bluuebunny/crossref_metadata_2025 huggingface dataset:
Furthering the Validity of a Tool to Assess Simulated Pregnancy Options Counseling Skills
Authors: Lupi Carla , Ward-Peterson Melissa , Coxe Stefany , Minor Suzanne , Eliacin Irmanie , Obeso Vivian
Published: September 2016

OBJECTIVE:

To further the validity of a tool to assess nondirective pregnancy options counseling skills.

METHODS:

Using a cross-sectional design, we explored four sources of construct validity evidence for an objective structured clinical examination for training and assessment of nondirective pregnancy options counseling: content, response process, internal structure, and relations to other variables. Content of the previously developed tool was enhanced through input from five family medicine educators. The objective structured clinical examination was implemented in a family medicine clerkship with third-year medical students from 2014 to 2015 using trained raters. Response process was addressed after a pilot round. Three new raters evaluated videotapes of 46 performances. Cronbach's alpha, intraclass correlation coefficients, and Spearman's rho were estimated with 95% confidence intervals.

RESULTS:

The content validity was affirmed. Cronbach's alpha was 0.71. According to Landis and Koch's criteria, all but two items unique to the clinical situation of pregnancy options counseling generated substantial to perfect agreement (0.62–1.00). Relations to other variables within the checklist were strong, ranging from 0.66 to 0.87.

DISCUSSION:

This tool for assessing pregnancy options counseling skills has excellent content and strong internal structure. Further work to improve the Global Rating Scale may be necessary for summative use.
Initial Experience With Percutaneous IM Rodding of the Humeri in Children With Osteogenesis Imperfecta
Authors: Grossman Leonid S. , Price Amber L. , Rush Eric T. , Goodwin Jennifer L. , Wallace Maegen J. , Esposito Paul W.
Published: September 2016

Background:

To report a single-center surgical experience treating humeral deformity and fractures in children with osteogenesis imperfecta (OI) using the Fassier-Duval (FD) intramedullary elongating rods.

Methods:

A retrospective review was conducted between December 2005 and July 2013 of all OI patients who underwent FD rodding with a minimum of 1-year follow-up. All patients were also being concurrently treated with bisphosphonates.

Results:

Eighteen patients underwent internal fixation on a total of 35 humeri: 7 males and 11 females with an average age of 49 months. Thirty-five procedures were performed using FD rodding, with 5 utilizing only the male portion. Thirty procedures were primary FD implantation and 5 were revisions. Twelve patients had type III OI and 6 patients type IV OI. Indications for surgery included recurrent fracture, severe bowing deformity, and pain. Osteotomy methods included closed osteoclasis, percutaneous, or open osteotomies. Two patients required transfusions during their hospital stay. At our determined endpoint, 23 humeri (65.7%) had acceptable results with a mean follow-up time of 43 months (SD=27) with no revision. The remaining 12 humeri (34.3%) necessitated revision with a mean time to revision of 35 months (SD=29). Reasons for revision included: migration resulting in pain and functional difficulty (8.6%), migration with bowing (8.6%), and hardware failure secondary to trauma (8.6%). In addition, 2 revisions were required for nonunion (5.7%) and 1 for malunion (2.9%). To our knowledge, all other osteotomies performed during surgery resulted in bony union.

Conclusions:

The use of the FD system for correction of humeral deformity demonstrates a reasonable option to improve comfort and function in children with recurrent fractures and deformity secondary to OI. The FD system allows for decreased revision rates and less morbid instrumentation.

Level of Evidence:

Level IV—retrospective case series.
Prognosticating Factors of Relapse in Clubfoot Management by Ponseti Method
Authors: Zhao Dahang , Li Hai , Zhao Li , Kuo Ken N. , Yang Xuan , Wu Zhenkai , Liu Jianlin , Zhu Jie
Published: September 2016

Background:

It is challenging that some Ponseti method corrected clubfeet have a tendency to relapse. Controversies remain as to the implication of initial severity, representing the deformity degree, as well as number of casts needed, representing the treatment process, in predicting relapse. However, no study has been reported to take these 2 parameters into comprehensive consideration for outcome measurement. The purpose of this study is to investigate the correlation between the initial Pirani score and the number of casts required to correct the deformity in our series; to evaluate noncompliance as a risk factor of the deformity recurrence in Ponseti treatment; to test the validity and predictive value of a new proposed parameter, ratio of correction improvement (RCI) which is indicated by the initial Pirani scores divided by the number of casts.

Methods:

A total of 116 consecutive patients with 172 idiopathic clubfeet managed by Ponseti method were followed prospectively for a minimum of 2 years from the start of brace wearing. RCI value and the other clinical parameters were studied in relation to the risk of relapse by using multivariate logistic regression analysis modeling.

Results:

A positive correlation between the initial Pirani score and the number of casts required to correct the deformity was found in our series (r=0.67, P<0.01). There were 45 patients (39%) with brace noncompliance. The relapse rate was 49% (22/45). The odds ratio of relapse in noncompliant patients was 10 times more that in compliant patients (odds ratio=10.30 and 95% confidence interval, 2.69-39.42; P<0.01). The multivariate logistic regression analysis showed that there was significant association between relapse and RCI value. There were 42 patients (36%) with RCI value <1, among them, the relapse rate was 57% in 24 patients. The odds ratio of relapse in patients with RCI value <1 was 27 times more likely to relapse than those >1 (odds ratio=26.77 and 95% confidence interval, 5.70-125.72; P<0.01).

Conclusions:

On the basis of the findings from our study, we propose the RCI to be a new parameter in predicting the risk of relapse in Ponseti method of clubfoot management. Early intervention is recommended to optimize the brace compliance particularly in case with lower RCI value.

Level of Evidence:

Level II—prognostic.
Knee Arthritis in Children: When Can It Be Safely Treated With Needle Joint Aspiration? A Large Children’s Tertiary Hospital Study
Authors: Tornero Eduard , De Bergua-Domingo Josep Maria , Domenech Pedro , Soldado Francisco , Torner Ferran , Castellanos Juan , Soriano Alex , Knörr Jorge
Published: September 2016

Background:

Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration.

Methods:

Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children’s tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration.

Results:

A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L.

Conclusions:

Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L.

Level of Evidence:

Level III.
Hospital-Level Changes in Adult ICU Bed Supply in the United States
Authors: Wallace David J. , Seymour Christopher W. , Kahn Jeremy M.
Published: September 2016

Objectives:

Although the number of intensive care beds in the United States is increasing, little is known about the hospitals responsible for this growth. We sought to better characterize national growth in intensive care beds by identifying hospital-level factors associated with increasing numbers of intensive care beds over time.

Design:

We performed a repeated-measures time series analysis of hospital-level intensive care bed supply using data from Centers for Medicare and Medicaid Services.

Setting:

All United States acute care hospitals with adult intensive care beds over the years 1996–2011.

Patients:

None.

Interventions:

None.

Measurements and Main Results:

We described the number of beds, teaching status, ownership, intensive care occupancy, and urbanicity for each hospital in each year of the study. We then examined the relationship between increasing intensive care beds and these characteristics, controlling for other factors. The study included 4,457 hospitals and 55,865 hospital-years. Overall, the majority of intensive care bed growth occurred in teaching hospitals (net, +13,471 beds; 72.1% of total growth), hospitals with 250 or more beds (net, +18,327 beds; 91.8% of total growth), and hospitals in the highest quartile of occupancy (net, +10,157 beds; 54.0% of total growth). In a longitudinal multivariable model, larger hospital size, teaching status, and high intensive care occupancy were associated with subsequent-year growth. Furthermore, the effects of hospital size and teaching status were modified by occupancy: the greatest odds of increasing ICU beds were in hospitals with 500 or more beds in the highest quartile of occupancy (adjusted odds ratio, 18.9; 95% CI, 14.0–25.5; p < 0.01) and large teaching hospitals in the highest quartile of occupancy (adjusted odds ratio, 7.3; 95% CI, 5.3–9.9; p < 0.01).

Conclusions:

Increasingly, intensive care bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high ICU occupancy.
A Direct Observation Checklist to Measure Respect and Dignity in the ICU
Authors: Carrese Joseph A. , Geller Gail , Branyon Emily D. , Forbes Lindsay K. , Topazian Rachel J. , Weir Brian W. , Khatib Omar , Sugarman Jeremy
Published: September 2016

Objective:

Treating patients and family members with respect and dignity is a core objective of health care, yet it is unclear how best to measure this in the ICU setting. Accordingly, we sought to create a direct observation checklist to assess the “respect and dignity status” of an ICU.

Design:

A draft checklist based on previous work was iteratively revised to enhance accuracy and feasibility.

Setting:

Seven ICUs within the Johns Hopkins Health System.

Subjects:

A total of 351 patient-clinician encounters with 184 different patients.

Interventions:

Four study team members pilot tested the checklist between January and August 2015.

Measurements and Main Results:

Standard psychometric analyses were performed. The direct observation checklist exhibits strong content and face validity as well as high reliability and internal consistency. All items load on one factor that supports the unidimensionality of the total index. Furthermore, concurrent validity of the direct observation checklist is demonstrated by statistically significant differences in mean scores between ICUs, between types of clinicians, and between patients’ clinical status and mood.

Conclusions:

We rigorously developed, pilot tested, and analyzed a direct observation checklist designed to assess the extent to which patients and families in the ICU setting are treated with respect and dignity. Future research should validate this checklist in other settings and compare its results with other measures. Data gathered about individual items on the direct observation checklist could be used to target areas for training and education; doing so should help facilitate more respectful treatment of patients and their families.
Ombitasvir-Paritaprevir-Ritonavir-Dasabuvir (Viekira Pak)–Induced Lactic Acidosis
Authors: Oberg Catherine L. , Hiensch Robert J. , Poor Hooman D.
Published: September 2016

Objective:

To report a case series of three patients with hepatitis C virus infection who all presented with severe type B lactic acidosis shortly after starting treatment with ombitasvir-paritaprevir-ritonavir-dasabuvir.

Design:

Case series.

Setting:

ICU.

Patients:

Three patients, all who had HCV cirrhosis with mild hepatic impairment (Child-Pugh A) and had started taking ombitasvir-paritaprevir-ritonavir-dasabuvir within the preceding 2 weeks, presented with similar nonspecific symptoms of lethargy, fatigue, and nausea. All had elevated lactate levels at admission without evidence of hypovolemia, cardiogenic failure, or vasodilatory shock.

Interventions:

All patients were given appropriate supportive intensive care for what was initially suspected to be sepsis, including a minimum of 30 mL/kg of IV fluids, infectious workup including blood cultures, broad-spectrum antibiotics, and mechanical ventilatory support. The first patient received continuous veno-venous hemofiltration. The second patient received hemodialysis. The third patient was initially started on hemodialysis despite high norepinephrine requirements and ultimately transitioned to continuous veno-venous hemofiltration.

Measurements and Main Results:

The first patient died despite maximal intensive care. The second patient improved immediately upon starting hemodialysis and was extubated within 48 hours and discharged home. The third patient eventually became hypotensive and was treated with repeated sessions of renal replacement therapy. He ultimately was extubated and discharged home. The infectious workup was negative for all three patients, and antibiotics were discontinued after 2 days in the second and third patients.

Conclusions:

Ombitasvir-paritaprevir-ritonavir-dasabuvir may cause type B lactic acidosis. Further study is warranted to identify risk factors and elucidate the mechanisms of excessive lactate production.
Association Between Executive Function and Problematic Adolescent Driving
Authors: Pope Caitlin N. , Ross Lesley A. , Stavrinos Despina
Published: September 2016

Objective:

Motor vehicle collisions (MVCs) are one of the leading causes of injury and death for adolescents. Driving is a complex activity that is highly reliant on executive function (EF) to safely navigate through the environment. Little research has examined the efficacy of using self-reported EF measures for assessing adolescent driving risk. This study examined the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire and performance-based EF tasks as potential predictors of problematic driving outcomes in adolescents.

Methods:

Forty-six adolescent drivers completed the (1) BRIEF, (2) Trail Making Test, (3) Backwards Digit Span, and (4) self-report on 3 problematic driving outcomes: the number of times of having been pulled over by a police officer, the number of tickets issued, and the number of MVCs.

Results:

Greater self-reported difficulty with planning and organization was associated with greater odds of having a MVC, whereas inhibition difficulties were associated with greater odds of receiving a ticket. Greater self-reported difficulty across multiple BRIEF subscales was associated with greater odds of being pulled over.

Conclusion:

Overall findings indicated that the BRIEF, an ecological measure of EF, showed significant association with self-reported problematic driving outcomes in adolescents. No relationship was found between performance-based EF measures and self-reported driving outcomes. The BRIEF could offer unique and quick insight into problematic driving behavior and potentially be an indicator of driving risk in adolescent drivers during clinical evaluations.
Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Temple
Authors: Carruthers Jean , Jones Derek , Hardas Bhushan , Murphy Diane K. , Donofrio Lisa , Sykes Jonathan M. , Carruthers Alastair , Creutz Lela , Marx Ann , Dill Sara
Published: September 2016

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of temple appearance before and after aesthetic treatment in practice and clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Temple Hollowing Scale.

METHODS

The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 298) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.1 [0.94–1.26] for clinically different image pairs and 0.67 [0.51–0.83] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.86). Interrater agreement was almost perfect during the second session (0.81, primary endpoint).

CONCLUSION

The Allergan Temple Hollowing Scale is a validated and reliable scale for physician rating of temple volume deficit.
Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Hand
Authors: Jones Derek , Donofrio Lisa , Hardas Bhushan , Murphy Diane K. , Carruthers Jean , Carruthers Alastair , Sykes Jonathan M. , Creutz Lela , Marx Ann , Dill Sara
Published: September 2016

BACKGROUND

A validated scale is needed for objective and reproducible comparisons of hand appearance before and after treatment in practice and clinical studies.

OBJECTIVE

To describe the development and validation of the 5-point photonumeric Allergan Hand Volume Deficit Scale.

METHODS

The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real-subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 296) completed during 2 sessions occurring 3 weeks apart.

RESULTS

A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.12 [0.99–1.26] for clinically different image pairs and 0.45 [0.33–0.57] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.83). Interrater agreement was almost perfect during the second session (0.82, primary end point).

CONCLUSION

The Allergan Hand Volume Deficit Scale is a validated and reliable scale for physician rating of hand volume deficit.
Therapeutic Efficacy of Intralesional Steroid With Carbon Dioxide Laser Versus With Cryotherapy in Treatment of Keloids: A Randomized Controlled Trial
Authors: Behera Biswanath , Kumari Rashmi , Thappa Devinder Mohan , Malathi Munisamy
Published: September 2016

BACKGROUND

Keloids are difficult to treat due to their poor response and high recurrence rate.

OBJECTIVE

We conducted a randomized controlled trial to compare the therapeutic efficacy of intralesional triamcinolone acetonide (ILTA) in combination with carbon dioxide laser (Group 1) versus in combination with cryotherapy (Group 2) in the treatment of keloids.

MATERIALS AND METHODS

Sixty patients with 101 keloids were randomized into 2 groups. On Day 1, keloids were ablated using either CO2 laser or cryotherapy followed by injection of ILTA at baseline and at 4 weeks interval for 3 months. Patients were followed up for 12 months to assess for therapeutic response and side effects.

RESULTS

Successful therapeutic response (>50% improvement) between the 2 groups (CO2 vs cryotherapy) were assessed in terms of reduction in thickness, reduction in volume, patient's self-assessment, observer's assessment, and Vancouver Scar Scale score at the end of 6 months and 12 months (55.55% vs 70.37%; 61.1% vs 77.8%; 75% vs 77.78%; 61.12% vs 85.18%; 52.78% vs 62.96% respectively). The difference in therapeutic response between the 2 groups was not statistically significant at the end of 12 months.

CONCLUSION

Both CO2 laser and cryotherapy in combination with ILTA were found to be equally effective in the treatment of keloids.
Facial Treatment Preferences Among Aesthetically Oriented Men
Authors: Jagdeo Jared , Keaney Terrence , Narurkar Vic , Kolodziejczyk Julia , Gallagher Conor J.
Published: September 2016

BACKGROUND

There is a paucity of data describing male attitudes toward age-related changes to their facial features and associated preferences for prioritizing treatment.

METHODS

Injectable-naive but aesthetically oriented men aged 30 to 65 participated in an online study (N = 600). Respondents indicated how concerned they were by the appearance of 15 age-related facial features, and the Maximum Difference scaling system was used to explore which features were most likely to be prioritized for treatment. The correlation between the features of most concern and the areas of treatment priority was assessed. Other aspects regarding the male perspective on aesthetic procedures, such as awareness, motivating factors, and barriers, also were explored.

RESULTS

Crow's feet and tear troughs were rated as the most likely to be treated first (80% of first preferences) followed by forehead lines (74%), double chin (70%), and glabellar lines (60%). The areas of most concern in order were tear troughs, double chin, crow's feet, and forehead lines. There was a strong correlation between the features of most concern and the areas of treatment priority (r
2 = 0.81).

CONCLUSION

The periorbital areas, in particular crow's feet and tear troughs, are of most concern and likely to be prioritized for treatment among aesthetically oriented men.
Simulation and Shoulder Dystocia
Authors: SHADDEAU ANGELA K. , DEERING SHAD
Published: September 2016

Shoulder dystocia is an unpredictable obstetric emergency that requires prompt interventions to ensure optimal outcomes. Proper technique is important but difficult to train given the urgent and critical clinical situation. Simulation training for shoulder dystocia allows providers at all levels to practice technical and teamwork skills in a no-risk environment. Programs utilizing simulation training for this emergency have consistently demonstrated improved performance both during practice drills and in actual patients with significantly decreased risks of fetal injury. Given the evidence, simulation training for shoulder dystocia should be conducted at all institutions that provide delivery services.
Dry Eye Assessment in Patients With Vitamin D Deficiency
Authors: Demirci Goktug , Karaman Erdur Sevil , Ozsutcu Mustafa , Eliacik Mustafa , Olmuscelik Oktay , Aydin Rukiye , Kocabora Mehmet Selim
Published: September 2016

Objectives:

The aim of this study was to evaluate tear film function in patients with vitamin D deficiency.

Methods:

In a single center, 60 eyes of 30 patients with vitamin D deficiency (group 1), and 60 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear break-up time (TBUT), scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity.

Results:

Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309±9 mOsm/L, 35.78±21.44 and 1.3±0.9, respectively) compared with group 2 (295±10 mOsm/L, 18.69±17.21 and 0.4±0.8, respectively) (P<0.001 for all). Schirmer I test and TBUT results in group 1 (8.5±3.7 mm and 8.7±0.6 sec, respectively) were significantly lower compared with group 2 (16.6±2.4 and 18.1±0.5, respectively) (P<0.001 for all).

Conclusions:

This study demonstrates that vitamin D deficiency is associated with tear hyperosmolarity and tear film dysfunction. Patients with vitamin D deficiency may be prone to dry eye.
Transcatheter Aortic Valve Replacement: Current Technology and Future Directions
Authors: Gilmore Richard C. , Thourani Vinod H. , Jensen Hanna A. , Condado Jose F. , Kayatta Michael O. , Rajaei Mohammad H. , Syed Amjad O. , Babaliaros Vasilis C. , Sarin Eric L. , Leshnower Bradley G.
Published: September 2016

Transcatheter aortic valve replacement as an alternative to open surgical repair is rapidly becoming more used in high-risk patients with aortic stenosis. Transcatheter aortic valve replacement offers the benefit of being much less invasive than traditional surgical repair and has evolved as a therapeutic option for patients with prohibitive surgical risk or those deemed surgically inoperable. Nevertheless, despite its potential to mitigate risk in this frail population, it comes with its own unique set of complications. Technological advancements in valve structure, function, and delivery have and continue to attempt to minimize these risks. This review aims to summarize current advancements in transcatheter aortic valve replacement technology while also introducing areas of future direction in this exciting new field.
The Application of Liquid Nitrogen Spray Cryotherapy in Treatment of Bronchial Stenosis
Authors: Janke Kelly J. , Abbas Abbas El-Sayed , Ambur Vishnu , Yu Daohai
Published: September 2016

Objective

Spray cryotherapy (SCT), the application of liquid nitrogen in a noncontact form, has been demonstrated to have efficacy in treating various types of pathologic lesions of the airway when used as an adjunct with bronchoscopy. The purpose of the study was to evaluate the results of the use of bronchoscopic SCT on the airway in a single institution.

Methods

We performed a retrospective review of data collected on all patients who underwent SCT to re-establish or improve airway patency in an 11-month period. Patients were classified based on the nature of their disease into benign or malignant. Demographic data, change in luminal patency, and clinical outcomes were recorded. The percent of stenosis was divided into grades according to the following classification: 1, ≤25%; 2,26% to 50%; 3,51% to 75%; and 4, ≥76%. We defined successful completion of treatment as obtaining a final patency of grade 1.

Results

Twenty-two patients met inclusion criteria, with 45.5% (10 patients) having benign stenosis and 54.5% (12 patients) malignant. At initial bronchoscopic evaluation, the median grade of stenosis was 4 for malignant disease and 3.5 for benign disease. The median final post-treatment grade of stenosis was 2 for malignant disease and 1 for benign. The median improvement in grade of stenosis after treatment was 2 for both malignant and benign causes (Wilcoxon test, P = 0.92). Final patency of grade 1 was achieved in 42% of malignant stenosis and 80% of benign. Overall, 86.4% of patients had an improvement in grade of stenosis after treatment. The rate of morbidity was 4.5% (1/22) of all patients.

Conclusions

The median change in grade after treatment was 2 grades of improvement for both the benign and malignant groups. These results provide evidence that the use of SCT is equally efficacious for both types of stenosis with an expectation of overall improvement in luminal patency, offering a safe and effective method of achieving airway patency in a minimally invasive fashion. This study contributes to the small but growing body of literature supporting the use of SCT in benign and malignant disease.
Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches
Authors: Lehr Eric J. , Guy T. Sloane , Smith Robert L. , Grossi Eugene A. , Shemin Richard J. , Rodriguez Evelio , Ailawadi Gorav , Agnihotri Arvind K. , Fayers Trevor M. , Hargrove W. Clark , Hummel Brian W. , Khan Junaid H. , Malaisrie S. Chris , Mehall John R. , Murphy Douglas A. , Ryan William H. , Salemi Arash , Segurola Romualdo J. , Smith J. Michael , Wolfe J. Alan , Weldner Paul W. , Barnhart Glenn R. , Goldman Scott M. , Lewis Clifton T. P.
Published: September 2016

Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.
Is Stopping Heparin Safe in Patients on Extracorporeal Membrane Oxygenation Treatment?
Authors: Chung Yoon Sang , Cho Dai Yun , Sohn Dong Suep , Lee Wang Soo , Won Hoyoun , Lee Dong Hoon , Kang Hyun , Hong Joonhwa
Published: September 2016

Anticoagulation treatment during extracorporeal membrane oxygenation (ECMO) treatment is unavoidable. However, discontinuation of heparin infusion is necessary when challenges associated with the use of heparin, such as bleeding and thrombocytopenia, are encountered. The medical records of 94 adult (age ≥ 18 years) patients treated with ECMO from January 2011 to March 2015, at Chung-Ang University Hospital, Seoul, Korea, were reviewed. Among the 94 patients, 55 patients underwent ECMO treatment for three or more days. In 52.7% of these patients (n = 29, group A), heparin was stopped for three or more days because of thrombocytopenic events (< 50,000 cells/mm3), higher than target range (> 230 seconds) activated clotting time (ACT), bleeding complications, or the need for other surgical procedures. In 43.6% of patients (n = 24, group B), heparin was continuously infused during the entire ECMO process. The mean length of ECMO support after the initiation of heparin discontinuation in patients in group A was 10.2 ± 14.7 days. There were no intracardiac, intravascular, or intracircuit thrombotic complications in group A. There was no difference in the ECMO weaning success rate between the two groups (41.4% in group A vs. 54.2% in group B, p = 0.353). Heparin discontinuation can be considered in a select group of patients with coagulation abnormalities or bleeding.
Gastrointestinal Polyposis in Cowden Syndrome
Authors: Shaco-Levy Ruthy , Jasperson Kory W. , Martin Katie , Samadder N.J. , Burt Randall W. , Ying Jian , Bronner Mary P.
Published: September 2016

Goals:

To further characterize the gastrointestinal manifestations of Cowden syndrome in clinically well-annotated patients to improve the diagnosis of this syndrome.

Background:

The gastrointestinal manifestations of Cowden Syndrome, an important heritable and multiorgan cancer syndrome, are not well defined. Proper diagnosis is essential for effective cancer surveillance and prevention in these patients.

Study:

Cowden patients with gastrointestinal polyps were selected for medical record and pathologic slide review.

Results:

Of 19 total patients, genetic testing revealed pathogenic PTEN mutations in 12. Pan-colonic (11-patients, 58%) and pan-gastrointestinal (8-patients, 42%) polyp distributions were common. Inflammatory (juvenile) polyps were the most common of the hamartomatous polyp (18 patients, 95%), along with expansive lymphoid follicle polyps (12 patients, 63%), ganglioneuromatous polyps (10 patients, 53%), and intramucosal lipomas (5 patients, 26%). The findings of 2 or more hamartomatous polyp types per patient emerged as a newly described and highly prevalent (79%) feature of Cowden syndrome. Ganglioneuromatous polyps, rare in the general population, and intramucosal lipomas, which may be unique to Cowden syndrome, should both prompt further evaluation. Colonic adenomas and adenocarcinomas were common; 10 patients (53%) had single and 3 (16%) had ≥3 adenomas, whereas 2 (11%) had colonic adenocarcinoma, strengthening the emerging association of colorectal cancer with Cowden syndrome.

Conclusions:

The clinical phenotypes and gastrointestinal manifestations in Cowden syndrome are quite variable but this series adds the following new considerations for this syndromic diagnosis: multiple gastrointestinal hamartomas, especially 2 or more hamartoma types, and any intramucosal lipomas or ganglioneuromas. These features should warrant consideration of Cowden syndrome.
A Real-World Evaluation of Repeat Paracentesis-guided Management of Spontaneous Bacterial Peritonitis
Authors: Goel Aparna , Biewald Mollie , Huprikar Shirish , Schiano Thomas , Im Gene Y.
Published: September 2016

Background:

Spontaneous bacterial peritonitis (SBP) is a common infection in cirrhosis associated with high mortality. More than 20% of patients with SBP do not respond to initial antibiotics. Guidelines differ in recommendations to repeat paracentesis (retap) to confirm antibiotic efficacy. We aim to evaluate the effect of retap-guided management of SBP on antibiotic escalation and 30-day transplant-free survival.

Materials and Methods:

Retrospective cohort study of cirrhotic patients with SBP admitted to a single transplant center from 2010 to 2014. Patients were divided into 2 groups: retap-guided management versus no retap. Prevalence of initial antibiotic treatment failure, defined as <25% decrease in ascitic polymorphonuclear cells, and factors associated with treatment failure, antibiotic escalation and 30-day transplant-free survival were evaluated.

Results:

Out of 210 patients, 146 (age 58, 74% male, mean model for end-stage liver disease score, 25) had retap and treatment failure was noted in 28 (22%). Gram-positive bacteria accounted for 44% of all positive cultures and third-generation cepahalosporin resistance was noted in 23%. Thirty-day transplant-free survival was 72% and 62% in retap and control groups, respectively (P=0.07). Treatment failure independently doubled the 30-day mortality rate (hazard ratio: 2.15, 1.03 to 4.50, P=0.04). After adjusting for age, model for end-stage liver disease and nosocomial infection, retap-guided management was not associated with improved survival (P=0.34).

Conclusions:

The prevalence of initial treatment failure is high (22%) in patients with SBP and doubles the 30-day mortality risk, supporting recommendations to retap all patients with SBP.
The Comparison of Effectiveness of Various Potential Predictors of Response to Treatment With SSRIs in Patients With Depressive Disorder
Authors: Bares Martin , Novak Tomas , Brunovsky Martin , Kopecek Miloslav , Höschl Cyril
Published: September 2016

The substantial non-response rate in depressive patients indicates a continuing need to identify predictors of treatment outcome. The aim of this 6-week, open-label study was (1) to compare the efficacy of a priori defined predictors: ≥20% reduction in MADRS score at week 1, ≥20% reduction in MADRS score at week 2 (RM ≥ 20% W2), decrease of cordance (RC), and increase of serum and plasma level of brain-derived neurotrophic factor at week 1; and (2) to assess whether their combination yields higher efficacy in the prediction of response to selective serotonin re-uptake inhibitors (SSRIs) than when used singly. Twenty-one patients (55%) achieved a response to SSRIs. The RM ≥20% W2 (areas under curve—AUC = 0.83) showed better predictive efficacy compared to all other predictors with the exception of RC. The identified combined model (RM ≥ 20% W2 + RC), which predicted response with an 84% accuracy (AUC = 0.92), may be a useful tool in the prediction of response to SSRIs.
Are Children or Adolescents More at Risk for Posttraumatic Stress Reactions Following Exposure to Violence?
Authors: Neugebauer Richard , Forde Allana , Fodor Kinga E. , Fisher Prudence W. , Turner J. Blake , Stehling-Ariza Tasha , Yamabe Saori
Published: September 2016

Whether children or adolescents exhibit higher levels of posttraumatic stress symptoms (PTSS) in response to violence is an unresolved research question. We examine this issue in UNICEF’s 1995 National Trauma Survey (NTS) of 8–19-year-olds (n = 942) who survived the Rwandan Genocide and lived and attended schools in the community. PTSS were assessed with a symptom checklist based on DSM-IV indexed using an overall score comprising the sum of scores on all items and mean item scores of each of five distinct factors identified in a factor analysis within this sample. Eighty percent of the sample had witnessed massacres; 25%, rape/sexual mutilation. The overall symptom score among children was significantly (p < 0.05) lower than among adolescents. Among the five separate factors, this direct association of age with symptom levels held for two: re-experiencing (p < 0.001) and dysphoric arousal (p < 0.05), but not for the remaining three: avoidance, numbing, and anxious arousal. This discordance in factorial response to violence may help explain prevailing inconsistencies in the age-PTSS association reported to date.
Theory of Mind in Euthymic Bipolar Patients and First-Degree Relatives
Authors: Santos Josep Manel , Pousa Esther , Soto Estel , Comes Anna , Roura Pere , Arrufat Francesc X. , Obiols Jordi E.
Published: September 2016

The present study analyzed the capacity for mentalization of patients with bipolar disorder (BD) and their first-degree relatives (FDR) and examined the implications of clinical variables and cognitive deficits. The study recruited 31 patients with type I BD, 18 FDR, and 31 paired healthy controls. Their capacity for mentalization was explored by means of first- and second-order false-belief tasks, the hinting task, and the Movie for the Assessment of Social Cognition (MASC). Patients and FDR were found to have a theory of mind (ToM) deficit when they were evaluated with the MASC, which was also related to a worse neurocognitive performance and to being a patient or FDR. The evidence of ToM deficits in FDRs supports the hypothesis that these deficits could be an independent trait marker for cognitive deficit. Further research is needed on FDR of patients with BD, using sensitive ToM assessment instruments such as the MASC.
Short-Term Health-Related Quality of Life of Critically Ill Children Following Daily Sedation Interruption*
Authors: Vet Nienke J. , de Wildt Saskia N. , Verlaat Carin W. M. , Mooij Miriam G. , Tibboel Dick , de Hoog Matthijs , Buysse Corinne M. P.
Published: September 2016

Objective:

Our earlier pediatric daily sedation interruption trial showed that daily sedation interruption in addition to protocolized sedation in critically ill children does not reduce duration of mechanical ventilation, length of stay, or amounts of sedative drugs administered when compared with protocolized sedation only, but undersedation was more frequent in the daily sedation interruption + protocolized sedation group. We now report the preplanned analysis comparing short-term health-related quality of life and posttraumatic stress symptoms between the two groups.

Design:

Preplanned prospective part of a randomized controlled trial.

Setting:

Two tertiary medical-surgical PICUs in the Netherlands.

Patients:

Critically ill children requiring mechanical ventilation.

Interventions:

None.

Measurements and Main Results:

Eight weeks after a child’s discharge from the PICU, health-related quality of life was assessed with the validated Child Health Questionnaire and, only for children above 4 years old, posttraumatic stress was assessed with the Dutch Children’s Responses to Trauma Inventory. Additionally, health-related quality of life of all study patients was compared with Dutch normative data. Of the 113 patients from two participating centers in the original study, 96 patients were eligible for follow-up and 64 patients were included (response rate, 67%). No difference was found with respect to health-related quality of life between the two study groups. None of the eight children more than 4 years old showed posttraumatic stress symptoms.

Conclusions:

Daily sedation interruption in addition to protocolized sedation for critically ill children did not seem to have an effect on short-term health-related quality of life. Also in view of the earlier found absence of effect on clinical outcome, we cannot recommend the use of daily sedation interruption + protocolized sedation.
Validation of Accelerometer Cut-Points in Children With Cerebral Palsy Aged 4 to 5 Years
Authors: Keawutan Piyapa , Bell Kristie L. , Oftedal Stina , Davies Peter S. W. , Boyd Roslyn N.
Published: September 2016

Purpose:

To derive and validate triaxial accelerometer cut-points in children with cerebral palsy (CP) and compare these with previously established cut-points in children with typical development.

Methods:

Eighty-four children with CP aged 4 to 5 years wore the ActiGraph during a play-based gross motor function measure assessment that was video-taped for direct observation. Receiver operating characteristic and Bland-Altman plots were used for analyses.

Results:

The ActiGraph had good classification accuracy in Gross Motor Function Classification System (GMFCS) levels III and V and fair classification accuracy in GMFCS levels I, II, and IV. These results support the use of the previously established cut-points for sedentary time of 820 counts per minute in children with CP aged 4 to 5 years across all functional abilities.

Conclusions:

The cut-point provides an objective measure of sedentary and active time in children with CP. The cut-point is applicable to group data but not for individual children.
Sporting Activities and Quality of Life in Children With Hemophilia: An Observational Study
Authors: Cuesta-Barriuso Ruben , Torres-Ortuño Ana , Pérez-Alenda Sofía , José Carrasco Juan , Querol Felipe , Nieto-Munuera Joaquín
Published: September 2016

Introduction:

Sports activities are part of multidisciplinary treatments in people with hemophilia.

Aim:

The objective of this study was to assess the incidence of sports activities in the quality of life as perceived by children with hemophilia.

Methods:

A total of 53 children with hemophilia aged 7 to 13 years and 51 children without hemophilia were evaluated. The perception of quality of life, clinical variables, and the frequency of sports activities were registered. The joint condition of patients with hemophilia was measured with the Spanish version of the Haemophilia Joint Health Score.

Results:

There were no significant differences in the perception of quality of life between children with hemophilia and children without hemophilia. Sports activities in people with hemophilia promoted a greater health satisfaction.

Conclusions:

Sports activity in children with hemophilia is associated with an improved quality of life and joint health. It is also associated with improved psychosocial wellness.
The Effects of Orthopedic Manual Physical Therapy in the Management of Juvenile Idiopathic Arthritis: A Case Report
Authors: Lantz Justin M. , Joshi Shruti , O'Hearn Michael
Published: September 2016

Purpose:

Juvenile idiopathic arthritis (JIA) is a cause of disability in childhood. Little research exists concerning physical therapy management, and no evidence exists for orthopedic manual physical therapy (OMPT) for JIA. The purpose of this case report is to describe the use of OMPT in combination with therapeutic exercise in the successful treatment of a child with oligoarticular JIA.

Key Points:

A 6-year-old girl with oligoarticular JIA presented with elbow pain and stiffness interfering with function. Treatment consisted of OMPT in combination with therapeutic exercise and a home exercise program.

Conclusions:

Improvements were demonstrated in elbow range of motion, pain, Childhood Health Assessment Questionnaire, Pediatric Outcomes Data Collection Instrument, and the Patient Specific Functional Scale.

Recommendations for Clinical Practice:

Orthopedic manual physical therapy may be considered as a treatment of a child with JIA.

Recommendations:

We provide evidence that OMPT may be considered as a treatment of a child with JIA.
Frequent NFIB-associated Gene Rearrangement in Adenoid Cystic Carcinoma of the Vulva
Authors: Xing Deyin , Bakhsh Salwa , Melnyk Nataliya , Isacson Christina , Ho Julie , Huntsman David G. , Gilks C. Blake , Ronnett Brigitte M. , Horlings Hugo M.
Published: September 2016

Adenoid cystic carcinoma is a rare malignant tumor that usually arises in the major and minor salivary glands and other locations containing secretory glands, including the lower female genital tract. Lower female genital tract carcinomas with adenoid cystic differentiation can be subclassified into 2 distinct groups based on the presence or absence of high-risk HPV. Cervical mixed carcinomas with some adenoid cystic differentiation are high-risk HPV-related but pure adenoid cystic carcinomas of vulvar and cervical origin appear to be unrelated to high-risk HPV. Mechanisms by which normal cells give rise to an HPV-unrelated adenoid cystic carcinoma remain largely unknown. Studies demonstrate that chromosomal translocation involving the genes encoding the transcription factors MYB and NFIB functions as a driving force of adenoid cystic carcinomas development regardless of anatomic site. The current study used fluorescence in situ hybridization with 3 different probes including MYB break-apart probe, NFIB break-apart probe, and MYB-NFIB fusion probe to assess for the presence of gene rearrangements in adenoid cystic carcinomas of the vulva. Six (66.7%) of 9 vulvar adenoid cystic carcinomas demonstrated NFIB rearrangement. Of these 6 cases with a disturbed NFIB, only 2 cases (33.3%) were positive for a MYB rearrangement that was also confirmed by a positive MYB-NFIB fusion pattern. NFIB-associated gene rearrangement is a frequent genetic event in vulvar adenoid cystic carcinomas. Chromosome translocations involving NFIB but with an intact MYB indicate the presence of novel oncogenic mechanisms for the development of adenoid cystic carcinomas of the vulva.