bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Access to and Use of Primary Care Practices that Patients Perceive as Having Essential Qualities of a Patient-Centered Medical Home Associated With Positive Patient Experience? Empirical Evidence From a U.S. Nationally Representative Sample
Authors: Xin Haichang , Kilgore Meredith L. , Sen Bisakha (Pia)
Published: May 2016

Objective:

The patient-centered medical home (PCMH) has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve healthcare quality and patient experience. This study examined how patient perceived PCMH is related to patient satisfaction and experience nationwide. This study advances academic discussion in that it is among the first to examine empirical evidence using a U.S. nationally representative sample.

Methods:

This retrospective cohort study used data from the 2010 to 2011 Medical Expenditure Panel Survey. This study focused on insured individuals aged 18 and older. We measured and identified cohorts for a “full PCMH,” a “partial PCMH” (i.e., with a usual source of care but not a PCMH), and an “unknown PCMH,” with the reference group being the “no regular provider” group and the partial PCMH group, respectively. Using logit models, we assessed patient experiences of the PCMH use controlling for covariates in 2010. Given the nature of the complex survey design, the weights and variance were adjusted using the survey procedures to yield nationally representative results.

Results:

The final study sample consisted of 7,743 individuals, representing 191 million individuals in the weighted population. After controlling for covariates in 2010, the full PCMH group was consistently observed to have higher odds of positive patient experience than individuals with no usual source of care: odds ratio (OR) = 1.89 (p = .003) for providers “listened carefully to you”; OR = 1.81 (p = .001) for providers “spent enough time with you”; OR = 1.85 (p = .007) for providers “showed respect for what you had to say”; and OR = 1.89 (p < .001) for the composite patient experience. Similarly, compared with the partial PCMH group, consistently higher odds of patient satisfaction among all patient experience measures were observed for the full medical home group: OR = 1.45 (p = .070, significant at α = 0.1 level) for providers “explained things so you understood”; OR = 1.69 (p = .002) for providers “listened carefully to you”; OR = 1.57 (p = .003) for providers “spent enough time with you”; OR = 1.48 (p = .039) for providers “showed respect for what you had to say”; and OR = 1.56 (p = .001) for the composite patient experience.

Conclusions:

Overall, the PCMH model was associated with improved patient satisfaction nationwide. Findings from this study have shed light on strategies of innovative healthcare delivery models in improving patient experience, which in turn, may translate to patients' compliance to treatment regimen and improved health outcomes.
Myofascial Trigger Points and Migraine-related Disability in Women With Episodic and Chronic Migraine
Authors: Ferracini Gabriela N. , Florencio Lidiane L. , Dach Fabíola , Chaves Thais C. , Palacios-Ceña María , Fernández-de-las-Peñas César , Bevilaqua-Grossi Débora , Speciali José G.
Published: May 2016

Objective:

The aim of this study was to investigate the differences in the presence of head and neck-shoulder trigger points (TrPs) between women with episodic or chronic migraine and their association with migraine-related disability.

Materials and Methods:

One hundred forty-three women, aged 18 to 60 years, with migraine were recruited to participate in this study. Migraine-related disability was evaluated with the Migraine Disability Assessment Questionnaire. TrPs were explored bilaterally within the masseter, temporalis, suboccipital, sternocleidomastoid, upper trapezius, and splenius capitis muscles.

Results:

Ninety-eight women exhibited episodic migraine, whereas 45 had chronic migraine. Women with chronic migraine reported a higher related disability than those with episodic migraine (P=0.045). Women with episodic migraine had a similar number of TrPs (total number: 4.3±3.3; active TrPs: 3.0±2.9; and latent TrPs: 1.3±2.1) to those with chronic migraine (total number: 4.8±3.2; active TrPs: 3.4±2.9; and latent TrPs: 1.4±1.9). No linear association was observed between the number of TrPs and migraine-related disability in women with episodic or chronic migraine.

Conclusions:

Women with episodic and chronic migraine had a similar number of TrPs. TrPs may be considered a trigger factor that can facilitate the onset of migraine or also can potentially be a promoting factor for pain once the migraine attack has started and hence may contribute to related disability. Nevertheless, we observed that the number of TrPs in the head and neck-shoulder muscles in an interictal state was not associated with the degree of migraine-related disability, suggesting a multifactorial nature of self-perceived disability in this population.
Mechanisms of the Maternal Exposome and Implications for Health Outcomes
Authors: Wright Michelle L. , Starkweather Angela R. , York Timothy P.
Published: May 2016

It is well established that the environment contributes to health. However, few studies have evaluated environmental exposures in women that may influence future health of their offspring. Knowledge gained may inform nursing how to better advocate for patients and families, and provide individualized interventions and education. Therefore, a more comprehensive investigation of the maternal exposome to uncover mechanistic insight into complex disease in offspring is warranted. To advance understanding of biologic mechanisms that contribute to high-risk birth outcomes and offspring predisposition to disease, it will be necessary to measure a range of exposures and biomarkers before and during pregnancy.
The Health Needs of Young Women
Authors: Burton Candace W.
Published: May 2016

Ongoing development of nursing science requires attention to the philosophical and theoretical bases upon which the science is built. A feminist theoretical perspective offers a useful lens for understanding the needs of both nurses and their clients. Adolescent and young adult women are an underserved and understudied population for whom nursing care can be especially beneficial. Considering the needs of this population from a philosophical perspective, through a feminist lens, is one effective means of developing nursing science approaches that contribute to and ultimately improve care for adolescent and young adult women.
Posterior Malleolar Fractures Associated With Tibial Shaft Fractures and Sequence of Fixation
Authors: Kempegowda Harish , Maniar Hemil H. , Richard Raveesh , Tawari Akhil , Jove Graham , Suk Michael , Beebe Michael J. , Han Chris , Tornetta Paul , Kubiak Erik N. , Horwitz Daniel S.
Published: May 2016

Objectives:

The purpose of this study was to evaluate posterior malleolar injuries associated with nailed tibial fractures and to determine the quality of reduction based on the sequence of fixation in associated fracture patterns.

Design:

Retrospective cohort study.

Patients:

1113 tibia fractures treated with an intramedullary nail at 3 level I trauma centers.

Intervention:

Tibial shaft fractures with posterior malleolar injury were analyzed regarding type of fracture, mechanism of injury, energy of injury, fracture characteristic, surgical characteristics including sequence of fixation, obvious intraoperative displacement of the posterior malleolar fragment, and the quality of reduction. One group (“malleolus-first”) consisted of patients in whom the posterior malleolus was fixed before tibial nailing and the other group (“tibia-first”) included patients in whom tibial nailing was done before posterior malleolus fixation.

Outcomes Measured:

Intraoperative displacement, quality of reduction.

Results:

Ninety-six of 1113 (9%) nailed tibial shaft fracture patients had a concomitant posterior malleolus fracture (9%). Of the 96 posterior malleolar fracture patients, 70 patients were operatively treated (73%). In the malleolus-first group (54 patients), intraoperative displacement of the posterior malleolar fragment was observed in 1 patient, and 1 case of poor reduction of the posterior malleolar fragment was observed (2%). In the tibia-first group (16 patients), obvious intraoperative displacement of the posterior malleolar fragment was observed in 5 patients (31%), and poor reduction of the posterior malleolar fragment was observed in 7 patients (44%). These percentages of patients with poor quality of reduction were statistically significantly different (p ≤ 0.01).

Conclusion:

Many low-energy tibia fractures with a spiral configuration do have an associated posterior malleolus fracture. In order to avoid intraoperative displacement and poor reduction, we recommend fixation of the posterior malleolar fragment before nailing of the tibia in associated fracture pattern.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis
Authors: Rabiee Anahita , Nikayin Sina , Hashem Mohamed D. , Huang Minxuan , Dinglas Victor D. , Bienvenu O. Joseph , Turnbull Alison E. , Needham Dale M.
Published: May 2016

Objectives:

To synthesize data on prevalence, natural history, risk factors, and post-ICU interventions for depressive symptoms in ICU survivors.

Data Sources:

PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and Cochrane Controlled Trials Registry (1970–2015).

Study Selection:

Studies measuring depression after hospital discharge using a validated instrument in more than 20 adults from non-specialty ICUs.

Data Extraction:

Duplicate independent review and data abstraction.

Data Synthesis:

The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n = 4,113). The Hospital Anxiety and Depression Scale-Depression subscale was used most commonly (58%). The pooled Hospital Anxiety and Depression Scale-Depression subscale prevalence (95% CI) of depressive symptoms at a threshold score greater than or equal to 8 was 29% (22–36%) at 2–3 months (12 studies; n = 1,078), 34% (24–43%) at 6 months (seven studies; n = 760), and 29% (23–34%) at 12–14 months (six studies; n = 1,041). The prevalence of suprathreshold depressive symptoms (compatible with Hospital Anxiety and Depression Scale-Depression subscale, ≥ 8) across all studies, using all instruments, was between 29% and 30% at all three time points. The pooled change in prevalence (95% CI) from 2–3 to 6 months (four studies; n = 387) was 5% (–1% to +12%), and from 6 to 12 months (three studies; n = 412) was 1% (–6% to +7%). Risk factors included pre-ICU psychologic morbidity and presence of in-ICU psychologic distress symptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms.

Conclusions:

Clinically important depressive symptoms occurred in approximately one-third of ICU survivors and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.
Rare side-effects of checkpoint inhibitors
Authors: Kourie Hampig R. , Awada Gil , Awada Ahmad H.
Published: May 2016

Purpose of review

The aim of this review is to draw the attention of the physicians and oncologists on the rare side-effects of checkpoint inhibitors not usually reported in clinical trials to treat them quickly and render their prognosis better.

Recent findings

Rare side-effects of checkpoint inhibitors are mainly neurologic, haematologic, rheumatologic, renal, and cardiac. The majority of reported side-effects are consequent of the treatment by ipilimumab in patients diagnosed with melanomas. Neurologic side-effects have poorer prognosis compared with other rare side-effects. There is no relationship between developing rare side-effects and the outcome of the disease.

It is important to be aware, when treating patients with checkpoint inhibitors, to detect as early as possible the unpredictable and uncontrollable rare side-effects of these agents. The large spectrum of these rare side-effects should be well documented and reported to assure to the physicians a road map for the diagnosis and the management of these toxicities.
Microsomal Prostaglandin E Synthase-1 Expression by Aortic Smooth Muscle Cells Attenuates the Differentiated Phenotype
Authors: Adedoyin Oreoluwa O. , Loftin Charles D.
Published: May 2016

The development of numerous types of cardiovascular disease is associated with alteration of the vascular smooth muscle cell (SMC) phenotype. We have previously shown that abdominal aortic aneurysm progression in a mouse model of the disease is associated with reduced differentiation of SMCs within the lesion and that cyclooxygenase-2 (COX-2) is critical to initiation and progression of the aneurysms. The current studies used human aortic SMC (hASMC) cultures to better characterize mechanisms responsible for COX-2-dependent modulation of the SMC phenotype. Depending on the culture conditions, hASMCs expressed multiple characteristics of a differentiated and contractile phenotype, or a dedifferentiated and secretory phenotype. The pharmacological inhibition of COX-2 promoted the differentiated phenotype, whereas treatment with the COX-2–derived metabolite prostaglandin E2 (PGE2) increased characteristics of the dedifferentiated phenotype. Furthermore, pharmacological inhibition or siRNA-mediated knockdown of microsomal prostaglandin E synthase-1 (mPGES-1), the enzyme that functions downstream of COX-2 during the synthesis of PGE2, significantly increased expression of characteristics of the differentiated SMC phenotype. Therefore, our findings suggest that COX-2 and mPGES-1–dependent synthesis of PGE2 contributes to a dedifferentiated hASMC phenotype and that mPGES-1 may provide a novel pharmacological target for treatment of cardiovascular diseases where altered SMC differentiation has a causative role.
The Facial Growth Pattern and the Amount of Palatal Bone Deficiency Relative to Cleft Size Should Be Considered in Treatment Planning
Authors: Berkowitz Samuel
Published: May 2016

Background:

The aim of this study is to determine the best surgical/orthodontic treatment plan for the complete bilateral and unilateral cleft lip and palate patient to achieve all treatment goals of facial aesthetics, speech, dental function, and psychosocial development.

Methods:

Review of 40 years of serial complete bilateral cleft lip and palate and complete unilateral cleft lip and palate dental casts and photographs from birth to adolescence, with serial cephs starting at 4 years. This was part of a multicenter international 3-dimensional palatal growth study of serial dental casts of patients who developed good speech, occlusion, and facial growth.

Results:

Nasoalveolar molding and gingivoperiosteoplasty were introduced without proven longitudinal benefits. The procedure bodily retruded the premaxilla, which “telescoped” backward causing synostosis at the premaxillary vomerine suture. The resulting midfacial recessiveness with an anterior dental crossbite can only be corrected by midfacial protraction or a Le Fort I surgery.

Conclusions:

Staged orthodontic/surgical treatment limiting premaxillary retraction forces to lip adhesion or forces that cause only premaxillary ventroflexion produce the best results. The palatal cleft should be closed between 18 and 24 months when the ratio of the cleft to the palatal size medial to the alveolar ridge is at least 10%. The protruding premaxilla should only be ventroflexed but never bodily retruded. The facial growth pattern and degree of palatal bone deficiency are the main items to be considered in treatment planning.
ACANTHAMOEBA ENDOPHTHALMITIS AFTER RECURRENT KERATITIS AND NODULAR SCLERITIS
Authors: Mammo Zaid , Almeida David R. P. , Cunningham Matthew A. , Chin Eric K. , Mahajan Vinit B.
Published: May 2016

Purpose:

To describe the clinical course of a patient with Acanthamoeba keratitis, who despite prompt treatment progressed to histopathology-confirmed Acanthamoeba retinitis and endophthalmitis.

Methods:

Case report.

Results:

A healthy 30-year-old male wearing soft contact lens was diagnosed with Acanthamoeba keratitis and treated medically and surgically over the course of 1 year with presumed resolution of the infection. Yet, his infection recurred with documented spread to sclerokeratitis, and overwhelming endophthalmitis. Concerns about extra-ocular spread prompted a therapeutic enucleation with histopathologic evidence of Acanthamoeba organisms throughout the globe.

Conclusion:

This is a case of a severe recurrent Acanthamoeba infection presenting initially as keratitis, followed by sclerokeratitis and histolopathology-confirmed endophthalmitis. This case demonstrates that despite persistent medical and surgical intervention, eradication of organisms may not be possible.
MULTICOLOR IMAGING OF INNER RETINAL ALTERATIONS AFTER INTERNAL LIMITING MEMBRANE PEELING
Authors: Feng Henry L. , Sharma Sumit , Asrani Sanjay , Mruthyunjaya Prithvi
Published: May 2016

Purpose:

To characterize the appearance of inner retinal alterations after internal limiting membrane (ILM) peeling using multicolor confocal scanning laser ophthalmoscopy (cSLO).

Methods:

Retrospective review of two eyes that underwent pars plana vitrectomy with internal limiting membrane peeling and postoperative multicolor cSLO with spectral-domain optical coherence tomography. Infrared, green, blue, standard multicolor, and blue-green enhanced multicolor reflectance images were evaluated alongside spectral-domain optical coherence tomography for inner retinal alterations.

Results:

Two eyes of 2 patients, aged 70 and 65 years, were identified. Preoperative diagnoses were epiretinal membrane with lamellar macular hole for Case 1 and full-thickness macular hole for Case 2. Time from surgery to initial multicolor cSLO imaging was 9 years in Case 1 and 3 weeks in Case 2. Inner retinal alterations were best visualized on blue reflectance, moderately visualized on green and blue–green enhanced multicolor, and less evident on infrared and standard multicolor. In Case 2, serial multicolor cSLO imaging demonstrated the emergence of inner retinal alterations between 3 weeks and 5 weeks postoperatively.

Conclusion:

Multicolor cSLO is a novel imaging modality capable of detecting inner retinal alterations in patients with a history of internal limiting membrane peeling, and may be clinically useful for monitoring anatomical changes associated with internal limiting membrane peeling.
Does Valsalva Maneuver Affect Corneal Morphology in Eyes With Keratoconus?
Authors: Duru Necati , Duru Zeynep , Çiçek Ayşe , Altınkaynak Hasan , Karatepe Haşhaş Arzu Seyhan , Arifoğlu Hasan Basri
Published: May 2016

Objectives:

The aim of this study was to investigate the effect of the Valsalva maneuver on corneal morphology and anterior chamber parameters in patients with keratoconus.

Methods:

A total of 39 eyes from 39 patients with keratoconus and 41 eyes from 41 age-matched and gender-matched healthy individuals were included in this cross-sectional study. Measurements of corneal front keratometry values (K-flat, K-steep, and K-max), central corneal thickness, corneal apex thickness, thinnest corneal thickness, corneal volume, anterior chamber volume (ACV), anterior chamber depth (ACD), and iridocorneal angle (ICA) were performed with a Pentacam Scheimpflug camera (Oculus, Germany) before and during the Valsalva maneuver. Changes in the anterior segment parameters from baseline and during the Valsalva maneuver and the differences in parameters between the keratoconus group and the control group were analyzed. A P value less than 0.05 was accepted as statistically significant.

Results:

In the patients with keratoconus, the Valsalva maneuver did not have any significant influence on the corneal parameters (P>0.05). However, ACV, ACD, and ICA decreased markedly during the Valsalva maneuver (P=0.006, P=0.048, and P=0.025, respectively). Changes caused by the Valsalva maneuver were similar for all parameters when compared with those in healthy individuals (P>0.05).

Conclusions:

During corneal topography imaging, the Valsalva maneuver observed in patients with keratoconus does not typically cause any significant change in corneal morphology.
Nonpainful wide-area compression inhibits experimental pain
Authors: Honigman Liat , Bar-Bachar Ofrit , Yarnitsky David , Sprecher Elliot , Granovsky Yelena
Published: May 2016

Compression therapy, a well-recognized treatment for lymphoedema and venous disorders, pressurizes limbs and generates massive non-noxious afferent sensory barrages. The aim of this study was to study whether such afferent activity has an analgesic effect when applied on the lower limbs, hypothesizing that larger compression areas will induce stronger analgesic effects, and whether this effect correlates with conditioned pain modulation (CPM). Thirty young healthy subjects received painful heat and pressure stimuli (47°C for 30 seconds, forearm; 300 kPa for 15 seconds, wrist) before and during 3 compression protocols of either SMALL (up to ankles), MEDIUM (up to knees), or LARGE (up to hips) compression areas. Conditioned pain modulation (heat pain conditioned by noxious cold water) was tested before and after each compression protocol. The LARGE protocol induced more analgesia for heat than the SMALL protocol (P < 0.001). The analgesic effect interacted with gender (P = 0.015). The LARGE protocol was more efficient for females, whereas the MEDIUM protocol was more efficient for males. Pressure pain was reduced by all protocols (P < 0.001) with no differences between protocols and no gender effect. Conditioned pain modulation was more efficient than the compression-induced analgesia. For the LARGE protocol, precompression CPM efficiency positively correlated with compression-induced analgesia. Large body area compression exerts an area-dependent analgesic effect on experimental pain stimuli. The observed correlation with pain inhibition in response to robust non-noxious sensory stimulation may suggest that compression therapy shares similar mechanisms with inhibitory pain modulation assessed through CPM.
The cortical response to a noxious procedure changes over time in preterm infants
Authors: Bembich Stefano , Marrazzo Francesca , Barini Alice , Ravalico Paola , Cont Gabriele , Demarini Sergio
Published: May 2016

The aim of the study was to investigate whether cortical response to a repeated noxious procedure may change over time in preterm infants. Possible reasons for change are: (1) advancing maturation of central nervous system; and (2) increasing experience with noxious procedures during hospital stay. Sixteen preterm infants were recruited, with a postmenstrual age (PMA) ranging between 29 and 36 weeks. Newborns were assessed during a heel-prick procedure, once a week for at least 3 consecutive times. Multichannel near-infrared spectroscopy was used to detect cortical activation, by measuring increase in cortical oxy-haemoglobin (HbO2). Parietal, temporal, and posterior frontal areas were monitored bilaterally. By regression analysis, we studied the effect of (1) increasing PMA and (2) increasing number of heel pricks, on the magnitude of cortical activation. We observed a bilateral nociceptive event-related activation of the posterior frontal cortex, mainly contralateral to the side pricked. Additionally, we found a significant positive effect of PMA, as HbO2 progressively increased in the posterior frontal cortex (P < 0.001), bilaterally, over time. Conversely, the degree of cortical activation decreased as the number of noxious events increased (P < 0.002). We conclude the following: (1) Preterm newborns showed a significant activation of the posterior frontal cortex in association with noxious stimuli; (2) Cortical activation was progressively greater with increasing PMA; (3) There was an inverse relationship between cortical activation and the number of heel pricks. We speculate that such findings may be due to both endogenous cortical maturation and experience-dependent neuroplasticity of the developing brain (eg, synaptogenesis, synaptic pruning).
A randomized, double-blind, positive-controlled, 3-way cross-over human experimental pain study of a TRPV1 antagonist (V116517) in healthy volunteers and comparison with preclinical profile
Authors: Arendt-Nielsen Lars , Harris Steve , Whiteside Garth T. , Hummel Michele , Knappenberger Terri , O'Keefe Sarah , Kapil Ram , Kyle Don
Published: May 2016

This experimental, translational, experimental pain, single-center, randomized, double-blind, single-dose, 3-treatment, 3-period cross-over proof-of-concept volunteer trial studied the efficacy of a novel TRPV1 antagonist (V116517) on capsaicin- and UV-B-induced hyperalgesia. Heat and pressure pain thresholds, von Frey stimulus–response functions, and neurogenic inflammation were assessed together with safety. Each treatment period was 4 days. The 3 single oral treatments were 300 mg V116517, 400 mg celecoxib (a COX-2 inhibitor), and placebo. The heat pain detection and tolerance thresholds were increased significantly (P < 0.0001) by V116517. Heat pain detection and tolerance thresholds showed significantly less capsaicin hyperalgesia after V116517 (P = 0.004 and P < 0.0001, respectively). Celecoxib reduced UV-B-provoked pressure pain sensitization (P = 0.01). Laser Doppler flowmetry and erythema index after UV-B were significantly (P < 0.0001) reduced by celecoxib. Stimulus–response function in capsaicin-treated areas showed significant differences between both celecoxib and placebo and between V116517 and placebo. The body temperature showed no change, and no side effects were reported for any of the treatments. The TRPV1 antagonists and the COX-2 inhibitor showed different antihyperalgesic profiles indicating different clinical targets. In addition, the preclinical profile of V116517 in rat models of UV-B and capsaicin-induced hypersensitivity was compared with the human experimental data and overall demonstrated an alignment between 2 of the 3 end points tested. The TRPV1 antagonist showed a potent antihyperalgesic action without changing the body temperature but heat analgesia may be a potential safety issue.
Reducing Depressive Symptoms in Nursing Home Residents: Evaluation of the Pennsylvania Depression Collaborative Quality Improvement Program
Authors: Crespy Scott D. , Van Haitsma Kimberly , Kleban Morton , Hann Carolyn J.
Published: May 2016

Depression reduces quality of life for nursing home (NH) residents and places them at greater risk for disability, medical morbidity, and mortality. However, accumulating evidence suggests that interventions for early detection and treatment can mitigate symptoms of clinical and subclinical levels of depression. The Promoting Positive Well-Being (PPW) program is a quality improvement (QI) intervention that features tools and strategies to assist NHs in early identification, assessment, treatment, and monitoring of residents with depressive symptoms. The PPW was evaluated in 40 NHs through an 8-month QI collaborative that provided participants with tools, webinar training, and technical support. Results showed a significant group by time interaction effect with facility quality rating as a covariate; the active group (n = 18 NHs) outperformed the waitlist control group (n = 19 NHs). In all, there was a 58% relative reduction in the percentage of residents with self-reported moderate-to-severe depressive symptoms. Most NHs reported that they were satisfied with the collaborative (97%) and would recommend it to others (86%); only 15% reported significant challenges. The rate of webinar attendance and data submission compliance was 92%. Results suggest that PPW is a promising approach that should be further evaluated in larger NH initiatives and other settings.
Measuring Chemotherapy Appointment Duration and Variation Using Real-Time Location Systems
Authors: Barysauskas Constance M. , Hudgins Gina , Gill Katie Kupferberg , Camuso Kristen M. , Bagley Janet , Rozanski Sheila , Kadish Sarah
Published: May 2016

Introduction:

Clinical schedules drive resource utilization, cost, and patient wait time. Accurate appointment duration allocation ensures appropriate staffing ratios to daily caseloads and maximizes scarce resources. Dana-Farber Cancer Institute (DFCI) infusion appointment duration is adjusted by regimen using a consensus method of experts including pharmacists, nurses, and administrators. Using real-time location system (RTLS), we examined the accuracy of observed appointment duration compared with the scheduled duration.

Methods:

Appointment duration was calculated using RTLS at DFCI between August 1, 2013, and September 30, 2013. Duration was defined as the total time a patient occupied an infusion chair. The top 10 administered infusion regimens were investigated (n = 805).

Results:

Median observed appointment durations were statistically different than the scheduled durations. Appointment durations were shorter than scheduled 98% (C), 95% (I), and 75% (F) of the time and longer than scheduled 77% (A) and 76% (G) of the time. Fifty-six percent of the longer than scheduled (A) appointments were at least 30 minute longer.

Conclusion:

RTLS provides reliable and unbiased data to improve schedule accuracy. Replacing consensus with system-based data may improve clinic flow, relieve staff stress, and increase patient satisfaction. Further investigation is warranted to elucidate factors that impact variation in appointment duration.
A global perspective: training opportunities in Adolescent Medicine for healthcare professionals
Authors: Golub Sarah A. , Arunakul Jiraporn , Hassan Areej
Published: May 2016

Purpose of review

The review briefly describes the current state of adolescent health globally, and highlights current educational and training opportunities in Adolescent Medicine for healthcare providers worldwide.

Recent findings

Despite a growing body of literature demonstrating a shift toward recognizing Adolescent Medicine as a subspecialty, there are very few countries that offer nationally recognized Adolescent Medicine training programs. In recent years, several countries have begun to offer educational programming, such as noncredentialed short training programs, conferences, and online courses. Challenges, including cultural barriers, financing, and lack of governmental recognition and support, have hindered progress in the development of accredited training programs globally.

It is crucial to support efforts for sustainable training programs, especially within low and middle-income countries where a majority of the world's adolescent population lives. Sharing knowledge of existing curriculums, programs, and systems will increase opportunities globally to build regional capacity, increase access to interdisciplinary services, and to implement health-promoting policies for youth worldwide.
Fermented Milk Consumption and Common Infections in Children Attending Day‐Care Centers
Authors: Prodeus Andrey , Niborski Violeta , Schrezenmeir Juergen , Gorelov Alexander , Shcherbina Anna , Rumyantsev Alexander
Published: May 2016

Objectives:

This multicenter, double‐blind, randomized, placebo‐controlled clinical trial investigated the effect of a fermented milk product containing the Lactobacillus casei National Collection of Microorganisms and Cell Cultures (CNCM) I‐1518 strain on respiratory and gastrointestinal common infectious diseases (CIDs) in children attending day‐care centers in Russia.

Methods:

Children ages 3 to 6 years received 100 g of a fermented milk product (n = 300) or a control product (n = 299) twice daily for 3 months, followed by a 1‐month observation period. The primary outcome was the incidence of CIDs during the product consumption period.

Results:

There was no significant difference in the incidence of CIDs between the groups (N = 98 with fermented milk product vs N = 93 with control product). The overall number of CIDs (and no severe cases at all) in both study groups and in all 12 centers, however, was unexpectedly low resulting in underpowering of the study. No differences were found between the groups in the duration or severity of disease, duration of sick leave from day‐care centers, parental missed working days, or in quality‐of‐life dimensions on the PedsQL questionnaire (P > 0.05).

There was, however, a significantly lower incidence of the most frequently observed CID, rhinopharyngitis, in children consuming the fermented milk product compared with those consuming the control product (N = 81 vs N = 100, relative risk 0.82, 95% confidence interval 0.69–0.96, P = 0.017) when considering the entire study period.

Conclusions:

Although no other significant differences were shown between the fermented milk and control product groups in this study, lower incidence of rhinopharyngitis may indicate a beneficial effect of this fermented milk product.
Social Support Is a Predictor of Lower Stress and Higher Quality of Life and Resilience in Brazilian Patients With Colorectal Cancer
Authors: Costa Ana Lucia Siqueira , Heitkemper Margaret M. , Alencar Gizelton Pereira , Damiani Lucas Petri , Silva Rodrigo Marques da , Jarrett Monica E.
Published: May 2016

Background:

The well-being of patients undergoing chemotherapy treatment for colorectal cancer (CRC) is affected by psychological effects associated with cancer treatment. However, little is known about the impact of these psychological factors in Brazilian patients with CRC.

Objective:

The aim of this study was to determine whether perceived stress, social support, and resilience are associated with quality of life in urban Brazilian patients receiving chemotherapy treatment for CRC.

Methods:

This was a cross-sectional study conducted with 144 Brazilian CRC patients in an ambulatory oncology clinic. The participants completed 5 questionnaires: Demographics, Perceived Stress Scale 14, Social Support Satisfaction Scale, Resilience Scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (C30 and CR29). Confirmatory factor analysis modeling and Cronbach’s α were used to examine construct validity and internal consistency. We used the MPlus 3.0 to construct and validate the structural model.

Results:

There was a moderate and positive effect of resilience on the physical, social, and emotional aspects of quality of life. Social support had a strong and positive direct effect on quality of life (ie, social, physical, social, and emotional). Social support had a negative effect on stress perception. Resilience was also negatively related to stress perception.

Conclusions:

Family support and professional social support are important factors for Brazilian CRC patients. Resilience is an important ally for patients. It is important for nurses to consider this when developing educational and psychological interventional strategies to reduce stress and ultimately improve quality of life in this population.

Implication for Practice:

Psychological factors that improve quality of life should be evaluated in patients undergoing treatment for cancer.
Examining IV Insulin Practice Guidelines in the Cardiac Surgery Patient
Authors: Westbrook Amy , Sherry Daisy , McDermott Martha , Gobber Michele , Pabst Mary
Published: May 2016

Recent changes in the Surgical Care Improvement Project guideline require blood glucose values be less than 180 mg/dL 18 to 24 hours after anesthesia end time after cardiac surgery. Our study compares the first group of patients transitioned off IV insulin on postoperative day 1, 24 hours after anesthesia end time, whereas the second group was transitioned off IV insulin on the second day, 48 hours after anesthesia end time. Results show no statistical difference in outcomes between groups.
Control of Stroke-Related Genu Recurvatum With Prolonged Timing of Dorsiflexor Functional Electrical Stimulation: A Case Study
Authors: Chantraine Frédéric , Schreiber Céline , Kolanowski Elisabeth , Moissenet Florent
Published: May 2016

Background and Purpose:

Abnormal knee hyperextension during the stance phase (genu recurvatum) is a common gait abnormality in persons with hemiparesis due to stroke. While ankle-foot orthoses (AFOs) are often used to prevent genu recurvatum by maintaining ankle dorsiflexion during the stance phase, AFOs reduce ankle joint mobility. Functional electrical stimulation (FES) is an alternative to the use of AFO for producing appropriately timed ankle dorsiflexion and with prolonged timing may also have value for reducing genu recurvatum.

Case Description:

A 51-year-old man with chronic stroke was the subject of this case study. The patient had excessive plantarflexion during stance phase (ie, dynamic equinus foot), with associated genu recurvatum.

Intervention:

Evaluation included clinical examination, instrumented gait analysis, 10-meter walk test, and 6-minute walk test. The patient underwent a trial of botulinum toxin to the plantarflexor muscles that was not effective for controlling the genu recurvatum. A subsequent trial with surface FES to elicit dorsiflexion during gait was effective, and he subsequently received an implanted FES system.

Outcomes:

Stimulation-induced contraction of the dorsiflexors during terminal swing phase resulted in improved ankle dorsiflexion at initial contact. Moreover, extension of stimulation into the loading phase ensured tibial advancement, which limited knee hyperextension. The patient was reevaluated 12 months following implantation with continued positive outcomes.

Discussion:

This case study illustrates the potential value of prolonged timing of dorsiflexor FES to manage genu recurvatum attributed to a dynamic equinus foot in a stroke survivor.
Paraffin-embedded Tissue Fragment Suspension (PETFS): A Novel Method for Quality Control Preparation in Immunohistochemistry
Authors: Ding Wei , Huang Ke , Lü Bingjian , Xu Liming , Liu Jimin , Jiang Chaozhe , Teng Xiaodong , Ren Xingchang , Wang Bo
Published: May 2016

Immunohistochemistry (IHC) is one of the most important adjunctive techniques in surgical pathology. Quality controls are essential for staining interpretation. The most common controls are cut from the formalin-fixed, paraffin-embedded tissue blocks in advance. In contrast, we developed paraffin-embedded tissue fragment suspension (PETFS), a novel method in liquid form, for quality control preparation. The liquid form controls were cut from the donor formalin-fixed, paraffin-embedded paraffin blocks, stored in the 4°C fridge easily, and added to the top and bottom of the test slide directly by pipetting. The tissue fragments from the PETFS had a comparable IHC staining pattern to that of the control sections from the original donor blocks. Over a 180-day testing period, the IHC staining pattern and intensity remained strong and specific. The clinical value of PETFS method was further validated by their successful application as controls for the expression of estrogen receptor, progesterone receptor, and C-erbB-2 in 240 breast invasive ductal carcinomas. We concluded that PETFS is a fast, low-cost, and less donor tissue consumption robust technique as quality controls for routine IHC staining in surgical pathologic practice.
Primary Retroperitoneal Myxoid Liposarcomas
Authors: Setsu Nokitaka , Miyake Mototaka , Wakai Susumu , Nakatani Fumihiko , Kobayashi Eisuke , Chuman Hirokazu , Hiraoka Nobuyoshi , Kawai Akira , Yoshida Akihiko
Published: May 2016

Myxoid liposarcomas (MLSs) are genetically defined by the presence of DDIT3 gene fusions and most commonly arise in the extremities of young adults. Whether MLSs develop primarily in the retroperitoneum is controversial, and a recent retrospective study found no molecularly confirmed examples. Because MLSs tend to metastasize to deep soft tissues, purported examples of primary retroperitoneal lesions might represent distant metastasis, most commonly from extremities. In addition, well-differentiated or dedifferentiated liposarcomas, which are characterized by MDM2 amplifications, may exhibit prominent myxoid changes and mimic MLSs. Here, we document 5 cases of MLSs that originated in the retroperitoneum that were identified through critical clinicopathologic reevaluation. These cases accounted for 2.3% of 214 primary retroperitoneal liposarcomas and 3.2% of 156 MLSs in our database. They occurred in 3 men and 2 women with a median age of 32 years. All tumors were localized to the retroperitoneum at presentation, and no patient developed extra-abdominal recurrences during the clinical course (median, 50 mo). All 5 cases exhibited at least focal classic histologic findings. All harbored DDIT3 gene rearrangements, and none harbored MDM2 amplifications according to fluorescence in situ hybridization. This study demonstrates that primary MLSs can occur in the retroperitoneum, albeit rarely, and can be accurately diagnosed through combined clinicopathologic and molecular analysis.
Serum Biomarkers Help Predict Attention Problems in Critically Ill Children With Traumatic Brain Injury
Authors: Wilkinson Amy A. , Simic Nevena , Frndova Helena , Taylor Margot J. , Choong Karen , Fraser Douglas , Campbell Craig , Dhanani Sonny , Kuehn Sally , Beauchamp Miriam H. , Farrell Catherine , Anderson Vicki , Guerguerian Anne-Marie , Dennis Maureen , Schachar Russell , Hutchison Jamie S.
Published: May 2016

Objective:

To evaluate the association between acute serum biomarkers, and the changes in attention at 1 year following traumatic brain injury.

Design and Setting:

A prospective observational and laboratory study conducted in PICUs at five Canadian children’s hospitals.

Study Population and Measurements:

Fifty-eight patients aged 5 to 17 years with traumatic brain injury were enrolled in the study. Nine brain-specific and inflammatory serum protein biomarkers were measured multiple times over the first week following injury. Attention was measured at “baseline” to represent pre-injury function and at 1 year following injury using the Conners Third Parent Rating Scale.

Results:

Compared with baseline, there were significantly more clinical symptoms of inattention at 1 year post injury. The Glasgow Coma Scale score, age at injury, baseline levels of inattention, and highest levels of serum biomarkers were used to estimate the probability of developing inattention. These independent variables were first evaluated individually followed by combinations of the best predictors using area under the receiver operating characteristic curve analyses. A combination of high baseline levels of inattention and high serum levels of the biomarker neuron-specific enolase was the best predictor for inattention. Glasgow Coma Scale and age at injury were not associated with inattention at 1 year post injury.

Conclusions:

Combining baseline assessment of attention with measurement of serum biomarkers shows promise as reliable, early predictors of long-term attention after childhood traumatic brain injury.
Brief Report: Immunization of HIV-Infected Adults in the UK With Haemophilus influenzae b/Meningococcal C Glycoconjugate and Pneumococcal Polysaccharide Vaccines
Authors: MacLennan Calman A. , Richter Alex , Hodson James , Faustini Sian , Birtwistle Jane , Whitelegg Alison , Chigiga Joyful , Singo Mebie , Walker-Haywood Jodie , Mulugeta Betselot , Masuka Sindiso , Mainey Chris , Plant Tim , Drayson Mark T. , Manavi Kaveh
Published: May 2016

U.K. guidelines for vaccinating HIV-infected adults against bacteria are based on limited data. We compared antibody responses between 211 HIV-infected and 73 HIV-uninfected adults vaccinated with pneumococcal polysaccharide vaccine (PPV) and Haemophilus influenzae b/meningococcal C polysaccharide-tetanus toxoid glycoconjugate vaccine (Hib/MenC-TT). IgG responses to Hib/MenC-TT were not significantly different. PPV induced median IgGs >1.3 μg/mL for 10/12 serotypes among HIV-uninfected participants and 5/12 in HIV-infected participants. HIV-uninfected adults had higher post-vaccination IgGs than HIV-infected adults for 4/12 serotypes (P < 0.001). Responses did not associate with CD4 count or viral suppression. In a U.K. HIV-infected population, Hib/MenC-TT induced similar responses to HIV-uninfected adults, whereas PPV induced poor responses.
Illness Perceptions, Medication Beliefs, and Adherence to Antiretrovirals and Medications for Comorbidities in Adults With HIV Infection and Hypertension or Chronic Kidney Disease
Authors: Weiss Jeffrey J. , Konstantinidis Ioannis , Boueilh Anna , Fierer Daniel S. , Gardenier Donald , Barber Mark G. , Kang Tony , Kress Anna , Ericson Katherine , Lira Marlene C. , Yostos Marina P. , Bogner Hillary R. , Wisnivesky Juan P. , Wyatt Christina M.
Published: May 2016

Background:

Mortality in patients with HIV infection is increasingly due to comorbid medical conditions. Research on how adherence to medications for comorbidities relates to antiretroviral (ARV) medication adherence and how interrelations between illness perceptions and medication beliefs about HIV and comorbidities affect medication adherence is needed to inform adherence interventions.

Methods:

HIV-infected adults with hypertension (HTN) (n = 151) or chronic kidney disease (CKD; n = 41) were recruited from ambulatory practices at an academic medical center. Illness perceptions and medication beliefs about HIV and HTN or CKD were assessed and adherence to one ARV medication and one medication for either HTN or CKD was electronically monitored for 10 weeks.

Results:

Rates of taking, dosing, and timing adherence to ARV medication did not differ from adherence to medication for HTN or CKD, with the exception that patients were more adherent to the timing of their ARV (78%) than to the timing of their antihypertensive (68%; P = 0.01). Patients viewed HIV as better understood, more chronic, having more negative consequences, and eliciting more emotions, compared with HTN. Patients viewed ARVs as more necessary than medication for HTN or CKD. Having a realistic view of the efficacy of ARVs (r = −0.20; P < 0.05) and a high level of perceived HIV understanding (r = 0.21; P < 0.05) correlated with better ARV adherence.

Conclusions:

Patients with HIV showed similar rates of adherence to ARVs as to medications for comorbidities, despite perceiving HIV as more threatening and ARVs as more important. This can be used in adapting existing interventions for ARV adherence to encompass adherence to medications for comorbid conditions.