bluuebunny/crossref_metadata_2025 huggingface dataset:
Von Willebrand factor antigen as a marker of disease activity in childhood-onset antineutrophil cytoplasmic antibody–associated vasculitis
Authors: Go Ellen , Aeschlimann Florence A , Lu Hua , Larry Jenna R , Hebert Diane , Yeung Rae S M , Noone Damien
Published: November 2023

Objective

Von Willebrand factor (VWF) antigen plays a role in vascular inflammation and thrombosis, both of which are important in the pathogenesis of ANCA-associated vasculitis (AAV). Previous work found that VWF correlates with disease activity in childhood-onset primary CNS vasculitis. We sought to determine the relationship between VWF and disease activity over time in children with AAV.

Methods

AAV patients with more than one VWF level measured were included in this retrospective study, and the relationships between active vasculitis, VWF and other disease measures were analysed. Generalized estimating equations analysis was used to account for repeated VWF measurements within a patient. Repeated measures correlation was used to determine associations of paired laboratory observations. Diagnostic performance was evaluated using receiver operating curve analysis.

Results

A total of 732 total VWF measurements were collected in 33 AAV patients. VWF antigen levels were higher during active disease [median 2.03 IU/ml, interquartile range (IQR) 1.35, 2.55] compared with inactive disease (median 1.18 IU/ml, IQR 0.94, 1.53). VWF antigen was the only variable that was significantly associated with active disease (odds ratio 3.01, P < 0.001, 95% CI 2.3, 3.93). The effect of VWF did not show a substantial difference between the disease subtypes. There was a moderate positive correlation between VWF antigen and disease activity, with an acceptable sensitivity and specificity rates.

Conclusion

Increased VWF antigen levels correlate with active vasculitis in this paediatric-onset AAV cohort and may be used as an additional biomarker in childhood AAV.
Consent for Research Involving Spanish- and English-Speaking Latinx Adults With Schizophrenia
Authors: Barrio Concepción , Fuentes Dahlia , Tibiriçá Lize , Hernandez Mercedes , Helu-Brown Paula , Golshan Shahrokh , Palmer Barton W
Published: November 2023

Background

Latinxs are vastly underrepresented in mental health research; one of many contributing factors may be complexities in the research consent process, including language preferences. We examined determinants of comprehension of research consent procedures and tested the effects of a preconsent research schema condition among 180 adults with schizophrenia (60 Latinx-English and 60 Latinx-Spanish preference, and 60 non-Latinx White).

Study Design

Participants were randomly assigned (equal allocation) to an educational session regarding clinical research concepts and processes (schema condition) or to an attention control. Following a subsequent simulated consent procedure for a hypothetical drug trail, comprehension of consent disclosures was measured with 2 standard measures.

Study Results

One-way ANOVAs showed significant medium effect size differences between ethnicity/language groups on both measures of comprehension (η2s = 0.066–0.070). The Latinx-Spanish group showed lower comprehension than non-Latinx White participants; differences between the 2 Latinx groups did not reach statistical significance. Group differences were not statistically significant after adjusting for differences in education, or on scores from structured measures of acculturation, health literacy, or research literacy. Two-way ANOVAs showed no significant main effects for consent procedure on either comprehension measure (Ps > .369; partial η2s < 0.006) and no significant group-by-consent interactions (Ps > .554; partial η2s < 0.008).

Conclusions

Although the preconsent procedure was not effective, the results suggest health and research literacy may be targets for reducing disparities in consent comprehension. The onus is on researchers to improve communication of consent information as an important step to addressing health care disparities.
The Association of Antipsychotic Postponement With 5-Year Outcomes of Adolescent First-Episode Psychosis
Authors: Bergström Tomi , Gauffin Tapio
Published: November 2023

Background and Hypothesis

Based on the need-adapted approach, delaying antipsychotics could help identify first-episode psychosis (FEP) adolescents who might not require them. However, some individuals might need antipsychotics, and postponing could harm their prognosis. This nationwide register-based follow-up aimed to test these two hypotheses.

Study Design

All adolescents aged 13–20 with a psychotic disorder (ICD-10 codes: F20–F29) in Finland between 2003 and 2013 were identified (n = 6354) from national registers. For each case, a fixed 1825-day follow-up period was established from the onset of psychosis or until death. The outcome was considered “good” if adolescents did not die and had not received psychiatric treatment and/or disability allowances during the final year of follow-up. Testing the first hypothesis involved all antipsychotic treatment-naïve adolescents with FEP (n = 3714). The second hypothesis was tested with a sub-sample of only those who had received antipsychotics during follow-up (n = 3258). To account for baseline confounders, hypotheses were tested via a stabilized inverse probability of treatment weighted generalized linear models with logit link function.

Study Results

Immediate antipsychotic treatment after the onset of psychosis was associated with poor 5-year outcome (adjusted odds ratio [aOR]: 1.8, 95% CI: 1.6–2.1). There was no statistically significant association between antipsychotic postponement and treatment outcome in those who eventually received antipsychotic treatment (aOR: 1.02, 95% CI: 0.7–1.2, P: .8), thus not providing support for second hypothesis.

Conclusions

There is a significant subgroup of adolescent with psychosis who do not require immediate antipsychotic treatment. A more robust design is needed to evaluate the causality of the observed association.
Business power, right-wing populism, and noisy politics: lessons from Brexit and Swiss referendums
Authors: Kinderman Daniel
Published: November 2023

This article contributes to debates on business power, noisy politics, and right-wing populism. The populist right weakens strategies of quiet politics, which many suggest has led to a steep decline of business power. I challenge this view and argue that a combination of innovative strategies and ample financial resources allow business associations to exercise power in this environment. Drawing on new empirical evidence, the article makes three central contributions. First, I suggest that the failure of Remain business advocacy in the 2016 Brexit referendum resulted from the constraints of administrative legislation (the PPERA), weaknesses in campaigning strategies, and the CBI leadership’s decision to not register as a campaign organization. Second, while my regression analysis provides some support for Culpepper’s quiet politics argument, the Swiss business federation Economiesuisse has won 90% of the referendum campaigns it has led, including many referendums with high issue salience against right-wing populists. Third, Economiesuisse shows that business strategies of ‘loud voice’ can be successful. With money and innovative public-facing campaigning strategies, business organizations can win in noisy environments and against right-wing populists.
CC14 guidance update: greener investments, greater uncertainty?
Authors: Brown Lloyd
Published: November 2023

This article examines the newly released Charity Commission guidance, known simply as the “CC14”. The CC14 provides investment guidance to the charity sector and has recently been renewed following the case of Butler-Sloss & Ors v The Charity Commission for England and Wales & Anor [2022] EWHC 974 (Ch). In Butler-Sloss, the High Court was asked to determine whether charitable trustees could deploy an investment plan that aligned with the Paris Agreement and excluded investments that contributed to climate change. Mr Michael Green J ruled that such an “ethical” investment plan was lawful. Following Butler-Sloss, the CC14’s use of “social investment” may indeed encourage “greener” investment opportunities amongst charitable trustees, in that the advice attempts to bring charitable trustee investment more in line with modern investment practices. However, this work opines that the guidance could be actively encouraging environmentally inspired investments at the expense of the sacrosanct fiduciary duty of investment.
What is a ‘strong’ synapomorphy? Redescriptions of Murray’s type species and descriptions of new taxa challenge the systematics of Hypsibiidae (Eutardigrada: Parachela)
Authors: Gąsiorek Piotr , Blagden Brian , Morek Witold , Michalczyk Łukasz
Published: November 2023

Hypsibiidae are the most species-rich group within the Hypsibioidea, and three (Diphasconinae, Itaquasconinae, and Pilatobiinae) of its four subfamilies are characterized by a division of the foregut into a rigid buccal and a flexible pharyngeal tube. The aim of this work is to provide a comprehensive background for sound taxonomic studies on several hypsibiid lineages. We redescribe the type species for the genera Adropion, Guidettion, and Platicrista, and provide diagnostic keys for several genera. We also demonstrate that the presence of an apodeme at the border of the buccal and pharyngeal tube is not a discriminative criterion separating Diphasconinae from Itaquasconinae and that the apodeme does not have a uniform morphology among Hypsibiidae. Itaquascon serratulumsp. nov. (Uganda) is the first integratively described species in the genus. Furthermore, new species of Platicrista are described: Platicrista borneensissp. nov. (Malaysia), Platicrista carpathicasp. nov. (Poland), and Platicrista niveasp. nov. (Taiwan). Moreover, Raribius minutissimussp. nov. (Scotland) is described from leaf litter. Finally, Pilatobius is divided into four morphogroups by cuticular sculpturing and dorsal gibbosities, which serve as decisive criteria; two received phylogenetic support and are erected as Degmiongen. nov. (the oculatus group) and Fontouriongen. nov. (the recamieri group).
Identifying Patient Characteristics Associated With Opioid Use to Inform Surgical Pain Management
Authors: Agarwal Anish K. , Xiong Ruiying , Ebert Jeffrey , Shofer Fran , Spencer Evan , Lee Daniel , Ali Zarina , Delgado M. Kit
Published: November 2023

Objective:

Balancing surgical pain management and opioid stewardship is complex. Identifying patient-level variables associated with low or no use can inform tailored prescribing.

Methods:

A prospective, observational study investigating surgical procedures, prescription data, and patient-reported outcomes at an academic health system in Pennsylvania. Surgical patients were consented following surgery, and prospective data were captured using automated text messaging (May 1, 2021–February 29, 2022). The primary outcome was opioid use.

Results:

Three thousand six hundred three (30.2%) patients consented. Variation in patient reported used included 28.1% of men reported zero use versus 24.3% of women, 20.5% of Black patients reported zero use versus 27.2% of white patients. Opioid-naïve patients reported more zero use as compared with chronic use (29.7% vs 9.8%). Patients reporting higher use had more telephone calls and office visits within 30 days but no change in emergency department utilization or admissions. Higher discharge pain score was associated with higher use. In the adjusted analysis of opioid use relative to the guideline, higher use was associated with age, male sex, obesity, discharge pain score, and history of mental health disorder. In the adjusted model, younger age and being opioid naïve were associated with low to zero use across procedures.

Conclusions:

Younger age, being opioid-naïve, and lower discharge pain score are associated with low or no postoperative opioid use. These characteristics can be used by clinicians to help tailor opioid prescribing to specific patients to reduce the risk of prolonged exposure and unused tablets in the community.
Cannabis Use Disorder Trends and Health Care Utilization Following Cervical and Lumbar Spine Fusions
Authors: Dietz Nicholas , Alkin Victoria , Agarwal Nitin , Sharma Mayur , Oxford Brent Garrison , Wang Dengzhi , Ugiliweneza Beatrice , Mettille Jersey , Boakye Maxwell , Drazin Doniel
Published: November 2023

Study Design.

Retrospective cohort

Objective.

To identify differences in complication rates following cervical and lumbar fusion over the first postoperative year between those with and without cannabis use disorder (CUD) and to assess how CUD affects opioid prescription patterns.

Summary of Background Data.

Cannabis is legal for medical purposes in 36 states and recreational use in 18 states. Cannabis has multisystem effects and may contribute to transient vasoconstrictive, pro-thrombotic, and inflammatory effects.

Methods.

The IBM MarketScan Database (2009-2019) was used to identify patients who underwent cervical or lumbar fusions, with or without CUD. Exact match hospitalization and post-discharge outcomes were analyzed at index, 6-, and 12-months.

Results.

Of 72,024 cervical fusion (2.0% with CUD) and 105,612 lumbar fusion patients (1.5% with CUD), individuals with CUD were more likely to be young males with higher Elixhauser index. The cervical CUD group had increased neurological complications (3% vs 2%) and sepsis (1% vs 0%) during index hospitalization, and neurological (7% vs 5%) and wound complications (5% vs 3%) at 12-months. The lumbar CUD group had increased wound (8% vs 5%) and MI (2% vs 1%) complications at 6-months and at 12-months. For those with cervical myelopathy, increased risk of pulmonary complications were observed with CUD at index hospitalization and 12 month follow up. For those with lumbar stenosis, cardiac complications and MI were associated with CUD at index hospitalization and 12 months. CUD was associated with opiate use disorder, decreasing postoperatively.

Conclusion.

No differences in reoperation rates were observed for CUD groups undergoing cervical or lumbar fusion. CUD was associated with increased risk of stroke for the cervical fusion cohort, and cardiac (including MI) and pulmonary complications for lumbar fusion at index hospitalization, and 6 and 12 months postoperatively. Opiate use disorder and decreased opiate dependence following surgery also correlated with CUD.
Assessment of the Readability of the Online Patient Education Materials of Intensive and Critical Care Societies
Authors: Hanci Volkan , Otlu Büşra , Biyikoğlu Ali Salih
Published: November 2023

OBJECTIVES:

This study aimed to evaluate the readability of patient education materials (PEMs) on websites of intensive and critical care societies.

DATA SOURCES:

Websites of intensive and critical care societies, which are members of The World Federation of Intensive and Critical Care and The European Society of Intensive Care Medicine.

SETTING:

Cross-sectional observational, internet-based, website, PEMs, readability study.

STUDY SELECTION:

The readability of the PEMs available on societies’ sites was evaluated.

DATA EXTRACTION:

The readability formulas used were the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Fog (GFOG).

DATA SYNTHESIS:

One hundred twenty-seven PEM from 11 different societies were included in our study. In the readability analysis of PEM, the FRES was 58.10 (48.85–63.77) (difficult), the mean FKGL and SMOG were 10.19 (8.93–11.72) and 11.10 (10.11–11.87) years, respectively, and the mean GFOG score was 12.73 (11.37–14.15) (very difficult). All readability formula results were significantly higher than the recommended sixth-grade level (p < 0.001). All PEMs were above the sixth-grade level when the societies were evaluated individually according to all readability results (p < 0.05).

CONCLUSIONS:

Compared with the sixth-grade level recommended by the American Medical Association and the National Institutes of Health, the readability of PEMs in intensive and critical care societies is relatively high. PEMs in intensive and critical care societies should be prepared with attention to recommendations on readability.
Plasma Exchange in Patients With Myositis due to Immune Checkpoint Inhibitor Therapy
Authors: Katyal Nakul , Katsumoto Tamiko R. , Ramachandran Kavitha J. , Yunce Muharrem , Muppidi Srikanth
Published: November 2023

Immune checkpoint inhibitors used to treat malignancies may lead to various immune-related adverse events (irAEs) including conditions such as myositis and myasthenia gravis (MG). Here, we describe 2 cases of myositis treated effectively with therapeutic plasma exchange (PLEX). A 64-year-old man with thymic cancer developed leg weakness and dyspnea 1 month after the second dose of nivolumab with moderate weakness in proximal and distal muscles, with elevated creatine kinase levels. Another 77-year-old man with Stage IIIB squamous cell carcinoma of the lung developed progressive proximal muscle weakness and became nonambulatory after cycle 2 of durvalumab with persistently high creatine kinase levels despite prednisone treatment. Electrophysiology revealed irritative myopathy without evidence of neuromuscular junction dysfunction and MG antibody testing was nonrevealing. With PLEX, both patients noticed rapid improvement in strength. PLEX in conjunction with other immunosuppressive agents can result in rapid improvement in irAE-myositis even in patients without associated MG.
Pregnancy in Seronegative Myasthenia Gravis: A Single-Center Case Series
Authors: Harada Yohei , Bettin Margaret , Juel Vern C. , Massey Janice M. , Sanders Donald B.
Published: November 2023

Introduction:

The course of double-seronegative myasthenia gravis (DSNMG) during and after pregnancy has not been well described.

Objective:

To assess the course of DSNMG during pregnancy and within 6 months postpartum.

Methods:

A retrospective cohort study of women with DSNMG seen in the Duke Myasthenia gravis (MG) Clinic after 2003.

Results:

Review of the Duke MG Clinic Registry and electronic medical record identified 8 patients who became pregnant after MG onset; the mean age at disease onset was 17.6 (SD = 10.0) years. Increased MG symptoms were observed in the first and third trimester and, most commonly, postpartum in 6 of 18 pregnancies. Except for 1 infant who developed respiratory distress that required neonatal intensive care admission, all the newborns were healthy at birth.

Conclusions:

As in seropositive MG, increased MG symptoms during pregnancy and within 6 months postpartum is also seen in women with DSNMG.
Sequential Lateral Lymphatic Metastasis Shows Similar Oncologic Outcomes to Upward Spread in Advanced Rectal Cancer After Preoperative Chemoradiotherapy
Authors: Kim Hye Jin , Choi Gyu-Seog , Cho Seung Hyun , Kang Min Kyu , Park Jun Seok , Park Soo Yeun , Kang Byung Woog , Kim Jong Gwang
Published: November 2023

BACKGROUND:

Whether lateral pelvic node metastasis should be considered as a regional or systemic disease is a longstanding debate. While previous Japanese studies have considered it to be locoregional disease, Western countries consider it a systemic disease and do not perform lateral pelvic node dissection after preoperative chemoradiotherapy.

OBJECTIVES:

To evaluate whether lateral pelvic node metastasis is a systemic or regional disease that is amenable to curative resection.

DESIGN:

Retrospective analysis of a prospectively collected database.

SETTING:

This study was conducted at a tertiary cancer center.

PATIENTS:

There were 616 consecutive patients who underwent curative total mesorectal excision alone or with lateral pelvic node dissection after preoperative chemoradiotherapy for locally advanced rectal cancer between 2011 and 2019.

MAIN OUTCOME MEASURES:

Three-year disease-free and overall survival.

RESULTS:

A total of 360 patients underwent total mesorectal excision, and 160 patients underwent total mesorectal excision with lateral pelvic node dissection. There was no difference in the 3-year disease-free survival (p = 0.844) or overall survival rates (p = 0.921) between the groups. Patients with lateral pelvic node metastasis showed similar disease-free survival to those with perirectal lymph node metastasis in the total mesorectal excision group. In a subgroup analysis, patients with internal iliac pelvic node metastasis showed a comparable disease-free survival to those with perirectal node involvement, and patients with other lateral pelvic node metastasis showed a similar disease-free survival to those with intermediate node involvement. In the lateral pelvic node dissection group, the lateral pelvic node metastatic rate was 32.5%. On multivariate analysis, <8 of unilateral harvested lateral pelvic nodes and advanced ypT stage were significantly associated with poor disease-free survival.

LIMITATION:

The retrospective design.

CONCLUSIONS:

Lateral lymphatic metastasis showed similar oncologic outcomes to upward spread, especially perirectal lymph nodes metastasis. Large cohort studies with long-term follow-up are required to confirm these results.
Education and Perspectives on the Use of Oral Skin Cancer Chemoprophylaxis: A Cross-Sectional Survey of Current Fellows in Mohs Micrographic Surgery & Dermatologic Oncology
Authors: Guzman Anthony K. , Schmults Chrysalyne D. , Ruiz Emily S.
Published: November 2023

BACKGROUND

According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown.

OBJECTIVE

To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus.

METHODS

An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery.

RESULTS

Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training.

CONCLUSION

Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.
Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study
Authors: Lai Jonathan , Bao Aaron , McCaffrey Tara , Salman Rumsha , Gelderen Evelien V. , Rizk Emanuelle , Thompson Katherine G. , Epstein Jeremy A. , Bibee Kristin , Scott Jeffrey
Published: November 2023

BACKGROUND

Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied.

OBJECTIVE

This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes.

METHODS

A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals.

RESULTS

Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383–14.304) or family history (aOR = 11.307, 95% CI 2.344–20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285–12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181–0.882).

LIMITATIONS

Single institution, retrospective study, limited surgical patients.

CONCLUSION

Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.
Alternating Treatment With Nonablative Fractional Laser and Radiofrequency Microneedling for the Treatment of Acne Scars: A Prospective, Randomized, Split-Face Study
Authors: Hartman Nina , Loyal Jameson , Borsack Summer , Goldman Mitchel
Published: November 2023

BACKGROUND

Acne scarring is an unfortunate sequela affecting up to 95% of patients with acne and carries profound psychosocial impact. Both nonablative fractional lasers (NAFL) and microneedling with radiofrequency (MNRF) have demonstrated comparable efficacy in the treatment of atrophic acne scars.

OBJECTIVE

To determine whether alternating NAFL and MNRF is superior to NAFL alone in the treatment of atrophic acne scars.

METHODS AND MATERIALS

This was a prospective, single-center, double-blinded, split-face clinical trial. Twenty patients with atrophic acne scars who had their facial halves randomized to receive either NAFL alone or NAFL alternating with MNRF. Patients received 4 total treatments at 4-week intervals.

RESULTS

Ninety days after the final treatment, both facial halves demonstrated a significant improvement in the mean global échelle d'évaluation clinique des cicatrices d'acné (ECCA) score from baseline (p < .001 for both halves). The average percentage improvement at the final end point was 20% to 30% from baseline. No significant difference was noted between facial halves for mean global ECCA score or percentage improvement at any time point.

CONCLUSION

Although both NAFL and MNRF are safe and effective in the treatment of atrophic acne scars, alternating NAFL and MNRF does not seem to be superior to NAFL alone.
Performance of Staging Systems for Non–Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Guerra Ricardo , Shahwan Kathryn T. , Nikahd Melica , Hyer Madison , Carr David R.
Published: November 2023

BACKGROUND

The performance of staging systems in non–head and neck cutaneous squamous cell carcinomas has not been well established.

OBJECTIVE

To evaluate the performance of the American Joint Committee on Cancer 8th Edition and Brigham and Women's Hospital staging systems in non–head and neck squamous cell carcinomas.

MATERIALS AND METHODS

Eligible tumors were identified and staged from an existing retrospective database. Cumulative incidence function curves of any poor outcome were generated. Distinctiveness, sensitivity, specificity, positive and negative predictive value, and concordance index were calculated.

RESULTS

1,042 primary tumors were included, with 38 resulting in any poor outcome and 16 in any major poor outcome. High-stage tumors represented 2.2% and 3.5% of tumors; these accounted for 10/38 of the poor outcomes (26.3%) and 8/16 of the major poor outcomes (50%). High-stage tumors predicted major poor outcomes with a sensitivity of 0.5 and specificity of 0.99 for the Brigham and Women's Hospital system, and a sensitivity of 0.5 and specificity of 0.97 for the American Joint Committee on Cancer 8th edition system. The concordance index for both was 0.74.

CONCLUSION

Current staging systems can be used to predict poor outcomes in cutaneous squamous cell carcinomas off the head and neck.
Racial–Ethnic, Education, and Socioeconomic Differences in the Treatment of Head and Neck Melanoma in situ: A Surveillance Epidemiology and End Results Population-Based Analysis
Authors: Tran Andrew X. , Barriera Paola , Xiong David , Knackstedt Thomas
Published: November 2023

BACKGROUND

Incidence and treatment disparities for cutaneous melanomas have been documented among racial and sociodemographic minorities. However, the association between treatment types, race, and socioeconomic status remains unknown.

OBJECTIVE

To characterize treatment differences for head and neck melanoma in situ (MIS) and lentigo maligna (LM) based on race and sociodemographic variables.

MATERIALS AND METHODS

A population-based retrospective cohort study of the Surveillance Epidemiology and End Results database (1998–2016) was performed. Univariate and multivariate logistic regression modeling evaluated the association of race and US census-reported sociodemographic factors with Mohs micrographic surgery (MMS) utilization.

RESULTS

A total of 76,328 adult patients with head and neck MIS/LM were included. MMS accounted for 11.8% of total cases, with increased utilization observed since 1998–2002. Compared with areas with greater percentages of individuals completing high school (first quartile), patients living in the second (Odds ratio [OR] 0.71; 95% confidence interval [CI] 0.64–0.80; p < .001), third (OR 0.74; 95% CI 0.63–0.86; p < .001), and fourth quartiles (OR 0.44; 95% CI 0.35–0.55; p < .001) were less likely to undergo MMS for their MIS/LM.

CONCLUSION

Educational efforts and awareness can bridge the knowledge gaps of appropriate treatment in patients with head and neck MIS/LM.
Clinical Characteristics of Marginally Recurrent Melanoma After Primary Excision: A Multisite Retrospective Analysis of 140 Cases Referred for Mohs Surgery
Authors: Soh Jonathan M. , Brodland David G. , Zitelli John A.
Published: November 2023

BACKGROUND

Marginally recurrent melanoma (MRM) manifests immediately adjacent to or within a scar and arises from incomplete tumor clearance after primary treatment. Little is known about the progression and treatment of MRM after all forms of excision.

OBJECTIVE

To determine the invasive growth potential, tumor-stage progression, and outcomes of those with MRM.

METHODS

One hundred forty patients with MRM were collected from 5 practice databases. All patients were treated with Mohs micrographic surgery. They were evaluated for Breslow depth and tumor stage change from the time of primary treatment and recurrent treatment.

RESULTS

Of 101 cases initially treated as melanoma in situ, 13 (12.9%) marginally recurred with invasive disease at the time of Mohs micrographic surgery. The median thickness of these recurrent melanomas was 0.58 mm. Of 39 cases initially treated as invasive melanoma, 10 (25.6%) marginally recurred with a greater Breslow depth. The median increase in thickness from initial treatment to recurrence was 1.31 mm.

CONCLUSION

Marginally recurrent melanoma retains its invasive growth potential. This can lead to Breslow depth increase, tumor-stage progression, and a worse prognosis on recurrence. Obtaining tumor-free margins is critical in initial and recurrence treatments.
Fatigue among anaesthesiologists in Europe
Authors: Camilleri Podesta Anne Marie , Redfern Nancy , Abramovich Igor , Mellin-Olsen Jannicke , Oremuš Krešimir , Kouki Pinelopi , Guasch Emilia , Novak-Jankovic Vesna , Sabelnikovs Olegs , Bilotta Federico , Grigoras Ioana
Published: November 2023

BACKGROUND

Anaesthesiologists deliver an increasing amount of patient care and often work long hours in operating theatres and intensive care units, with frequent on-calls and insufficient rest in between. In the long term, this will negatively influence mental and physical health and well being. As fatigue becomes more prevalent, this has predictable implications for patient safety and clinical effectiveness.1

OBJECTIVE

This study aimed to evaluate the prevalence, severity, causes and implications of work-related fatigue amongst specialist anaesthesiologists.

DESIGN

An online survey of specialist anaesthesiologists.

PARTICIPANTS

The survey was sent to anaesthesiologists in 42 European countries by electronic mail.

MAIN OUTCOME MEASURES

Responses from a 36-item online survey assessed work-related fatigue and its impact on anaesthesiologists in European countries.

RESULTS

Work-related fatigue was experienced in 91.6% of the 1508 respondents from 32 European countries. Fatigue was caused by their working patterns, clinical and nonclinical workloads, staffing issues and excessive work hours. Over 70% reported that work-related fatigue negatively impacted on their physical and mental health, emotional well being and safe commuting. Most respondents did not feel supported by their organisation to maintain good health and well being.

CONCLUSION

Work-related fatigue is a significant and widespread problem amongst anaesthesiologists. More education and increased awareness of fatigue and its adverse effects on patient safety, staff well being and physical and mental health are needed. Departments should ensure that their rotas and job plans comply with the European Working Time Directive (EWTD) and introduce a fatigue risk management system to mitigate the effects of fatigue.
High Incidence of Postoperative Nausea and Vomiting in Transgender Women Undergoing Facial Feminization Procedures
Authors: Mukerji Shivali , Uppalapati Akhil , Lee Rebekah , Price Ryan , Debryn Deen , Nozari Ala , Streed Carl , Kim Eugene
Published: November 2023

Background:

Postoperative nausea and vomiting (PONV) is a significant concern due to its impact on patient comfort, recovery time, and extended hospital stay. Previous research links higher PONV rates in women during their periovulatory phase to estrogen. This study investigates the PONV risk in transgender women after facial feminization surgery.

Methods:

Retrospective chart reviews of transgender women aged older than 18 undergoing facial feminization from 2014 to 2020 were undertaken. Data included demographics, hormone use history, comorbidities, and PONV history. PONV was classified as any nausea/vomiting episode before discharge. Anesthesia records were examined, and PACU notes were analyzed for PONV indicators. A cis-gender male and female cohort undergoing rhinoplasty served as controls.

Results:

Of the 282 transgender women receiving facial feminization surgery, 104 experienced PONV, marking a 37% PONV rate. Compared with the 11% PONV rate among cis-gender rhinoplasty patients, this was notably higher. Hormone therapy discontinuation showed no influence on PONV incidence.

Conclusions:

Transgender women undergoing facial feminization surgery have a 38% PONV rate, surpassing the 11% rate in cis-gender rhinoplasty patients and the general 20%–30% rate for all procedures, including the 25% for oral and maxillofacial surgery. This suggests a heightened PONV risk for transgender women after facial feminization procedures.
Structural Anomalies in Multifetal Gestations
Authors: Hoover Elizabeth A. , Yamamura Yasuko , Thompson Gwyneth
Published: November 2023

Multifetal gestations are at increased risk for structural anomalies relative to singletons. Determination of chorionicity is critical, as the risk is highest for monochorionic pregnancies. In a singleton gestation, counseling is structured around optimization of fetal outcomes and careful consideration of the patient’s choices in management decisions. However, in multifetal gestations affected by a fetal anomaly, complex counseling with consideration for the pregnancy as a whole is necessary. We review the incidence of structural anomalies in twins and highlight unique considerations including selective termination for discordant anomalies. We emphasize the role of shared decision making between provider and patient.
Cataract surgery after corneal refractive surgery: preoperative considerations and management
Authors: Ting DSJ , Gatinel Damien , Ang Marcus
Published: November 2023

Purpose of review

Corneal refractive surgery (CRS) is one of the most popular eye procedures, with more than 40 million cases performed globally. As CRS-treated patients age and develop cataract, the number of cases that require additional preoperative considerations and management will increase around the world. Thus, we provide an up-to-date, concise overview of the considerations and outcomes of cataract surgery in eyes with previous CRS, including surface ablation, laser in-situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE).

Recent findings

Challenges associated with accurate biometry in eyes with CRS have been mitigated recently through total keratometry, ray tracing, intraoperative aberrometry, and machine learning assisted intraocular lens (IOL) power calculation formulas to improve prediction. Emerging studies have highlighted the superior performance of ray tracing and/or total keratometry-based formulas for IOL power calculation in eyes with previous SMILE. Dry eye remains a common side effect after cataract surgery, especially in eyes with CRS, though the risk appears to be lower after SMILE than LASIK (in the short-term). Recent presbyopia-correcting IOL designs such as extended depth of focus (EDOF) IOLs may be suitable in carefully selected eyes with previous CRS.

Ophthalmologists will increasingly face challenges associated with the surgical management of cataract in patients with prior CRS. Careful preoperative assessment of the ocular surface, appropriate use of IOL power calculation formulas, and strategies for presbyopia correction are key to achieve good clinical and refractive outcomes and patient satisfaction. Recent advances in CRS techniques, such as SMILE, may pose new challenges for such eyes in the future.
Impact of COVID-19 on HPV Vaccination Rates in New York City and Long Island
Authors: Bower Maria , Kothari Ulka , Akerman Meredith , Krilov Leonard R. , Fiorito Theresa M.
Published: November 2023

Background:

In the United States, uptake of human papillomavirus (HPV) vaccination has been exceptionally low as compared with other vaccines. During the coronavirus disease (COVID-19) pandemic, routine vaccinations were deferred or delayed, further exacerbating HPV vaccine hesitancy. The specific effect of the pandemic on HPV vaccination rates in the United States has not been yet described.

Methods:

We aimed to determine the percentage of children achieving full HPV vaccination (2 doses) by age 15 years and to compare prepandemic to pandemic rates of HPV vaccination at pediatric practices across our institution. A retrospective chart review was performed to compare HPV vaccination rates in the “prepandemic” and “pandemic” periods for all children 9 through 14 years of age. Additionally, peaks in COVID-19 positivity were compared with HPV vaccination rates.

Results:

Of children 9–14 years old, 49.3% received at least 1 dose of HPV vaccine in the prepandemic period, compared with 33.5% during the pandemic (P < 0.0001). Only 33.5% of patients received the full 2-dose series of HPV prepandemic, compared with 19.0% of patients during the pandemic (P < 0.0001). When COVID-19 positivity rates peaked, HPV vaccination also declined.

Conclusions:

The issue of low HPV vaccination rates was amplified due to the COVID-19 pandemic, as illustrated by the correlation between peaks in COVID-19 positivity and low rates of HPV vaccination.
Point-of-Care Ultrasound for Tuberculosis in Young Children with Severe Acute Malnutrition
Authors: Vonasek Bryan J. , Kumwenda Tapiwa , Gumulira Joe , Nyirongo Mwawi , Heller Tom , Palmer Megan , McCollum Eric D. , Chiunda Mary , Garcia-Prats Anthony J. , Bélard Sabine , Mvalo Tisungane
Published: November 2023

Point-of-care ultrasound (POCUS) to diagnose tuberculosis (TB) was assessed in 131 children under 5 years old hospitalized with severe acute malnutrition. Of these, 23% had confirmed or unconfirmed TB and 5% were HIV-infected. There were no POCUS findings associated with TB diagnosis. POCUS visualization quality was satisfactory for 65% and examination acceptability was “good” for 52%.
Evaluation of corneal power from an AS-OCT thick lens model and ray tracing: reliability of the keratometer index
Authors: Langenbucher Achim , Hoffmann Peter , Cayless Alan , Wendelstein Jascha , Szentmáry Nóra
Published: November 2023

Purpose:

To investigate and compare different strategies of corneal power calculations using keratometry, paraxial thick lens calculations and ray tracing.

Setting:

Tertiary care center.

Design:

Retrospective single-center consecutive case series.

Methods:

Using a dataset with 9780 eyes of 9780 patients from a cataractous population the corneal front (Ra/Qa) and back (Rp/Qp) surface radius/asphericity, central corneal thickness (CCT), and entrance pupil size (PUP) were recorded using the Casia 2 tomographer. Beside keratometry with the Zeiss (PKZ) and Javal (PKJ) keratometer index, a thick lens paraxial formula (PG) and ray tracing (PR) was implemented to extract corneal power for pupil sizes from 2 mm to 5 mm in steps of 1 mm and PUP.

Results:

With PUP PKZ/PKJ overestimates the paraxial corneal power PG in around 97%/99% of cases and PR in around 80% to 85%/99%. PR is around 1/6 or 5/6 diopters (D) lower compared with PKZ or PKJ. For a 2 mm pupil PR is around 0.20/0.91 D lower compared with PKZ/PKJ and for a 5 mm pupil PR is comparable with PKZ (around 0.03 D lower) but around 0.70 to 0.75 D lower than PKJ.

Conclusions:

“True” values of corneal power are mostly required in lens power calculations before cataract surgery, and overestimation of corneal power could induce trend errors in refractive outcome with axial length and lens power if compensated with the effective lens position.
Lymphovenous shunts in the treatment of lymphedema
Authors: Sun Jeremy Mingfa , Yamamoto Takumi
Published: November 2023

Lymphedema is a progressive disease with no known cure. Characterized by the accumulation of lymphatic fluid and subsequent swelling in the affected limbs, it often poses significant challenges to those living with it. Although various conservative treatments have been used to manage lymphedema, such as compression therapy and physical rehabilitation, surgical interventions have emerged as promising avenues for more substantial relief. Lymphovenous shunts have been described since the 1960s and have garnered much attention in the recent two decades due to technological advances in optics, imaging, and surgical instruments. This review article explores the use of different lymphovenous shunts such as lymphatic implantation, lymph node-to-vein anastomoses (LNVAs), dermal-adipose lymphatic flap venous wrapping (DALF-VW), and supermicrosurgical lymphovenous anastomoses (LVAs) as treatment modalities for lymphedema. We will discuss the underlying principles, indications, techniques, and potential benefits. By examining the current state of knowledge and ongoing research in the field, we aim to provide insights into the role of lymphovenous shunts in the comprehensive management of lymphedema and shed light on the prospects for this treatment option.
Medicare Data Linkages for Conducting Patient-Centered Outcomes Research on Economic Outcomes
Authors: Brown Derek S. , Srinivasan Mithuna , Zott Courtney , Wilson Kala , Dullabh Prashila , Smith Scott R.
Published: November 2023

Background:

Medicare patients and other stakeholders often make health care decisions that have economic consequences. Research on economic variables that patients have identified as important is referred to as patient-centered outcomes research (PCOR) and can generate evidence that informs decision-making. Medicare fee-for-service (FFS) claims are widely used for research and are a potentially valuable resource for studying some economic variables, particularly when linked to other datasets.

Objective:

The aim of this study was to identify and assess the characteristics of federally funded administrative and survey data sources that can be linked to Medicare claims for conducting PCOR on some economic outcomes.

Research Design:

A targeted internet search was conducted to identify a list of relevant data sources. A technical panel and key informant interviews were used for guidance and feedback.

Results:

We identified 12 survey and 6 administrative sources of linked data for Medicare FFS beneficiaries. A majority provide longitudinal data and are updated annually. All linked sources provide some data on social determinants of health and health equity-related factors. Fifteen sources capture direct medical costs (beyond Medicare FFS payments); 5 capture indirect costs (eg, lost wages from absenteeism), and 7 capture direct nonmedical costs (eg, transportation).

Conclusions:

Linking Medicare FFS claims data to other federally funded data sources can facilitate research on some economic outcomes for PCOR. However, few sources capture direct nonmedical or indirect costs. Expanding linkages to include additional data sources, and reducing barriers to existing data sources, remain important objectives for increasing high-quality, patient-centered economic research.
End-of-Life Care Planning
Authors: Kitt-Lewis Erin , Loeb Susan J.
Published: November 2023

Demographic shifts toward an older and sicker prison population present challenges for corrections leaders and incarcerated people. The priority of custody and control over care in prisons can deprive people of a modicum of autonomy even about expressing their end-of-life wishes. This study was undertaken to inform best practices and identify essential components of end-of-life care planning (EOLCP) for people who will likely die incarcerated. Individual interviews with formerly incarcerated people (n = 16) provided insights on EOLCP knowledge, perceptions, and future plans as each reflected on experiences while incarcerated. Zoom Video Communications were used for the interviews, and audio recordings were transcribed verbatim, verified, and deidentified prior to thematic analysis. Themes were defined and discussed until consensus was reached between the 2 researchers. End-of-life care planning themes included the following: understanding of and experience with advanced directives/care planning (AD/ACP), defining AD/ACP, timing of AD/ACP accessibility to health care resources, how to approach EOLCP in prison, advantages of EOLCP, and barriers to EOLCP. Formerly incarcerated peoples' knowledge, perceptions, and future plans revealed important considerations when developing a contextually relevant toolkit for EOLCP for people living in prison.
On Death and Examination of the Dead in the Ottoman Empire: A Historical Perspective
Authors: Öner Bedirhan Sezer , Çetin Selçuk
Published: November 2023

The aims of this study were to examine the procedures performed during the death examination by scanning the qadi registry books of the Ottoman Empire in the 16th–18th centuries and to compare them with the procedures performed today. In our study, a total of 12 Konya qadi registry records from the period between 16th and 18th centuries (1563–1731) were examined. In our study, a total of 70 cases that underwent death discovery and examination were found out of 12 Konya qadi registry books. When the causes of death were evaluated in the cases in which the dead were discovered, being trapped in the wreckage was found as the most common cause with a total of 9 cases. This was followed by drowning (n = 8), being found dead in the open area (n = 8), and sharp injuries (n = 7). Because of the developments in all fields of medicine, it is understandable that wound descriptions are much more detailed today. However, descriptions such as “black bruise, battery, wounding” were found in the qadi registers as well. This case study is one of the most historic and comprehensive death series.