bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthesia for Functional Endoscopic Sinus Surgery
Authors: Devarajan Jagan
Published: January 2019

Functional endoscopic sinus surgery is one of the most common ear, nose, and throat procedures performed for various indications including chronic rhinosinusitis and nasal polyps with a success rate of as high as 90%. It is a relatively safe procedure, and common adverse events are related to the close proximity of the surgical site to orbit, meninges, brain and optic nerve. Anesthetic management is critical in providing immobility and airway protection. The anesthesiologist plays a significant role in assisting with hemostasis and facilitating a relatively bloodless clear surgical field. Both induction and emergence should be smooth in order to decrease intraoperative and postoperative bleeding respectively. Various airway management and protection techniques and anesthetic regimens have been successfully utilized to produce optimal outcomes.
Utilization of Practice Improvement Methodologies to Enhance OR Efficiency
Authors: Bastien Alexandra
Published: January 2019

The operating room suite is a challenging model since many stakeholders and variables have influence on its management. The practice of medicine in this arena is often perceived as chaotic and on a case-by-case basis. In actuality this is an arena of “organized chaos.” Coordinating and understanding the medical process in this area of a hospital is called the field of operating room management. Due to production pressures and financial constraints, operating room management decisions are often anecdotal with inexperienced personnel at the front-line processes making these decisions. It is imperative that anesthesia training include understanding the concepts of operating room management because anesthesiologists are integral to maintain and improving successful models while not compromising patient care.
Integrative Nursing and Planetary Health
Authors: Rosa William E. , Upvall Michele J. , Andrus Veda L.
Published: January 2019

The world is entering a new era of existence, one in which people can no longer afford to focus solely on their human needs, desires, innovations, and experiences. The reverberations of the human footprint on the globe are being felt socially, politically, ethically, and ecologically and are threatening survival. The environments in which people live and work are constantly changing, requiring integrative nurses to elevate their level of consciousness to the broader systemic impacts of their contributions. Adopting a whole-systems lens grants integrative nurses as healers the ability to provide contextually reverent care for self, other, communities, the organizations they serve, and the planet as an overarching and complex system. Planetary health is the emerging domain of integrative nursing scholarship that requires immediate and wholehearted commitment to oneness, wellbeing, and social justice. Planetary health is at the core of an integrative way of life and living, for in the end, the planet—its life forms, its oceans and lands, and the caring-healing heart of humanity itself—is all that will sustain the people of the earth.
Nutrition and Integrative Nursing
Authors: Sandquist Laura , Kubes Laurie Heil
Published: January 2019

This chapter focuses on creating an optimal healing environment for not only a patient’s inner physiology but also for one’s psychological relationship with food through an integrative nursing perspective on nutrition. The concept of creating precision nutrition is explored along with food story, food ethics, and sustainable nutrition practices. Emerging ideas are addressed such as viewing food as information for the body and the resulting impact on inflammation, the microbiome, distressing symptoms, and disease. The chapter further highlights the vital importance surrounding the use of food as medicine. The goal of the chapter is to review the philosophies upon which an integrative nursing perspective on nutrition is founded and to provide a framework for practical clinical application of sustainable nutrition recommendations with patients.
Integrative Nursing in the Community
Authors: Koithan Mary , Jaurigue Lisa , Chesser Sharyn
Published: January 2019

Historical approaches to community health nursing align with the values, concepts, and principles of integrative nursing. Caring across individual, family, community, and population levels of scale, integrative community health nurses recognize that the whole is reflected in the individual and the individual is reflected in the whole. Innovative integrative models of practice support optimal personal wellbeing, build community capacity, and nurture whole-systems wellbeing. This chapter discusses the principles of integrative nursing as a context for nursing in communities and presents three exemplars of integrative community healthcare programs: school nurses, the Partnership for Native American Cancer Prevention, and Capacitar International.
Integrative Nursing and Mental Health
Authors: Kristofersson Gisli K. , Kaas Merrie J.
Published: January 2019

Integrative nursing offers exciting opportunities to create new models of integrative mental health care to meet growing demands by patients and providers, especially when it comes to access to the broad range of interventions needed to promote mental health and reduce the impact of mental illness. This becomes ever more important as less inclusive treatment paradigms become more prominent in the treatment of mental health disorders. Integrative nursing and psychiatric mental health nursing share many of the same historical emphasis points, including the focus on the therapeutic alliance and the individual needs of the client. This shared heritage lends the fusion of the two, strong face value as well as a strong, mutually beneficial philosophical foundation. Integrative mental health nursing builds on the six principles of integrative nursing to develop a plan for integrated health services based on a whole-person, whole-systems approach using a careful risk benefit analysis.
What Is Personality Disorder?
Authors: Svrakic Dragan M. , Divac-Jovanovic Mirjana
Published: January 2019

The central problem with persons suffering from personality disorder is not their extreme behaviors but rather a fragmented substrate of personality, while extreme behaviors merely represent specific compensatory strategies. The pathodevelopment of personality disorder involves multiple interacting factors (e.g., biogenetic dispositions, early adversity), leading to aberrant brain and mind organization, notably a hypofunctional prefrontal cortex and fragmented object relations, respectively. Such fragmented personality is adaptively dysfunctional and thus vulnerable to disintegration, particularly under stress and strong affects. Consequently, these patients continue to need sources of organization, both internally (through fantasy and exaggerations) and interpersonally (through self-objects who define and maintain the pathological albeit compensatory self-image). Interpersonal conflicts are actively sought and reflect either trait aggression and/or alloplastic adaptation. Personality disorder can be thought of as a homeostatic attempt of the mind to heal itself, akin to callus formation, a form of psychological survival through mental deviance.
Dynamic Nosology and Clinical Assessment of Fragmented Personality
Authors: Svrakic Dragan M. , Divac-Jovanovic Mirjana
Published: January 2019

This chapter introduces a dynamic, personalized, context- and time-sensitive diagnosis of personality in health and disorder. Adaptive flexibility of the mind implies that its component subsystems and functions must also be flexible and semistable, including healthy personality and personality disorder. The model defines a 3D diagnostic space, in which each individual is uniquely and flexibly positioned. “Vertical diagnosis” is based on the duration, pervasiveness, and frequency of periods of fragmented functioning. It is cross-matched with “horizontal diagnosis,” based on the predominant adaptive style. Such dynamic nosology accounts for fluctuations in mental functioning as the individual “moves” in the diagnostic space. The approach captures the flexibility of the mind, self-reorganizing to adapt to changing conditions, and champions the positive connotation of change, challenging the widespread therapeutic nihilism about severe personality pathology. Clinical diagnosis of personality disorder, notably interpersonal (relational), behavioral, and intrapersonal approaches, together with psychological testing are discussed in detail.
Prelude, War, and Aftermath
Authors: Turse Nick
Published: January 2019

This chapter presents a broad summary of this conflict, beginning with its roots in nineteenth-century colonial French Indochina. It details the buildup of U.S. military and economic aid to the South Vietnamese regime after French withdrawal, early U.S. intervention in the ongoing civil war between North and South Vietnam, and the gradual escalation of America’s presence in Southeast Asia under presidents Kennedy, Johnson and Nixon. It describes how and where the war was fought, who served and why, and on-going political and social movements in the U.S. throughout the war and after U.S. withdrawal. It summarizes the human costs in Vietnam and the United States. It describes attempts by psychiatrists to create frameworks for understanding and addressing the trauma, anguish, alienation, and rage experienced and expressed by the U.S. veterans who fought this controversial war, including official recognition in the new diagnosis of post-traumatic stress disorder.
Measurement of Severity of Combat, Involvement in Harming Civilians and Prisoners, and Personal Vulnerability Load
Authors: Dohrenwend Bruce P. , Yager Thomas J. , Wall Melanie M. , Adams Ben G. , Turse Nick
Published: January 2019

This chapter presents detailed measures of each of the three factors that most strongly affect the psychological impact of the Vietnam war on U.S. male veterans. These descriptions build on the detailed accounts in Chapter 2 of the use of military records to develop more comprehensive measures of war-zone experiences. The measures of harm to civilians and prisoners are based on veteran self-reports. The measures of pre-Vietnam vulnerability load include data from military records, such as the Armed Forces Qualification Test (AFQT), pre-war education levels, and NVVRS interview data that enable diagnoses of important types of psychiatric disorder other than PTSD. Less central, but perhaps no less important, other risk factor variables and their measurement are set forth in later chapters at the point they are first introduced.
Harming Civilians or Prisoners
Authors: Dohrenwend Bruce P. , Yager Thomas J. , Lewis-Fernández Roberto , Adams Ben G. , Turse Nick
Published: January 2019

This chapter uses responses to direct, closed questions about personal involvement to identify 12.8% of veterans as harmers. It examines qualitative information to compare self-identified harmers of civilians or prisoners with other veterans. It investigates the qualitative data to discover the specific circumstances in which this type of harm took place. It suggests that harm to prisoners may usually have occurred following attacks on clearly identifiable enemy forces. In contrast, many incidents of harm to civilians appear to have occurred in attempts by U.S. forces to implement the policy of clearing the population from areas considered to be under enemy control. Other than their much more severe combat exposure, this analysis reveals very few characteristics of the harmers that differentiated them from those not directly involved in inflicting such harm. The harmers themselves tend to suffer from persistent guilt and anger.
PTSD in Women Who Served as Nurses in Vietnam
Authors: Yager Thomas J. , Dohrenwend Bruce P.
Published: January 2019

This chapter reviews nurses’ traumatic events and stressful war-time experiences. Onset of war-related PTSD and its persistence many years after nurses’ service were elevated among those who had pre-Vietnam vulnerabilities, particularly pre-war psychiatric disorders. The rate of war-related PTSD onset among nurses was higher than that among male veterans with low probable combat exposure; and the odds of its persistence were nearly four times higher among nurses than among male veterans with moderate probable combat exposure. Likely sources of war-related stress among the nurses included their service in the operating room, their personal risk of enemy attack, and of sexual harassment and attack by fellow American soldiers. Nevertheless, the large majority of nurses reported a strong positive effect of military service on their lives.
Medical Solipsism
Authors: Montgomery Erwin B.
Published: January 2019

A conventional notion of knowledge is explicit and declarative statements of objective facts and principles. Procedural knowledge, such as riding a bike, is evidenced by it having to be learned. Knowledge includes the corpus of medical facts and principles as examples, but so is how the facts and principles are used. Medical facts and principles can be justified by referring to research and study. How does one justify how one uses facts and principles? The lack of clarity opens the discussion to solipsism—a claim is true because one believes it to be true. When involved, solipsism ends the discussion and with it any hopes of progress. The only protection is holding the person responsible for the consequence. There are many situations where solipsism may arise, including evidence-based medicine that recognizes only randomized control trials, governmental regulatory agencies, balkanized medical systems, and, most importantly, the individual clinician.
End of Life
Authors: Fritz Zoë
Published: January 2019

All practising clinicians will inevitably have to deal with the death of their patients. It is very important that we acknowledge our own biases and subjugate those to the needs of the patient for whom we are caring. Doctors prescribe drugs to alleviate symptoms or apply organ support to those whose bodies are failing. They can be asked, by patients or families, to provide life-sustaining treatments that do not offer any clinical relief or to administer drugs to ‘end suffering’. At both extremes, there are laws to protect both patient and doctor. It is this legislation, case law, and General Medical Council guidance that will be reviewed in this chapter. Discussion will focus on the right to refuse life-sustaining treatment; the role of the Mental Capacity Act and respecting ‘best interests’; the legal (and philosophical) distinction between withholding and withdrawing treatment; the doctrine of double effect; assisted suicide; and euthanasia.
Child Health Law
Authors: O’ Donnell Roddy
Published: January 2019

lIn the UK, every human being below the age of 18 years is considered a child in the eyes of the law. In the legal concept known as parens patriae, the state has a duty to protect dependent persons from harm. All clinicians are duty bound to act in the child’s best interests and the child’s welfare must be paramount. In almost all circumstances, it should be expected that the people who speak for their child’s best interests will be their parents or legal guardians. In the past 20 years, consideration of when children should be considered capable of making informed choices about their medical treatment and when the state should decide has changed considerably. Under UK law, all NHS organizations and their employees must now undertake measures to protect a child in their care such that disclosure and effective action to protect children overrides the duty to maintain confidentiality.
Infection in the Immunocompromised Host (Oxford Specialist Handbook)
Authors: Fox Simon , Angus Brian , Minassian Angela , Rawlinson Thomas
Published: January 2019

There is an increasing number of patients who are immunocompromised either by malignancy, new therapies, or infection. This handbook aims to provide a clinically relevant guide for use by specialist trainee and consultant medical staff caring for immunocompromised patients in a hospital setting, including but not limited to the areas of infectious diseases, haematolo-gy, oncology, transplant medicine, HIV and genitourinary medicine, rheumatology, and general medicine. Divided into three sections, the handbook takes both a patient-centred approach, and a pathogen-centred approach. This includes the assessment, investigation, and management of different clinical syndromes presenting in patients with primary immunodeficiency, HIV infection, immunodeficiency as a result of therapeutic immunosuppression, haematological and solid organ malignancy, and immunodeficiency related to organ transplant. Medical conditions resulting in defective immunity (e.g. diabetes mellitus and chronic renal failure) are also covered in addition to travel in the immunocompromised. Furthermore, it includes guidance on the investigation and management of viral, bacterial, parasitic, and fungal infections of particular relevance to the immunocompromised host.
Retelling one’s life story—how narratives improve quality of life in chronic language impairment
Authors: Corsten Sabine , Hardering Friedericke
Published: January 2019

Recent research in the field of narrative-based medicine has investigated the effectiveness of using illness narratives to stimulate coping processes. This chapter examines the utilization of the narrative approach in treating persons with aphasia—a neurological language disorder—many of whom experience reduced social participation and a change in identity. Although life-story work can support processes of sense-making, only a few studies use a biographic–narrative approach in aphasic patients due to their impaired language abilities. The chapter describes an adapted biographic-narrative intervention developed to assist with identity renegotiation and social participation. In order to show the benefits associated with the intervention and how the participants’ sense of self changed through the approach, the chapter examines a study with 27 aphasic people. It covers how the findings provide foundations for future work using biographic–narrative interventions to influence quality of life and identity renegotiation in people with chronic diseases.
Studies of disease occurrence
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Although the definition of measures of disease occurrence, such as incidence and prevalence, may be relatively straightforward, there will be issues of how to operationalize these. The solutions will depend on what systems exist in the location of study such as clinical records, a prospective registration system. Alternatively, if there are no such systems, then alternative solutions will need to be investigated. This could include a proxy measure of disease or could involve undertaking one or more surveys to identify prevalence or new onset cases. Overall, the decision would need to be made on the basis of specific needs relating to an individual project where actual incidence data were not available, to ascertain whether an alternative (proxy) measure may be suitable.
Quantifying the association between exposures and diseases
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Having conducted a specific study design, the task is then to use the information collected to provide an effect measure which quantifies the magnitude of the association between the exposure(s) of interest and the disease under study. Epidemiological studies, and in particular their subsequent analysis, are therefore aimed at quantifying the level of increased risk when exposed to a particular factor, as this chapter explains. The effect measure which can be obtained to quantify the strength of the association, varies according to the type of study conducted. Just because there is a relationship between exposure and disease (even a strong one) does not mean that the relationship is causal.
Studies of disease causation
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

The most important aspect that will influence the validity of any epidemiological study is the careful selection of the subjects for investigation. Separate issues relate to the sampling of subjects for disease status in case–control studies, and sampling by exposure status in cohort studies. In simplest terms, the issues are who should be the cases and, given that, who should be the controls. Thus, in each instance the needs are to identify the sampling frame and then what should be the process for selecting the specific sample or subsamples needed for study. In addition to consideration of who to study, other factors such as how to identify and verify plus the size of the planned study are all topics to be addressed.
Use of secondary data
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Primary data collection is challenging and with increasing electronic data capture in routine healthcare and other aspects of life, it is possible to address several epidemiological questions by robust analysis of such ‘secondary data’. There are considerable advantages in terms of scope, size, and speed of study to be balanced against the quality and depth of using primary data. Even when such direct contact is not required, there is often the need to extract necessary information from individual subject records such as medical files. There is often no alternative source of information, although the greater digitization of information is changing that scenario with the potential that the availability of such information might preclude the need for primary data.
Obtaining valid information
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Validity in respect of information that is collected in an epidemiological study is a measure of how accurate the data collected are, relative to an underlying truth. Classical approaches aim to ensure that the approach is both sensitive (low false negatives) and specific (low false positives) as, for example, in determining the presence or absence of a disease. A modified approach is needed where the value of an attribute is collected. Underpinning both these approaches is the need to consider what is the test of the underlying truth. The reader may already be aware of the application of validity tests in assessing the performance of diagnostic and screening tests. It is conventional to evaluate this performance in terms of the two indicators, sensitivity and specificity.
Bias
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

There are several reasons (e.g. sources of bias), why a study’s results may deviate from the truth. Recruitment and/or follow-up, which is non-random as to who does not provide data is a major source of bias. Other sources include observer preferences and the subject’s answers being informed, for example, by their current or prior status. It is not easy to undertake the perfect, bias-free, study. The challenge is to design the study to minimize the likelihood of bias and to undertake the necessary subanalyses, where appropriate, to obtain a sense of how important a particular bias might have been in explaining the results obtained.
Reversible Cerebral Vasoconstriction Syndrome
Authors: Shafer Krystle , Molyneaux Bradley J.
Published: January 2019

Reversible cerebral vasoconstriction syndrome is a rare disorder that causes acute thunderclap headaches due to reversible cerebral ischemia that results from cerebral arterial vasoconstriction. More common in women, there are many identified triggers to this condition including pregnancy and medications. This condition can be tricky to diagnose and usually requires cerebral angiography. Treatment focuses on relieving the vasoconstriction and protection against cerebral ischemia. The vast majority of the patients have no long- lasting complications from this disorder although in rare cases permanent disability and death may occur.
Subarachnoid Hemorrhage
Authors: Hsiang-Yi Chou Sherry
Published: January 2019

Subarachnoid hemorrhage (SAH) affects over 30,000 Americans per year, leaves over half of its survivors in severe disability, and has a mortality rate of approximately 20%. SAH syndrome presents with a complex disease course and symptoms involving both the central nervous system (CNS) as well as extra-CNS systems. SAH may lead to early brain injury, cerebral vasospasm, and delayed cerebral ischemia, which increases SAH morbidity and mortality. SAH-related extra-CNS organ injuries include neurogenic stunned myocardium, neurogenic pulmonary edema, syndrome of inappropriate antidiuretic hormone secretion, cerebral salt wasting syndrome, systemic inflammatory response syndrome, fever, and venous thromboembolism, all of which require careful critical care management. Though multiple randomized trials in the recent years have not successfully identified any effective neuroprotective therapy in SAH, the overall SAH outcome has significantly improved over the past two decades.
The Management of Traumatic Spinal Cord Injury
Authors: Panczykowski David M. , Stone Jeremy G. , Okonkwo David O.
Published: January 2019

The management of traumatic spinal cord injury (SCI) requires thorough neurologic assessment and injury classification to guide treatment as well as inform prognosis. Initial radiographic evaluation is aimed at efficiently determining spinal column stability and should begin with high-quality multislice helical computed tomography imaging, including coronal and sagittal reconstructions. The primary objective of clinical SCI management is to prevent or ameliorate secondary injury caused by cardiovascular instability and/or pulmonary insufficiency, in addition to other comorbid processes common to this disease. Vigilant monitoring and treatment in the critical care setting is one of the most important means of reducing morbidity and mortality following SCI.
Inflammation and Demyelination
Authors: Rubin Daniel B. , Vaitkevicius Henrikas
Published: January 2019

Autoimmune disease affecting the central nervous system is a common cause for admission to the neurointensive care unit. Although well-described clinical syndromes exist, patients more commonly present with progressive neurologic dysfunction and some combination of laboratory and radiographic evidence of central nervous system inflammation. The urgency to intervene to prevent permanent damage to the nervous system often conflicts with diagnostic uncertainty. This chapter outlines some of the basic diagnostic and therapeutic principles of autoimmune diseases of the central nervous system. The chapter characterizes disorders not as a list of individual disease entities but rather as clusters of syndromes based on common underlying mechanisms of immune dysfunction. This approach focuses on early interventions rather than precise diagnosis. As our understanding of the immune system continues to grow, this framework will allow for a more sophisticated approach to the management of patients with these complex, often devastating but frequently reversible, neurologic illnesses.
Neuromuscular Conditions
Authors: Malaiyandi Deepa , Živković Saša A.
Published: January 2019

Neuromuscular disorders in an intensive care unit (ICU) setting may manifest as (a) an exacerbation of a previously known neuromuscular disorder, (b) a new onset of a previously undiagnosed neuromuscular disorder, or (c) a neuromuscular complication of a critical illness. Examination limitations, complex comorbidities, and technical difficulties associated with electrodiagnostic testing in an ICU setting also create unique challenges during evaluation of patients with possible neuromuscular disorders. Respiratory failure may occur as an initial sign of an underlying neuromuscular disorder, as a chronic respiratory insufficiency, or as an inability to wean the patient from mechanical ventilation. Respiratory function is often closely related to dysphagia, which may also lead to aspiration and sudden worsening of respiratory function. In addition to weakness, progressive cardiomyopathy associated with myopathies can precipitate cardiac failure and arrhythmias and even necessitate heart transplantation. This chapter reviews clinical manifestations of neuromuscular disorders in the ICU.
Multimodality Monitoring
Authors: Ayodele Maranatha , O’Phelan Kristine
Published: January 2019

Advancements in the critical care of patients with various forms of acute brain injury (traumatic brain injury, subarachnoid hemorrhage, stroke, etc.) in its current evolution recognizes that in addition to the initial insult, there is a secondary cascade of physiological events in the injured brain that contribute significantly to morbidity and mortality. Multimodality monitoring (MMM) in neurocritical care aims to recognize this secondary cascade in a timely manner. With early recognition, critical care of brain-injured patients may then be tailored to preventing and alleviating this secondary injury. MMM includes a variety of invasive and noninvasive techniques aimed at monitoring brain physiologic parameters such as intracranial pressure, perfusion, oxygenation, blood flow, metabolism, and electrical activity. This chapter provides an overview of these techniques and offers a practical guide to their integration and use in the intensive care setting.
Hypothermia and Fever Control in Neurocritical Care
Authors: Polderman Kees H.
Published: January 2019

The brain is responsible for thermoregulatory control, and brain injury can result in disruptions to this system. Temperature management is a crucial component of neurocritical care, as temperature can modify cellular injury. Hyperthermia has clearly and consistently shown detrimental effects after brain injury, prompting the increasing focus on targeted temperature control. Hypothermia has numerous mechanisms that have led to it being considered as a possible neuroprotectant for reducing secondary brain injury from multiple causes. However, while animal studies have demonstrated clear beneficial effects, robust clinical trials have not reported the same level of benefit in a consistent fashion. This chapter reviews the physiology, mechanisms of action, and current evidence and provides practical suggestions regarding temperature management in the neurocritical care patient.
The formation of compact dwarf ellipticals through merging star clusters
Authors: Urrutia Zapata F , Fellhauer M , Alarcón Jara A G , Matus Carrillo D R , Aravena C A
Published: January 2019

In the past decades, extended old stellar clusters have been observed. These extended objects cover a large range in masses, from extended clusters or faint fuzzies to ultracompact dwarf galaxies. It has been demonstrated that these extended objects can be the result of the merging of star clusters in cluster complexes (small regions in which dozens to hundreds of star clusters form). This formation channel is called the ‘Merging Star Cluster Scenario’. This work tries to explain the formation of compact ellipticals in the same theoretical framework. Compact ellipticals are a comparatively rare class of spheroidal galaxies, possessing very small effective radii and high central surface brightnesses. With the use of numerical simulations we show that the merging star cluster scenario, adopted for higher masses, as found with those galaxies, can reproduce all major characteristics and the dynamics of these objects. This opens up a new formation channel to explain the existence of compact elliptical galaxies.
Carotid Artery Stenting and Intracranial Thrombectomy for Tandem Cervical and Intracranial Artery Occlusions
Authors: Kim Byungjun , Kim Byung Moon , Bang Oh Young , Baek Jang-Hyun , Heo Ji Hoe , Nam Hyo Suk , Kim Young Dae , Yoo Joonsang , Kim Dong Joon , Jeon Pyoung , Baik Seung Kug , Suh Sang Hyun , Lee Kyung-Yul , Kwak Hyo Sung , Roh Hong Gee , Lee Young-Jun , Kim Sang Heum , Ryu Chang Woo , Ihn Yon-Kwon , Jeon Hong-Jun , Kim Jin Woo , Byun Jun Soo , Suh Sangil , Park Jeong Jin , Lee Woong Jae , Roh Jieun , Shin Byoung-soo
Published: January 2019

BACKGROUND

It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO).

OBJECTIVE

To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone).

METHODS

We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success.

RESULTS

Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P = .002) and good outcome rates (64.3% vs 26.3%, P = .007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P = .014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P = .684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P = .999) or antiplatelet medications (10.2% vs 18.8%; P = .392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187).

CONCLUSION

CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.
Factors Impacting Practice of Home Kangaroo Mother Care with Low Birth Weight Infants Following Hospital Discharge
Authors: Dawar Rebecca , Nangia Sushma , Thukral Anu , Chopra Sapna , Khanna Rajesh
Published: January 2019

Objective

To identify enablers and barriers related to home Kangaroo Mother Care (KMC) adoption after hospital discharge.

Study design

An exploratory study, using a mixed methods evaluation, followed 60 mother–infant dyads from the hospital ward to 4 weeks post-hospital discharge.

Results

Fifty-three of the mothers (88.3%) completed all study visits. The majority of mothers were breastfeeding and practicing skin-to-skin contact 4 weeks post-discharge. Seven mothers (13.2%) discontinued skin-to-skin contact at 4 weeks. KMC was practiced on average 3.3 h/day and 5.1 days/week. The top two enablers reported were significantly related to the amount of time skin-to-skin was practiced, with support for household responsibilities being most significant (U = 195, p = 0.008). Lack of privacy (p = 0.002) and lack of motivation (p = 0.034) were negatively correlated to duration of skin-to-skin contact.

Conclusion

Future programs may increase dissemination and adoption of home KMC by specifically addressing enablers and barriers correlated to duration of skin-to-skin contact.
Favorable Bioactivity of the SDHI Fungicide Benzovindiflupyr Against Sclerotinia sclerotiorum Mycelial Growth, Sclerotial Production, and Myceliogenic and Carpogenic Germination of Sclerotia
Authors: Huang Xue-ping , Luo Jian , Song Yu-fei , Li Bei-xing , Mu Wei , Liu Feng
Published: January 2019

Sclerotinia sclerotiorum, which can cause Sclerotinia stem rot, is a prevalent plant pathogen. This study aims to evaluate the application potential of benzovindiflupyr, a new generation of succinate dehydrogenase inhibitor (SDHI), against S. sclerotiorum. In our study, 181 isolates collected from different crops (including eggplant [n = 34], cucumber [n = 27], tomato [n = 29], pepper [n = 35], pumpkin [n = 32], and kidney bean [n = 25]) in China were used to establish baseline sensitivity to benzovindiflupyr. The frequency distribution of the 50% effective concentration (EC50) values of benzovindiflupyr was a unimodal curve, with mean EC50 values of 0.0260 ± 0.011 μg/ml, and no significant differences in mean EC50 existed among the various crops (P > 0.99). Benzovindiflupyr can effectively inhibit mycelial growth, sclerotial production, sclerotial shape, and myceliogenic and carpogenic germination of the sclerotia of S. sclerotiorum. In addition, benzovindiflupyr showed good systemic translocation in eggplant. Using benzovindiflupyr at 100 μg/ml yielded efficacies of 71.3 and 80.5% for transverse activity and cross-layer activity, respectively, which were higher than those of acropetal and basipetal treatments (43.6 and 44.7%, respectively). Greenhouse experiments were then carried out at two experimental sites for verification. Applying benzovindiflupyr at 200 g a.i. ha−1 significantly reduced the disease incidence and severity of Sclerotinia stem rot. Overall, the results demonstrated that benzovindiflupyr is a potential alternative product to control Sclerotinia stem rot.
A CASE OF CAT SCRATCH DISEASE DIAGNOSED BY INDIRECT FLUORESCENT ANTIBODY ASSAY OF IgM SPECIFIC FOR A JAPANESE STRAIN OF Bartonella henselae
Authors: Uchi Sho-Hei , Yanai Ryoji , Tsuneoka Hidehiro , Otsuyama Ken-ichiro , Sonoda Koh-Hei , Kimura Kazuhiro
Published: January 2019

Purpose:

To report a case of cat scratch disease–associated retinitis diagnosed with an indirect fluorescent antibody (IFA) assay for immunoglobulin M (IgM) specific for a strain (YH-01) of Bartonella henselae recently identified in Japan.

Methods:

Case report of a 24-year-old pregnant woman presented with general fever, fatigue, as well as blurred vision, and a central visual field deficiency in her right eye and was suspected as cat scratch disease because she had started to feed a feral dog a month ago.

Results:

The patient's serum tested negative, however, with an IFA assay for IgG or IgM specific for the Houston-1, common strain of B. henselae. Further testing with an IFA assay for IgM specific for the YH-01 strain yielded a positive result. On the basis of the clinical findings and the IFA results, we were thus able to make a definitive diagnosis of cat scratch disease.

Conclusion:

An IFA assay based on the YH-01 or combination of both YH-01 and Houston-1 strains of B. henselae may show increased sensitivity for the diagnosis of cat scratch disease in Japan.
Tolerability and Functionality of a Wireless 24-Hour Ocular Telemetry Sensor in African American Glaucoma Patients
Authors: Marando Catherine M. , Mansouri Kaweh , Kahook Malik Y. , Seibold Leonard K.
Published: January 2019

Purpose:

The purpose of the study was to evaluate the tolerability and functionality of a wireless ocular telemetry sensor in African American patients with glaucoma.

Materials and Methods:

In this prospective, observational cohort study, 20 African American patients with primary open angle glaucoma (POAG) were evaluated at the University of Colorado Eye Center. Before lens placement, patients recorded ocular comfort and underwent a baseline eye exam. Following the exam, patients were fitted with a SENSIMED Triggerfish contact lens sensor and data recording device. Patients were sent home and instructed to record their activities in a journal and return in 24 hours. Repeat exams were performed at various time points in clinic before and after lens removal.

Results:

All 20 patients retained the lens for the 24-hour study period. The patient reported comfort was excellent, with a nadir of mean recorded comfort of 7.05/10. Significant clinical changes were noted in lid/conjunctival erythema, BCVA, refraction, and pachymetry over the course of lens wear. The majority of these changes were improved or resolved by 1 hour after lens removal. Voltage output was significantly greater nocturnally than diurnally (184.79 mV and 71.48 mV, respectively; P<0.0001). There was no significant change in signal variability or slope over the entire duration of the sleep/wake period based on sleep.

Conclusions:

The wireless ocular sensor is well tolerated over a 24-hour period in African American patients with POAG despite transient changes in visual acuity and conjunctival erythema. Clinically usable 24-hour profiles were generated for all patients, with voltage output increasing significantly during periods of sleep.
Neurologic Outcomes in a Two-Center Cohort of Neonatal and Pediatric Patients Supported on Extracorporeal Membrane Oxygenation
Authors: Bembea Melania M. , Felling Ryan J. , Caprarola Sherrill D. , Ng Derek K. , Tekes Aylin , Boyle Katharine , Yiu Alvin , Rizkalla Nicole , Schwartz Jamie , Everett Allen D. , Salorio Cynthia
Published: January 2019

Contemporary studies of long-term outcomes in children supported on extracorporeal membrane oxygenation (ECMO) in the United States are limited. We enrolled 99 ECMO patients between July 2010 and June 2015 in a two-center prospective observational study that included neurologic and neuropsychologic evaluation at 6 and 12 months, using standardized outcome measures. Pre-ECMO, 20 (20%) had a pre-existing neurologic diagnosis, 40 (40%) had cardiac arrest, and 10 of 47 (21%) children with neuroimaging had acute abnormal findings. Of 50 children eligible for follow-up at 6 or 12 months, 40 (80%) returned for at least one visit. At the follow-up visit of longest interval from ECMO, the median Vineland Adaptive Behavior Scales-II (VABS-II) score was 91 (interquartile range [IQR], 81–98), the median Pediatric Stroke Outcome Measure (PSOM) score was 1 (IQR, 0–2), and the median Mullen Scales of Early Learning composite score was 85 (IQR, 72–96). Presence of new neuroimaging abnormalities during ECMO or within 6 weeks post-ECMO was associated with VABS-II score <85 or death within 12 months after ECMO. The Pediatric Cerebral Performance Category at hospital discharge showed a strong relationship with unfavorable VABS-II and PSOM scores at 6 or 12 months after ECMO. In this study, we report a higher prevalence of pre-ECMO neurologic conditions than previously described. In survivors to hospital discharge, median scores for adaptive behavior and cognitive, neurologic, and quality of life assessments were all below the general population means, but most deficits would be considered minor within each of the domains tested.
Chronic Ovine Studies Demonstrate Low Thromboembolic Risk in the Penn State Infant Ventricular Assist Device
Authors: Lukic Branka , Clark J. Brian , Izer Jenelle M. , Cooper Timothy K. , Finicle Heidi A. , Cysyk Johua , Doxtater Bradly , Yeager Eric , Reibson John , Newswanger Raymond K. , Leibich Patrick , Bletcher Kirby , Weiss William J.
Published: January 2019

Mechanical circulatory support for children under 6 years of age remains a challenge. This article describes the preclinical status and the results of recent animal testing with the Penn State Infant Left Ventricular Assist Device (VAD). The objectives have been to 1) demonstrate acceptably low thromboembolic risk to support Food and Drug Administration approval, 2) challenge the device by using minimal to no anticoagulation in order to identify any design or manufacturing weaknesses, and 3) improve our understanding of device thrombogenicity in the ovine animal model, using multicomponent measurements of the coagulation system and renal ischemia quantification, in order to better correlate animal results with human results.

The Infant VAD was implanted as a left VAD (LVAD) in 18–29 kg lambs. Twelve LVAD and five surgical sham animals were electively terminated after approximately 30 or 60 days. Anticoagulation was by unfractionated heparin targeting thromboelastography R times of 2x normal (n = 6) or 1x normal (n = 6) resulting in negligible heparin activity as measured by anti-Xa assay (<0.1 IU/ml). Platelet inhibitors were not used.

There were no clinically evident strokes or evidence of end organ dysfunction in any of the 12 electively terminated LVAD studies. The degree of renal ischemic lesions in device animals was not significantly different than that found in five surgical sham studies, demonstrating minimal device thromboembolism.

In summary, these results in a challenging animal test protocol support the conclusion that the Penn State Infant VAD has a low thromboembolic risk and may allow lower levels of anticoagulation.
Using Performance Management to Implement a Preprocedural Checklist for Gastrointestinal Endoscopy Procedures
Authors: Wittren Susan P. , Cunningham Gregor Stephanie R. , Niesen Cynthia R.
Published: January 2019

Providing safe patient care is an important focus of healthcare organizations. In surgical settings, mortality rates have been shown to decrease from 1.5% to 0.8% and complication rates from 11% to 7% when institutions use the World Health Organization's Surgical Safety Checklist. In our hospital-based gastrointestinal endoscopy unit, we recognized that inconsistencies in the preprocedural readiness of patients were causing inefficiencies in scheduling. Therefore, we initiated a quality improvement project to determine whether a preprocedural checklist and positive reinforcement for the nurses in the units could improve endoscopy preparation of patients. The checklist was used to prepare patients and to facilitate nurse-to-nurse communications. We completed a 6-week pilot study (preintervention and postintervention). The results demonstrated the importance of having nurses use a checklist in hospital care units to adequately prepare patients and to accurately communicate patient readiness before gastrointestinal endoscopy procedures. Nursing leadership used positive reinforcement as a strategy to encourage the use of the preprocedural checklist. A postpilot survey of nurses involved in the study show that the preprocedural checklist enhanced care and communication between the patient care units and resulted in direct and indirect benefits for nurses and patients.
Gastroesophageal Reflux Disease
Authors: Chen Jingtao , Brady Patrick
Published: January 2019

Gastroesophageal reflux disease (GERD) is a common chronic disorder in industrialized countries. Gastroesophageal reflux disease is one of the most frequent diseases encountered by primary care providers. The primary symptoms of GERD include heartburn, regurgitation, globus sensation, dysphagia, chest pain, and belching. If symptoms are left untreated, a major concern is complications and the potential risk of esophageal adenocarcinoma associated with GERD. With the increasing prevalence and incidence of GERD and the increasing cost of this disease, there is a need for advanced practice registered nurses to understand the nature of GERD including its pathophysiology, signs and symptoms, and treatment options to address the disease.