan Joseph , Zender Jill , Sheaks Paige , Osborne Scott , Roddy Jeramy , Hair Amy
Published: October 2020

Objectives:

To evaluate the association of preoperative risk factors and postoperative outcomes in infants with complex congenital heart disease.

Design:

Single-center retrospective cohort study.

Setting:

Neonatal ICU and cardiovascular ICU.

Patients:

Infants of all gestational ages, born at Texas Children’s Hospital between 2010 and 2016, with complex congenital heart disease requiring intervention prior to discharge.

Interventions:

None.

Measurements and Main Results:

A total of 399 patients were enrolled in the study. Preoperative risk factors included feeding, type of feeding, feeding route, and cardiac lesion. Postoperative outcomes included necrotizing enterocolitis, hospital length of stay, and days to full feeds. The occurrence rate of postoperative necrotizing enterocolitis (all stages) was 8%. Preoperative feeding, type of feeding, feeding route, and cardiac lesion were not associated with higher odds of postoperative necrotizing enterocolitis. Cardiac lesions with ductal-dependent systemic blood flow were associated with a hospital length of stay of 19.6 days longer than those with ductal-dependent pulmonary blood flow (p < 0.001) and 2.9 days longer to reach full feeds than those with ductal-dependent pulmonary blood flow (p < 0.001), after controlling for prematurity. Nasogastric feeding route preoperatively was associated with a length of stay of 29.8 days longer than those fed by mouth (p < 0.001) and 2.4 days longer to achieve full feeds (p < 0.001), after controlling for prematurity and cardiac lesion. Preoperative diet itself was not associated with significant change in length of stay or days to reach full feeds.

Conclusions:

Although cardiac lesions with ductal-dependent systemic blood flow are considered high risk and may increase length of stay and days to achieve full feeds, they are not associated with a higher risk of postoperative necrotizing enterocolitis. Nasogastric route is not associated with a significantly higher risk of necrotizing enterocolitis, but longer length of stay and days to reach full feeds. These findings challenge our perioperative management strategies in caring for these infants, as they may incur more hospital costs and resources without significant medical benefit.
Early Use of Antiseizure Medication in Mechanically Ventilated Traumatic Brain Injury Cases: A Retrospective Pediatric Health Information System Database Study
Authors: Haque Kelly D. , Grinspan Zachary M. , Mauer Elizabeth , Nellis Marianne E.
Published: October 2020

Objectives:

Traumatic brain injury is a leading cause of morbidity and mortality in children. Post-traumatic seizures occur in 25% of children with severe traumatic brain injury and may worsen outcomes. Our objective was to use a retrospective cohort study to examine the association between the early seizure occurrence and the choice of early antiseizure medication in children with traumatic brain injury.

Design:

Retrospective cohort study using the Pediatric Health Information Systems database, 2010–2017.

Setting:

Fifty-one U.S. children’s hospitals.

Patients:

Children (< 18 yr old at admission) with diagnostic codes for traumatic brain injury who were mechanically ventilated at the time of admission and with hospital length of stay greater than 24 hours.

Interventions:

None.

Measurements and Main Results:

A total of 3,479 children were identified via coding and including in the analysis. Patients receiving antiseizure medication starting day 0 with levetiracetam were compared with those receiving phenytoin. The outcome was seizure occurrence, identified using validated International Classification of Diseases, 9th Revision, Clinical Modification and International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. The median (interquartile range) age of patients was 4 (1–11) years, and the most common mechanism of injury was motor vehicle accident, occurring in 960 of patients (27%). A total of 2,342 patients (67%) received levetiracetam on day 0 and 1,137 patients (33%) received phenytoin on day 0. Totally 875 patients (37%) receiving levetiracetam on day 0 developed seizures, compared with 471 patients (41%) receiving phenytoin on day 0 (p = 0.02). Upon multivariable analysis adjusting for age, injury by child abuse, subdural hemorrhage, ethnicity, and admission year, children receiving phenytoin on day 0 were 1.26 (95% CI, 1.07–1.48) times more likely to be associated with post-traumatic seizure occurrence, compared with children receiving levetiracetam on day 0 (p = 0.01).

Conclusions:

Early administration of levetiracetam was associated with less-frequent seizure occurrence than early administration of phenytoin in mechanically ventilated children with traumatic brain injury. Additional studies are necessary to determine if the association is causal or due to unmeasured confounders and/or selection bias.
Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children
Authors: Murray Liza , Fickenscher Kristin , Moffatt Mary , Frazier Terra , Jackson Jami , Anderst Jim
Published: October 2020

Objectives

To evaluate the likelihood of abuse for various fractures, we aimed to compare the prevalence of concomitant suspicious injuries (CSIs) in subjects with fractures presumed to be low risk for abuse to those with non–low-risk fractures (aim 1) and to evaluate the prevalence of low-risk and non–low-risk fractures identified on skeletal survey (SS) (aim 2).

Methods

Subjects included toddlers 9 to 23 months of age presenting to a children's hospital system with a fracture and having an SS completed (aim 1) as well as those who had an SS completed for any concern for abuse (aim 2). For aim 1, we performed a 5-year retrospective case-control study. Low-risk fractures were defined as extremity buckle, clavicle, supracondylar, or toddler's fractures. Controls included moderate- and high-risk fracture groups. Groups were compared for the prevalence of CSIs. For aim 2, we described the frequencies of all fracture types identified by SS completed for any concern for abuse over the same period.

Results

For aim 1, there were 58 low-risk, 92 moderate-risk, and 8 high-risk fractures. The rates of CSIs were not significantly different between low- and moderate-risk fractures (odds ratio, 0.9; 95% confidence interval, 0.4–2.5), whereas half of high-risk fractures had CSIs. Forty-five subjects had an occult fracture on SS completed for any abuse concern. All low-risk fractures were identified by SS, most commonly buckle fractures (22.2% of cases).

Conclusions

Fractures presumed to be low risk for abuse in young, mobile children require consideration of abuse as a cause.