bluuebunny/crossref_metadata_2025 huggingface dataset:
Glaucoma Drainage Device Technique in a Cohort of Experienced Glaucoma Surgeons in Australia and New Zealand
Authors: Lee Graham A. , Craig Jamie E. , Liu Lance , Danesh-Meyer Helen V.
Published: September 2020

Précis:

Glaucoma drainage devices (GDD) by Australian and New Zealand glaucomatologists are implanted superotemporally under a peribulbar anesthesia without the use of mitomycin C. Intraluminal stents and tube fenestration are utilized and covered with a scleral graft.

Purpose:

To evaluate current practice patterns of surgical techniques for GDD among Australia and New Zealand Glaucoma Society members routinely performing GDD surgery.

Methods:

Survey of surgeons who performed more than 20 GDD in past 5 years.

Results:

Surgeon participation rate was 31/32 (96.8%). The most common surgical techniques were Baerveldt GDD (24/32, 77.4%), superotemporal placement (31/31, 100%), and peribulbar anesthesia (21/31, 67.7%). Mitomycin C antimetabolite was used routinely by 9/31 surgeons (29.0%). Most surgeons employed intraluminal stents (23/31, 74.2%) with tube fenestrations (19/31, 61.3%). GDD was placed behind the recti muscles (27/31, 87.1%) and secured with nylon (8/0, 9/0 or 10/0) by 29/31 (93.6%). Most common sclerostomy techniques for tube insertion was a 23-G needle passed ab externo (18/31, 58.1%). Tube placement was in the sulcus (11/31, 35.5%) for pseudophakic patients. The external portion of the tube was most commonly covered with a full-thickness scleral patch graft (21/31, 67.7%). Majority of surgeons (21/31, 67.7%) reviewed patients 3 to 4 times in the first month.

Conclusions:

Although a wide range of practice patterns for GDD implantation exists among Australia and New Zealand Glaucoma Society surgeons, there are consistent techniques currently in use to optimize patient outcomes. This report can help surgeons seeking to improve outcomes and minimize complications when trialing the different surgical options.
Peripheral Facial Nerve Palsy in Children With Enterovirus Infection
Authors: Papan Cihan , Keeren Kathrin , Schroten Horst , Tenenbaum Tobias
Published: September 2020

Enteroviruses are one of the leading causes of central nervous system infections, but their causative role in peripheral facial nerve palsy is unresolved. We used data from a large national Enterovirus Surveillance Database to identify cases of facial nerve palsy, showing a rate of 3.8% of patients with facial nerve palsy to have enterovirus infection.
Immune Response Persistence and Safety of a Booster Dose of the Tetravalent Dengue Vaccine in Adolescents and Adults Who Previously Completed the 3-dose Schedule 4–5 Years Earlier in Latin America
Authors: Coronel Diana , García-Rivera Enid J. , Rivera Doris Maribel , Arredondo-García José Luis , Dietze Reynaldo , Perroud Ana Paula , Cortés Margarita , Bonaparte Matthew , Wang Hao , Pagnon Anke , Jantet-Blaudez Frédérique , Peñalosa Luis Andrey Rojas , Dayan Gustavo , Zambrano Betzana , DiazGranados Carlos A. , Noriega Fernando
Published: September 2020

Background:

We previously described an increased immune response 28 days after a booster dose of the live, attenuated, tetravalent dengue vaccine (CYD-TDV) in healthy adolescents and adults in Latin America (CYD64, NCT02623725). This follow-up study evaluated immune response persistence and safety of a CYD-TDV booster dose up to Month (M) 24 post-booster.

Methods:

This study included 250 participants who previously received 3 primary doses of CYD-TDV in the CYD13 (NCT00993447) and CYD30 (NCT01187433) studies, and who were randomized 4–5 years later to receive a CYD-TDV booster or placebo (3:1). Dengue neutralizing antibodies against the parental dengue virus strains were assessed using the plaque reduction neutralization test (PRNT50) at M6, M12, and M24 post-booster. Post-booster memory B-cell responses were assessed in a subset of participants using the FluoroSpot assay up to M12 post-booster.

Results:

In the CYD-TDV group (n = 187), dengue neutralizing antibody geometric mean titers (GMTs) declined from the peak at day 28 through to M24 for all serotypes. GMTs at M24 were similar to those at pre-booster among baseline dengue seropositives. A similar trend was observed for baseline dengue seronegatives, albeit at a lower magnitude. Previous vaccination-induced detectable B-cell memory responses in seropositives and seronegatives that decreased to pre-booster levels at M12 post-booster. The CYD-TDV booster dose was well-tolerated.

Conclusions:

In baseline dengue seropositives, following a CYD-TDV booster dose administered 4–5 years after primary immunization, dengue neutralizing antibody GMTs and B-cell memory responses peaked in the short-term before gradually decreasing over time. A CYD-TDV booster dose could improve protection against dengue during outbreak periods.
Multisystem Inflammatory Syndrome Associated With COVID-19 With Neurologic Manifestations in a Child: A Brief Report
Authors: De Paulis Milena , Oliveira Danielle Bruna Leal , Vieira Rodolfo P. , Pinto Isabella Coutinho , Machado Rafael Rahal Guaragna , Cavalcanti Mariana Pauferro , Soares Camila Pereira , de Araujo Ananda Medeiros Pereira , Araujo Danielle Bastos , Bachi Andre Luis Lacerda , Leal Fabyano Bruno , Dorlass Erick Gustavo , Gilio Alfredo Elias , Durigon Edison Luiz , Barreira Eliane Roseli
Published: September 2020

Although first considered a benign infection, recent studies have disclosed severe and potentially lethal inflammatory manifestations of COVID-19 in children. We report the case of a 4-year-old child with a post-infectious multisystem inflammatory syndrome associated with COVID-19, with a Kawasaki-like shock and prominent neurologic features, for whom a cytokine storm and reduced brain-derived neurotrophic factor were well documented.
Rhabdomyolysis and Acute Kidney Injury as Leading COVID-19 Presentation in an Adolescent
Authors: Tram Nathalie , Chiodini Benedetta , Montesinos Isabel , Vicinanza Alfredo , Beretta-Piccoli Xavier , Gubbelmans Natacha , Demey Milena , Genis Nathalie , Tilmanne Anne , Smeesters Pierre R. , Ismaili Khalid
Published: September 2020

Severe acute respiratory syndrome coronavirus 2, the virus responsible of the current COVID-19 pandemic, has limited impact in the pediatric population. Children are often asymptomatic or present mild flu-like symptoms. We report the case of a COVID-19-infected adolescent presenting severe rhabdomyolysis and acute kidney injury without any fever or respiratory symptoms.
Better Together? An Examination of the Relationship Between Acute Care Hospital Mergers and Patient Experience
Authors: Attebery Timothy , Hearld Larry R. , Carroll Nathan , Szychowski Jeff , Weech-Maldonado Robert
Published: September 2020

EXECUTIVE SUMMARY

The United States is experiencing another wave of hospital mergers. Whether patients benefit from these mergers, however, remains an open issue for many interested stakeholders. One measure of the potential benefit of hospital mergers is how they affect patient experience. This study used a quasi-experimental design to examine the relationship between hospital mergers and four different Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (i.e., overall, physician communication, nurse communication, and staff responsiveness). The study findings showed an association between hospitals that experienced a merger and slower growth in HCAHPS scores for two of the four HCAHPS domains (overall and nurse communication) when compared to matching hospitals that did not merge. Findings from this study can guide and inform hospital administrators, health system boards, state and federal government regulators and policymakers, and others across the spectrum of healthcare stakeholders.
The Relationship Between “Leader in LGBT Healthcare Equality” Designation and Hospitals’ Patient Experience Scores
Authors: DiLeo Rita , Borkowski Nancy , O’Connor Stephen J. , Datti Paul , Weech-Maldonado Robert
Published: September 2020

EXECUTIVE SUMMARY

An increasing number of lesbian, gay, bisexual, and transgender (LGBT) individuals openly acknowledge their identity; however, the fear of discrimination prevents many from seeking healthcare—an issue challenged by a lack of culturally competent LGBT healthcare providers. With more than 4% of American adults identifying as LGBT individuals, greater attention to their needs is imperative to improve care and access for this population. This study examined organizational and market factors associated with hospitals achieving the “Leader in LGBT Healthcare Equality” (Healthcare Equality Index, HEI; HEI Leader) designation and reported patient experience scores. We found that system-affiliated hospitals have 4.16 greater odds and teaching hospitals have 2.86 greater odds of earning the HEI Leader designation compared to nonsystem and nonteaching hospitals, respectively. Governmental hospitals have 2.47 greater odds of achieving HEI Leader status, while for-profit hospitals have 86% lower odds of having HEI Leader status compared to not-for-profit hospitals. Hospitals located in a metropolitan area have 3.19 greater odds of being an HEI Leader. The percentage of minorities and per capita income in a county also demonstrated a positive association with being an HEI Leader, with odds ratios of 1.00 and 1.02, respectively, while lower education was associated with 4% lower odds of being an HEI Leader. The main finding of this study was that HEI Leader-designated hospitals reported significantly higher overall hospital rating patient experience scores (B = 1.785; p ≤ .001) as compared to non-HEI Leader hospitals. As such, participation in the HEI may be viewed as a motivation for hospitals attaining HEI Leader designation.
Monitoring early stage lung disease in cystic fibrosis
Authors: Nissenbaum Claire , Davies Gwyneth , Horsley Alexander , Davies Jane C.
Published: September 2020

Purpose of review

Early stage lung disease has long been synonymous with infancy and childhood. As diagnosis happens earlier and conventional management improves, we are seeing larger proportions of people with cystic fibrosis (CF) in adolescence and even adulthood with well preserved lung health. The availability of highly effective cystic fibrosis transmembrane conductance regulator modulator drugs for a large proportion of the CF population will impact even further. Transitioning into adult care with ‘normal’ lung function will become more common. However, it is crucial that we are not blasé about this phase, which sets the scene for future lung health. It is well recognized that lung function assessed by spirometry is insensitive to ‘early’ changes occurring in the distal, small airways. Much of our learning has come from studies in infants and young children, which have allowed assessment and optimization of alternative forms of monitoring.

Recent findings

Here, as a group of paediatric and adult CF specialists, we review the evidence base for sensitive physiological testing based on multibreath washout, lung imaging, exercise and activity monitoring, assessment of infection and quality of life measures.

We seek to emphasise the importance of further work in these areas, as outcome measures become widely applicable to a growing CF population.
Opioids and sleep
Authors: Cutrufello Nicholas J. , Ianus Vlad D. , Rowley James A.
Published: September 2020

Purpose of review

Summarize the effects of opioids on sleep including sleep architecture, sleep disordered breathing (SDB) and restless legs syndrome.

Recent findings

Opioids are associated with the development of central sleep apnea (CSA) and ataxic breathing. Recent reports suggest that adaptive servo-ventilation may be an effective treatment for CSA associated with opioids.

Opioids have multiple effects on sleep, sleep architecture and SDB. Although originally described with methadone use, most commonly used opioids have also been shown to affect sleep. In patients on chronic methadone, sleep architecture changes include decreases in N3 and REM sleep. However, in patients with chronic nonmalignant pain, opioids improve sleep quality and sleep time. Opioids, generally at a morphine equivalent dose more than 100 mg/day, are associated with an increased incidence of CSA and ataxic breathing as well as obstructive sleep apnea. Other risk factors may include concomitant use of other medications such as antidepressants, gabapentinoids and benzodiazepines. Opioid-induced CSA can be potentially treated with adaptive servo-ventilation. Finally, opioids are a potential therapeutic option for restless legs syndrome unresponsive to dopamine agonists and other medications. However, use in patients with restless legs syndrome should proceed with caution, taking into account the risk for dependence and development of SDB.
Synergic role of preoperative 18F-fluorodeoxyglucose PET and MRI parameters in predicting histopathological features of endometrial cancer
Authors: Mapelli Paola , Ironi Gabriele , Bergamini Alice , Mangili Giorgia , Rancoita Paola MV , Taccagni Gian Luca , Venturini Elena , Petrone Micaela , Nisi Valerio , Fallanca Federico , De Marzi Patrizia , Colarieti Anna , Candotti Giorgio , Bocciolone Luca , Candiani Massimo , Gianolli Luigi , Picchio Maria , De Cobelli Francesco
Published: September 2020

Background

The aim of the present study is to explore the correlation between PET and MRI parameters of primary tumour and clinicopathological features and to determine their synergic predictive role in patients with endometrial cancer candidate to surgery.

Methods

Retrospective study including 27 patients with endometrial cancer and preoperative 18F-fluorodeoxyglucose (18F-FDG)-PET and MRI scan. The following parameters, calculated on the primary tumour, were used for analysis: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) for PET scans; mean apparent diffusion coefficient (ADCmean) and volume index for MRI scans. FIGO stage, grade, histotype, lymphovascular space invasion (LVSI) and myometrial invasion were the considered clinicopathological features.

Results

MRI volume index was a good predictor for deep myometrial invasion [area under the curve (AUC) = 0.85; P = 0.003] and for LVSI (AUC = 0.74; P = 0.039). A cutoff value of 9.555 for MRI volume index was predictive for deep myometrial invasion (sensitivity = 84.6%; specificity = 76.9%); a cutoff of 12.165 was predictive for LVSI (sensitivity = 69.2%; specificity = 83.3%). A TLG cutoff value of 26.03 was predictive for deep myometrial invasion (sensitivity = 84.6%; specificity = 76.9%). A high-direct correlation was found with MRI volume index (rho = 0.722; P < 0.001); low-direct correlation with SUVmax (rho = 0.484; P = 0.012), SUVmean (rho = 0.47; P = 0.015) and TLG (rho = 0.482; P = 0.013) were identified. The SUVmax/ADCmean ratio showed a low-direct correlation with percentage of myometrial invasion (rho = 0.467; P = 0.016).

Conclusion

Volume index, TLG and SUVmax/ADCmean ratio are associated with deep myometrial invasion. As myometrial invasion is the index used to predict lymph node involvement in endometrial cancer, the synergic use of these imaging parameters may be suggested to predict lymphnodal metastases.
Renography with a semiautomated algorithm for diuretic decision 7 min postradiopharmaceutical administration: a feasibility study
Authors: Bäck Anna-Karin , Savvopoulos Christos , Kero Tanja , Grybäck Per , Geijer Håkan
Published: September 2020

Objective

The F+10 method for diuretic renography (diuretics given 10 min after the radiopharmaceutical) could be a time-conserving method. This method involves a 30-min dynamic acquisition where diuretics are administered only when necessary by the Nuclear Medicine technologist performing the examination. The purpose of this study was to assess the method’s performance and to discover the optimal threshold of residual activity for a diuretic administration 7 min into the F+10 renography by reprocessing raw data from prior performed examinations with 20-min acquisitions without diuretics.

Methods

Retrospectively, raw data from 320 original examinations of adult patients performed from 2013 to 2015 were reprocessed into 7-min series and categorized as requiring diuretic or not. The diuretic decisions made by an expert panel were used as a reference. A receiver-operating characteristic curve was drawn to assess the optimal cutoff value for the residual renal activity. Sensitivity, specificity, positive and negative predictive values, as well as the Youden J index were calculated.

Result

The experts classified 50% (160 examinations) as in need of diuretics. The receiver-operating characteristic curve demonstrated the theoretical optimal cutoff value at 7 min to be 94% of maximum activity (sensitivity 0.93, specificity 0.81, Youden J index 0.73). A clinically acceptable threshold is suggested to be 85% (sensitivity 0.99, specificity 0.59, Youden J index 0.58).

Conclusion

99mTc-mercaptoacetyltriglycine renography with the F+10 method and the threshold 85% for diuretic decision 7 min into the renography is a feasible and acceptable method in clinical practice.
Management and evaluation of sodium [131I] iodide contamination after oral administration
Authors: Labbe Elise , Peyronnet Damien , Desmonts Cédric , Vigne Jonathan
Published: September 2020

Radioiodine therapy using oral administration of Iodine-131 (131I) is a widespread employed strategy for the treatment of hyperthyroidism and thyroid cancer. Such a therapy requires well-trained staff, equipment and procedures regarding radiation safety. The aims of this work are to report an incidental experience of radioprotection with a 370 MBq sodium [131I] iodide capsule, which arose following vomiting one minute after the oral administration in a nuclear medicine department and assessment of capsule leakage in a stomach like environment by in vitro experiment. Measurements of the radiation dose rate at the different steps of the decontamination procedure were performed and management of the situation described. Dose rate in vomit was 113 µSv/h [directional dose equivalent H’(0.07)] after capsule withdrawal and was decreased by 10 times after the first decontamination attempt. To evaluate the 131I release following administration to the patient, an in vitro experiment was designed to recap capsules degradation in a stomach like environment including acidic solution (pH 1) and temperature at 35–37°c. A significant release of 131I (<6%) was observed in the first 2 min of the in vitro experiment. Sodium [131I] iodide capsules disruption occurred at 150 s for capsule 1 and 133 s for capsule 2. Incidental contamination with 131I in the clinics is of important concern in nuclear medicine and precautions that allow optimization and pertinent management of the situation should be known by the nuclear medicine and radioprotection community.
Preliminary evaluation of 18F-FDG-PET/MRI for differentiation of serous from nonserous pancreatic cystic neoplasms: a pilot study
Authors: Sagheb Soodeh , Metser Ur , Razaz Suzan , Menezes Ravi , Gallinger Steven , Jhaveri Kartik S.
Published: September 2020

Objectives

The aim of the study was to evaluate preliminary feasibility of 18F-FDG-PET/MRI in differentiation of pancreatic serous cystic neoplasms (SCNs) from non-SCNs.

Methods

From August 2017 to June 2019, 10 patients (3 men, 7 women; mean age, 63 years) previously diagnosed with pancreatic cystic neoplasm underwent simultaneous 18F-FDG-PET/MRI prospectively on an integrated 3-Tesla hybrid PET/MRI scanner. PET images were analyzed visually and semiquantitatively measuring standardized uptake values (SUV) including lesion SUVmax and SUVmean, lesion to pancreas and lesion to liver SUVmax and SUVmean ratio independent of MRI diagnosis. The reference standard for lesion diagnosis was by MRI features and interval follow-up.

Results

Visual assessment of PET images demonstrated uptake in 57% of SCNs. Lesion to liver SUVmax ratio of ≥0.5 showed the highest accuracy (90%) and area under the curve (0.9) followed by lesion SUVmax of ≥1.6 and lesion to pancreas SUVmax ratio of ≥0.77 for diagnosis of SCN. The sensitivity for lesion SUVmax of ≥1.6 was less than two other ones (71 versus 100%). All non-SCNs exhibited SUVmax value less than 1.6 while 33 and 66% demonstrated lesion to liver SUVmax ratio of >0.5 and lesion to pancreas SUVmax ratio of >0.77, respectively. PET/MRI specificity was 67, 100, 67 and 33% through lesion to liver SUVmax ratio, lesion SUVmax, lesion SUVmean and lesion to pancreas SUVmax ratio, respectively, for diagnosis of SCN.

Conclusion

Preliminary results show that PET/MRI utilization is promising for differentiation of pancreatic SCN from non-SCN lesions. This could reduce need for surveillance imaging or avoidance of unnecessary intervention in pancreatic cystic neoplasms with uncertain diagnoses.
A review of thulium-fiber laser in stone lithotripsy and soft tissue surgery
Authors: Enikeev Dmitry , Traxer Olivier , Taratkin Mark , Okhunov Zhamshid , Shariat Shahrokh
Published: September 2020

Purpose of review

To evaluate emerging evidence and practical applications of thulium-fiber laser (TFL) for genitourinary soft tissue disease and urinary stone disease treatment.

Recent findings

A systematic review was developed using the PubMed, ScienceDirect, Wiley, SpringerLink and Mary Ann Liebert Scopus databases between 2012 and 2020 years, using the PRISMA statement. We analyzed recent publications including in vitro and in humans outcomes of surgery using TFL. This new laser technology can be used in soft tissue diseases and stones present in the genitourinary system. Most of the comparisons are made with the Ho:YAG laser, using completely different settings. Nevertheless, TFL is safe, feasible and effective in the management of urologic diseases, showing superiority to Ho:YAG even in some studies.

The introduction of pulsed TFL technology has enabled the ablation of stones at rates comparable to or better than currently existing lasers in vitro, while also potentially reducing stone retropulsion. TFL is effective in treating genitourinary soft tissue diseases, including benign prostatic hyperplasia, and early data indicate that it may be effective in the treatment of urinary stone disease. More clinical studies are needed to better understand the indications for this novel technology and clarify its position in the urologic endoscopy armamentarium.
Machine learning in the optimization of robotics in the operative field
Authors: Ma Runzhuo , Vanstrum Erik B. , Lee Ryan , Chen Jian , Hung Andrew J.
Published: September 2020

Purpose of review

The increasing use of robotics in urologic surgery facilitates collection of ‘big data’. Machine learning enables computers to infer patterns from large datasets. This review aims to highlight recent findings and applications of machine learning in robotic-assisted urologic surgery.

Recent findings

Machine learning has been used in surgical performance assessment and skill training, surgical candidate selection, and autonomous surgery. Autonomous segmentation and classification of surgical data have been explored, which serves as the stepping-stone for providing real-time surgical assessment and ultimately, improve surgical safety and quality. Predictive machine learning models have been created to guide appropriate surgical candidate selection, whereas intraoperative machine learning algorithms have been designed to provide 3-D augmented reality and real-time surgical margin checks. Reinforcement-learning strategies have been utilized in autonomous robotic surgery, and the combination of expert demonstrations and trial-and-error learning by the robot itself is a promising approach towards autonomy.

Robot-assisted urologic surgery coupled with machine learning is a burgeoning area of study that demonstrates exciting potential. However, further validation and clinical trials are required to ensure the safety and efficacy of incorporating machine learning into surgical practice.
Relationship Between Symptomatic Dimensions and Global Functioning of Non–Help-Seeking Individuals at Risk for Psychosis
Authors: Ayoub Ibrahim Ali , Andrade Julio Cesar , Serpa Mauricio Henriques , Alves Tania Maria , Hortêncio Lucas , Freitas Elder Lanzani , van de Bilt Martinus Theodorus , Rössler Wulf , Gattaz Wagner Farid , Loch Alexandre Andrade
Published: September 2020

This study aims to analyze the relationship between the symptomatic dimensions of psychosis and functioning of individuals at risk for psychosis (ultrahigh risk [UHR]) in a non–help-seeking UHR sample from the general population. The sample is the same as the one used in the Brazilian Subclinical Symptoms and Prodromal Psychosis cohort study. We applied questionnaires of functioning (Global Assessment of Functioning Scale) and symptomatic dimensions (Scale of Prodromal Symptoms). Next, we correlated the symptomatic dimensions with functioning. We found a significant relationship between avolition and uncommon thought content with poor functioning, whereas the remaining symptoms were not as relevant. Poor functioning was most related to avolition, a negative symptom, followed by unusual thought content, a positive symptom.
Short-Term Outcomes following Virtual Surgery–Assisted Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction
Authors: Allen Robert J. , Nelson Jonas A. , Polanco Thais O. , Shamsunder Meghana G. , Ganly Ian , Boyle Jay , Rosen Evan , Matros Evan
Published: September 2020

Background:

Despite reports demonstrating feasibility of immediate dental implant placement in mandibular reconstruction with free fibula flaps for benign disease, this practice is not routinely used in the oncologic setting. The authors aim to demonstrate the safety of immediate dental implant placement for oncologic mandible reconstruction.

Methods:

In 2017, the authors’ center began immediate dental implant placement in free fibula flaps for oncologic patients undergoing mandibulectomy reconstruction. Immediate dental implant placement patients were compared to a historical cohort also reconstructed with computer-aided design and manufacturing technology beginning in 2011 (n = 34) as a noninferiority study design. Primary outcomes of interest included 90-day complications, time to radiotherapy, and time to and number of patients achieving dental restoration.

Results:

Sixty-one patients underwent free fibula flaps following mandibulectomy using computer-aided design and manufacturing. Seventy-two dental implants were placed in the immediate dental implant placement cohort (n = 27). No differences were noted in major or minor 90-day complications between groups (p > 0.05). Radiotherapy was required in 55 percent in the immediate dental implant placement cohort versus 62 percent in the historical cohort, with no significant difference in time to radiotherapy (67.6 days versus 62.2 days, respectively). One dental implant was removed for nonosseointegration noted during vestibuloplasty. Fourteen (51.8 percent) immediate dental implant patients had complete dental restoration at 90 days compared with none in the historical cohort (p < 0.05).

Conclusions:

Immediate dental implant placement is a safe procedure with an unchanged short-term complication profile and no delay in radiotherapy initiation. Patients undergoing immediate dental implant placement are more likely to complete full dental rehabilitation. Long-term and health-related quality-of-life outcomes remain to be determined.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Patient Misidentification Events in the Veterans Health Administration: A Comprehensive Review in the Context of High-Reliability Health Care
Authors: Kulju Stephen , Morrish Wendy , King Lori , Bender John , Gunnar William
Published: September 2020

Objectives

The Veterans Health Administration maintains national patient safety event reporting and root cause analysis (RCA) databases. These were reviewed to understand the prevalence of and provide insight into patient misidentification. The results were compared with a high-reliability health care framework.

Methods

We reviewed patient safety reports and RCA reports to identify and categorize patient identification–related events from October 1, 2016, to September 30, 2018. We analyzed 3232 patient safety reports and 67 RCAs, aggregated the findings, and compared them against The Joint Commission’s High Reliability Health Care Maturity Model.

Results

Patient misidentification occurred in both inpatient and outpatient settings, for which the ratio of adverse events to close calls was similar. The ratio of adverse events to close calls varied for specific care areas. The most common RCA event characteristic was Two identifiers not used (39%). The most common failure mode was Procedure performed on wrong patient (31%). Issues related to policy and processes accounted for 42% of the root causes. Actions taken were primarily related to policy, process, and staff training/education (56%); these actions were rated as effective by the reporting facilities.

Conclusions

Patient misidentification is prevalent in both the inpatient and outpatient settings. However, specific care areas reported more close calls, an indicator of good safety culture. There were associations between policy and process issues, consistent use of 2 identifiers, and misidentification events. This review provides insight from the Veterans Health Administration national databases that health care institutions can use to improve their systems.
Stimulant Prescribing Error Assessment Rubric Development
Authors: Loskutova Natalia Y. , Lutgen Cory , Smail Craig , Staton Elizabeth W. , Nichols Stephanie D. , Pinckney Richard G.
Published: September 2020

Objective

Stimulant medications are used to treat attention-deficit/hyperactivity disorder (ADHD) in adults. However, stimulants are among the most frequently prescribed medications that have a potential to be used nonmedically. We sought to define types of errors associated with treatment of ADHD in adults and to describe a classification rubric for stimulant-related prescribing faults.

Methods

An expert panel conducted a scoping review of the literature and rubric development. The literature search including relevant English language publications indexed in Medline (1990–present, human) and Embase (1990–present, human). In addition, we reviewed relevant documentation such as medication labels and guides containing information related to medications used for the treatment of adult ADHD. The initial version draft rubric was developed by adapting an existing framework for prescribing errors. The expert panel further defined a classification rubric and developed error subcategories, classifications, and descriptions.

Results

Two error categories were identified. Category 1 errors are errors resulting from prescribing faults, which further included errors in decision making/judgment; errors related to monitoring for potential harm of stimulants; possible errors: events that should generally be avoided or be used with caution; and suboptimal prescribing. Category 2 errors result from prescription writing, further defined as failure to communicate essential information and transcription errors.

Conclusions

This study provides a comprehensive description of medication errors associated with stimulant and related medications. Our findings have the potential to assist decision making and to tailor delivery programs, recommendations, guidelines, and clinical decision support health information technology on stimulant prescribing and monitoring.
Interstitial Lung Disease in Giant Cell Arteritis
Authors: Kimbrough Bradly A. , Baqir Misbah , Johnson Tucker F. , Vasireddy Amit , Ryu Jay H.
Published: September 2020

Background/Objective

Giant cell arteritis (GCA) is a large-vessel vasculitis with systemic manifestations. A few case reports have described a possible association of GCA with interstitial lung disease (ILD). The primary aim of the present study was to describe the pattern, severity, and course of ILD in patients with GCA.

Methods

This medical records review study evaluated adult patients presenting to Mayo Clinic in Rochester, MN, from January 1, 1997, through December 31, 2018, who had the diagnoses of GCA and ILD. Clinical, laboratory, and radiologic data were analyzed.

Results

In total, 23 patients were in the study. Median (range) age was 78 (58–93) years, and 14 (61%) were women. Six patients (26%) had a cough at GCA diagnosis. At ILD diagnosis, 15 patients had respiratory symptoms, including dyspnea (n = 12, 52%), dry cough (n = 6, 26%), wheezing (n = 1, 4%), and chest pain (n = 1, 4%). On initial chest computed tomography, the most common pattern of ILD was probable usual interstitial pneumonia (n = 7, 30%), indeterminate for usual interstitial pneumonia (n = 5, 22%), and combined pulmonary fibrosis and emphysema (n = 3, 13%). Airway abnormalities were present in 10 patients: 6 with bronchial wall thickening, 2 with bronchiectasis, and 2 with both. At follow-up computed tomography, 8 patients had ILD progression. Three patients with cough improved after initiation of glucocorticoid therapy.

Conclusions

Interstitial lung disease and airway abnormalities may be associated with GCA. Although cough may improve, ILD in some patients with GCA may progress despite immunosuppressive therapy.
Buprenorphine Analgesia Reduces Survival With ALM Resuscitation in a Rat Model of Uncontrolled Hemorrhage: Concerns for Trauma-Related Research
Authors: Letson Hayley L. , Dobson Geoffrey P.
Published: September 2020

The effect of analgesia on physiological systems has received little attention in trauma research. Our aim was to examine the effect of two different analgesics, buprenorphine and carprofen, on adenosine, lidocaine, and magnesium (ALM) resuscitation in a rat model of laparotomy and non-compressible hemorrhage. Male Sprague-Dawley rats were randomly assigned to Saline Carprieve, ALM Carprieve, Saline Buprenorphine, or ALM Buprenorphine (all n = 10). Anesthetized animals underwent surgical placement of chronic catheters and laparotomy, then hemorrhage was induced by liver resection (60% left lateral lobe). After 15 min, animals received 0.7 mL/kg 3% NaCl ± ALM bolus, and after 60 min, 4 h 0.5 mL/kg/h 0.9% NaCl±ALM drip with 72 h monitoring. Carprieve groups received 5 mg/kg s.c. every 24 h and Buprenorphine groups received 0.05 mg/kg Temgesic every 6 to 12 h. Survival, hemodynamics, blood chemistry, and hematology were measured. ALM Carprieve led to 100% survival compared to 40% survival in ALM Buprenorphine group (P = 0.004). In Saline-treated rats, buprenorphine reduced median survival time by 91% (22 h to 2 h). Recovery of mean arterial pressure (MAP) at 60 min was lower in the buprenorphine versus Carprieve groups (83% vs. 101% for ALM and 62% vs. 95% for Saline groups). Buprenorphine was also associated with higher blood lactates and potassium. No analgesic-related differences were found in total white cells, lymphocytes, platelet count, hyperthermia, weight loss, or pica. We conclude that reduced survival and MAP recovery appears to a buprenorphine effect on cardiovascular function. Until the underlying mechanisms can be elucidated, buprenorphine should be used with caution in small and possibly large models of trauma and shock.
The Effects of Dexmedetomidine Post-Conditioning on Cardiac and Neurological Outcomes After Cardiac Arrest and Resuscitation in Swine
Authors: Shen Rongrong , Pan Dong , Wang Zhengquan , Jin Xiaohong , Li Zilong , Wang Haojie
Published: September 2020

Introduction:

One of the main contents of post-resuscitation care is to alleviate cardiac and neurological damage in cardiac arrest (CA) victims. Recently, dexmedetomidine pre- and post-conditioning have been shown to both effectively protect the heart and brain against regional ischemia reperfusion injury. In this study, we investigated the effects of dexmedetomidine post-conditioning on cardiac and neurological outcomes after CA and resuscitation in swine.

Methods:

A total of 28 male domestic swine were randomized into four groups: sham, cardiopulmonary resuscitation (CPR), low-dose dexmedetomidine post-conditioning (LDP), and high-dose dexmedetomidine post-conditioning (HDP). Sham animals underwent the surgical preparation only. The animal model was established by 8 min of CA and then 5 min of CPR. After the animal was successfully resuscitated, a loading dose of 0.25 μg/kg of dexmedetomidine was intravenously injected followed by continuous infusion of 0.25 μg/kg/h for 6 h in the LDP group, and meanwhile a double dose of dexmedetomidine was similarly administered in the HDP group. The same amount of saline was given in the other two groups. All the resuscitated animals were monitored for 6 h and then returned to their cages for an additional 18 h of observation.

Results:

After resuscitation, significantly greater cardiac, neurological dysfunction, and injuries were observed in all animals experiencing CA and resuscitation when compared with the sham group. However, the severity of cardiac and neurological damage was significantly milder in the two dexmedetomidine-treated groups than in the CPR group. Dexmedetomidine post-conditioning also significantly decreased post-resuscitation tissue inflammation, oxidative stress, and cell apoptosis and necroptosis in the heart and brain when compared with the CPR group. In addition, these protective effects produced by dexmedetomidine post-conditioning were significantly greater in the HDP group than in the LDP group.

Conclusions:

Dexmedetomidine post-conditioning dose-dependently improved post-resuscitation cardiac and neurological outcomes through the inhibition of tissue inflammation, oxidative stress, and cell apoptosis and necroptosis.
Aerosol Exposure During Surgical Tracheotomy in SARS-CoV-2 Positive Patients
Authors: Loth Andreas G. , Guderian Daniela B. , Haake Birgit , Zacharowski Kai , Stöver Timo , Leinung Martin
Published: September 2020

Introduction:

Since December 2019, the novel coronavirus SARS-CoV-2 has been spreading worldwide. Since the main route of infection with SARS-CoV-2 is probably via contact with virus-containing droplets of the exhaled air, any method of securing the airway is of extremely high risk for the health care professionals involved. We evaluated the aerosol exposure to the interventional team during a tracheotomy in a semiquantitative fashion. In addition, we present novel protective measures.

Patients and Methods:

To visualize the air movements occurring during a tracheotomy, we used a breathing simulator filled with artificial fog. Normal breathing and coughing were simulated under surgery. The speed of aerosol propagation and particle density in the direct visual field of the surgeon were evaluated.

Results:

Laminar air flow (LAF) in the OR reduced significantly the aerosol exposure during tracheostomy. Only 4.8 ± 3.4% of the aerosol was in contact with the surgeon. Without LAF, however, the aerosol density in the inspiratory area of the surgeon is 10 times higher (47.9 ± 10.8%, P < 0.01). Coughing through the opened trachea exposed the surgeon within 400 ms with 76.0 ± 8.0% of the aerosol—independent of the function of the LAF. Only when a blocked tube was inserted into the airway, no aerosol leakage could be detected.

Discussion:

Coughing and expiration during a surgical tracheotomy expose the surgical team considerably to airway aerosols. This is potentially associated with an increased risk for employees being infected by airborne-transmitted pathogens. Laminar airflow in an operating room leads to a significant reduction in the aerosol exposure of the surgeon and is therefore preferable to a bedside tracheotomy in terms of infection prevention. Ideal protection of medical staff is achieved when the procedure is performed under endotracheal intubation and muscle relaxation.
Effects of Norepinephrine on the Intestinal Vascular System in Rabbits With Endotoxic Shock
Authors: Nakamura Fumiko , Muroya Takashi , Onoe Atsunori , Ikegawa Hitoshi , Kuwagata Yasuyuki
Published: September 2020

We hypothesized that jejunal mucosal tissue blood flow would decrease following norepinephrine (NE) administration in endotoxic shock. We aimed of this study to evaluate changes in superior mesenteric venous (SMV) blood flow and jejunal mucosal tissue blood flow of the intestinal vascular system over time by administration of NE in rabbits with endotoxic shock. We created four groups (n = 8 each): control group, lipopolysaccharide (LPS; 1 mg/kg) group, NE (2 μg/kg/min) group, and LPS+NE group. As indicators of circulation, we measured mean arterial blood pressure (MAP), cardiac output, SMV blood flow, and jejunal mucosal tissue blood flow every 30 min from 0 to 240 min. The drop in MAP observed in the LPS group was suppressed by NE administration. SMV blood flow dropped temporarily with LPS administration, but then rose thereafter. Administration of NE to the LPS group suppressed the transient decline in SMV blood flow, which did not drop below that of the control group. In the LPS group, jejunal mucosal tissue blood flow transiently dropped and then rose, reflecting the pattern in SMV blood flow. In the LPS+NE group, however, although there was no drop in SMV blood flow, jejunal mucosal tissue blood flow remained low. An interaction between NE and LPS was observed regarding jejunal mucosal tissue blood flow from 90 to 180 min (P = 0.033). We showed that NE maintained MAP and SMV blood flow but decreased jejunal mucosal tissue blood flow. In a rabbit model of endotoxic shock, NE had a negative effect on jejunal mucosal tissue blood flow.
A Pilot Study of a Top-Tier Contraception Simulation Program to Improve Long-Acting Reversible Contraception Practices Among Health Care Trainees
Authors: Madrigal Jessica M. , Stempinksi-Metoyer Kelly , Johnson Camille A. , Patel Ashlesha
Published: September 2020

Background and Objectives

Long-acting reversible contraception methods are effective tools in family planning. However, resident physicians and other health care trainees may experience knowledge gaps and low utilization because of limited opportunity for training. The purpose of this pilot study is to evaluate self-assessed knowledge, counseling, and long-acting reversible contraception (LARC) device placement skills among health care trainees who attended a 1-day simulation-based training. In addition, we describe a simulation-based training program we developed to facilitate the use of LARC among health professionals.

Methods

We conducted a cross-sectional evaluation of health care trainees attending simulation-based training on 2 occasions in 2017 and one occasion in 2018 in Chicago, Illinois. Participants rated their experience, comfort providing counseling, and placement skills with all LARC methods. Knowledge was measured using a series of multiple-choice questions. Responses to the survey were summarized using frequencies and percentages.

Results

A total of 253 health care professionals attended the simulations, and 244 completed the presurvey (96.4% response rate). Of those, 172 respondents were health care trainees, of which a majority were resident physicians. More than half reported never using top-tier methods in practice. Most indicated moderate to low knowledge to counsel patients and low skills to place each of the devices before training; self-reported knowledge and skills increased after completing training. Presimulation knowledge scores ranged from 0 to 19, with a median score of 14 of 19 correct responses. After training, average scores increased by 3 points (P < 0.0001).

Conclusions

One-day training events can provide didactic education and simulation-based skills training in device placement that may result in increased access among the patients served by these providers.
Obstetric Nurses’ Knowledge, Attitudes, and Professional Support Related to Actual Care Practices About Urinary Incontinence
Authors: Li Tiantian , Wang Jia , Chen Xiaomin , Chen Ling , Cai Wenzhi
Published: September 2020

Objectives

The objective of this study was to evaluate obstetric nurses’ knowledge, attitudes, and practices (KAP) toward urinary incontinence (UI) during pregnancy and identify factors associated with their actual specific care practices for recommending pelvic floor muscle training (PFMT).

Methods

A cross-sectional study was conducted among obstetric nurses attending an academic conference about perinatal care in China. Data were collected through a self-administered questionnaire, including demographic and professional information, professional supports included clinical protocol and learning experience, knowledge, attitudes, and practices of UI.

Results

Four hundred and seven obstetric nurses completed the survey (89.8% response rate). The correct answer rates of the vast majority of knowledge items was more than 80%. The majority of participants strongly agreed that antenatal PFMT is effective in UI treatment and prevention (69.5% and 69.0% respectively). Although only less than 30% of participants always recommended PFMT to incontinent or continent pregnant women (29.5% and 25.3%, respectively), obstetric nurses with clinical protocol, learning experience, and positive attitudes were more likely to recommend PFMT for treating UI (odds ratio [OR], 2.165, P < 0.001; OR, 1.759; P = 0.014; OR, 2.326; P < 0.001, respectively). Obstetric nurses with clinical protocol and positive attitudes were more likely to recommend PFMT for preventing UI (OR, 2.252; P < 0.001; OR, 1.693; P = 0.005, respectively).

Conclusions

Most obstetric nurses have good knowledge and positive attitudes toward UI during pregnancy, but fail to deliver care for it. Clinical protocol, learning experience, and positive attitudes are facilitators of their actual specific care practices for recommending PFMT. This finding suggests the need for developing clinical protocols and education programs regarding UI during pregnancy.
A Randomized Controlled Trial of a Multimedia Patient Education Tool for Stress Versus Urgency Urinary Incontinence
Authors: Schroeder Michelle , Plotner Elisabeth A. , Sharma Shefali , Hunter Krystal , Spector Sean , Lipetskaia Lioudmila
Published: September 2020

Objective

The aim of this study was to determine whether there was a difference in patient education when comparing traditional conversation-based patient counseling with multimedia-based patient counseling about stress and urgency urinary incontinence.

Methods

Patients seeking treatment for urinary incontinence were randomized to traditional, conversation-based counseling from a physician regarding stress and urgency urinary incontinence (control group) or view a video (multimedia) as their counseling (treatment group). A vignette-based assessment of the patient’s knowledge of stress and urgency urinary incontinence was administered as a pretest, immediate posttest, and 6- to 8-week delayed posttest. The Incontinence Impact Questionnaire, short form, was used to assess quality of life and was administered at the initial visit and at the 6- to 8-week follow-up call. Patient satisfaction was recorded at the end of the initial visit using a continuous visual analog scale, and health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine–Short Form or Short Assessment of Health Literacy–Spanish.

Results

In the 98 participants, immediate posttest scores trended toward significance between the control and treatment groups (P = 0.086). This trend was lost at the delayed posttest (P = 0.122). Both methods of education showed a significant difference between pretest, immediate posttest, and delayed posttest (P < 0.001). There were no demographic differences between groups.

Conclusions

Multimedia-based patient education represents an effective method of providing patient education regarding urinary incontinence because those who received video education showed comparable comprehension of this topic when compared with standard physician counseling. Video education can feasibly be used as an alternative to, or in conjunction with, current patient education practices in a urogynecology setting.