bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of life of rural poor elderly in Anhui, China
Authors: Rong Jian , Ding Hong , Chen Guimei , Ge Yanhong , Xie Tingting , Meng Nana
Published: February 2020

This study is to explore the quality of life (QoL) of the rural poor elderly in central China (Anhui province) and the influencing factors.

A multi-stage random sampling method was used to extract 3352 effective samples of the rural elderly in Anhui, including 1206 poor and 2146 non-poor elderly subjects. Euro QoL 5-dimension questionnaire (EQ-5D) was used for the measurement of QoL. Descriptive statistics and χ
2 test were used to compare and analyze the sociodemographic characteristics and QoL scores between poor and non-poor elderly. Multiple linear regression was used to assess the influencing factors of QoL.

There were significant differences in gender, age, education levels, professions, chronic diseases, physical discomfort within 2 weeks, hospitalization within 1 year, economic sources, and migrant workers between the rural poor and non-poor elderly groups. The QoL of rural poor elderly scored significantly higher than the non-poor elderly, in all these five dimensions. The average EuroQol Visual Analogue Scale (EQ-VAS) of poor elderly was 65.689, lower than the non-poor elderly (71.039). After controlling the confounding factors, there was a significant statistical difference in the total utility score of EQ-5D between the poor and non-poor elderly groups.

The QoL of poor elderly in central China is lower than non-poor elderly, with the worst dimension of pain/discomfort. The QoL of rural poor elderly in this area could be affected by many factors, to which more attention should be paid.
Evaluation of multiple screening methods for cervical cancers in rural areas of Xinjiang, China
Authors: Naizhaer Gulimire , Yuan Jianlin , Mijiti Patima , Aierken Kailibinuer , Abulizi Guzhalinuer , Qiao Youlin
Published: February 2020

This study is to evaluate the screening methods of cervical cancers for rural females in Kash bachu, Xinjiang, China.

A total number of 3000 married females were surveyed, and subjected to the gynecological examination. In these subjects, 1993 females received the careHPV (human papillomavirus) test, while 1007 females underwent the visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). The subjects positive for careHPV detection were subjected to Cervista, Cobas 4800, and Aptima HPV detection, and Thinprep Cytologic Test (TCT). The subjects positive for 1 detection only received colposcopy cervical biopsy.

A total of 569 subjects received the cervical biopsy, and the positive rate was 2.3% (69/3000), while the detection rate for CIN (cervical intraepithelial neoplasia) II and above levels was 1.13% (34/3000). Receiver operator characteristic (ROC) curve analysis showed that, the area under the curve (AUC) value for the careHPV test was 0.671, which was higher than the VIA/VILI (0.619), suggesting higher diagnostic value for the careHPV test. For the Cervista, Cobas 4800, Aptima HPV detection, and TCT methods, the highest AUC value was observed for the TCT method, indicating that the TCT method is the most valuable for the cervical cancer screening.

The diagnostic value of careHPV test is superior to the VIA/VILA detection method. The TCT method has the greatest value for the cervical cancer screening. The Cervista HPV detection method should be considered where the conditions are limited.
Health Care Access and Utilization for Latino Youth in the United States
Authors: Alberto Cinthya K. , Pintor Jessie Kemmick , Martínez-Donate Ana P. , Chen Jie , Ortega Alexander N.
Published: February 2020

Objectives:

We sought to determine the associations between maternal citizenship and health care access and utilization for US-born Latino youth and to determine whether maternal distress is a moderator of the associations.

Methods:

Using 2010–2017 Integrated Public Use Microdata Series National Health Interview Survey data, multivariable logistic regressions were run to examine the associations among maternal citizenship and health care access and utilization for US-born Latino youth. Maternal citizenship and distress interactions were tested.

Results:

Noncitizen mothers had higher odds of reporting uninsurance, lack of transportation for delaying care, and lower odds of health care utilization for their youth than citizen mothers. Compared with no distress, moderate and severe distress were positively associated with uninsurance, delayed medical care due to cost, lack of transportation, and having had an emergency department visit for their youth. Moderate distress was positively associated with youth having had a doctor’s office visit. Noncitizen mothers with moderate distress were less likely to report their youth having had an emergency department visit than citizen mothers with moderate distress. Among severely distressed mothers, noncitizen mothers were more likely to report youth uninsurance and delayed care due to lack of transportation compared with citizen mothers.

Conclusions:

Health care access and utilization among US-born Latino youth are influenced by maternal citizenship and distress. Maternal distress moderates the associations among maternal citizenship and youth’s health care access and use. Almost one-third of all US-born youth in the United States are Latino and current federal and state noninclusive immigration policies and anti-Latino immigrant rhetoric may exacerbate health care disparities.
Are dietary fish oil supplements appropriate for dyslipidemia management? A review of the evidence
Authors: Sherratt Samuel C.R. , Lero Michael , Mason R. Preston
Published: February 2020

Purpose of review

The purpose of this review is to assess whether dietary fish oil supplements can be appropriate for patients with elevated triglycerides and cardiovascular risk based on a comprehensive analysis of their composition, and level of regulatory oversight.

Recent findings

Approximately 19 million people in the United States take fish oil supplements, many for the purpose of treating or preventing heart disease. Unlike prescription products, fish oil supplements are classified as food by the Food and Drug Administration (FDA) and are not required to undergo manufacturing oversight or clinical testing. Analysis of widely used dietary fish oil supplements show that they may have lower amounts of ω-3 than advertised as well as significant levels of saturated fat and oxidized oils which actually may contribute to dyslipidemia. Clinical outcome trials have failed to show a consistent cardiovascular benefit with fish oil supplements and other low-dose mixed ω-3 fatty acids.

In light of limited regulatory oversight and evidence of quality concerns, dietary fish oil supplements are not an appropriate substitute for FDA approved prescription ω-3 fatty acids for their indicated use in treatment of elevated triglycerides or the prevention of cardiovascular events.
Inborn errors of apolipoprotein A-I metabolism: implications for disease, research and development
Authors: Zanoni Paolo , von Eckardstein Arnold
Published: February 2020

Purpose of review

We review current knowledge regarding naturally occurring mutations in the human apolipoprotein A-I (APOA1) gene with a focus on their clinical complications as well as their exploitation for the elucidation of structure–function–(disease) relationships and therapy.

Recent findings

Bi-allelic loss-of-function mutations in APOA1 cause HDL deficiency and, in the majority of patients, premature atherosclerotic cardiovascular disease (ASCVD) and corneal opacities. Heterozygous HDL-cholesterol decreasing mutations in APOA1 were associated with increased risk of ASCVD in several but not all studies. Some missense mutations in APOA1 cause familial amyloidosis. Structure–function-reationships underlying the formation of amyloid as well as the manifestion of amyloidosis in specific tissues are better understood. Lessons may also be learnt from the progress in the treatment of amyloidoses induced by transthyretin variants. Infusion of reconstituted HDL (rHDL) containing apoA-I (Milano) did not cause regression of atherosclerosis in coronary arteries of patients with acute coronary syndrome. However, animal experiments indicate that rHDL with apoA-I (Milano) or apoA-I mimetic peptides may be useful for the treatment of heart failure of inflammatory bowel disease.

Specific mutations in APOA1 are the cause of premature ASCVD or familial amyloidosis. Synthetic mimetics of apoA-I (mutants) may be useful for the treatment of several diseases beyond ASCVD.
Familial combined hypolipidemia: angiopoietin-like protein-3 deficiency
Authors: Arca Marcello , D’Erasmo Laura , Minicocci Ilenia
Published: February 2020

Purpose of review

Angiopoietin-like protein-3 (ANGPTL3) is emerging as a key player in lipoprotein transport with an expanding role on fatty acid and glucose metabolism. Its deficiency is associated with a favorable metabolic profile. The present review will highlight the recent understanding of metabolic and cardiovascular consequences of ANGPTL3 inactivation by considering both genetic and pharmacological investigations.

Recent findings

Experimental studies have further illustrated the complex interplay between ANGPTL3 and ANGPTL4–8 in orchestrating lipid transport in different nutritional status. Individuals with familial combined hypolipidemia due to homozygous loss-of-function mutations in ANGPTL3 gene showed improved metabolism of triglyceride-rich lipoproteins during fasting and postprandial state and increased fatty acid oxidation and insulin sensitivity. Moreover, mendelian randomizations studies demonstrated that partial ANGPTL3 deficiency associates with reduced risk of atherosclerotic cardiovascular events and, eventually, diabetes mellitus. Finally, inactivation of ANGPTL3, using either a specific mAb or antisense oligonucleotide, was reported to reduce plasma levels of atherogenic lipoprotein in humans and improve hepatic fat infiltration in animal models.

Human and animal studies have further dissected the complex role of ANGPTL3 in the regulation of energy substrate metabolism. Moreover, genetic and pharmacological investigations have convincingly indicated that the inactivation of ANGPTL3 may be a very promising strategy to treat atherogenic metabolic disorders.
Tangier disease: update for 2020
Authors: Hooper Amanda J. , Hegele Robert A. , Burnett John R.
Published: February 2020

Purpose of review

To appraise recent advances in our knowledge of the severe genetic HDL deficiency disorder, Tangier disease.

Recent findings

While Tangier disease can cause premature atherosclerotic cardiovascular disease (ASCVD), new evidence suggests that heterozygous ABCA1 variant carriers are also at increased risk. Advances have been made in the study of the neurological abnormalities observed in Tangier disease, both in their assessment and the identification of potential new therapies.

Tangier disease is an extremely rare condition and, as such, the published literature around its range of clinical manifestations, including peripheral neuropathy, premature ASCVD and platelet abnormalities is limited. Patient registries may assist in this regard.
The impact of diabetes in head and neck cancer
Authors: Vilaseca Isabel , Fuster Gemma , Avilés-Jurado Francesc-Xavier
Published: February 2020

Purpose of review

A strong association between diabetes mellitus and carcinogenesis has been reported in different organs. The purpose of this review is to summarize the new evidences in relation to diabetes mellitus and its association with the development, prognosis, and therapeutic strategies of head and neck squamous cell carcinomas (HNSCC).

Recent findings

Recent publications suggest that glycemic metabolism is altered in HNSCC. Elevated blood glucose levels, before or around the time of diagnosis, have been reported to reduce survival rates in HNSCC. Also, the homeostasis model assessment-insulin resistance has been independently associated with disease-free survival, suggesting that improving the glycemic control may improve the prognosis in this group of patients.

Epidemiological studies revealed that cancer patients with diabetes mellitus have less cancer-related mortality after antiglycemic treatment, opening the option to include antiglycolytic agents, such as metformin, in the therapeutic plan. This finding is in accordance with in-vitro studies that demonstrated a decrease in tumor-cell proliferation with antidiabetic medications.

Recent findings highlight the importance of glucose metabolism in the pathogenesis and progression of cancer cells. The knowledge of these altered pathways gives us an opportunity to design target treatments aimed to modulate glucose catabolism.
Total Pancreatectomy for Pancreatic Carcinoma
Authors: Petrucciani Niccolo , Nigri Giuseppe , Giannini Giulia , Sborlini Elena , Antolino Laura , de'Angelis Nicola , Gavriilidis Paschalis , Valente Roberto , Lainas Panagiotis , Dagher Ibrahim , Debs Tarek , Ramacciato Giovanni
Published: February 2020

The role of total pancreatectomy (TP) to treat pancreatic carcinoma is still debated. The aims of this study were to systematically review the previous literature and to summarize the indications and results of TP for pancreatic carcinoma. A systematic search was performed to identify all studies published up to November 2018 analyzing the survival of patients undergoing TP for pancreatic carcinoma. Clinical effectiveness was synthetized through a narrative review with full tabulation of results. Six studies published between 2009 and 2016 were retrieved, including 316 patients. The major indication was positive pancreatic margin at frozen section during partial pancreatectomy. The overall morbidity ranged from 36% to 69%, and mortality from 0% to 27%. Overall survival ranged from 52.7% to 67% at 1 year, from 20% to 42% at 3 years of follow-up, whereas the 5-year estimated overall survival ranged from 4.5% to 21.9%. Total pancreatectomy has an important role in the armamentarium of pancreatic surgeons. Postoperative morbidity and mortality are not negligible, but a trend for better postoperative outcomes in recent years is noticed. Mortality related to difficult glycemic control is rare. Long-term survival is comparable with survival after partial pancreatectomy for carcinoma.
Prediction of the Probability of Malignancy in Mucinous Cystic Neoplasm of the Pancreas With Ovarian-Type Stroma
Authors: Ohtsuka Takao , Nakamura Masafumi , Hijioka Susumu , Shimizu Yasuhiro , Unno Michiaki , Tanabe Minoru , Nagakawa Yuichi , Takaori Kyoichi , Hirono Seiko , Gotohda Naoto , Kimura Wataru , Ito Kei , Katanuma Akio , Sano Tsuyoshi , Urata Takahiro , Kita Emiri , Hanada Keiji , Tada Minoru , Aoki Takeshi , Serikawa Masahiro , Okamoto Kojun , Isayama Hiroyuki , Gotoh Yoshitaka , Ishigami Kousei , Yamaguchi Hiroshi , Yamao Kenji , Sugiyama Masanori , Okazaki Kazuichi
Published: February 2020

Objective

The aim of the study was to develop a formula for predicting the probability of malignancy of mucinous cystic neoplasm (MCN) of the pancreas with ovarian-type stroma.

Methods

A total of 364 patients were enrolled. A total score was calculated as the sum of the approximate integers of the odds ratios of the predictive factors identified by multivariate analysis. The relationship between the total score and pathological results was assessed.

Results

A total of 321 patients had benign MCN and 43 had malignant MCN. Five possible predictive factors were analyzed: 56 years or older, high serum carcinoembryonic antigen level, high carbohydrate antigen 19-9 level, tumor size of 51 mm or greater, and the presence of mural nodules. The total score was significantly higher in patients with malignant MCN (median, 24; range, 0–37) compared with benign MCN (median, 5; range, 0–33; P < 0.001). Receiver operating characteristic curve analysis demonstrated that the area under the curve was 0.86, and the sensitivity and specificity of the total score for discriminating malignant MCNs were 72% and 83%, respectively, using a cut-off value of 22.

Conclusions

The current simple formula can predict the malignancy of MCN and may thus contribute to the adequate management of patients with MCN.
Predictors of Recurrence and Survival in Patients With Surgically Resected Pancreatic Neuroendocrine Tumors
Authors: Rosenblum Rachel E. , Harris Cynthia K. , Baeg Kiwoon Joshua , Starr Julie A. , Brais Lauren K. , Stashek Kristen M. , Ward Stephen C. , Katona Bryson W. , Clancy Thomas E. , Wisnivesky Juan P. , Kulke Matthew H. , Metz David C. , Kim Michelle Kang , Chan Jennifer A.
Published: February 2020

Objective

Given the lack of consensus on surveillance guidelines after pancreatic neuroendocrine tumor (PanNET) resection, we assessed outcomes in a large cohort of patients with nonmetastatic, surgically resected PanNETs.

Methods

Data of patients with PanNETs resected between 1990 and 2017 were retrospectively collected using databases at 3 academic institutions. The National Death Index was queried to determine vital status. Kaplan-Meier analysis was used to estimate recurrence-free survival (RFS) and disease-specific survival (DSS) rates. Variables associated with recurrence and disease-related death were identified through Cox multivariate analyses.

Results

Of 307 patients with PanNET who underwent resection, recurrence occurred in 79 (26%) of patients. For stage I and II disease, 5-year RFS rates were 90% and 43%, whereas 5-year DSS rates were 98% and 86% (P < 0.0001 and P = 0.0038, respectively). For grades 1, 2, and 3 disease, 5-year RFS rates were 87%, 49%, and 18%, and 5-year DSS rates were 98%, 89%, and 51% (P < 0.0001 for both). Stage II, grade 2, and grade 3 disease were each associated with increased recurrence and disease-specific death.

Conclusions

Stage and grade are important prognostic factors that should be utilized to tailor postsurgical surveillance after curative resection of PanNET.
A Comparison of the Pathological Types of Undifferentiated Carcinoma of the Pancreas
Authors: Shiihara Masahiro , Higuchi Ryota , Izumo Wataru , Furukawa Toru , Yamamoto Masakazu
Published: February 2020

Objectives

This study aimed to identify the detailed clinicopathological features of undifferentiated carcinoma of the pancreas (UCP).

Methods

We investigated clinical, imaging features and the prognoses of 261 patients; 8 were our patients, and the remainder were identified by searching English-language articles in PubMed.

Results

We classified patients with UCP into 3 types based on pathological findings: osteoclast-like giant cell–associated carcinoma, pleomorphic cell carcinoma (PLC), and spindle cell carcinoma. There were no remarkable differences in clinical, radiological features between these 3 types. However, PLCs were significantly more likely to be unresectable than were the other 2 types (P < 0.001). Patients with osteoclast-like giant cell–associated carcinoma achieved the best overall survival (OS) rates (P < 0.001), whereas those with spindle cell carcinoma had significantly longer OS rates than did those with PLC (P = 0.004). These OS patterns were maintained when considering only those patients who underwent resection. Patients with PLC had both lower curative resection and high lymph node metastasis rates (P = 0.029, P = 0.023). Patients who underwent resection had more favorable prognoses than did those who did not.

Conclusions

Surgery is the first choice for resectable UCP. Pleomorphic cell carcinoma is particularly malignant; postoperative treatment should be introduced immediately.
A Nonchordomatous-looking Chordoma: When INI-1 and Radiology Came to the Rescue!!!
Authors: Singh Angad , Das Anirban , Chatterjee Argha , Achari Rimpa B. , S. Reghu K. , Roy Paromita
Published: February 2020

SMARCB1/integrase interactor (INI)-1 is one of the core subunit proteins of the ATP-dependent SWI/SNF chromatin remodeling complex and acts as a tumor suppressor. INI-1 loss can be easily assessed using immunohistochemistry and is an important diagnostic clue for a histopathologist. Chordoma is a malignant tumor commonly occurring in the sacrococcygeal spine of adults and is characterized by nuclear expression of brachyury. Poorly differentiated chordoma, a morphologically and molecularly distinct entity, also shows nuclear brachyury positivity along with INI-1 loss. It usually occurs in children and has a predilection to involve the base of the skull. We describe a case of a poorly differentiated chordoma in a 5-year-old girl and discuss its unusual histomorphologic and immunohistochemical features.
A Very Rare Congenital Dyserythropoietic Anemia Variant—Type IV in a Patient With a Novel Mutation in the KLF1 Gene: A Case Report and Review of the Literature
Authors: Belgemen-Ozer Tugba , Gorukmez Orhan
Published: February 2020

Congenital dyserythropoietic anemias comprise a group of very rare hereditary disorders characterized by ineffective erythropoiesis and distinct morphologic abnormalities of the erythroblasts in the bone marrow. The wide variety of phenotypes observed in these patients makes the diagnosis difficult; identification of the genetic variants is crucial in differential diagnosis and clinical management. We report the nineth case with congenital dyserythropoietic anemia type IV, with a novel mutation that has not been reported before.
Intracerebral Nontraumatic Hemorrhagic Stroke in Children: Case Series and Literature Review
Authors: Buonsenso Danilo , Pata Davide , Plosnić Mihael , Musolino Anna M. , Ferrrara Pietro , Gambacorta Alessandro , Piastra Marco , Chiaretti Antonio
Published: February 2020

Pediatric stroke is an event caused by disturbance of cerebral circulation that occurs in individuals between 28 days and 18 years of age. Although an uncommon event, pediatric stroke still carries significant morbidity and mortality. Unlike adults, causes of pediatric stroke are various and include vascular, infectious, hematologic, neoplastic, and toxic etiologies. Clinical presentation of nontraumatic intracerebral hemorrhages in older children is similar to adults, however in neonates and infants signs and symptoms can be more subtle, especially with smaller hemorrhages. Management of nontraumatic intracerebral hemorrhage consists of stabilizing the patient, management of the hemorrhage itself, and reduction of the rebleeding risk. Even so, when child reaches a medical care, morbidity and mortality rates are still high. We described a case series of pediatric patients with intracerebral nontraumatic hemorrhagic stroke from different etiologies. Although increasingly recognized, such situations are still poorly described in children and our report offers a good overview on this topic.
Successful Splenectomy Management in a Patient With Moderate Factor VII Deficiency and Concomitant Severe Hereditary Spherocytosis
Authors: Goudarzipour Kourosh , Amiri Vahid , Eshghi Peyman
Published: February 2020

By the advent of the effective therapies for many coagulation diseases and hereditary spherocytosis (HS), patient’s survival has been improved significantly; however, if patients are diagnosed late or left untreated, both diseases could ominously be life threatening. Concurrent occurring of factor VII (FVII) deficiency and HS is extremely rare and there is no literature report that explain this condition, thus far. In this study, we confronted a 9-year-old female patient diagnosed with HS and enlarged spleen as a result of this blood disorder. Given to her sever signs and symptoms of splenomegaly, she was candidate for emergent splenectomy. However, assessment of coagulation tests revealed a prolonged prothrombin time, suggesting the moderate FVII deficiency. With a multidisciplinary consultation, we decided to performed total splenectomy with prophylaxis administration of totally 6 doses of active recombinant FVII, initiated 1 hour before surgery and followed until 30 hours postoperation. As a result of cautious undertaken in Mofid Children’s Hospital, the patient did not experience any hemostatic defect. Patient is now 14-year-old, generally well-being under regular surveillance of FVII deficiency.
Primary Graft Failure but Treatment Success: A Case of Reversion to Heterozygosity After Allogeneic Hematopoietic Cell Transplantation With Autologous Hematopoietic Recovery in a Child With CBL-related Juvenile Myelomonocytic Leukemia
Authors: Oshrine Benjamin
Published: February 2020

Juvenile myelomonocytic leukemia (JMML) typically requires allogeneic hematopoietic cell transplantation with full donor chimerism for cure. Certain genetic subtypes, including JMML due to germline mutations in CBL, can have a more indolent course. We describe a young male patient with CBL-related JMML who experienced primary graft failure after allogeneic hematopoietic cell transplantation. Despite autologous recovery, the resulting hematopoietic tissue did not harbor the original homozygous CBL mutations, due to reversion of prior loss of heterozygosity of the 11q chromosomal region. The patient remains disease free without further leukemia-directed therapy.
Patients’ and Nurses’ Perceptions of the Effectiveness of an Oral Cancer Agent Education Process
Authors: Tolotti Angela , Pedrazzani Carla , Bonetti Loris , Bianchi Monica , Valcarenghi Dario
Published: February 2020

Background

The increase in the use of oral cancer drugs implies that nurses take on new roles for which education and support to patients and family members become fundamental for promoting therapeutic adherence.

Objective

To describe the patients’ and nurses’ perceptions on the effectiveness of the educational process in oral cancer treatment.

Methods

A mixed method with a convergent design was used. Data were collected using a questionnaire (structured according to the Multinational Association of Supportive Care in Cancer Teaching Tool for Patients Receiving Oral Agents for Cancer guidelines) and semistructured interviews with patients. Focus groups were used with the nurses. Quantitative data were analyzed with SPSS 22.0 (IBM SPSS 22.0, Armonk, New York). Qualitative data were analyzed using semantic analysis.

Results

One hundred forty-two questionnaires were analyzed. Patients were usually informed by physicians and nurses (81%), alone (33%) or in the presence of an informal carer (29.6%). Language comprehension was high, with a significant difference between those 70 years or older (P = .04) and those younger than 70 years. From the interviews (n = 16), 3 themes were identified: emotions during communication, feeling reassured by the presence of family members and nurses, feeling welcomed and an active part of the educational process. Three themes were identified from the focus groups (n = 4): prerequisites for an effective therapeutic education, nurses’ skills, and educational process barriers.

Conclusions

Overall, patients were satisfied with the education received. They perceived nurses as people who can help them understand the information they have received and manage their treatment and adverse effects.

Implications for Practice

This study highlighted some important points for an effective educational process: having a nurse to refer to, technical relationship competences, joint visits with physicians, and being available by phone.
The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting
Authors: Hickman Susan E. , Parks Melanie , Unroe Kathleen T. , Ott Monica , Ersek Mary
Published: February 2020

There is a growing recognition of significant, unmet palliative care needs in nursing facilities, yet limitations in the workforce limit access to palliative care services. Attention to palliation is particularly important when there are efforts to reduce hospitalizations to help ensure there are no unintended harms associated with treating residents in place. A specialized palliative care registered nurse (PCRN) role was developed as part of the OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality, and Improving Symptoms: Transforming Institutional Care) program, a federally funded project to reduce potentially avoidable hospitalizations. Working in collaboration with existing clinical staff and medical providers, the PCRN focuses on managing symptoms, advance care planning, achieving goal concordant care, and promoting quality of life. The PCRN serves as a resource for families through education and support. The PCRN also provides education and mentorship to staff to increase their comfort, knowledge, and skills with end-of-life care. The goals of this article are to provide an overview of the PCRN role and its implementation in nursing facilities and describe core functions that are transferrable to other contexts.
Perceptions of Nurse Managers and Nurse Preceptors
Authors: Gregg Jessica C.
Published: February 2020

Assessing new graduate nurses’ competency is an important outcome of the orientation and evaluation process. Nurse managers and nurse preceptors act as key stakeholders in the transition of new graduate nurses to professional practice and are often charged with the responsibility of assessing the competency of new graduate nurses. This article provides insight in regard to the perception of postorientation competency levels of new graduate nurses.
Simultaneous Detection of Neisseria gonorrhoeae and Fluoroquinolone Resistance Mutations to Enable Rapid Prescription of Oral Antibiotics
Authors: de Korne-Elenbaas Jolinda , Pol Arno , Vet Jacqueline , Dierdorp Mirjam , van Dam Alje P. , Bruisten Sylvia M.
Published: February 2020

Background

Absence of rapid antimicrobial resistance testing of Neisseria gonorrhoeae (Ng) hinders personalized antibiotic treatment. To enable rapid ciprofloxacin prescription, a real-time polymerase chain reaction (PCR) for simultaneous detection of Ng and fluoroquinolone resistance–associated gyrA-S91F mutation was evaluated.

Methods

Analytical NGRES quantitative PCR kit (NYtor BV) performance was assessed on 50 Ng transcription-mediated amplification (TMA)–negative and 100 Ng TMA-positive samples. To assess clinical use, 200 samples were prospectively analyzed, in parallel to routine diagnostic tests. Also, 50 urine, 50 anal, 50 pharyngeal, and 50 vaginal Ng TMA-positive samples were retrospectively analyzed. To assess if patients carried strains with different ciprofloxacin sensitivity at different anatomical locations, 50 urine/anal or vaginal/anal sample pairs collected during a single visit were analyzed.

Results

The NGRES quantitative PCR kit showed 97% sensitivity and 100% specificity for Ng detection and 92% sensitivity and 99% specificity for gyrA-S91F detection. Relative to TMA results, 85% Ng detection sensitivity and 99% specificity were found. Regarding the 200 prospectively analyzed clinical samples, 13 were Ng positive, of which 10 were also tested for antibiotic susceptibility by culture. The kit showed concordance for GyrA-S91F detection in 9 of 10 samples. Ng was detected in 96% and 94% of vaginal and urine TMA-positive samples, in 84% of anal samples and only in 22% of pharyngeal samples. Discordant ciprofloxacin sensitivity was found for 2 of 26 characterized urine/anal sample pairs.

Conclusion

The NGRES quantitative polymerase chain reaction (qPCR) kit can be implemented in diagnostic testing for vaginal, urine, and anal Ng TMA-positive samples to enable rapid prescription of oral ciprofloxacin.
Are There Differences in Pediatric Psychiatric Emergency Department Patients Related to Utilization Frequency?
Authors: Portley Robert , North Carol S.
Published: February 2020

Objectives

The increasing frequency of visits to the pediatric psychiatric emergency department in the United States signals a need for a better understanding of factors contributing to more frequent utilization. This study examined characteristics of patients associated with higher utilization of the pediatric psychiatric emergency department to increase understanding of this group of patients.

Methods

This was a retrospective observational study. Data were abstracted from the electronic medical record system from January 2012 to December 2017 for patients with a completed mental health consultation. There were 8504 total encounters for 6950 unique patients during this period. Analyses were conducted to test associations between maximum number of visits in any 1-year period for each patient and demographic and clinical factors.

Results

Younger age was independently associated with greater mean number of visits within any 1 year. No independent associations were found between maximum number of visits within 1 year and sex, race, language, insurance type, distance from emergency department, time spent in the emergency department, or reason for visit.

Conclusions

The greater emergency department use by younger children found in this study may be an indicator of insufficient treatment at other levels of care. Additional research examining more demographic variables and demographic characteristics in greater detail is needed to fully characterize the most frequent users of costly pediatric psychiatric emergency department care.
Equitable and Timely Care of Febrile Neonates
Authors: Nash Katherine A. , Kimia Amir , Fleegler Eric W. , Guedj Romain
Published: February 2020

Objectives

In pediatric emergency departments (EDs), racial/ethnic minorities are less likely to receive needed and timely care; however, clinical protocols have the potential to mitigate disparities. Neonatal fever management is protocolized in many EDs, but the timeliness to antibiotic administration is likely variable. We investigated the timeliness of antibiotic administration for febrile neonates and whether timeliness was associated with patients' race/ethnicity.

Methods

Retrospective cross-sectional study of febrile neonates evaluated in one pediatric ED that uses an evidence-based guideline for the management of neonatal fever between March 2010 and December 2015. Primary outcome was time from ED arrival to antibiotic administration. Analysis of variance tests compared mean time with antibiotic administration across race/ethnicity. Multivariable linear regression investigated racial/ethnic differences in time to antibiotic administration after adjusting for patient demographics, timing of visit, the number of physicians involved, and ED census.

Results

We evaluated 317 febrile neonates. Of the 269 patients with racial/ethnic data (84.9%), 54% were white non-Hispanic, 13% were black non-Hispanic, and 23% were Hispanic. The mean time to antibiotic administration was 204 minutes (range = 51–601 minutes). There was no significant association between patient race/ethnicity and time to first antibiotic administration. Emergency department census was significantly associated with timeliness.

Conclusions

There was a 10-hour range in the time to antibiotic administration for febrile neonates; however, variability in timeliness did not differ by race or ethnicity. This study demonstrates the need to further examine the role of protocols in mitigating disparities as well as factors that influence timeliness in antibiotic administration to febrile neonates.
Lessons Learned From Introducing Staff to Quality Improvement Through Systematic Training at the Boston Public Health Commission
Authors: Lau Douglas K. , Henry Ann , Ebekozien Osagie
Published: February 2020

Context:

The widespread adoption of quality improvement (QI) in public health departments holds the promise of transformational change for the American public health system; however, there is a lack of published literature pertaining to organization-level experiences with introductory QI training programs for health department staff. This practice report aims to share the innovative approach, experience, and results of introducing staff to QI principles at the Boston Public Health Commission (BPHC).

Program:

The BPHC is an accredited health department that introduced more than 80% of its 1100 staff members to QI between January 2015 and December 2018. The commission's QI training program benefited from (1) visible support from senior leaders, (2) well-documented QI training plans, (3) innovative QI training curricula, (4) flexible delivery methods, and (5) a responsive monitoring and evaluation system.

Methods:

To assess the effectiveness of QI training at the BPHC, participant questionnaires from QI training sessions (run between January 2015 and June 2018) and a separate questionnaire on organizational QI culture (administered to the supervisory staff in May 2018) were assessed using the Kirkpatrick model of training evaluation.

Evaluation:

On the basis of Kirkpatrick's 4 levels of training effectiveness, 91% of participants were satisfied with training content (level 1), 94% of participants found the facilitators effective (level 2), 84% of participants indicated they would apply QI concepts in everyday work (level 3), and 75% of supervisors reported an organization-wide improvement in QI culture (level 4).

Discussion:

These results show that the BPHC's QI training program has been resoundingly effective, with positive outcomes across all 4 levels of the Kirkpatrick model. These results reinforce the idea of the BPHC's experience as an exemplar for introductory QI training. Interested health departments should heed the lessons learned from this and other organizational experiences as they attempt to scale up QI competencies among staff members.
Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting
Authors: Calvache Jose Andres , Benavides Edison , Echeverry Sebastian , Agredo Francisco , Stolker Robert Jan , Klimek Markus
Published: February 2020

Objective

The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties.

Methods

After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated.

Results

Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like “staffing and work pressure” and “supervisor/manager expectations and actions promoting patient safety,” “organizational learning—continuous improvement,” and “hospital management support for safety,” as well as “repeated errors and perception of safety.” Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60.

Conclusions

Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.
Early scale-up of antiretroviral therapy at diagnosis for reducing economic burden of cardiometabolic disease in HIV-infected population
Authors: Yang Chun-Ting , Toh Han-Siong , Liao Chia-Te , Kuo Shihchen , Ou Huang-Tz , Ko Nai-Ying
Published: February 2020

Objective:

The current study aims to assess the effect of early scale-up of antiretroviral therapy (ART) at HIV diagnosis on the economic burden of cardiometabolic diseases (CMDs) in HIV-infected population.

Design:

Cohort study.

Methods:

The study cohort comprised 10 693 newly diagnosed HIV patients without CMDs before HIV diagnosis identified from a nationwide HIV cohort in Taiwan. The patients were stratified by ART use [medication possession ratio ≥0.8: (high) vs. <0.8: (low)] and AIDS-defining illnesses (ADI) status [present: (+) vs. absent: (−)] at the first year of HIV diagnosis into four groups: ART (low) and ADI (−), ART (low) and ADI (+), ART (high) and ADI (−), and ART (high) and ADI (+). The economic analysis of incident CMDs was from the perspective of Taiwan's single-payer healthcare system and estimated using generalized estimating equations.

Results:

CMDs significantly increased annual direct medical costs by 31% (hypertension) to 127% [cardiovascular diseases (CVDs)]. The annual cost burden of diabetes, dyslipidemia, and CVDs in the ART (high) and ADI (−) group significantly decreased by 42, 30, and 31%, respectively, compared with the ART (low) and ADI (+) group. Compared with the ART (low) and ADI (+) group, the annual cost burden of CVDs in the ART (high) and ADI (−) and ART (high) and ADI (+) groups decreased by 31 and 14%, respectively, suggesting increased cost-savings when ART is initiated at diagnosis before ADI occurrence.

Conclusion:

The early scale-up of ART at diagnosis before ADI occurrence is important for minimizing the economic burden of incident CMDs among HIV-infected patients.
Associations of antiretroviral therapy and comorbidities with neurocognitive outcomes in HIV-1-infected patients
Authors: Siangphoe Uma , Archer Kellie J. , Nguyen Christopher , Lee Kwan R.
Published: February 2020

Objective:

The aim of this study was to evaluate associations of antiretroviral therapy (ART) and comorbidities with neurocognitive impairments (NCIs) in ART-naive HIV-1-infected patients in clinical practice.

Design:

A retrospective study was conducted in ART-naive patients with HIV-1 diagnosis between January 2009 and December 2013 in the United States.

Methods:

The primary outcome was any NCI that included HIV-associated neurocognitive disorders (HAND), Alzheimer's disease, Parkinson's disease, multiple sclerosis, and other dementias.

Results:

A total of 47 862 patients met eligibility criteria (30 828 antiretroviral-treated and 17 034 antiretroviral-untreated). The median age was 45 years [interquartile range (IQR) 35--52] with 31% of patients aged at least 50 years. Seventy-five percent were men. Overall, ART was associated with reduced risks of any NCI (hazard ratio 0.41, 95% CI: 0.37--0.45), HAND (hazard ratio 0.57, 95% CI: 0.48--0.69), Alzheimer's disease (hazard ratio 0.36, 95% CI: 0.24--0.54), Parkinson's disease (hazard ratio 0.36, 95% CI: 0.25--0.51), multiple sclerosis (hazard ratio 0.26, 95% CI: 0.18--0.37), and other dementias (hazard ratio 0.50, 95% CI: 0.45--0.55). Meanwhile, the risk of any NCI was significantly increased in patients with various comorbidities including cardiac arrhythmia, paralysis, other neurological disorders, complicated diabetes, hypothyroidism, renal failure, lymphoma, rheumatoid arthritis, weight loss, and depression as compared with patients without those comorbidities.

Conclusion:

ART may reduce the risk of NCIs in HIV-infected patients in general. Further research to investigate NCIs on specific antiretroviral regimens and comorbidities may provide insights regarding the long-term clinical care of these patients.
Semen virome of men with HIV on or off antiretroviral treatment
Authors: Li Yanpeng , Altan Eda , Pilcher Chris , Hartogensis Wendy , Hecht Frederick M. , Deng Xutao , Delwart Eric
Published: February 2020

Objectives:

Improving immune status of people living with HIV through antiretroviral therapy (ART) may also reduce shedding of other viruses in semen. We characterized the seminal fluid virome of men with HIV and tested potential associations between viruses present and CD4+ T-cell count, HIV viremia, and antiretroviral therapy (ART) status.

Design and methods:

Metagenomics was used to enrich and sequence viral nucleic acids from the seminal fluid of 55 semen samples from 42 men living with HIV from San Francisco with a median age of 33 (IQR, 28.7-45) and median CD4+ T-cell counts of 837 cells/μl (IQR, 258–1571 cells/μl). All samples were collected between 2005 and 2015, and ART status was ascertained from medical records.

Results:

Anelloviruses, cytomegalovirus (CMV), and multiple genotypes of human papillomaviruses were detected. Participants shed from 0 to 4 distinct human viruses. Longitudinally collected seminal fluid samples showed changes in the viruses shed. Viruses were more frequently shed by individuals with detectable HIV viremia (43.7 vs. 15.4%, P = 0.042). A trend was seen for increased shedding by individuals who were not on ART (42.8 vs. 17.8%, P = 0.082) or with CD4+ T-cell count less than 350 cells/μl (35.3 vs. 20%, P = 0.27).

Conclusion:

Seminal fluid from men with HIV from San Francisco contains nucleic acids from three different DNA viral families. A greater number of viruses, particularly CMV, were shed by participants with detectable HIV viremia (18.9 vs. 0%, P = 0.022). Control of viremia through ART may lower shedding of other viruses in semen in addition to HIV.
Combining Dynamic Contrast-Enhanced Magnetic Resonance Imaging and Apparent Diffusion Coefficient Maps for a Radiomics Nomogram to Predict Pathological Complete Response to Neoadjuvant Chemotherapy in Breast Cancer Patients
Authors: Chen Xiangguang , Chen Xiaofeng , Yang Jiada , Li Yulin , Fan Weixiong , Yang Zhiqi
Published: February 2020

Objective

The objective of this study was to develop a nomogrom for prediction of pathological complete response (PCR) to neoadjuvant chemotherapy in breast cancer patients.

Methods

Ninety-one patients were analyzed. A total of 396 radiomics features were extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) maps. The least absolute shrinkage and selection operator was selected for data dimension reduction to build a radiomics signature. Finally, the nomogram was built to predict PCR.

Results

The radiomics signature of the model that combined DCE-MRI and ADC maps showed a higher performance (area under the receiver operating characteristic curve [AUC], 0.848) than the models with DCE-MRI (AUC, 0.750) or ADC maps (AUC, 0.785) alone in the training set. The proposed model, which included combined radiomics signature, estrogen receptor, and progesterone receptor, yielded a maximum AUC of 0.837 in the testing set.

Conclusions

The combined radiomics features from DCE-MRI and ADC data may serve as potential predictor markers for predicting PCR. The nomogram could be used as a quantitative tool to predict PCR.