bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceptual Effects of Physical and Visual Accessibilities in Intensive Care Units
Authors: Rashid Mahbub , Khan Nayma , Jones Belinda
Published: February 2018

This article reports the findings of a 2-phase quasi-experimental study looking at the perceptual effects of physical and visual accessibilities on clinical staff in intensive care units (ICUs). In a previous CCNQ article by Rashid et al, the first phase of the study was reported comparing, among other things, physical and visual accessibilities and their associations with staff perception in 2 ICUs with the open-plan and racetrack-type layouts. The data for that phase of the study were collected in December 2014, which included the data on physical and visual accessibilities collected using the spatial analysis techniques of Space Syntax, and the data on staff perception collected using a questionnaire survey. Since then, the open-plan ICU has been completely redesigned using a layout composed of 4-bed pods (each dubbed as a HYPERPOD by the designer). However, the racetrack ICU has remained unchanged. In August 2016, more than years after the data for the first phase of this study were collected, the authors went back to the study sites to collect similar data using the methods of the previous study by Rashid et al. The purpose of the 2-phase study was 2-fold: (1) to see whether staff perception and their associations with physical and visual accessibilities observed in the racetrack ICU during the first phase would remain unchanged during the second phase of the study; and (2) to see whether staff perception and their associations with physical and visual accessibilities observed in the open-plan ICU during the first phase would change in the new ICU during the second phase of the study. The findings of the study comparing the racetrack ICU of the first and second phases show that while staff perception in this unit changed, its associations with the physical and visual accessibilities of the unit did not change during the period between the first and second phases of the study. In contrast, the findings of the study comparing the open-plan ICU of the first phase and the new ICU with 4-bed pods of the second phase show that staff perception as well as its associations with the physical and visual accessibilities of the unit changed in a positive direction from the open-plan ICU to the new ICU. It is concluded that staff perception is likely to change over time even in the absence of environmental changes, but any change in staff perception can be made more effective when it is associated with thoughtful environmental design changes.
Estimated Cost Savings
Authors: Silveira Lori J. , Fleck Susan B. , Sonnenfeld Nancy , Manna Jill , Zhang Lijing , Irby Kimberly B. , Brock Jane E.
Published: February 2018

Everyone with Diabetes Counts (EDC) is a national disparities reduction program funded by the Centers for Medicare & Medicaid Services to improve outcomes in the underserved minority, diverse, and rural populations. This analysis evaluates West Virginia's pilot program of diabetes self-management education (DSME), one component of EDC. We frequency-matched 422 DSME completers to 1688 others by demographics and enrollment from Medicare fee-for service claims. We estimated savings associated with reduced hospitalizations in multivariable negative binomial models. DSME completers had 29% fewer hospitalizations (adjusted P < .0069). We estimated savings of $35 900 per 100 DSME completers in West Virginia.
Warfarin Dosing According to the Genotype-guided Algorithm is Most Beneficial in Patients With Atrial Fibrillation: A Randomized Parallel Group Trial
Authors: Makar-Aušperger Ksenija , Krželj Kristina , Lovrić Benčić Martina , Radačić Aumiler Matea , Erdeljić Turk Viktorija , Božina Nada
Published: February 2018

Background:

Observational studies have indicated potential benefits of CYP2C9- and VKORC1-guided dosing of warfarin but randomized clinical trials have resulted in contradictory findings. One of the reasons for contradiction may be the negligence of possible differences between warfarin indications. This study aims to determine efficacy and safety of genotype-guided and clinically guided dosing of warfarin in atrial fibrillation (AF), deep-vein thrombosis (DVT), and pulmonary embolism (PE) within the first 5 days after the introduction of therapy.

Methods:

In this single-center, single-blinded, randomized, controlled trial including patients of both sexes, ≥18 years of age, and diagnosed with AF, DVT, or PE, a total of 205 consecutive patients were allocated into the group where warfarin therapy was genotype-guided pharmacogenetics guided (PHG), and where it was adjusted according to the clinical parameters non pharmacogenetics guided (NPHG). Genotyping of CYP2C9*2, *3, and VKORC1 was performed using the real-time polymerase chain reaction method. The primary outcomes were the percentage of time in the therapeutic international normalized ratio (INR) (2.0–3.0) range and the percentage of patients who achieved a stable anticoagulation defined as the INR (2.0–3.0) range in at least 2 consecutive measurements.

Results:

In patients with AF, the percentage of time spent in the therapeutic range of INR was higher in the PHG group [mean = 26% (SD 25.0)] than in the NPHG group [mean = 14% (SD 18.6)], [Δ = 12; 95% confidence interval, 0–23; P = 0.040]. There was no significant difference in other 2 indications for warfarin treatment. A stable dose of warfarin was achieved in a statistically higher number of patients in the PHG group 14/30 (47%) than in the NPHG group 7/32 (22%) (odds ratio = 3.13, 95% confidence interval, 0.92–10.98; P = 0.039).

Conclusions:

CYP2C9 and VKORC1 genotype-guided dosing of warfarin may be beneficial in patients diagnosed with AF. There is no evidence for such conclusion in patients with DVT and PE.
Management of Severely Atrophic Maxilla in Ectrodactyly Ectodermal Dysplasia-cleft Syndrome
Authors: Rachmiel Adi , Turgeman Shahar , Emodi Omri , Aizenbud Dror , Shilo Dekel
Published: February 2018

Background:

Ectrodactyly ectodermal dysplasia-cleft syndrome is a rare genetic syndrome with an incidence of 1/90,000 live births, characterized by cleft lip and palate, severely hypoplastic maxilla, and hypodontia. Patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome suffer from a severely hypoplastic maxilla that is highly difficult to treat using traditional orthognathic methods. In this study, we propose using distraction osteogenesis to achieve a major advancement while maintaining good stability and minimal relapse. To our knowledge, this is the first description of patients with this syndrome treated using distraction osteogenesis.

Methods:

Five patients diagnosed with ectrodactyly ectodermal dysplasia-cleft syndrome were included in the study. All patients had been operated on according to the well-established protocol of cleft lip and palate reconstruction before maxillary distraction osteogenesis. Hard and soft-tissue changes were evaluated by cone beam computed tomography and lateral cephalograms before distraction osteogenesis (T1), at the postdistraction point (T2) and after 1 year of follow-up (T3).

Results:

Examination revealed marked maxillary advancement in all our patients with a significant mean difference in hard tissue parameters (condylion to A point = 18 mm; nasion-sella line to A point = 15.2 degrees) and a notable improvement in facial convexity (20.9 degrees). One year follow-up measurements demonstrated mild relapse rates of 6% in the horizontal plane.

Conclusions:

We conclude that despite the challenging anatomic and physiological features of ectrodactyly ectodermal dysplasia-cleft patients, by enhancing current surgical techniques, there is promising potential for improved patient outcomes, achieving normognathic facial appearance with implant supported rehabilitation.
Clinically Significant Enhancement of Voriconazole Efficacy by Moxifloxacin and Gentamicin in Fungal Keratitis
Authors: Matoba Alice Y. , Divatia Mukul K. , Arguello Robert A. , Chevez-Barrios Paty
Published: February 2018

Purpose:

To report the effect of topical antibiotics moxifloxacin 0.3% and gentamicin 0.3% on the clinical efficacy of topical antifungal agent voriconazole 1% in cases of culture- or biopsy-proven fungal keratitis.

Methods:

Two cases of fungal keratitis in which the addition of topical moxifloxacin or moxifloxacin and gentamicin led to an improved clinical response to topical voriconazole were reviewed retrospectively.

Results:

One patient with clinical resistance of his fungal keratitis to both topical voriconazole and natamycin had resolution of his keratitis with the addition of topical moxifloxacin and gentamicin to voriconazole. One patient who had a poor response to topical voriconazole had a dramatic response to the increase of the voriconazole regimen and addition of moxifloxacin.

Conclusions:

In a subset of patients with fungal keratitis, the addition of topical moxifloxacin 0.3% or moxifloxacin 0.3% and gentamicin 0.3% may enhance the therapeutic effect of topical voriconazole 1%.
Topical Interferon Alpha-2b Induced Reactive Lymphoid Hyperplasia Masquerading as Orbital Extension of Ocular Surface Squamous Neoplasia
Authors: Lee Graham A. , Hess Lauren , Glasson William J. , Whitehead Kevin
Published: February 2018

Purpose:

The use of topical interferon alpha-2b is a well-established treatment for ocular surface squamous neoplasia. There have been numerous reports on its efficacy and high safety profile. Benign reactive lymphoid hyperplasia in ocular tissues has not been previously documented by histopathology after interferon treatment.

Methods:

This case report describes a 55-year-old man who had successful resolution of his ocular surface squamous neoplasia after topical treatment, but developed forniceal tissue deposits.

Results:

The appearance of the lesions was unexpected and alerted the clinician to the possibility of further neoplastic extension.

Conclusions:

Excisional biopsy of the lesions confirmed benign reactive lymphoid hyperplasia and resolved with no recurrence.
Five Keratoplasties From One Donor Cornea
Authors: Oganesyan Oganes G. , Neroev Vladimir V. , Grdikanyan Arthur A. , Getadaryan Vostan R.
Published: February 2018

Purpose:

To describe the feasibility of same-day, consecutive use of a single donor cornea in 5 patients with corneal pathology, who required anterior lamellar and endothelial keratoplasties.

Methods:

Descemet membrane (DM) with endothelium was completely stripped from a single corneoscleral button and punched out from the endothelial side with a circular, standard punch. Using a custom-made punch for linear cutting of DM, we obtained 4 quarter-grafts (Q-graft). The denuded and punched-out corneal stroma was transplanted in 1 patient with keratoconus, using the big-bubble deep anterior lamellar keratoplasty (DALK) technique. The 4 DM Q-grafts were consecutively transplanted to 4 patients with Fuchs dystrophy using the quarter Descemet membrane endothelial keratoplasty (Q-DMEK or 1/4 DMEK) technique.

Results:

All surgical procedures were performed successfully during 1 surgical session. No intraoperative or postoperative complications requiring intervention were observed. Six months after surgery, the decimal best-corrected visual acuity achieved was 0.66 after DALK and 0.95 ± 0.1 (range, 0.8–1.0) in the 4 Q-DMEK cases; the endothelial cell density was 1680 ± 254 cells/mm2 (range, 1492–2039 cells/mm2). Six months postoperatively, all corneas were clear.

Conclusions:

In this limited series, we demonstrate that 1 donor cornea can be successfully used for 5 recipients. Although performing DALK and Q-DMEK on a single day is technically challenging, it is feasible and can dramatically reduce the shortage and the cost of corneal tissue. Strict case selection is necessary. Further study on this approach is required.
Fibrous Histiocytoma of the Lacrimal Sac in an 11-Year-Old Male
Authors: Santamaria Joseph A. , Gallagher Colin F. , Mehta Aditya , Davies Brett W.
Published: February 2018

Fibrous histiocytoma is a soft tissue tumor with cells resembling both fibroblasts and histiocytes. Occasionally in the orbit, they rarely arise in the lacrimal sac. Similar to prior cases described, the patient presented with symptoms of epiphora and a slowly enlarging mass inferior to the right medial canthus. Imaging demonstrated a circumscribed 1.2 cm × 1.1 cm × 1.1 cm mass within the lacrimal sac without surrounding bony destruction. Grossly, the tumor appeared homogenous and rubbery. Pathologic study results from the case demonstrated zones of hypercellularity and hypocellularity with a fibrous appearance, admixed with spindle cells and collections of foamy histiocytes. A diagnosis of benign fibrous histiocytoma was rendered, with the patient experiencing a complete resolution of symptoms at subsequent follow up. To the authors’ knowledge, this is the first reported solitary case report of a fibrous histiocytoma of the lacrimal sac in a pediatric patient.
A Mid-scala Cochlear Implant Electrode Design Achieves a Stable Post-surgical Position in the Cochlea of Patients Over Time—A Prospective Observational Study
Authors: Dees Guido , Smits Jeroen Jules , Janssen A. Miranda L. , Hof Janny R. , Gazibegovic Dzemal , Hoof Marc van , Stokroos Robert J.
Published: February 2018

Introduction:

Cochlear implant (CI) electrode design impacts the clinical performance of patients. Stability and the occurrence of electrode array migration, which is the postoperative movement of the electrode array, were investigated using a mid-scalar electrode array and postoperative image analysis.

Methods:

A prospective observational study was conducted. A mid-scalar electrode was surgically placed using a mastoidectomy, followed by a posterior tympanotomy and an extended round-window or cochleostomy insertion. A few days after surgery and 3 months later Cone Beam Computed Tomography (CBCT) was performed. The two different CBCT's were fused, and the differences between the electrode positions in three dimensions were calculated (the migration). A migration greater than 0.5 mm was deemed clinically relevant.

Results:

Fourteen subjects participated. The mid-scalar electrode migrated in one patient (7%). This did not lead to the extrusion of an electrode contact. The mean migration of every individual electrode contact in all patients was 0.36 mm (95% confidence interval 0.22–0.50 mm), which approximates to the estimated measurement error of the CBCT technique.

Conclusion:

A mid-scalar electrode array achieves a stable position in the cochlea in a small but representative group of patients. The methods applied in this work can be used for providing postoperative feedback for surgeons and for benchmarking electrode designs.
Hearing Restoration in Cochlear Nerve Deficiency: the Choice Between Cochlear Implant or Auditory Brainstem Implant, a Meta-analysis
Authors: Vesseur Annemarie , Free Rolien , Snels Chantal , Dekker Friedo , Mylanus Emmanuel , Verbist Berit , Frijns Johan
Published: February 2018

Objective:

To answer the dilemma clinician's face when deciding between cochlear implant (CI) and auditory brainstem implant (ABI) treatment options in patients with cochlear nerve deficiency (CND).

Study Design:

Case study supplemented with literature review and meta-analysis.

Setting:

Tertiary referral center.

Patient(s):

Child with CHARGE syndrome and congenital deafness.

Intervention(s):

ABI as there was no benefit after bilateral cochlear implantation.

Main Outcome Measures:

Speech and language development, quality of life.

Results:

In one ear the cochleovestibular nerve was present on magnetic resonance imaging (MRI) without preoperative ABR responses. In the contra lateral ear the nerve could not be identified, despite present ABR responses. Nevertheless, there was no positive outcome with CI. The patient had improved speech and language and quality of life with ABI. Of the 108 patients with CND and CI identified in the literature review, 25% attained open-set speech perception, 34% attained closed-set speech perception, and 41% detected sounds or less. The appearance of the cochlear nerve on MRI was a useful predictor of success, with cochlear nerve aplasia on MRI associated with a smaller chance of a positive outcome post cochlear implantation compared with patients with cochlear nerve hypoplasia.

Conclusion:

Although patients with (apparent) cochlear nerve aplasia are less likely to benefit from CI, CI before ABI is supported as some patients attain closed or open-set levels of speech perception after cochlear implantation.
Selection of Single- Versus Double-Lumen Peripherally Inserted Central Catheters and the Influence on Alteplase Use
Authors: Byrne Dia , Penwarden Linda
Published: February 2018

The purpose of this article is to share the efforts of one institution in reducing risk of central line-associated bloodstream infections (CLABSIs). The aim is to review alteplase use as a marker for peripherally inserted central catheter (PICC) occlusions, which may increase risk of CLABSIs. The discovery that alteplase use increased with the number of PICC lumens allowed for exploration of ordering and placement practices. Following education, placement of double-lumen PICCs decreased.
Mothering With Advanced Ovarian Cancer: “You've Got to Find That Little Thing That's Going to Make You Strong”
Authors: Arida Janet A. , Bressler Toby , Moran Samantha , D'Arpino Sara , Carr Alaina , Hagan Teresa L.
Published: February 2018

Background

Mothers with ovarian cancer are at risk of experiencing additional demands given their substantial symptom burden and accelerated disease progression.

Objective

This study describes the experience of mothers with ovarian cancer, elucidating the interaction between their roles as mothers and patients with cancer.

Methods

We conducted a secondary analysis of focus groups with women with advanced ovarian cancer. Using descriptive coding, we developed a coding framework based on emerging findings and group consensus. We then identified higher-order themes capturing the breadth of experiences described by mothers with ovarian cancer.

Results

Eight of the 13 participants discussed motherhood. The mean age of participants was 48.38 (SD, 7.17) years. All women were white (9/9), most had some college education (6/9), and the majority were married (5/9). Mean time since diagnosis was 7.43 (SD, 4.69) months; more than half of women (5/9) were currently receiving treatment. Themes and exemplar quotes reflected participants' evolving self-identities from healthy mother to cancer patient to woman mothering with cancer. Subthemes related to how motherhood was impacted by symptoms, demands of treatment, and the need to gain acceptance of living with cancer.

Conclusions

The experience of motherhood impacts how women experience cancer and how they evolve as survivors. Similarly, cancer influences mothering.

Implications for Practice

Healthcare providers should understand and address the needs of mothers with ovarian cancer. This study adds to the limited literature in this area and offers insight into the unique needs faced by women mothering while facing advanced cancer.
The Brief Perceived Cognitive Impairment Scale–Korean
Authors: Kim Hee-Ju , Barsevick Andrea M.
Published: February 2018

Background

Practical brief measures are needed for clinicians and researchers to identify and effectively manage cognitive impairment in cancer patients.

Objective

This study evaluated the reliability (ie, internal consistency reliability) and validity (ie, construct, convergent, concurrent, and known-group validity) of the Brief Perceived Cognitive Impairment Scale–Korean (BPCIS-K).

Methods

From a university hospital, 249 cancer patients participated. The BPCIS-K was constructed with 6 items evaluating key aspects of cognitive impairment in cancer patients. For internal consistency reliability, Cronbach's α and item-total correlations were evaluated. For construct validity, confirmatory factor analysis was performed. For convergent validity, Pearson correlations were tested with the Functional Assessment of Cancer Therapy–Cognitive Function. For concurrent validity, Pearson correlations were tested with the Functional Assessment of Chronic Illness Therapy–Fatigue. For known-group validity, t tests were performed.

Results

The BPCIS-K showed high internal consistency reliability (Cronbach's α = .92; item-total correlations ranged from 0.76 to 0.81). Factor analysis confirmed the scale is unidimensional. It is highly associated with another validated cognitive impairment measure (r = -0.91, P < .001) and moderately correlated with a fatigue measure (r = −0.52, P < .001). In known-group validity, female and patients undergoing treatment experienced more severe impairment than did male patients and patient awaiting treatment (P = .05, P = .08, respectively).

Conclusion

The BPCIS-K is valid and reliable for assessing cancer patients' perceived cognitive impairment, particularly in concentration, memory, and executive functions.

Implication for Practice

This study introduces a practical brief measure to clinicians and researchers.
Integrating Palliative Care Into Global Health Initiatives
Authors: Rosa William E.
Published: February 2018

The landscape of global health is quickly evolving as international health care systems and nursing organizations are developing solutions to dilemmas that face the global village and planet as a whole. Nurses remain key players in advancing all major transnational initiatives. Despite admirable efforts by many governing bodies to unify globalized health improvement, palliative care as a specialty has often not been included as a priority for health research, education, practice, or policy. The purpose of this article is to identify both opportunities and challenges for nurses to integrate palliative care into established global health initiatives and the emerging professional organizational movements impacting the future development of both global and palliative nursing. Partnerships across disciplines, with policy makers, and in research, education, and practice will assist in the creation of new knowledge and in continuing to establish the evidence-based value of palliative care on a global scale.
Care in Nursing Facilities After Palliative Consult
Authors: Carpenter Joan G. , Berry Patricia H. , Ersek Mary
Published: February 2018

Despite hospital palliative care consultations during which goals of care are discussed in the context of poor prognoses, older adults are admitted to nursing homes (NHs) for post-acute care where the focus is on rehabilitation. The purpose of this qualitative descriptive study was to describe factors that influence discontinuity between a palliative care consult and NH care and explore the potential consequences of this discontinuity. Twelve adults (mean age, 80 years) were enrolled from 1 community hospital and NH in the mid-Atlantic United States. Semistructured interviews and medical record reviews were used to elicit information about clinical course, care processes, and patient/family preferences at hospital discharge and up to 4 times after NH admission. Data were analyzed using inductive content analysis techniques. Analysis revealed 2 themes: inadequate communication, characterized by the lack of information about the palliative care consult after hospital discharge, and prognosis incongruence, evidenced by data demonstrating a discrepancy between hospital prognosis and NH care. Ongoing communication between settings to readdress goals of care, prognosis, and symptoms—the central tenets of palliative care—is lacking. Efforts to improve access to comprehensive palliative care delivery after hospitalization and during NH transitions are greatly needed.
Developing a Training for Certified Nursing Assistants to Recognize, Communicate, and Document Discomfort in Residents With Dementia
Authors: Rodriguez Vanessa , Reinhardt Joann P. , Spinner Ruth , Blake Sharon
Published: February 2018

Nursing home residents with advanced dementia experience significant symptom burden and may be unable to articulate their needs. Observational tools, such as the Pain Assessment in Advanced Dementia (PAINAD) scale, are available to evaluate changes in behavior that may signify discomfort or pain. Studies proposing a short and effective curriculum, primarily for certified nursing assistants (CNAs) on how to use and incorporate the PAINAD in daily patient care, are scarce. This performance improvement project involves the design and implementation of a training curriculum for CNAs for using the PAINAD and discusses barriers to be considered for further projects. Certified nursing assistant perceptions of their experience with the training and the use of the tool were also assessed with a brief evaluation. Seventy-three initial PAINAD forms were completed along with 52 follow-up PAINAD forms. A pairedttest (N = 52) showed a significant decrease in the PAINAD scores from initial (mean, 6.06) to follow-up (mean, 1.85) (P< .001), suggesting a reduction of patient discomfort. The process of collecting and examining these data was meant to reinforce the identification and reduction of behavioral distress through the application of this tool. The training was perceived as effective and the tool as easy to use, indicating it can be incorporated into daily care responsibilities of CNAs.
Moral Injury and Religiosity in US Veterans With Posttraumatic Stress Disorder Symptoms
Authors: Koenig Harold G. , Youssef Nagy A. , Ames Donna , Oliver John P. , Teng Ellen J. , Haynes Kerry , Erickson Zachary D. , Arnold Irina , Currier Joseph M. , O'Garo Keisha , Pearce Michelle
Published: February 2018

Moral injury (MI) involves feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs related to traumatic experiences. This multisite cross-sectional study examined the association between religious involvement (RI) and MI symptoms, mediators of the relationship, and the modifying effects of posttraumatic stress disorder (PTSD) severity in 373 US veterans with PTSD symptoms who served in a combat theater. Assessed were demographic, military, religious, physical, social, behavioral, and psychological characteristics using standard measures of RI, MI symptoms, PTSD, depression, and anxiety. MI was widespread, with over 90% reporting high levels of at least one MI symptom and the majority reporting at least five symptoms or more. In the overall sample, religiosity was inversely related to MI in bivariate analyses (r = −0.25, p < 0.0001) and multivariate analyses (B = −0.40, p = 0.001); however, this relationship was present only among veterans with severe PTSD (B = −0.65, p = 0.0003). These findings have relevance for the care of veterans with PTSD.
Clinicopathologic Characteristics of Thyroid-like Low-grade Nasopharyngeal Papillary Adenocarcinoma: A Case Report
Authors: Li Liang , Zhou Fengjuan , Lin Fanzhong , Han Cuihong
Published: February 2018

Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is an extremely rare neoplasm. It morphologically resembles papillary thyroid carcinoma and is immunochemically positive for thyroid transcription factor 1. Herein, we reported a case of TL-LGNPPA in a female patient of 35 years old. She felt pharyngeal foreign body sensation of unknown cause and subsequently developed dyspnea after activities. Nasopharyngeal plain computerized tomography showed no abnormalities, but laryngoscopy showed a peanut-sized smooth neoplasm with a pedicel at the posterior edge of the nasal septum. The mass was completely resected by nasopharyngoscopy. Histologic examination showed the tumor was composed of papillary configuration and tubular glands; each papilla was covered with cuboidal or columnar epithelial cells; tubular architecture and spindle cell component were also observed; some tumor cells had psammoma bodies. Immunohistochemically, tumor cells were positive for CKpan, CK7, CK19, VIM, and thyroid transcription factor 1, but negative for thyroglobulin, CK20, S-100, P63, P40, smooth muscle actin, CDX-2, and glial fibrillary acidic protein. This patient was diagnosed with TL-LGNPPA and followed up for 16 months, and metastasis and recurrence were not observed.
Emergency Information Forms for Children With Medical Complexity
Authors: Copper Tara Conway , Jeffe Donna B. , Ahmad Fahd A. , Abraham George , Yu Feliciano , Hickey Brianna , Schnadower David
Published: February 2018

Objectives

Children with medical complexity (CMC) are at risk for poor outcomes during medical emergencies. Emergency information forms (EIFs) provide essential medical information for CMC during emergencies; however, they are not widely used. We sought to identify factors related to optimal care for CMC to inform development of EIFs for CMC.

Methods

We interviewed 26 stakeholders, including parents of CMC, healthcare providers, health information technology, and privacy compliance experts. We inquired about barriers and facilitators to emergency care of CMC, as well as the desired content, structure, ownership, and maintenance of an EIF. Audio recordings were transcribed and analyzed inductively for common themes using thematic analysis techniques.

Results

Providers identified problems with documentation and poor caregiver understanding as major barriers to care. Parents reported poor provider understanding of their child's condition as a barrier. All groups reported that summary documents facilitate quality care. Recommended content included demographic/contact information, medical history, medications, allergies, advance directives, information about the patient's disease, and an action plan for anticipated emergencies. Twenty-three participants indicated a preference for electronic EIFs; 19 preferred a Web-based EIF that syncs with the medical record, with paper or portable electronic copies. Although 13 participants thought that EIFs should be patient owned to ensure availability during emergencies, 19 expected medical providers to create and update EIFs.

Conclusions

Stakeholders interviewed reported a preference for Web-based, sync-capable EIFs with portable copies. Emergency information forms could be maintained by providers but owned by patients to optimize emergency care and align with the concept of the medical home.
IDEAL IMPLANT Structured Breast Implants: Core Study Results at 6 Years
Authors: Nichter Larry S. , Hardesty Robert A. , Anigian Gregg M.
Published: February 2018

Background:

The structured breast implant uses different technology than saline or silicone gel implants, making it a third type of implant. The U.S. Food and Drug Administration and Health Canada granted approval in November of 2014. This implant is filled with saline but has an internal structure consisting of a series of nested shells that support the upper pole when upright and control fluid movement. It combines certain key features and benefits of saline and silicone gel implants. As with saline, the filler is only saline, which women like for peace of mind in case of rupture/deflation. As with silicone gel, it has a natural feel, but without the risk of silent rupture and U.S. Food and Drug Administration–recommended magnetic resonance imaging scans—women can simply look in the mirror and know their implants are intact.

Methods:

This U.S. trial enrolled 502 women: 399 primary augmentations and 103 replacements of existing augmentation implants. Investigators were 45 American Board of Plastic Surgery–certified plastic surgeons at 35 sites. Of the 502 women enrolled, 438 (87.3 percent) completed 6-year follow-up visits, a higher percentage than other Core breast implant trials.

Results:

At 6 years, patient satisfaction was 89.7 percent for primary and 91.6 percent for replacement augmentations; surgeon satisfaction was 92.6 percent for primary and 94.0 percent for replacement augmentation. Kaplan-Meier adverse event rates were as follows: Baker grade III and IV capsular contracture, 5.7 percent for primary and 11.5 percent for replacement augmentation; and rupture/deflation, 1.8 percent for primary and 4.7 percent for replacement augmentation.

Conclusion:

Six-year results from 438 women show that the structured breast implant has high patient and surgeon satisfaction, a low rate of capsular contracture, and a low rate of rupture/deflation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Multidetector Computed Tomography Imaging: Effect of Sparse Sampling and Iterative Reconstruction on Trabecular Bone Microstructure
Authors: Mookiah Muthu Rama Krishnan , Subburaj Karupppasamy , Mei Kai , Kopp Felix K. , Kaesmacher Johannes , Jungmann Pia M. , Foehr Peter , Noel Peter B. , Kirschke Jan S. , Baum Thomas
Published: February 2018

Multidetector computed tomography–based trabecular bone microstructure analysis ensures promising results in fracture risk prediction caused by osteoporosis. Because multidetector computed tomography is associated with high radiation exposure, its clinical routine use is limited. Hence, in this study, we investigated in 11 thoracic midvertebral specimens whether trabecular texture parameters are comparable derived from (1) images reconstructed using statistical iterative reconstruction (SIR) and filtered back projection as criterion standard at different exposures (80, 150, 220, and 500 mAs) and (2) from SIR-based sparse sampling projections (12.5%, 25%, 50%, and 100%) and equivalent exposures as criterion standard. Twenty-four texture features were computed, and those that showed similar values between (1) filtered back projection and SIR at the different exposure levels and (2) sparse sampling and equivalent exposures and reconstructed with SIR were identified. These parameters can be of equal value in determining trabecular bone microstructure with lower radiation exposure using sparse sampling and SIR.
Significance and Prevalence of Haziness Surrounding the Hepatic Artery and Celiac Axis on Computed Tomographic Imaging After Pancreaticoduodenectomy
Authors: Liu Hanna , Imagawa David , Ward Garrett , Dullet Navjit , Lall Chandana
Published: February 2018

Purpose

This study was conducted to assess the prevalence and significance of “haziness” around the hepatic artery and celiac axis in patients after pancreaticoduodenectomy.

Methods

This retrospective study was conducted on 116 patients who underwent pancreaticoduodenectomy or a similar procedure and had no clinical evidence of tumor recurrence or malignancy within 2 years from the date of surgery.

Results

Most images exhibited at least mild to moderate haziness around the hepatic artery and celiac axis. Patients with benign vs malignant results on formal pathology had no significant difference in severity of findings. Haziness remained in the mild to moderate range 2 years after surgery.

Conclusions

Mild to moderate soft tissue stranding with increased attenuation around the hepatic artery and celiac axis is a common finding after pancreaticoduodenectomy that may persist for years after surgery. Such haziness alone has low specificity for tumor recurrence and should not be regarded as an indicator of malignancy.
Effect of Leptin on Marrow Adiposity in Ovariectomized Rabbits Assessed by Proton Magnetic Resonance Spectroscopy
Authors: Li Shaojun , Jiang Hongning , Wang Bo , Gu Mingjun , Zhang Ning , Liang Wenwen , Wang Yu
Published: February 2018

Objective

Leptin acts to influence bone metabolism through indirect hypothalamic relay and direct peripheral pathways. Leptin enhances the differentiation of mesenchymal stem cells to the osteoblast rather than the adipocyte lineage, but the in vivo impacts of leptin on ovariectomy (OVX)-induced marrow adiposity are poorly understood. In this work, we aimed to address this question.

Methods

Forty-five female New Zealand rabbits were divided into sham + vehicle, OVX + vehicle, and OVX + leptin for 5 months. Magnetic resonance spectroscopy and dual-energy x-ray absorptiometry were performed to longitudinally evaluate marrow fat fraction and bone density at 0, 2.5, and 5 months, respectively. At the end of experiment, quantitative parameters of marrow adipocytes were assessed by histopathology.

Results

Estrogen-deficient rabbits markedly exhibited expansion of marrow fat in a time-dependent manner, with a variation of marrow fat fraction (+19.7%) at 2.5 months relative to baseline conditions, and it was maintained until 5 months (+49.2%; all P < 0.001), which was accompanied by diminished bone density. Adipocyte diameter, density, and adipocytes area percentage in the OVX controls was increased by 50.7%, 76.3%, and 135.5%, respectively, relative to the sham controls (all P < 0.001). These OVX-induced marrow adiposity and bone loss were partly restored by leptin treatment. Treatment with leptin prevented OVX-induced increases in bone turnover in rabbits.

Conclusions

Early leptin administration inhibits the adipogenic effect of estrogen deficiency in terms of reverting marrow fat expansion seen in OVX rabbits. Magnetic resonance spectroscopy may be a useful tool for longitudinal and interventional assessments in osteoporosis.
Maxillary Hypoplasia With Congenital Oligodontia Treated by Maxillary Distraction Osteogenesis
Authors: Mishima Sayaka , Yamaguchi Takako , Watanabe Takuma , Komatani Toru , Nakao Kazumasa , Takahashi Katsu , Bessho Kazuhisa
Published: February 2018

It is known that congenitally missing teeth can often cause differences in craniofacial morphology; however, there are few reported cases of orthognathic surgical treatment for these patients. Herein, the authors report a rare case of maxillary hypoplasia with congenital oligodontia treated by maxillary distraction osteogenesis with internal device. A 17-year-old male presenting with multiple tooth agenesis and maxillary recession was referred to our hospital for orthognathic surgical treatment. Preoperative simulation surgery was performed using Full-Color 3-dimensional salt model. After surgery, improvement in maxillary recession and occlusal stability was observed. This report demonstrates the advantages of the method used herein, which includes reduction in operating time with increase in the safety of the procedure.
Is There an Association Between Bothersome Urinary Symptoms and Postpartum Depression?
Authors: Doering Andrew D. , Hundley Andrew F. , Hudson Catherine O. , Benedict Jason A. , Lynch Courtney D. , Schaffir Jonathan A.
Published: February 2018

Objective

Bothersome urinary symptoms are often present postpartum. The objective of this study was to examine the association between bothersome urinary symptoms and screening positive for postpartum depression.

Methods

Women presenting at the routine 6-week postpartum visit were screened for risk of depression with the Edinburgh Postnatal Depression Scale. A questionnaire comprising delivery characteristics and demographics, 20-item Postpartum Symptom Inventory (PSI), Urinary Distress Inventory (UDI) short form, Incontinence Impact Questionnaire (IIQ) short form, and history of depression and antidepressant use was completed. Scores were then compared.

Results

Data from 104 women were analyzed, with 89% reporting excellent or good health; 73% delivered vaginally; 22% reported a history of depression, and 7% were taking an antidepressant. Twelve percent were classified as at risk of depression. Median UDI score was 5.6 (range, 0–44.4). Median IIQ score was 0 (range, 0–85.7). There was no statistically significant association between bothersome urinary symptoms and the odds of screening positive for depression using either the UDI (adjusted odds ratio [OR], 2.9; 95% confidence interval [CI], 0.7–12.5) or the IIQ (adjusted OR, 0.5; 95% CI, 0.1–2.9). The UDI score was associated with elevated PSI scores as PSI scores increased by 5.4 points if a woman had a UDI score that was greater than zero versus a UDI score of zero, controlling for education level, age, and whether the patient had a cesarean delivery (95% CI, 2.2–8.6; P = 0.001). The UDI score was not associated with antidepressant use (OR, 2.4; 95% CI, 0.5–13.2). The IIQ score had no associations with PSI score (adjusted difference in means, 2.9; 95% CI, −0.9 to 6.8; P = 0.13) or antidepressant use (OR, 1.9; 95% CI, 0.4–9.3).

Conclusions

No statistically significant association between bothersome urinary symptoms and the odds of screening positive for increased risk of postpartum depression was found. Future work in this area is needed.
Validation of the American Association for the Surgery of Trauma emergency general surgery grade for skin and soft tissue infection
Authors: Ray-Zack Mohamed D. , Hernandez Matthew C. , Younis Moustafa , Hoch Wyatt B. , Soukup Dylan S. , Haddad Nadeem N. , Zielinski Martin D.
Published: February 2018

INTRODUCTION

Skin and soft tissue infections (SSTIs) present with variable severity. The American Association for the Surgery of Trauma (AAST) developed an emergency general surgery (EGS) grading system for several diseases. We aimed to determine whether the AAST EGS grade corresponds with key clinical outcomes.

METHODS

Single-institution retrospective review of patients (≥18 years) admitted with SSTI during 2012 to 2016 was performed. Patients with surgical site infections or younger than 18 years were excluded. Laboratory Risk Indicator for Necrotizing Fasciitis score and AAST EGS grade were assigned. The primary outcome was association of AAST EGS grade with complication development, duration of stay, and interventions. Secondary predictors of severity included tissue cultures, cross-sectional imaging, and duration of inpatient antibiotic therapy. Summary and univariate analyses were performed.

RESULTS

A total of 223 patients were included (mean ± SD age of 55.1 ± 17.0 years, 55% male). The majority of patients received cross sectional imaging (169, 76%) or an operative procedure (155, 70%). Skin and soft tissue infection tissue culture results included no growth (51, 24.5%), monomicrobial (83, 39.9%), and polymicrobial (74, 35.6%). Increased AAST EGS grade was associated with operative interventions, intensive care unit utilization, complication severity (Clavien-Dindo index), duration of hospital stay, inpatient antibiotic therapy, mortality, and hospital readmission.

CONCLUSION

The AAST EGS grade for SSTI demonstrates the ability to correspond with several important outcomes. Prospective multi-institutional study is required to determine its broad generalizability in several populations.

LEVEL OF EVIDENCE

Prognostic, level IV.
First detection of bee viruses in hoverfly (syrphid) pollinators
Authors: Bailes Emily J. , Deutsch Kaitlin R. , Bagi Judit , Rondissone Lucila , Brown Mark J. F. , Lewis Owen T.
Published: February 2018

Global declines of insect pollinators jeopardize the delivery of pollination services in both agricultural and natural ecosystems. The importance of infectious diseases has been documented in honeybees, but there is little information on the extent to which these diseases are shared with other pollinator orders. Here, we establish for the first time the presence of three important bee viruses in hoverfly pollinators (Diptera: Syrphidae): black queen cell virus (BQCV), sacbrood virus (SBV) and deformed wing virus strain B (DWV-B). These viruses were detected in two
Eristalis
species, which are behavioural and morphological bee mimics and share a foraging niche with honeybees. Nucleotide sequences of viruses isolated from the
Eristalis
species and
Apis mellifera
were up to 99 and 100% identical for the two viruses, suggesting that these pathogens are being shared freely between bees and hoverflies. Interestingly, while replicative intermediates (negative strand virus) were not detected in the hoverflies, viral titres of SBV were similar to those found in
A. mellifera
. These results suggest that syrphid pollinators may play an important but previously unexplored role in pollinator disease dynamics.
The effect of dispersal on rates of cumulative cultural evolution
Authors: Dyble M.
Published: February 2018

The ability to develop cultural adaptations to local environments is critical to the biological success of humans. Although overall population size and connectedness are thought to play an important role in increasing the rate of cumulative cultural evolution, the independent effect of dispersal rules on rates of cultural evolution has not been examined. Here, a computational model is used to explore the effect of dispersal on the rate of cultural evolution in traits transmitted patrilineally (from father to son), matrilineally (mother to daughter) and bilineally (through both sexes). Two dispersal conditions are modelled: patrilocality (where females disperse and males stay) and bilocality (where either sex may disperse). The results suggest that when only females disperse, the capacity for cumulative cultural evolution in traits shared only among males is severely constrained. This occurs even though overall rates of dispersal and the number of cultural models available to males and females are identical in both dispersal conditions. The constraints on the evolution of patrilineally inherited traits could be considered to represent a process of ‘cultural inbreeding', analogous to genetic inbreeding.
High throughput characterization of genetic effects on DNA:protein binding and gene transcription
Authors: Kalita Cynthia A. , Brown Christopher D. , Freiman Andrew , Isherwood Jenna , Wen Xiaoquan , Pique-Regi Roger , Luca Francesca
Published: February 2018

Many variants associated with complex traits are in non-coding regions, and contribute to phenotypes by disrupting regulatory sequences. To characterize these variants, we developed a streamlined protocol for a high-throughput reporter assay, BiT-STARR-seq (Biallelic Targeted STARR-seq), that identifies allele-specific expression (ASE) while accounting for PCR duplicates through unique molecular identifiers. We tested 75,501 oligos (43,500 SNPs) and identified 2,720 SNPs with significant ASE (FDR 10%). To validate disruption of binding as one of the mechanisms underlying ASE, we developed a new high throughput allele specific binding assay for NFKB-p50. We identified 2,951 SNPs with allele-specific binding (ASB) (FDR 10%); 173 of these SNPs also had ASE (OR=1.97, p-value=0.0006). Of variants associated with complex traits, 1,531 resulted in ASE and 1,662 showed ASB. For example, we characterized that the Crohn’s disease risk variant for rs3810936 increases NFKB binding and results in altered gene expression.
Learning common and specific patterns from data of multiple interrelated biological scenarios with matrix factorization
Authors: Zhang Lihua , Zhang Shihua
Published: February 2018

High-throughput biological technologies (e.g., ChIP-seq, RNA-seq and single-cell RNA-seq) rapidly accelerate the accumulation of genome-wide omics data in diverse interrelated biological scenarios (e.g., cells, tissues and conditions). Data dimension reduction and differential analysis are two common paradigms for exploring and analyzing such data. However, they are typically used in a separate or/and sequential manner. In this study, we propose a flexible non-negative matrix factorization framework CSMF to combine them into one paradigm to simultaneously reveal common and specific patterns from data generated under interrelated biological scenarios. We demonstrate the effectiveness of CSMF with four applications including pairwise ChIP-seq data describing the chromatin modification map on protein-DNA interactions between K562 and Huvec cell lines; pairwise RNA-seq data representing the expression profiles of two cancers (breast invasive carcinoma and uterine corpus endometrial carcinoma); RNA-seq data of three breast cancer subtypes; and single-cell sequencing data of human embryonic stem cells and differentiated cells at six time points. Extensive analysis yields novel insights into hidden combinatorial patterns embedded in these interrelated multi-modal data. Results demonstrate that CSMF is a powerful tool to uncover common and specific patterns with significant biological implications from data of interrelated biological scenarios.