bluuebunny/crossref_metadata_2025 huggingface dataset:
Postdischarge Smoking Cessation in Subgroups of Hospitalized Smokers: A Latent Class Analysis
Authors: Ylioja Thomas , Cochran Gerald , Chang Yuchiao , Tindle Hilary A. , Rigotti Nancy A.
Published: July 2017

Background

Hospitalization presents a window of opportunity to treat smoking, and hospital-initiated smoking treatment has demonstrated effectiveness. Despite effective interventions, not all smokers will discontinue use, highlighting the need to better understand which patients achieve cessation. Traditional regression methods may not capture the complexity of inpatient smoker subgroups.

Methods

Latent class analysis (LCA) was conducted with data from 397 hospitalized adult cigarette smokers enrolled in a randomized trial. Six categorical indicator variables known to impact cessation were selected to estimate subgroups: health conditions (smoking-related disease [SRD], depressive symptoms, positive screen for alcohol problems) and smoking-related variables (time to first cigarette, cigarettes/day, smoking indoors). The probability of achieving biologically verified 7-day tobacco cessation 6 months after discharged was estimated.

Results

A 3-class model best fit the trial data: a Light Smokers subgroup had lower probability for most indicators; a High Health Burden subgroup had high smoking behavior probabilities and similar health problems to the Light Smokers subgroup; and a Heavy Smoking Drinking Depressed subgroup had high nicotine dependence, depressive symptoms, and alcohol misuse probabilities. Probability of biologically verified cessation conditional on class membership was significantly higher ( P < .001) for the High Health Burden and the Light Smokers subgroups compared with the Heavy Smoking Drinking Depressed subgroup.

Conclusion

Results suggest that subgroups with lower probabilities of alcohol misuse and depression and higher probability of SRD had higher probability of successful cessation after hospital discharge. Hospitalized patients with nicotine dependence combined with behavioral and mental health problems have additional cessation barriers that may require intervention focus.
Homeless Veterans’ Experiences with Substance Use, Recovery, and Treatment through Photo Elicitation
Authors: Sestito Samuel F. , Rodriguez Keri L. , Saba Shaddy K. , Conley James W. , Mitchell Michael A. , Gordon Adam J.
Published: July 2017

Background

Homeless veterans often have addictions and comorbidities that complicate utilization of longitudinal health care services, such as primary care. An understanding of experiences of veterans enrolled in a Homeless Patient Aligned Care Team (H-PACT) may improve addiction treatment engagement in these settings. The authors aimed to describe H-PACT veterans’ experiences with substance use (SU), substance use recovery (SUR), and substance use treatment (SUT).

Methods

Homeless veterans were recruited from a veteran primary care medical home clinic between September 2014 and March 2015. Twenty veterans were given digital cameras and prompts for taking photographs about their health and health care and participated in 2 photo elicitation interviews. For this secondary analysis, transcripts from the audio-recorded interviews were analyzed by 2 coders using qualitative content analysis.

Results

The majority of participants (75%, n = 15) discussed SU, SUR, and/or SUT in regards to their health and health care utilization. SU themes centered on disclosure of addiction or dependency; substances used; repercussions of SU; SU as a coping mechanism; and association of SU with military service. SUR themes included disclosure of length of sobriety; perceived facilitators of SUR in health, beliefs, social, environmental, financial, and creative pursuit domains; and perceived barriers to SUR in beliefs, social, and environmental domains. SUT themes focused on perceived facilitators of SUT in access to Department of Veterans Affairs (VA) and non-VA services and social domains and perceived barriers to SUT in the social domain.

Conclusions

Providers seeking to elicit addiction-related clinical history and facilitate SUR and SUT might look to the current findings for guidance. Provider training in motivational interviewing may be warranted, which allows for an exploration of health-related consequences of SU and supports patients’ self-efficacy.
Awareness of State Legislation on Naloxone Accessibility associated with Willingness to Prescribe Naloxone
Authors: Okoro Olihe N. , Bastianelli Karen M. , Wen Ya-Feng , Bilden Elisabeth F. , Konowalchuk Brian K. , Schneiderhan Mark E.
Published: July 2017

Background

Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution.

Methods

Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems’ institutional review boards.

Results

Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n = 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5–22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3–15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation ( r = 0.43, P < .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone ( r = 0.37, P < .0001), general knowledge ( r = 0.24, P = .0032), and perception of professional responsibility ( r = 0.19, P = .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws ( P = .0016) and self-confidence about dosing, prescribing, and writing protocols ( P = .0011).

Conclusions

Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.
Increasing Availability of Benzodiazepines among People who Inject Drugs in a Canadian Setting
Authors: Walton Geoffrey , Dong Huiru , Milloy M. J. , DeBeck Kora , Kerr Thomas , Wood Evan , Hayashi Kanna
Published: July 2017

Background

Benzodiazepine misuse is associated with mortality and is common among people who inject drugs (PWID). This study aimed to examine the temporal trends in the availability of benzodiazepines among PWID in a Canadian setting, and to identify factors associated with more immediate access to benzodiazepines.

Methods

Data were derived from 3 prospective cohorts of PWID in Vancouver, Canada, between June 2012 and May 2015. The primary outcome was the perceived availability of benzodiazepines, measured in 3 levels: not available, delayed availability (available in ≥10 minutes), and immediate availability (available in <10 minutes). The authors used multivariable generalized estimating equations to identify factors associated with availability of benzodiazepines.

Results

In total, 1641 individuals were included in these analyses. In multivariable analyses, factors associated with immediate benzodiazepine availability included incarceration (adjusted odds ratio [AOR]: 1.42, 95% confidence interval [CI]: 1.06, 1.89) and participation in methadone maintenance therapy (MMT) (AOR: 1.35, 95% CI: 1.14, 1.60). Factors associated with delayed benzodiazepine availability included incarceration (AOR: 1.45, 95% CI: 1.02, 2.07) and participation in MMT (AOR: 1.77, 95% CI: 1.48, 2.12). Benzodiazepine availability increased throughout the study period for both immediate (AOR: 1.14, 95% CI: 1.10, 1.18 per 6-month follow-up period) and delayed (AOR: 1.17, 95% CI: 1.12, 1.22 per 6-month follow-up period) availability.

Conclusions

Among our sample of PWID, benzodiazepine availability is increasing and was associated with health and criminal justice system characteristics. Our findings indicate a need to examine prescribing practices and educate both PWID and health care providers about the risks associated with benzodiazepine use.
CENP-A and topoisomerase-II antagonistically affect chromosome length
Authors: Ladouceur A.-M. , Ranjan Rajesh , Smith Lydia , Fadero Tanner , Heppert Jennifer , Goldstein Bob , Maddox Amy Shaub , Maddox Paul S.
Published: July 2017

The size of mitotic chromosomes is coordinated with cell size in a manner dependent on nuclear trafficking. In this study, we conducted an RNA interference screen of the Caenorhabditis elegans nucleome in a strain carrying an exceptionally long chromosome and identified the centromere-specific histone H3 variant CENP-A and the DNA decatenizing enzyme topoisomerase-II (topo-II) as candidate modulators of chromosome size. In the holocentric organism C. elegans, CENP-A is positioned periodically along the entire length of chromosomes, and in mitosis, these genomic regions come together linearly to form the base of kinetochores. We show that CENP-A protein levels decreased through development coinciding with chromosome-size scaling. Partial loss of CENP-A protein resulted in shorter mitotic chromosomes, consistent with a role in setting chromosome length. Conversely, topo-II levels were unchanged through early development, and partial topo-II depletion led to longer chromosomes. Topo-II localized to the perimeter of mitotic chromosomes, excluded from the centromere regions, and depletion of topo-II did not change CENP-A levels. We propose that self-assembly of centromeric chromatin into an extended linear array promotes elongation of the chromosome, whereas topo-II promotes chromosome-length shortening.
S1PR1 on tumor-associated macrophages promotes lymphangiogenesis and metastasis via NLRP3/IL-1β
Authors: Weichand Benjamin , Popp Rüdiger , Dziumbla Sarah , Mora Javier , Strack Elisabeth , Elwakeel Eiman , Frank Ann-Christin , Scholich Klaus , Pierre Sandra , Syed Shahzad N. , Olesch Catherine , Ringleb Julia , Ören Bilge , Döring Claudia , Savai Rajkumar , Jung Michaela , von Knethen Andreas , Levkau Bodo , Fleming Ingrid , Weigert Andreas , Brüne Bernhard
Published: July 2017

Metastasis is the primary cause of cancer death. The inflammatory tumor microenvironment contributes to metastasis, for instance, by recruiting blood and lymph vessels. Among tumor-infiltrating immune cells, tumor-associated macrophages (TAMs) take a center stage in promoting both tumor angiogenesis and metastatic spread. We found that genetic deletion of the S1P receptor 1 (S1pr1) alone in CD11bhi CD206+ TAMs infiltrating mouse breast tumors prevents pulmonary metastasis and tumor lymphangiogenesis. Reduced lymphangiogenesis was also observed in the nonrelated methylcholanthrene-induced fibrosarcoma model. Transcriptome analysis of isolated TAMs from both entities revealed reduced expression of the inflammasome component Nlrp3 in S1PR1-deficient TAMs. Macrophage-dependent lymphangiogenesis in vitro was triggered upon inflammasome activation and required both S1PR1 signaling and IL-1β production. Finally, NLRP3 expression in tumor-infiltrating macrophages correlated with survival, lymph node invasion, and metastasis of mammary carcinoma patients. Conceptually, our study indicates an unappreciated role of the NLRP3 inflammasome in promoting metastasis via the lymphatics downstream of S1PR1 signaling in macrophages.
Nilpotent Lie Algebras and Systolic Growth of Nilmanifolds
Authors: Cornulier Yves
Published: July 2017

Introduced by Gromov in the nineties, the systolic growth of a Lie group gives the smallest possible covolume of a lattice with a given systole. In a simply connected nilpotent Lie group, this function has polynomial growth, but can grow faster than the volume growth. We express this systolic growth function in terms of discrete cocompact subrings of the Lie algebra, making it more practical to estimate. After providing some general upper bounds, we develop methods to provide nontrivial lower bounds. We provide the first computations of the asymptotics of the systolic growth of nilpotent groups for which this is not equivalent to the volume growth. In particular, we provide an example for which the degree of growth is not an integer; it has dimension 7. Finally, we gather some open questions.
Snowshoe Hare Virus Causing Meningoencephalitis in a Young Adult From Northern Manitoba, Canada
Authors: Lau Lawrence , Wudel Beverly , Kadkhoda Kamran , Keynan Yoav
Published: July 2017

We describe a dramatic presentation of meningoencephalitis, in a young Aboriginal male from Northern Manitoba, due to infection with the Snowshoe hare virus, a member of the California serogroup viruses. Snowshoe hare virus represents a rare cause of meningoencephalitis, and, to date, few Canadian cases have been described in the literature.
Endoscopic Endonasal and Transcranial Surgery for Microsurgical Resection of Ventral Foramen Magnum Meningiomas: A Preliminary Experience
Authors: Khattar Nicolas , Koutourousiou Maria , Chabot Joseph D , Wang Eric W , Cohen-Gadol Aaron A , Snyderman Carl H , Fernandez-Miranda Juan C , Gardner Paul A
Published: July 2017

BACKGROUND

Purely ventral foramen magnum meningiomas are challenging tumors to treat given their location, and proximity and relationship to vital neurovascular structures.

OBJECTIVE

To present endoscopic endonasal surgery (EES) as a complementary approach to the far-lateral suboccipital approach (FLA) for ventral midline tumors.

METHODS

From May 2008 to October 2013, 5 patients underwent EES and 5 FLA for primary ventral foramen magnum meningiomas. We retrospectively reviewed their records to evaluate outcomes.

RESULTS

Nine of 10 patients presented with long-tract and lower cranial nerve deficits. All patients who presented with deficits preoperatively completely normalized after tumor resection regardless of approach. Gross total resection was achieved in 2 cases in the EES group and 4 cases in the FLA group (the rest were near total). Vascular encasement was a limitation to gross total resection with both approaches. Preoperative median Karnofsky Performance Scale score was 80 and improved to 100 in both groups.

Following EES, 1 patient developed cerebrospinal fluid leak with resultant meningitis. Two patients developed hydrocephalus, one of which developed an epidural abscess following necrosis of the nasoseptal flap, requiring debridement. In the FLA group, 1 patient developed a pseudomeningocele associated with hydrocephalus. One patient developed an abdominal fat graft site hematoma.

CONCLUSION

Both approaches provide excellent results for resection of ventral foramen magnum meningiomas, with reconstruction and hydrocephalus as the main sources of complication. In our practice, EES is a preferred technique in ventral, purely midline tumors with limited inferior extension and reduced lower cranial nerve manipulation, whereas FLA is preferred in tumors with lateral and caudal extension below the tip of the dens.
Epidemic Network Analysis for Mitigation of Invasive Pathogens in Seed Systems: Potato in Ecuador
Authors: Buddenhagen C. E. , Hernandez Nopsa J. F. , Andersen K. F. , Andrade-Piedra J. , Forbes G. A. , Kromann P. , Thomas-Sharma S. , Useche P. , Garrett K. A.
Published: July 2017

Seed systems have an important role in the distribution of high-quality seed and improved varieties. The structure of seed networks also helps to determine the epidemiological risk for seedborne disease. We present a new approach for evaluating the epidemiological role of nodes in seed networks, and apply it to a regional potato farmer consortium (Consorcio de Productores de Papa [CONPAPA]) in Ecuador. We surveyed farmers to estimate the structure of networks of farmer seed tuber and ware potato transactions, and farmer information sources about pest and disease management. Then, we simulated pathogen spread through seed transaction networks to identify priority nodes for disease detection. The likelihood of pathogen establishment was weighted based on the quality or quantity of information sources about disease management. CONPAPA staff and facilities, a market, and certain farms are priorities for disease management interventions such as training, monitoring, and variety dissemination. Advice from agrochemical store staff was common but assessed as significantly less reliable. Farmer access to information (reported number and quality of sources) was similar for both genders. However, women had a smaller amount of the market share for seed tubers and ware potato. Understanding seed system networks provides input for scenario analyses to evaluate potential system improvements.

[Formula: see text] Copyright © 2017 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Anaphylaxis and intimate behaviour
Authors: Liccardi Gennaro , Caminati Marco , Senna Gianenrico , Calzetta Luigino , Rogliani Paola
Published: July 2017

Purpose of review

Intimate behaviours may represent an unusual way of exposure to a culprit allergen, or the frame for sex-related allergies due to triggers typically linked to that situation. The present review aims at summarizing the state of the art about the topic, in order to spread the awareness and the basic know-how in the field of sexual-related allergies.

Recent findings

Kiss-related IgE-mediated reactions are caused in sensitized partners mainly by the passive transport of allergenic molecules through saliva, skin or oral mucosa. It has also been recently suggested that kissing may act as an epicutaneous way for induction of allergic sensitization. Among food and drugs, not only but mostly, peanuts and beta-lactams, respectively, are the usual trigger. Although controversial, 1-hour wait before kissing and a proper mouth cleaning have been suggested as prevention strategies. Sexual intercourse related local or systemic symptoms can be caused by seminal plasma hypersensitivity, an IgE-mediated/type IV reaction due to prostate-specific antigen, which carries high homology to the canine prostatic kallikrein (Can f 5). Although applied to few patients, successful desensitization and immunotherapy protocols have been proposed.

Intimate behaviours are possible modalities of contact with the allergen. The exact prevalence of such hypersensitivity reactions is not known, but for its implications on Quality of Life and reproductive wishes, the possible link between sex and allergy should become part of the personal culture of clinical allergists and every clinician, in order to extend and improve the diagnosis of unusual or unexplained conditions.
An Effective Negative Pressure Wound Therapy–Compatible Local Antibiotic Delivery Device
Authors: Rand Ben C. C. , Wenke Joseph C.
Published: July 2017

Objectives:

The current clinical standard for local antibiotic depot is polymethylmethacrylate (PMMA) beads. Unfortunately, these are not ideal and negative pressure wound therapy (NPWT) reduces their limited effectiveness. Recently, a chitosan sponge has been shown to be an effective carrier of antibiotics. Because it acts as a delivery vehicle with increased wound contact area instead of an antibiotic depot, it may be more effective. The objectives of this study were to determine if (1) a chitosan sponge would be more effective than PMMA beads as a local antibiotic delivery device and (2) the chitosan sponge remains an effective method of delivery when used in conjunction with NPWT.

Methods:

Contaminated musculoskeletal wounds were created on the proximal tibia of goats; the animals were assigned to 1 of 4 groups (bead pouch, beads with NPWT, sponge pouch, and sponge with NPWT). The animals were survived for 48 hours, and the bacteria in the wound were quantified. The antibiotic levels in the blood and within the NPWT canisters were measured throughout the study period.

Results:

After treatment, there were significantly fewer bacteria in wounds treated with antibiotic chitosan sponge delivery than antibiotic PMMA bead depot (P < 0.05), and NPWT did not reduce the effectiveness of the chitosan sponge even though large amounts of vancomycin was found in the canisters. The peak serum levels of vancomycin were well below what is considered safe levels.

Conclusions:

Antibiotic delivery to the wound using a chitosan sponge is compatible with NPWT and is more effective than PMMA antibiotic depot. The chitosan sponge works in conjunction with NPWT and may improve the outcomes of open fracture wounds.
Economic Considerations of Acute Pain Medicine Programs
Authors: Gray Chancellor F. , Smith Cameron R. , Zasimovich Yury , Tighe Patrick J.
Published: July 2017

Acute pain medicine (APM) services influence many different aspects of postoperative recovery and function. Here, we discuss the various stakeholders of an APM service, review the direct and indirect impact on said stakeholders, review the shared and competing interests between APM programs and various payer systems, and discuss how APM services can help service lines align with the interests of the recent Centers for Medicare and Medicaid Services Innovations Comprehensive Care for Joint Replacement Model.
Readmissions for Recurrent Sepsis: New or Relapsed Infection?*
Authors: DeMerle Kimberley Marie , Royer Stephanie C. , Mikkelsen Mark E. , Prescott Hallie C.
Published: July 2017

Objectives:

Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode.

Design:

Retrospective cohort study.

Setting:

University of Michigan Health System.

Patients:

All hospitalizations (May 15, 2013 to May 14, 2015) with a principal International Classification of Diseases, Ninth revision, Clinical Modification diagnosis of septicemia (038.x), severe sepsis (995.92), or septic shock (785.52), as well as all subsequent hospitalizations and sepsis readmissions within 90 days. We determined organism and site of sepsis through manual chart abstraction.

Interventions:

None.

Measurements and Main Results:

We identified 472 readmissions within 90 days of sepsis, of which 137 (29.1%) were for sepsis. In sepsis readmissions, the site and organisms were most commonly urinary (29.2%), gastrointestinal (20.4%), Gram negative (29.9%), Gram positive (16.8%), and culture negative (30.7%). Ninety-four readmissions (68.6%) were for infection at the same site as initial sepsis hospitalization. Nineteen percent of readmissions were confirmed to be same site and same organism. However, accounting for the uncertainty from culture-negative sepsis, as many as 53.2% of readmissions could plausibly due to infections with both the same organism and same site.

Conclusions:

Of the patients readmitted with sepsis within 90 days, two thirds had infection at the same site as their initial admission. Just 19% had infection confirmed to be from the same site and organism as the initial sepsis hospitalization. Half of readmissions were definitively for new infections, whereas an additional 34% were unclear since cultures were negative in one of the hospitalizations.
Rational therapeutic choice for older patients with lymphoma
Authors: Bron Dominique , Soubeyran Pierre
Published: July 2017

Purpose of review

The choice for an optimal treatment in older lymphoma patients is a real challenge for hemato-oncologists. They have to treat a potentially curative lymphoma, and concomitantly protect their patients from unacceptable toxicities. Some recommendations are provided for the major subtypes of lymphomas including the antitumoral treatment and primarily the optimal supportive care.

Recent findings

All the recent literature data converge to say that the approach of an older patient with a malignant hemopathy is a multistep procedure. This process comprises the appraisal of life expectancy of the patient with or without the disease, the prognostic factors of the tumor, the functional, physiological and cognitive functions evaluation, the socio-economical environment and the patient's expectancy in terms of quality of life. Major progresses have been achieved in the management of diffuse large B cell lymphoma and mantle cell lymphoma in patients up to 80 and above 80 years old.

With all these information in hands, the hematologist will decide if the treatment's objective is the standard treatment with optimal supportive care (fit patients), tailor-made adapted chemotherapy (unfit patients) or preservation of quality of life (frail patients).
Embryonic Stem Cell-Like Population in Dupuytren’s Disease Expresses Components of the Renin-Angiotensin System
Authors: On Nicholas , Koh Sabrina P. , Brasch Helen D. , Dunne Jonathan C. , Armstrong James R. , Tan Swee T. , Itinteang Tinte
Published: July 2017

Background:

The renin-angiotensin system (RAS) mediates cardiac and renal fibrosis. Dupuytren’s disease (DD) is a proliferative fibromatosis affecting the hands. This study investigated the expression of the RAS in DD.

Methods:

3,3-Diaminobenzidine (DAB) and immunofluorescent immunohistochemical (IHC) staining for (pro)renin receptor (PRR), angiotensin-converting enzyme (ACE), angiotensin II receptor 1 (ATIIR1), and angiotensin II receptor 2 (ATIIR2) was performed on 4-μm thick formalin-fixed paraffin-embedded sections of DD cords and nodules from 6 patients. Western blotting (WB) and NanoString mRNA analysis were performed to confirm RAS protein expression and transcriptional activation, respectively.

Results:

IHC staining demonstrated the expression of PRR, ACE, ATIIR1, and ATIIR2 on the ERG+ and CD34+ endothelium of the micro vessels surrounding the DD cords and nodules. PRR was also expressed on the pericyte layer of these microvessels. WB confirmed protein expression of PRR, ACE, and ATIIR2 but not ATIIR1. NanoString analysis confirmed transcriptional activation of PRR, ACE, ATIIR1, but ATIIR2 was below detectable levels.

Conclusions:

We demonstrated expression of PRR, ATIIR1, ATIIR2, and ACE on the embryonic stem cell–like cell population on the microvessels surrounding DD nodules and cords by IHC staining, although the expression of ATIIR1 was not confirmed by WB and that of ATIIR2 was below detectable levels on NanoString analysis. These findings suggest the embryonic stem cell–like cell population as a potential therapeutic target for DD, by using RAS modulators.
Genetics of Endometriosis
Authors: KRISHNAMOORTHY KAVITHA , DECHERNEY ALAN H.
Published: July 2017

Endometriosis is a complex, puzzling disease in women of reproductive age. The exact cause of the disease is unknown; however, different genetic and environmental factors contribute to the evolution of the disorder. Further investigation has led to the discovery of inheritance as a complex genetic trait. Candidate genes were identified to isolate regions of genes that affect disease risk. Additional linkage studies have been performed to map specific genes along the entire genome. Recent advances to determine the genetic component of endometriosis include genome-wide association studies. This chapter focuses on different approaches to identify the genetic links of endometriosis and its pathogenesis.
PROPHYLACTIC PREOPERATIVE LASER RETINOPEXY DOES NOT REDUCE THE OCCURRENCE OF RHEGMATOGENOUS RETINAL COMPLICATIONS IN MACULAR SURGERY
Authors: Garg Aakriti , Chang Jonathan S. , Tosi Gian Marco , Esposti Pierluigi , Chen Royce W. , Horowitz Jason , Hoang Quan V. , Schiff William M. , Barile Gaetano R. , Chang Stanley
Published: July 2017

Purpose:

Knowledge on the utility of prophylactic 360° laser retinopexy before pars plana vitrectomy in the absence of peripheral retinal pathology is limited. This study compares the occurrence of rhegmatogenous events in the setting of small-gauge pars plana vitrectomy with and without prophylactic preoperative laser.

Methods:

Our multicenter, retrospective case–control analysis reviewed patients who underwent epiretinal membrane removal or macular hole repair through 23- or 25-gauge pars plana vitrectomy: 205 controls who did not receive prophylactic laser and 176 cases who received preoperative prophylactic laser retinopexy anterior to the equator. Main outcome measures were the rate and characteristics of postoperative retinal tears and detachments. Patients with previous pars plana vitrectomy or significant retinal disease were excluded.

Results:

Of those patients with prophylactic laser and those without, there was no significant difference in the number of retinal breaks (1.7% vs. 0.49%, respectively; P = 0.339) or retinal detachments (0% vs. 0.49%, respectively; P = 1.00). Of the lasered group, there was one sclerotomy-related retinal break and two non–sclerotomy-related retinal breaks. Of the nonlasered group, there was one non–sclerotomy-related retinal break and one sclerotomy-related retinal detachment.

Conclusion:

Preoperative prophylactic peripheral laser retinopexy does not seem to offer an added benefit in the prevention of intraoperative and postoperative rhegmatogenous events.
Changes in Higher-Order Aberrations After Phototherapeutic Keratectomy for Subepithelial Corneal Infiltrates After Epidemic Keratoconjunctivitis
Authors: Kepez Yildiz Burcin , Urvasizoglu Semih , Yildirim Yusuf , Agca Alper , K. Besek Nilay , Fazil Korhan , Eris Erdem , Aygit Ebru Demet , Taskapili Muhittin , Demirok Ahmet
Published: July 2017

Purpose:

To investigate how corneal aberrations change after phototherapeutic keratectomy (PTK) for subepithelial infiltrates after adenoviral keratoconjunctivitis.

Methods:

The records of patients who underwent transepithelial PTK for subepithelial infiltrates were retrospectively reviewed. Preoperative best-corrected visual acuity (VA) and the results of slit-lamp biomicroscopy examinations were recorded. The PTK procedure was performed under topical anesthesia with an Amaris excimer laser. Patients' manifest refraction values, topographical examination results, and corneal aberrations before and after surgery were analyzed.

Results:

Twenty-four eyes of 16 women (84.3%) and 3 men (15.7%) were treated. The mean follow-up time was 6.0 ± 2.5 (range: 3–12) months, and the mean ablation depth was 82.3 ± 1.0 (range: 80–88) μm. Postoperative median best-corrected VA increased from 0.6 (range: 0.4–1.0) logarithm of the minimum angle of resolution to 0.2 (range: 0.1–0.5) logarithm of the minimum angle of resolution (P = 0.048), coma decreased from 0.56 (range: 0.29–0.37) to 0.44 (range: 0.07–0.74), secondary astigmatism decreased from 0.45 (range: 0.12–1.9) to 0.17 (range: 0.03–0.49), and total higher-order aberrations decreased from 1.24 (range: 0.61–6.74) to 0.9 (range: 0.33–1.64) (P = 0.008, 0.0032, and 0.018, respectively).

Conclusions:

PTK is an effective method for treating corneal opacity after epidemic keratoconjunctivitis, which yields significant improvements in both VA and visual quality.
Use of Topical Insulin to Treat Refractory Neurotrophic Corneal Ulcers
Authors: Wang Angeline L. , Weinlander Eric , Metcalf Brandon M. , Barney Neal P. , Gamm David M. , Nehls Sarah M. , Struck Michael C.
Published: July 2017

Purpose:

To report the clinical course of 6 patients with refractory neurotrophic corneal ulcers that were treated with topical insulin drops.

Methods:

Retrospective chart review of patients who had neurotrophic corneal ulcers or epithelial defects refractory to standard medical and surgical treatment. Insulin drops, prepared by mixing regular insulin in artificial tears with a polyethylene glycol and propylene glycol base at a concentration of 1 unit per milliliter, were prescribed 2 to 3 times daily.

Results:

Six patients, aged 2 to 73 years, developed neurotrophic corneal ulcers refractory to a range of medical and surgical treatments, including bandage contact lens, amniotic membrane grafting, and permanent tarsorrhaphy. Each patient was administered topical insulin drops with complete corneal reepithelialization within 7 to 25 days.

Conclusions:

Topical insulin may be a simple and effective treatment for refractory neurotrophic corneal ulcers. Further study is required to determine the clinical efficacy and side effect profile of insulin drops.
Rotavirus Infection in the Auckland Region After the Implementation of Universal Infant Rotavirus Vaccination
Authors: McAuliffe Gary N. , Taylor Susan L. , Drinković Dragana , Roberts Sally A. , Wilson Elizabeth M. , Best Emma J.
Published: July 2017

Background:

In July 2014, New Zealand introduced universal infant vaccination with RotaTeq (Merk & Co.) administered as 3 doses at 6 weeks, 3 and 5 months of age. We sought to assess the impact of rotavirus vaccination on gastroenteritis (GE) hospitalizations in the greater Auckland region and analyze changes in rotavirus testing in the period around vaccine introduction.

Methods:

Hospitalizations, laboratory testing rates and methods were compared between the pre-vaccine period (2009–2013), post-vaccine period (January 2015 to December 2015) and year of vaccine introduction (2014).

Results:

There was a 68% decline in rotavirus hospitalizations of children <5 years of age after vaccine introduction (from 258/100,000 to 83/100,000) and a 17% decline in all-cause gastroenteritis admissions (from 1815/100,000 to 1293/100,000). Reductions were also seen in pediatric groups too old to have received vaccine. Despite these changes, rotavirus testing rates in our region remained static in the year after vaccine introduction compared with the 2 prior years, and after vaccine introduction, we observed a high rate of false positives 19/58 (33%) in patients with reactive rotavirus tests.

Conclusions:

Rotavirus vaccine has had a significant early impact on gastroenteritis hospitalizations for children in the Auckland region. However, continued rotavirus testing at pre-vaccine rates risks generating false positive results. Laboratories and clinicians should consider reviewing their testing algorithms before vaccine introduction.
The Perinatal-Neonatal Care Journey for Parents of Preterm Infants
Authors: Franck Linda S. , McNulty Alison , Alderdice Fiona
Published: July 2017

Preterm birth is traumatic for parents, but there are few reports of parents' views on how the healthcare journey can be improved. This secondary thematic analysis used focus group data from parent consultation on proposed neonatal services standards for Northern Ireland to discover parents' experiences and recommendations for the perinatal, neonatal, and home care phases. Parents of preterm infants (n = 40) described their healthcare journey as positive overall and were grateful for the caring and competent care providers they encountered. However, parents described experiences that varied in quality and family centeredness across the care journey from perinatal to home care. They noted inconsistencies in healthcare team communication and provider practices and reported receiving limited emotional and practical support at all phases. In the perinatal phase, parents described difficult situations of discovering medical problems leading to preterm birth. In the neonatal intensive care unit phase, they also experienced unmet needs for involvement in decision making, financial strain, and difficulty coping with transfers and discharge. Parents experienced emotional challenges and lack of support in the home care phase. Parents identified actions that health systems can take to improve the consistency of care and communication across all phases and settings to encourage better collaboration and transitions in care.
Quality Improvement Initiative for Family-Centered Care in the Neonatal Intensive Care Unit of a Tertiary Hospital in South Africa
Authors: Maree Carin , Kekana Poppy , van der Walt Christa , Yazbek Mariatha , Leech Ronell
Published: July 2017

The introduction of family-centered care in the neonatal intensive care unit was identified as a high priority to facilitate bonding and attachment with potential positive outcomes for the parents and infants. The aim of the study was, therefore, to develop and implement a quality improvement initiative to foster family-centered care in a tertiary neonatal intensive care unit from birth onward. A pretest posttest intervention design was used using mixed methods over 3 phases to determine the perceived level of family-centered care according to healthcare professionals and parents using self-administered questionnaires; to develop and implement a quality improvement initiative to enhance family-centered care in a neonatal intensive care unit using a nominal group technique, followed by the quality improvement process; and to evaluate the outcomes of the initiative by repeating the self-administered questionnaires to parents and staff. Various activities were introduced as part of the initiative such as early breastfeeding, early introduction of parents to their infant, open visitation policy, and involvement in caring activities. The perceived level of care according to staff and parents increased. It is expected to enhance bonding and attachment between the infants and their parents, with consequential long-term positive outcomes.
Utilization of Large Data Sets in Maternal Health in Finland
Authors: Lamminpää Reeta , Gissler Mika , Vehviläinen-Julkunen Katri
Published: July 2017

In recent years, the use of large data sets, such as electronic health records, has increased. These large data sets are often referred to as “Big Data,” which have various definitions. The purpose of this article was to summarize and review the utilization, strengths, and challenges of register data, which means a written record containing regular entries of items or details, and Big Data, especially in maternal nursing, using 4 examples of studies from the Finnish Medical Birth Register data and relate these to other international databases and data sets. Using large health register data is crucial when studying and understanding outcomes of maternity care. This type of data enables comparisons on a population level and can be utilized in research related to maternal health, with important issues and implications for future research and clinical practice. Although there are challenges connected with register data and Big Data, these large data sets offer the opportunity for timely insight into population-based information on relevant research topics in maternal health. Nurse researchers need to understand the possibilities and limitations of using existing register data in maternity research. Maternal child nurse researchers can be leaders of the movement to utilize Big Data to improve global maternal health.
A Rare Presentation of a Morel-Lavallee Lesion of the Lower Leg Successfully Treated With Ultrasound-Guided Aspiration
Authors: Falconi Audrey , Crellin Holly , Tagawa Chelsea
Published: July 2017

A Morel-Lavallee lesion (MLL) is a relatively rare condition that is caused by a traumatic shearing force. This force leads to a closed degloving injury of the subcutaneous tissue and fascia that creates a potential space that can fill with lymph, blood, and necrotic fat. The MLLs are traditionally seen after high impact trauma and typically located at the greater trochanter and pelvis, although recent reports have found them to be located at the knee, thigh, and lower leg. The MLLs typically present as swelling at the site of injury, which can be difficult to differentiate from several other diagnoses. This case report discusses an MLL in the lower extremity that occurred during a rugby game. A lack of familiarity with MLLs often leads to delayed diagnosis and treatment. The diagnosis was eventually made with an magnetic resonance imaging, and the lesion was successfully treated with ultrasound-guided aspiration and compression. The athlete was able to return to play without recurrence of the lesion.
Functional Movement Screening and Injury Rates in High School and Collegiate Runners: A Retrospective Analysis of 3 Prospective Observational Studies
Authors: Bring Benjamin V. , Chan Miriam , Devine Robin C. , Collins Christy L. , Diehl Jason , Burkam Benjamin
Published: July 2017

Objective:

Determine if the Functional Movement Screening (FMS) can be used to predict injury in high school and collegiate cross-country and track runners.

Design:

Prospective Observational, Cohort Study, Level of Evidence, 2.

Setting:

High schools and colleges in the Central Ohio area.

Patients:

Inclusion: (1) cross-country or track runners at participating schools; (2) full participation without restrictions; and (3) signed informed assent or consent. Exclusion: (1) Any injury or lower extremity surgery within 30 days; (2) planned limited participation in the upcoming season; or (3) other participation restrictions.

Interventions:

Functional Movement Screening was completed before the start of each season. Injuries were tracked during the regular season. No interventions were made based on FMS score.

Main Outcome Measures:

Functional Movement Screening scores, including overall, lower extremity, and specific exercises were compared between runners who did and did not sustain an injury using 2 sample t tests. A cutoff FMS score of ≤14 (most common in previous studies), and ≤15 (determined by a receiver operating characteristic curve), were compared using χ2 tests.

Results:

One hundred eighty-three runners were enrolled in the study. Overall, 32 (17.5%) runners sustained an injury. Functional Movement Screening score was not accurate in predicting injury for ≤14 (sensitivity: 65.6%; specificity: 39.7%; and area under the curve = 0.501) or ≤15 (sensitivity: 84.4% and specificity: 23.8%). There was no difference in risk of injury for runners with a FMS score of ≤14 (15.5%) and >14 (18.8%) (P = 0.572) or with a FMS score of ≤15 (17.5%) and >15 (17.4%) (P = 0.988).

Conclusions:

Functional Movement Screening composite score may not be useful for injury prediction in populations of high school and collegiate runners.
Noonan Syndrome: An Underestimated Cause of Severe to Profound Sensorineural Hearing Impairment. Which Clues to Suspect the Diagnosis?
Authors: Ziegler Alban , Loundon Natalie , Jonard Laurence , Cavé Hélène , Baujat Geneviève , Gherbi Souad , Couloigner Vincent , Marlin Sandrine
Published: July 2017

Objective:

To highlight Noonan syndrome as a clinically recognizable cause of severe to profound sensorineural hearing impairment.

Study Design:

New clinical cases and review.

Setting:

Patients evaluated for etiological diagnosis by a medical geneticist in a reference center for hearing impairment.

Patients:

Five patients presenting with confirmed Noonan syndrome and profound sensorineural hearing impairment.

Interventions:

Diagnostic and review of the literature.

Results:

Five patients presented with profound sensorineural hearing impairment and molecularly confirmed Noonan syndrome. Sensorineural hearing impairment has been progressive for three patients. Cardiac echography identified pulmonary stenosis in two patients and was normal for the three other patients. Short stature was found in two patients. Mild intellectual disability was found in one patient. Inconspicuous clinical features as facial dysmorphism, cryptorchidism, or easy bruising were of peculiar interest to reach the diagnosis of Noonan syndrome.

Conclusion:

Profound sensorineural hearing impairment can be the main feature of Noonan syndrome. Associated features are highly variable; thus, detailed medical history and careful physical examination are mandatory to consider the diagnosis in case of a sensorineural hearing impairment.
Pediatric Gastroenterologists’ Approach to Venous Thromboembolism Prophylaxis in Pediatric Inflammatory Bowel Disease
Authors: Chien Kimberley A. , Hammad Hoda T. , Gerber Linda , Sheth Sujit , Sockolow Robbyn , Kucine Nicole
Published: July 2017

The risk of venous thromboembolism (VTE) is significantly increased in patients with inflammatory bowel disease (IBD). For the adult population, prophylaxis guidelines exist to help guide physicians in their management of high‐risk IBD patients. Although it is known that children with IBD also experience increased rates of VTE, there is no clear consensus on how best to prevent these unwanted complications. We sought to better understand practicing pediatric gastroenterologists’ awareness of this issue and practices surrounding prevention of VTE in their pediatric patients. We found that pediatric gastroenterologists are well aware of the increased risk for VTE in children with IBD, that anticoagulant prophylaxis is infrequently used for pediatric patients, and that the most commonly cited reason for not providing prophylaxis is the lack of available guidelines in the literature.
Transgender Individuals and Osteoporosis Prevention
Authors: Sedlak Carol A. , Roller Cyndi Gale , van Dulmen Manfred , Alharbi Homood A. , Sanata Jessica D. , Leifson Marci A. , Veney Amy J. , Alhawatmeh Hossam , Doheny Margaret O'Bryan
Published: July 2017

BACKGROUND:

Risk behaviors and hormone use place transgender individuals (TIs) in jeopardy for osteoporosis.

PURPOSE:

The purpose of this study was to expand the science about the knowledge, health beliefs, and osteoporosis (OP) preventing behaviors of TIs.

METHODS:

This was a mixed-methods pilot study of a convenience sample of 31 TIs 30 years and older. Participants completed an online Osteoporosis Bone Health Survey. Fifteen participants were randomly selected for an interview to describe their perceptions of bone health.

RESULTS:

Transgender individuals performed poorly on the knowledge measure. There were no significant findings for osteoporosis health beliefs. Participants' daily dietary dairy calcium intake was 800 mg and daily walking activity was 17 minutes. Perceptions of bone health revealed two essential elements, knowing and doing.

CONCLUSION:

Determining TIs' bone health perception is important because of their unique healthcare issues. Healthcare providers need to be aware of TIs' bone health needs to help enhance TIs' OP knowledge, health beliefs, and preventing behaviors.
Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team
Authors: Arana Melissa , Harper Licia , Qin Huanying , Mabrey Jay
Published: July 2017

The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.