bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid-Induced Hyperalgesia, Tolerance, and Chronic Postsurgical Pain: A Dilemma Complicating Postoperative Pain Management
Authors: Elmofty Dalia H.
Published: May 2018

Perioperative pain management continues to be a challenge for physicians. Postoperative pain can compromise patient progress and lead to poor outcomes or chronic pain. Opioid medications, the mainstay of treatment for perioperative pain, can cause opioid-induced hyperalgesia and opioid tolerance. Attempts should be made to modify factors that increase the risk for chronic postsurgical pain. Certain patient factors and anesthetic and surgical techniques have been implicated. Incorporating multimodal methods for perioperative pain management using nonconventional opioids, such as methadone, cyclooxygenase inhibitors, NMDA antagonists, and regional techniques can improve outcomes and prevent opioid-induced hyperalgesia, opioid tolerance, and chronic postsurgical pain in patients on long-term opioid therapy.
Anticoagulation Regimens and Interventional Pain Procedures
Authors: Oryhan Christine , Vorenkamp Kevin , Warren Daniel
Published: May 2018

With the aging population and new anticoagulant medications, such as direct oral anticoagulants, being marketed in the United States, it is very important for pain physicians to be aware of the anticoagulants available and how they affect the safety of interventional pain procedures. In addition to anticoagulant and antiplatelet medications, other medications commonly used in the chronic pain population may put patients at increased risk of bleeding complications. Certain patient characteristics, particularly in the chronic pain population, may also increase a patient’s risk of bleeding. The chapter reviews common and emerging anticoagulant and antiplatelet medications and the ideal holding time before or after interventional pain procedures, particularly in the spine. The chapter also discusses the diagnosis, treatment, and outcomes of spinal epidural hematomas.
Perioperative Epidural Pain Management in Children
Authors: Lazar Alina
Published: May 2018

In adults, the postoperative benefits of epidural analgesia are well established, but in children the literature is sparse and controversy exists about the benefits, risks, ideal placement technique, and dosage of medication infused epidurally. Little is known about the neurotoxicity of various medications currently administered in the epidural space or the long-term consequences of epidural analgesia. The management of epidural analgesia in children is complicated by the narrow therapeutic window of epidural drugs, especially in neonates and young infants, and the difficulties of evaluating patients with developmental or cognitive limitations. When its indications are carefully chosen, and with meticulous care provided by all perioperative team members (anesthesiologists, surgeons, intensivists, and nurses), epidural analgesia remains a gold standard of postoperative pain management in children.
The Vasovagal Reflex and Neuraxial Techniques
Authors: Anitescu Magdalena , Shah Chirag
Published: May 2018

Syncope, or the transient loss of consciousness, is one of the leading causes of emergency department visits. Syncope can be neurally mediated, orthostatic, cardiac, or cerebrovascular. Neurally mediated vasovagal syncope is the most frequent form. Diagnostic modalities are tilt- table testing and implantable loop recorders. Therapeutic options usually begin with supportive measures, such as a fluid bolus or changing patient positioning, but complex cases may require vasoactive agents or placement of a pacemaker. In many situations patients who present to the operating room for various surgeries may suffer from asymptomatic neurally mediated syncope. Regional anesthetic techniques and interventional pain procedures can complicate syncope by superimposing sympathectomy.
Interscalene Catheters: Complications and Management
Authors: Aboumerhi Hassan , Malik Tariq M.
Published: May 2018

About 4.5 million people visit physicians for shoulder pain every year. Most shoulder surgeries are performed in an ambulatory setting and pain control can be problematic during the recovery period. Continuous interscalene block, which is quite effective for postprocedural pain relief, is not risk free. Some postprocedure concerns can be resolved easily over the phone, but others require additional examination, imaging, or even surgical intervention. Effective and safe management of a brachial plexus catheter requires a complete perioperative plan, open communication with the patient and family, and recognition and early treatment of complications. Also needed is a good working relationship between nurses, anesthesia care givers, and orthopedic surgeons.
Anticoagulation in Regional Anesthesia
Authors: Mardini Issam A. , Liu Jiabin , Elkassabany Nabil
Published: May 2018

Regional anesthesia and analgesia provide attractive options for patients undergoing major orthopedic procedures. The use of anticoagulation medications in the elderly patient population and in patients with cardiovascular risks is very common. The guidelines from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and other societies have been adopted widely over many years. The guidelines provide a basis for adequate delay intervals between dosing of medications and performing neuraxial or peripheral nerve blocks (PNBs), thus allowing for safer practice of regional anesthesia. Following guidelines never eliminates risk, but it allows balanced clinical practice by physicians in regard to the risks and benefits for individual patients.
Cognitive Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder
Authors: Sun Amanda , Wasser Tobias
Published: May 2018

This chapter provides a summary of a landmark study on anxiety disorders and the roles of psychotherapy and psychopharmacology in their treatment. When treating adults with panic disorder, is imipramine in combination with cognitive behavioral therapy more effective than monotherapy with either treatment alone? Furthermore, what is the durability and tolerability of their responses? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Suicide Risk in Bipolar Disorder
Authors: Katz Rachel , Beech Robert
Published: May 2018

This chapter provides a summary of a landmark study on bipolar disorder, tackling the serious issue of suicidality in this at-risk group of patients. Is there a difference in suicide risk for patients with bipolar disorder who are treated with lithium, divalproex, or carbamazepine? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant case that applies the findings from the study to a clinical scenario.
Predictors of Suicidal Events
Authors: Maksimowski Michael , Qayyum Zheala
Published: May 2018

This chapter provides a summary of a landmark study in child and adolescent psychiatry. Youths with a history of psychiatric illness are known to be at greater risk of suicide. What are the predictors of suicidal events and attempts in adolescents with a history of suicide attempts and depression? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. Several characteristics were identified that correlated with subsequent suicidal events. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Cognitive Behavior Therapy, Sertraline, and Their Combination for Children and Adolescents with OCD
Authors: Gilman Falisha , Qayyum Zheala
Published: May 2018

This chapter provides a summary of a landmark study in child and adolescent psychiatry. Is sertraline, cognitive behavioral treatment, or their combination more effective in the initial treatment of children and adolescents with clinically significant obsessive-compulsive disorder? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Initial Treatment of Bipolar I Disorder in Children and Adolescents
Authors: Ng Stephanie , Martin Andres
Published: May 2018

This chapter provides a summary of a landmark study in child and adolescent psychiatry. In medication-naïve children and adolescents with bipolar I disorder who have had a recent manic or mixed phase episode, should risperidone, lithium, or divalproex sodium be used for initial treatment? Also, for partial responders or nonresponders to the first medication, which agent should be added on or switched to? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Prevalence and Severity of Psychiatric Comorbidities
Authors: Yarnell Stephanie , Edens Ellen
Published: May 2018

Chapter 20—The Prevalence and Severity of Psychiatric Comorbidities provides a summary of a landmark study in epidemiology, the The National Comorbidity Survey Replication (NCS-R). This chapter study sought to answer some fundamental questions. How common are comorbid psychiatric conditions? What are the prevalence and severity rates for comorbid anxiety, mood, impulse control, and substance use disorders? Starting with these questions, this chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Efficacy and Safety of Electroconvulsive Therapy in Depressive Disorders
Authors: Taylor Joseph J. , Ostroff Robert
Published: May 2018

This chapter will summarize an important systematic review and meta-analysis. The authors of this study analyzed decades of evidence from thousands of patients in order to address fundamental questions about the safety and efficacy of electroconvulsive therapy for depressive symptoms. The data from this manuscript continue to inform clinical practice in regards to this stigmatized yet potentially life-saving treatment. The chapter will discuss the setup and implementation of the systematic review and meta-analysis before focusing on the results and their implications. The last section of the chapter will identify relevant studies and present a hypothetical clinical case that requires the reader to apply basic concepts learned from the systematic review and meta-analysis.
Sequenced Treatment Alternatives to Relieve Depression
Authors: Lin Eric , Ho Pochu
Published: May 2018

This chapter provides a summary of the landmark Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial on major depressive disorder. The STAR*D trial was designed to address some basic questions about depression treatment. What are the outcomes and the remission rates for depression? What are the long-term outcomes, especially the relapse rates, for patients receiving sequential depression therapies? Starting with these questions, this chapter describes the basics of the STAR*D trial, including funding, study location, study population, number of study participants, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. In addition, this chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Cognitive Therapy versus Medication in the Treatment of Moderate to Severe Depression
Authors: Barron Daniel , Ostroff Robert
Published: May 2018

This chapter provides a summary of a landmark study on major depressive disorder. Is paroxetine or cognitive therapy more effective in treating patients with moderate to severe major depressive disorder? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Exposure and Ritual Prevention, Clomipramine, or Their Combination for Obsessive-Compulsive Disorder
Authors: Kitay Brandon M. , Bloch Michael H.
Published: May 2018

This chapter provides a summary of a landmark study on the management of obsessive-compulsive disorder (OCD) in adults. Is the combination of exposure and ritual prevention (a cognitive behavior therapy based intervention) along with clomipramine more efficacious than monotherapy with either treatment for OCD? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study interventions, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications for clinical management, and concludes with an exemplary clinical case applying the evidence.
Psychotherapy for Borderline Personality Disorder
Authors: Grunwald David , Robinson Erica , Fineberg Sarah
Published: May 2018

This chapter provides a summary of a landmark study on borderline personality disorder. How does transference-focused psychotherapy, supportive therapy, and dialectical behavioral therapy compare in the treatment of borderline personality disorder? Starting with that question, the chapter describes the basics of this study, including funding sources, study location, who was studied, and how many patients participated in the study. The study design is described, as well as the study intervention, follow-up, endpoints, results, and finally a discussion of criticisms and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Dialectical Behavior Therapy versus Community Treatment by Experts for Reducing Suicidal Behaviors among Patients with Borderline Personality Disorder
Authors: Saunders David , Robinson Erica , Fineberg Sarah
Published: May 2018

This chapter provides a summary of a landmark study on borderline personality disorder. Is dialectical behavior therapy more effective than treatment offered by nonbehavioral psychotherapy experts in reducing suicidal behaviors and treating borderline personality disorder? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Ten-Year Course of Borderline Personality Disorder
Authors: Johnson Kevin , Robinson Erica , Fineberg Sarah
Published: May 2018

This chapter provides a summary of a landmark study on borderline personality disorder. What is the long-term prognosis of those with borderline personality disorder (BPD) compared to those with major depressive disorder or other personality disorders? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The findings show a favorable long-term prognosis that is comparable to that of other psychiatric disorders; 85% of those with BPS show at least 12-months of continuous remission after ten years. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Effectiveness of Antipsychotics in the Treatment of Schizophrenia
Authors: Lane Chadrick , Ranganathan Mohini
Published: May 2018

This chapter provides a summary of the landmark study Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). Phase 1 of CATIE evaluated whether there are measurable differences in effectiveness between antipsychotics (risperidone vs. olanzapine vs. ziprasidone vs. quetiapine vs. perphenazine) in the treatment of patients with schizophrenia. Starting with that question, the chapter describes the fundamentals of the study, including funding, study location, inclusion and exclusion criteria, how many participants were included, research design, interventions, follow-up, endpoints, outcomes, as well as criticisms and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Switching Antipsychotics to Reduce Metabolic Risk
Authors: Lin Eric , Cahill John
Published: May 2018

This chapter provides a summary of the landmark Comparison of Antipsychotics for Metabolic Problems trial on schizophrenia treatment. This trial was designed to help clarify some of the clinical considerations in choosing antipsychotics. Does switching to aripiprazole from olanzapine, quetiapine, or risperidone confer metabolic benefits? Does the switch to aripiprazole cause clinical destabilization? Starting with these questions, it describes the basics of the study, including funding, study location, study population characteristics, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Methadone Maintenance versus Detoxification and Psychosocial Treatment for Opioid Dependence
Authors: Hicks Hamilton , Muvvala Srinivas
Published: May 2018

This chapter provides a summary of a landmark study on substance use disorders. The study authors tackle a fundamental question in the treatment of opioid dependence. Should patients with opioid dependence be treated with methadone maintenance treatment or prolonged and psychosocially enriched methadone-assisted detoxification? Starting with that question, this chapter describes the basics of the study, including the funding source, study location, who was studied, number of study participants, study design, study interventions, follow-up, study endpoints, results, as well as criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Pregnancy Management
Authors: Mathiesen Amber , Roy Kali
Published: May 2018

This chapter describes a patient’s pregnancy options and subsequent care after a pregnancy becomes “high risk” due to a known genetic condition or birth defect. It reviews the reproductive options available, including continuation of pregnancy, adoption, and pregnancy termination. The timing of pregnancy termination is described, including methods used during the first and second trimesters, as well as later term. This chapter also reviews the possible management referrals that may be made if the patient chooses to continue the pregnancy, including perinatology, specialized imaging, cardiology, neonatology, fetal surgery and interventions, pediatric surgery, pediatric subspecialties, pathology, and palliative care. It also discusses referrals for further support.
Analgosedation and Neuromuscular Blockers
Authors: Wijdicks Eelco F. M. , Clark Sarah L.
Published: May 2018

Sedation is beneficial to many restless patients but it may prolong the length of stay in the intensive care unit, prolong time on the ventilator, and have negative effects on the cardiovascular system, causing hemodynamic instability. Use of neuromuscular blockers has decreased due to better awareness of the risks. These risks include prolonged intensive-care-unit–acquired weakness, prolonged mechanical ventilation, risk of patient awareness during paralysis, risk for venous thromboembolism, and anaphylaxis. It is therefore important to have a good knowledge of these drugs and when to use them. This chapter provides a rationale of how to use sedatives and neuromuscular blockers in neurocritically ill patients.
Antihypertensives and Antiarrhythmics
Authors: Wijdicks Eelco F. M. , Clark Sarah L.
Published: May 2018

Acute brain injury can precipitate a hypertensive response, which for the most part is the result of stress-induced, increased sympathetic activity. Acute stroke with hypertension may not be a response but more often a prior, untreated hypertension or a patient with no access to medication. This hypertensive response may wane quickly, and aggressive treatment of these temporary surges in blood pressure could have unwanted consequences. Important characteristics of most antihypertensive drugs used in the neurosciences intensive care unit are cost, having a rapid onset with a short duration of action, and having a low incidence of adverse side effects. Many of the antiarrhythmic drugs also have antihypertensive effects, so these drug classes are best combined in one chapter. This chapter discusses blood pressure targets, the most appropriate antihypertensive medications to use for acute management, and clinically relevant cardiac arrhythmias and their treatment.
Drugs Used to Prevent Complications
Authors: Wijdicks Eelco F. M. , Clark Sarah L.
Published: May 2018

Comprehensive neurosciences nursing care goes far in providing optimal support, but the acute immobilization and anticipated prolonged bed rest requires the use of prophylactic drugs. Many options relate to failure to move limbs, failure to breathe adequately and placement of intravenous catheters This chapter covers the more critical preventive measures.

Prevention of deep venous thrombosis, hyperglycemia, stress ulcers, ventilator-associated pneumonia, urinary tract infections, vascular access infections, ventriculitis, and post-craniotomy infections are discussed in this chapter. Pharmacists assist in effective stewardship and surveillance of critically ill patients by helping select the appropriate antibiotics, determining the need for drug levels, and initiating or stopping preventative medications.
Karl Kahlbaum
Authors: Shorter Edward , Fink Max
Published: May 2018

In 1874, Karl Kahlbaum, a German psychiatrist in an obscure private hospital, pulled various symptom pictures together into a single diagnosis: “catatonia.” Kahlbaum had earlier pioneered the modern classification of illness with his concepts of course and outcome as demarcating the various disease entities. He thought that, similar to neurosyphilis, catatonia had a common cause and common clinical course but, unlike neurosyphilis, often a relatively benign outcome. He believed the illness progressed in fixed stages. At the same time, Kahlbaum’s associate, Ewald Hecker, described madness in young people (“hebephrenia”), which became the forbearer of “schizophrenia.” Kahlbaum’s ideas were not immediately accepted: there was a core of true believers, but many psychiatrists in the Atlantic community did not readily take up the diagnosis and remained skeptical that Kahlbaum had done anything other than repackage familiar symptoms in a new and unfamiliar box.
Kidnapped!
Authors: Shorter Edward , Fink Max
Published: May 2018

Catatonia remained a subtype of schizophrenia for the next hundred years because a “Praetorian guard” around Kraepelin relentlessly flacked their teacher’s diagnoses. There was, to be sure, some initial support for Kahlbaum’s diagnosis as a separate entity, yet Kraepelin’s “textbook,” in its various editions, carried the day. Psychosis became the hallmark of schizophrenia, and catatonic patients who became psychotic simply had their diagnoses changed. In a world dominated by “schizophrenia,” catatonia was only of nodding interest. By the end of the Second World War, the term “schizophrenia” had lost whatever specificity it might once have possessed, and catatonia in schizophrenia had shed its distinctiveness as a treatable motor syndrome.
The Neuroleptic Malignant Syndrome
Authors: Shorter Edward , Fink Max
Published: May 2018

Reports of fatal febrile, hypertensive, tachycardic neurotoxic cases followed quickly on the introduction of potent new neuroleptic drugs in the 1970s. Patients became mute, rigid, posturing, and staring, showing the signs of catatonia. Labeled the neuroleptic malignant syndrome (NMS), attention was first given to neuroleptic blockade of dopamine receptors as the cause, but treatments with dopamine agonists (bromocriptine) and muscle relaxants (dantrolene) offered little benefit. When catatonia was recognized, treatments with benzodiazepines (lorazepam, diazepam) and induced seizures (electroshock, ECT) led to clinical relief and the saving of lives. The recognition of NMS as catatonia stimulated a revision of the century-long view of catatonia as a form of schizophrenia, with calls for catatonia to be considered independent of schizophrenia.
Catatonia in DSM-III and After
Authors: Shorter Edward , Fink Max
Published: May 2018

For almost a century, catatonia was considered only as a sign of schizophrenia and cases were classified as “schizophrenia, catatonic type,” as in DSM-III in 1980. Awareness that catatonia was an identifiable syndrome independent of schizophrenia and treatable with approaches not effective in relieving schizophrenia led to the development of rating scales to identify catatonia, benzodiazepine challenge tests to verify the diagnosis, and efficient protocols to successfully treat the syndrome. By 1994, in DSM-IV, catatonia was also identified as a syndrome secondary to a medical condition and assigned a unique identification number. By 2013, in DSM-5, the class of catatonic schizophrenia was deleted, and catatonia was recognized as an identifiable, verifiable, and treatable behavior syndrome.
New Faces of Catatonia?
Authors: Shorter Edward , Fink Max
Published: May 2018

Initially, the stuporous, excited (delirious mania), and febrile neurotoxic forms (neuroleptic malignant syndrome) of catatonia were recognized as distinctive. As catatonia became systematically defined by symptoms identified in lists of symptom rating scales, verified by benzodiazepine challenge tests, and validated by responses to treatments by benzodiazepines (lorazepam, diazepam) and electroconvulsive therapy (ECT), other syndromes met these criteria—anti-NMDAR encephalitis, self-injurious behavior (SIB), selective mutism, pervasive refusal syndrome, and akinetic mutism, among others. Such classification brought these syndromes within the catatonia variants, relieved by catatonia treatments. Such identification is feasible when clinicians consider the medical (Sydenham) model of diagnosis, the process of identification by symptoms, verification by objective tests, and validation by response to specific treatments.
Treatments of Catatonia
Authors: Shorter Edward , Fink Max
Published: May 2018

For the many varieties of catatonia, all medical ministrations were applied with little success until sodium Amytal (amobarbital) was shown to be specifically successful beginning in the 1930s. Induced seizures as treatments for psychoses in 1930s were also found to effectively relieve catatonia. These treatments were so successful, and the incidence of catatonia so reduced, that questions were raised whether and why catatonia had disappeared. By 1980s, the benzodiazepines were offered as replacements for barbiturates. The specificity of benzodiazepines in relieving up to 80 percent of catatonia cases, with ECT successful in the remainder, encouraged belief that catatonia was best seen as a unique systemic medical illness. Solving the puzzle of catatonia is one of medicine’s unheralded treatment triumphs.
Young people and transitional care in rheumatology
Authors: McDonagh Janet E. , Gleeson Helena
Published: May 2018

Young people are distinctly different from children and adults and as such require developmentally appropriate, youth-friendly rheumatology services to meet their medical and psychosocial needs. Adolescent development continues into the third decade of life and both influences and is affected by, health and illness (including rheumatic disease) during this time. Effective transitional care in rheumatology is underpinned by the core principles of adolescent medicine, self-management of long-term conditions, and a youth-friendly rheumatology service including staff trained in adolescent health.
Outcomes of paediatric rheumatic disease
Authors: Minden Kirsten
Published: May 2018

Paediatric rheumatic illnesses are among the most common chronic diseases in children and adolescents. These illnesses have important impacts on patient’s body functions and structures, activities, and social participation. Knowledge about the effect and consequences of these diseases is necessary to formulate appropriate aims of treatments. The multidimensional outcomes of paediatric rheumatic diseases and their measurement are reviewed in this chapter.
Outcome measurement is complex in patients who have growing needs and changing expectations as they develop, especially in chronic conditions that have a variable and often unpredictable course, such as juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis. Considerable work has been conducted recently in an effort to better define and value global outcomes for these patients. New and reliable outcome measures have been developed to capture all aspects of the patient’s life and integrate the patients’ perspective.
Existing outcome studies of paediatric rheumatic diseases have consistently shown, even though differing in their methodology, that patient outcomes have improved over the last decade. More patients with chronic inflammatory rheumatic conditions survive into adulthood, and patients’ long-term health, functional, and quality of life outcomes have improved. However, outcomes are still less than ideal. More than one-half of the patients with paediatric rheumatic diseases have ongoing active disease in early adulthood. Over one-third have evidence of disability and organ damage, with each underlying disease being associated with specific complications. Clearly, given the inherent potential for disability, morbidity, even mortality, young people with paediatric-onset rheumatic diseases require ongoing medical care into adulthood.
Genetics of juvenile rheumatic diseases
Authors: Hinks Anne , Thomson Wendy
Published: May 2018

Juvenile rheumatic diseases are heterogeneous, complex genetic diseases; to date only juvenile idiopathic arthritis (JIA) has been extensively studied in terms of identifying genetic risk factors. The MHC region is a well-established risk factor but in the last few years candidate gene and large-scale genome-wide association studies have been utilized in the search for non-HLA risk factors. There are now 17 JIA susceptibility loci which reach the genome-wide significance threshold for association and a further 7 regions with evidence for association in more than one study. In addition, some subtype-specific associations are emerging. These risk loci now need to be investigated further using fine-mapping strategies and then appropriate functional studies to show how the variant alters the gene function. This knowledge will not only lead to a better understanding of disease pathogenesis for juvenile rheumatic diseases but may also aid in the classification of these heterogeneous diseases. It may identify new pathways for potential therapeutic targets and help in the prediction of disease outcome and response to treatment.
Immunosuppressants
Authors: Ledingham Joanna , Westlake Sarah
Published: May 2018

A variety of immunosuppressants and disease-modifying anti-rheumatic drugs (DMARDs) with beneficial effects on inflammatory rheumatic diseases have been identified over the last 50 years. Their use for these conditions is now well established and has led to considerable improvements in disease management. Their use earlier in the inflammatory disease process and the use of combination therapies have also led to significantly improved patient outcomes.
This chapter provides an overview of the immunosuppressants and DMARDs used to treat rheumatic disease, focusing particularly on those in common use and with the best evidence for efficacy. The mechanism of action, toxicity, and clinical indications are outlined. Tips for practical prescribing and for monitoring for potential complications are also included.
Residual enhancing disease after surgery for glioblastoma: evaluation of practice in the United Kingdom
Authors: Ma Ruichong , Chari Aswin , Brennan Paul M , Alalade Andrew , Anderson Ian , Solth Anna , Marcus Hani J , Watts Colin ,   British Neurosurgical Trainee Research Collaborative, Kolias Angelos , Sinha Rohit , O’Neill Kevin , Paine Heidi , Rasul Fahid , Ashkan Keyoumars , Corns Robert , Jenkinson Michael , Kitchen Neil , Holliman Damian , Glancz Laurence , Aly Ahmed , Smith Stuart , Plaha Puneet , Dyson Edward , Toescu Sebastian , Haliasos Nick , Ghosh Arnab , McKintosh Edward , Rominiyi Olamide , Jellinek David , Gallagher Mat , Jones Tim , Wykes Victoria , Grundy Paul , Haq Imran , Brydon Howard
Published: May 2018

Background

A growing body of clinical data highlights the prognostic importance of achieving gross total resection (GTR) in patients with glioblastoma. The aim of this study was to determine nationwide practice and attitudes towards achieving GTR and dealing with residual enhancing disease.

Methods

The study was in 2 parts: an electronic questionnaire sent to United Kingdom neuro-oncology surgeons to assess surgical practice followed by a 3-month prospective, multicenter observational study of current neurosurgical oncology practice.

Results

Twenty-seven surgeons representing 22 neurosurgical units completed the questionnaire. Prospective data were collected for 113 patients from 15 neurosurgical units. GTR was deemed to be achieved at time of surgery in 82% (91/111) of cases, but in only 45% (36/80) on postoperative MRI. Residual enhancing disease was deemed operable in 16.3% (13/80) of cases, however, no patient underwent early repeat surgery for residual enhancing disease. The most commonly cited reason (38.5%, 5/13) was perceived lack of clinical benefit.

Conclusion

There is a subset of patients for whom GTR is thought possible, but not achieved at surgery. For these patients, early repeat resection may improve overall survival. Further prospective surgical research is required to better define the prognostic implications of GTR for residual enhancing disease and examine the potential benefit of this early re-intervention.
Relationships Among DNP and PhD Students After Implementing a Doctoral Student Organization
Authors: Travers Jasmine L. , Weis Marjorie , Merrill Jacqueline A.
Published: May 2018

BACKGROUND

Early career contact, between clinically focused DNP and research-focused PhD nursing students, may encourage desirable intradisciplinary synergies.

AIM

The aim of the study was to assess relationships among DNP and PhD nursing students after initiating a doctoral student organization.

METHOD

An online survey assessed student interaction pre- and post-doctoral student organization implementation. Analysis consisted of paired t-test, social network analysis, and content analysis methods.

RESULTS

Response rates were 72 percent (n = 86) and 60 percent (n = 72) before and after implementation. Network density and centralization increased by 17 percent and 3 percent, respectively; intradisciplinary ties increased by 39 percent. The average student had approximately two new relationships; clique membership increased by 60 percent. Narrative responses corroborated network measurements.

CONCLUSION

We documented additional integration and organized communication among students after this strategy to increase collaboration. Educators preparing nurses to work across research and practice may consider network analysis methods to evaluate their efforts.
Using Illness Perceptions to Cluster Chronic Pain Patients
Authors: Frostholm Lisbeth , Hornemann Christina , Ørnbøl Eva , Fink Per , Mehlsen Mimi
Published: May 2018

Objectives:

The aims of our study were (1) to identify possible subgroups of individuals with chronic pain based on their illness perceptions (IPs); (2) to examine whether these subgroups differed in health status and health expenditure; and (3) to examine whether the subgroups differed in their response to participation in a lay-led Chronic Pain Self-Management Program (CPSMP).

Materials and Methods:

Four hundred twenty-four participants in a randomized controlled trial on the CPSMP completed a questionnaire on their perceptions of their chronic pain condition at baseline. In addition, they completed a range of health status measures at baseline and 3 months after end of participation in the CPSMP. Health care expenditure was obtained from Danish health registers. We performed cluster analyses to identify possible subgroups based on the participants’ perceptions of their chronic pain condition.

Results:

Cluster analysis of IPs resulted in 3 meaningful clusters, classified as “distressed, certain cause,” “distressed, uncertain cause,” and “nondistressed, certain cause,” respectively. The 2 distressed groups had significantly higher scores on pain catastrophizing, illness worry, and emotional distress than did the nondistressed. Moderator analyses showed, that the “distressed, certain cause” had significant positive effect of participating in the CPSMP on pain catastrophizing and emotional distress, whereas the “distressed, uncertain cause” had a decrease and the “nondistressed, certain cause” an increase in primary health expenditure.

Discussion:

Clusters based on IPs meaningfully distinguished individuals with chronic pain on health measures and outcome of participating in the CPSMP, and may prove useful in future studies to understand responses to treatment.
Fathers' Stress in a Neonatal Intensive Care Unit
Authors: Noergaard Betty , Ammentorp Jette , Garne Ester , Fenger-Gron Jesper , Kofoed Poul-Erik
Published: May 2018

Background:

Healthcare professionals in neonatal intensive care units (NICUs) tend to focus attention on the mothers and the newborn infants. Thus, fathers may find it difficult to establish an optimal father–child relationship and their stress may increase and persist during hospitalization.

Purpose:

To investigate the impact of a more father-friendly NICU on paternal stress and their participation in childcare.

Methods:

A quasiexperimental design was conducted on Danish-speaking fathers of newborn infants 28 or more weeks' gestational age. The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) was used to measure paternal perceptions of stressors. Paternal participation in childcare was measured using 7 additional items. The questionnaires were distributed on admission to the NICU, at the 14th day of hospitalization, and at the time of discharge. The primary outcome was the difference in the PSS:NICU overall stress score on admission to the NICU and at the time of discharge in the control group compared with the intervention group.

Results:

A total of 109 fathers were included. The overall PSS:NICU stress score increased after the intervention. Paternal involvement, staff expectations, and the social expectation to fulfill the traditional role of a breadwinner and additionally of a caregiver may have caused increased stress.

Implications for Practice:

Healthcare professionals must be aware of the father's need to be an equal coparent. Nurses, as key persons, should motivate and expect fathers to be involved, and support them to establish a father–child relationship, although they might become more stressed.

Implications for Research:

More adequate outcome measures are needed to determine the effect of interventions on paternal stress.
Evidence Regarding the Use of Bubble Continuous Positive Airway Pressure in the Extremely Low Birth-Weight Infant
Authors: Alessi Samantha
Published: May 2018

Background:

Gentle ventilation with optimal oxygenation is integral to prevention of chronic lung disease in the extremely low birth-weight (ELBW) infant. Various types of noninvasive ventilation are used in neonatal intensive care units worldwide. Bubble continuous positive airway pressure (BCPAP) has been in use in newborn intensive care since 1975.

Purpose:

To synthesize the current evidence on the use of BCPAP in the ELBW infant and its relationship to outcomes, particularly morbidity and mortality.

Methods/Search Strategies:

A literature review was completed using PubMed, EMBASE, CINAHL, and Cochrane with a focus on BCPAP use in the ELBW population.

Findings/Results:

No study found was exclusive to the ELBW population. All studies ranged from ELBW to full-term neonates. Studies supported the use of BCPAP in the ELBW, demonstrating decreased incidence of chronic lung disease and barotrauma through the use of oscillation and permissive hypercapnia.

Implications for Practice:

Literature supports the use of nasal bubble CPAP in the ELBW population. Barriers such as septal erosion, pneumothorax, inconsistent pressures, and air in the abdomen were identified and management recommendations were provided.

Implications for Research:

Studies are needed comparing outcomes of nasal bubble CPAP use with other forms of CPAP in the ELBW infant, comparison of prongs to mask for nasal bubble CPAP, and comparing interventions to recommend optimal care bundles to prevent nasal septum injuries.
Effects of the Affordable Care Act on Young Women With Gynecologic Cancers
Authors: Smith Anna Jo Bodurtha , Fader Amanda N.
Published: May 2018

OBJECTIVE:

To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer.

METHODS:

We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I–II vs III–IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21–26 years vs women aged 27–35 years. We used the National Cancer Database with the 2004–2009 surveys as the pre-ACA years and the 2011–2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level.

RESULTS:

A total of 1,912 gynecologic cancer cases pre-ACA and 2,059 post-ACA were identified for women aged 21–26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27–35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI −4.0 to 0.1, P=.04) for young women aged 21–26 years vs women aged 27–35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4–6.9, P=.03) for women aged 21–26 years. Receipt of fertility-sparing treatment increased for women in both age groups post-ACA (P for trend=.004 for women aged 21–26 years and .001 for women aged 27–35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001).

CONCLUSIONS:

Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.
Trends in Place of Death Among Patients With Gynecologic Cancer in the United States
Authors: Hicks-Courant Katherine , Melamed Alexander , Worley Michael J. , Kim Young Bae , Schorge John O. , Rauh-Hain J. Alejandro
Published: May 2018

OBJECTIVE:

To describe the change over time in place of death (hospital, home, hospice) among all women in the United States who died of gynecologic malignancies and compare them with other leading causes of female cancer deaths.

METHODS:

This is a retrospective cross-sectional study using national death certificate data from the Mortality Multiple Cause-of-Death Public Use Record Data. All women who died from gynecologic, breast, lung, and colorectal cancers were identified according to International Classification of Diseases, 10th Revision, cause of death from 2003 to 2015. Regression analyses with ordinary least-squares linear probability modeling were used to test for differences in location of death over time, and differences in trends by cancer type, while controlling for age, race, ethnicity, marital status, and education status.

RESULTS:

From 2003 to 2015, 2,133,056 women died from gynecologic, lung, breast, and colorectal malignancies in the United States. A total of 359,340 died from gynecologic malignancies, including ovarian cancer (n=188,366 [52.4%]), uterine cancer (n=106,454 [29.6%]), cervical cancer (n=52,320 [14.6%]), and vulvar cancer (n=12,200 [3.4%]). Overall, 49.2% (n=176,657) of gynecologic cancer deaths occurred at home or in hospice. The relative increase from 2003 to 2015 in the rate of deaths at home or in hospice was 47.2% for gynecologic cancer deaths (40.5% in 2003 to 59.5% in 2015). In adjusted analyses, the trend in the percentage of deaths at home or in hospice increased at a rate of 1.6 percentage points per year for gynecologic cancer deaths (95% CI 1.5–1.6) vs 1.5 (95% CI 1.4–1.5, P<.001), 1.4 (95% CI 1.4–1.5, P<.001), and 1.5 (95% CI 1.4–1.5, P=.09) percentage points per year for lung, breast, and colorectal cancer deaths, respectively.

CONCLUSION:

Between 2003 and 2015, there was a 47.2% increase (40.5–59.5%) in the rates of gynecologic cancer deaths occurring at home or in hospice. This trend may represent an increase in advance care planning and value-based treatment decisions.