bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotype distribution, clinical characteristics, and racial differences observed in chronic hepatitis C patients in Pingtung, Taiwan
Authors: Jang Tyng-Yuan , Liang Po-Cheng , Liu Ta-Wei , Wei Yu-Ju , Yeh Ming-Lun , Hsu Cheng-Ting , Hsu Po-Yao , Lin Yi-Hung , Hsieh Meng-Hsuan , Huang Ching-I , Huang Chung-Feng , Lin Zu-Yau , Chen Shinn-Cherng , Huang Jee-Fu , Dai Chia-Yen , Yu Ming-Lung , Chuang Wan-Long
Published: January 2021

Background:

The World Health Organization (WHO) set out to eliminate hepatitis C virus (HCV) infection by 2030, a goal Taiwan might achieve before 2025. Using effective direct antiviral agents (DAAs) against chronic hepatitis C (CHC) in Taiwan, the treatment of CHC has been initiated in rural areas. Here, we aimed to elucidate the clinical and virological characteristics of HCV infection, and the treatment efficacy of DAAs in patients from Pingtung county in southern Taiwan.

Methods:

A total of 152 chronic hepatitis patients treated with DAAs were consecutively enrolled. Baseline characteristics and therapeutic efficacy were evaluated.

Results:

HCV genotype 2 was the most common viral genotype (39.5%), followed by 1b (36.8%), 6 (10.5%), and 1a (9.2%). The sustained virological response (SVR) rate was 98.7%. Hakka patients accounted for 22.4% of the study cohort, of which 14.7% had HCV genotype 6. There were no differences in clinical characteristics between Hakka and non-Hakka patients. Patients with HCV genotype 6 were younger in age (OR/CI: 0.95/0.91-1.00, p = 0.04) and composed of more people who inject drugs (PWID) (OR/CI: 17.6/3.6-85.5, p <0.001), when compared with other patients.

Conclusion:

We demonstrated that DAA therapy can achieve a 98.7% SVR rate among CHC patients in Pingtung county of southern Taiwan, with a relative higher prevalence of genotype 6. The most important factor attributed to genotype 6 infection was PWID.
RISE: Exploring Volunteer Retention and Sustainability of a Second Victim Support Program
Authors: Connors Cheryl A. , Dukhanin Vadim , Norvell Matt , Wu Albert W.
Published: January 2021

EXECUTIVE SUMMARY

The Resilience In Stressful Events (RISE) program that supports healthcare professionals traumatized by stressful clinical events has had a stable, volunteer-based membership since its inception in 2011 at Johns Hopkins Hospital. For this study, we explored RISE members’ perceptions of the program that contribute to their retention and the program’s sustainability. We distributed a survey with quantitative and qualitative elements to assess perceptions in seven domains of interest. The response rate was 100%. Pearson chi-squared tests established statistical associations among quantitative variables. Qualitative data were explored using content analysis. Of 27 respondents, 19 had been members for 3 or more years. The training completion percentage was 100%, and the annual turnover percentage was 12%. Members found their duties to be meaningful (100%), personally satisfying (96%), and positively impactful (93%). A total of 89% reported confidence in their competency to perform RISE duties, 84% in their autonomy, and 56% in their personal resilience; 28% reported some burnout from RISE duties. Cronbach’s α for these domain scores ranged from 0.65 to 0.97. Content analysis also revealed positive perceptions of RISE volunteering and personal empowerment. Members indicated a personal affinity with RISE and gains in energy and enjoyment from their membership. Contributing factors to volunteer retention may include members’ perceptions that RISE builds valued skills and supports their affinity for others.
Examining the Acceptability of a Resilience Building Intervention Among Adults Aging With HIV
Authors: Fazeli Pariya L. , Hopkins Cierra N. , Wells Andrea , Lambert Crystal Chapman , Turan Bulent , Kempf Mirjam-Colette , Vance David E.
Published: January 2021

Few interventions have targeted resilience resources in people living with HIV (PLWH). We tested the acceptability of an existing resilience intervention in middle-age and older PLWH. Fourteen PLWH attended one 3-hr group session, which included videos, quizzes, and written activities. Participants provided quantitative and qualitative feedback. The mean acceptability rating was 8.71 (1.27) on a 10-point scale. A majority of participants reported that the intervention was an appropriate length; that it improved their resilience, mood, and ability to manage HIV; and that they would likely continue using the tools. Average content retention accuracy was 75% (12.66). Qualitative feedback suggested addressing HIV-specific stressors, including disclosure concerns, stigma, health concerns, and treatment adherence. The resilience intervention was deemed highly acceptable among older PLWH. Uptake may increase by addressing HIV-specific stressors and improving comprehensibility. Future research should further refine and test the efficacy of a modified version of the intervention.
Standardized adult-gerontology acute care nurse practitioner point-of-care ultrasound training: A new perspective in the age of a pandemic
Authors: Chen Leon L.
Published: January 2021

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (AGACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPs.
Multifocal Skull Base Defects With Associated Spontaneous Cerebrospinal Fluid Leaks
Authors: Schwartz Nofrat , Brown Kevin D. , Sasaki-Adams Deanna , Morgan Selleck A. , Zanation Adam M. , Thorp Brain D. , O’Connell Brandan P.
Published: January 2021

Objective:

Spontaneous cerebrospinal fluid (CSF) leaks are thought to arise due to elevated intracranial pressure which is distributed across the skull base, potentially predisposing the development of multifocal CSF leaks. The aims of this study are to evaluate the characteristics of this population at presentation and surgical outcomes.

Study Design:

Retrospective case series.

Setting:

Tertiary referral center.

Patients:

Patients 18 years or older with spontaneous CSF leak diagnosis were eligible for study inclusion. Multifocal spontaneous CSF leak was defined as leaks originating from more than one skull base defect at anatomically distinct subsites.

Intervention:

None.

Main Outcome Measure:

Clinical presentation and surgical outcome.

Results:

Two hundred ninety-three patients with diagnosis of spontaneous CSF leak were identified. Of these, 11 (3.8%) were characterized as having multifocal spontaneous CSF leaks. Mean body mass index was significantly higher in multifocal CSF leak patients (31.5 ± 8.5 vs 46.2 ± 9.9, p < 0.0001). There was also higher prevalence of women (100% vs 63.8%, p = 0.012) and African-Americans (63.6% vs 23.4%, p = 0.003). The overall success rate of CSF leak repair was 95%. Fifty percent of patients developed headaches or blurry vision after surgical repair, and two patients required ventriculoperitoneal shunting.

Conclusions:

Multifocal spontaneous CSF leaks are rare and occurred in 3.8% of patients with spontaneous CSF. These patients were morbidly obese and more likely to be female and African American. Surgical repair conferred excellent outcomes. However, these patients have high risk of developing symptoms suggestive of elevated intracranial pressure postoperatively and should be counseled accordingly.
Uses and pitfalls of measurement of end-tidal carbon dioxide during cardiac arrest
Authors: Nicholson Tonia C. , Paiva Edison F.
Published: January 2021

Purpose of review

To discuss recent studies relevant to the utility of measuring end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) and its correlation with outcome in adults experiencing cardiac arrest.

Recent findings

Over the past couple of years, at least five studies have included measurement of ETCO2 in their methods. Two of these studies were prospective and two retrospective. All considered ETCO2 measurements after out-of-hospital cardiac arrest, either in the prehospital setting, or after arrival in the emergency department. All assessed for an association between ETCO2 measurement and return of spontaneous circulation (ROSC). However, the timing of measurement, whether a one-off value or a trend and the cut-off values used to determine whether or not there was an association were different in all cases.

Higher values of ETCO2 during resuscitation from cardiac arrest are generally associated with a greater likelihood of ROSC. However, timing of measurements and cut-off values used show significant variability across different studies, making it hard to draw any conclusions about the utility of any particular reading for prognostication. Future studies might aim to develop an accepted standard for the timing and cut-off value of ETCO2 used, to enable comparison of the parameter across different studies.
The microbiome and the immune system in critical illness
Authors: Miniet Ashley A. , Grunwell Jocelyn R. , Coopersmith Craig M.
Published: January 2021

Purpose of review

Although the gut microbiome plays a crucial role in the maintenance of health, it is hypothesized to drive morbidity and mortality in critically ill patients. This review describes the relationship between the gut microbiome and the immune system in critical illness.

Recent findings

The gut microbiome is converted to a pathobiome in the ICU, characterized by decreased microbial diversity and pathogen predominance. These changes are induced by a pathologic microenvironment and are further exacerbated by common medical treatments initiated in the ICU. The conversion of the microbiome to a pathobiome has direct consequences on the regulation of inflammation and immunity by loss of beneficial host responses and initiation of maladaptive changes that can further propagate critical illness.

The gut microbiome is dramatically altered in the ICU. In light of constant crosstalk between the microbiome and the host immune system, the pathobiome may play a key mechanistic role in driving a maladaptive response in critically ill patients. The pathobiome represents a potential therapeutic target in the management of critical illness whereby restoration of a healthier microbiome may directly alter the host inflammatory response, which could lead to improved patient outcomes.
Cytokine-induced liver injury in coronavirus disease-2019 (COVID-19): untangling the knots
Authors: Anirvan Prajna , Narain Sonali , Hajizadeh Negin , . Aloor Fuad Z , Singh Shivaram P. , Satapathy Sanjaya K.
Published: January 2021

Liver dysfunction manifesting as elevated aminotransferase levels has been a common feature of coronavirus disease-2019 (COVID-19) infection. The mechanism of liver injury in COVID-19 infection is unclear. However, it has been hypothesized to be a result of direct cytopathic effects of the virus, immune dysfunction and cytokine storm-related multiorgan damage, hypoxia-reperfusion injury and idiosyncratic drug-induced liver injury due to medications used in the management of COVID-19. The favored hypothesis regarding the pathophysiology of liver injury in the setting of COVID-19 is cytokine storm, an aberrant and unabated inflammatory response leading to hyperproduction of cytokines. In the current review, we have summarized the potential pathophysiologic mechanisms of cytokine-induced liver injury based on the reported literature.
Impact of statin use on the risk and prognosis of hepatocellular carcinoma: a meta-analysis
Authors: Wang Jianfeng , Li Xiaogang
Published: January 2021

Background

Previous studies have demonstrated that statin use might be associated with a reduced risk of hepatocellular carcinoma (HCC). However, the value of statin on the prognosis still needs to be evaluated. Based on the above considerations, we conducted a meta-analysis regarding the value of statin on the prevention and prognosis of HCC.

Methods

Articles regarding the impact of statin use on the risk, prognosis of HCC and published before October 2020 were searched in the five databases. We computed odds ratio (OR)/relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (CIs) regarding the association between statin use and the risk or prognosis of HCC by using STATA 12.0 software.

Results

Twenty-six studies (including 1772 463 participants) detected the association between statin use and risk of HCC. Additionally, seven studies (including 8925 statin users and 76 487 no-statin users) explored the association between statin use and mortality of HCC. The meta-analysis showed that statin use was associated with lower risk and all-cause mortality of HCC with random effects models (risk: OR/RR = 0.57, 95% CI 0.49–0.65, I2 = 86.0%, P < 0.0001; all-cause mortality: HR = 0.80, 95% CI 0.68–0.94, I2 = 77.6%, P < 0.0001). However, statin use was not associated with cancer-specific mortality of HCC with a random effects model (HR = 0.80, 95% CI 0.62–1.03, I2 = 73.9%, P = 0.002).

Conclusion

In conclusion, our results have demonstrated the salutary effect of statin on the prevention and prognosis of HCC.
Improving Payment for Collaborative Mental Health Care in Primary Care
Authors: Wolk Courtney Benjamin , Alter Carol L. , Kishton Rachel , Rado Jeffrey , Atlas Jacob A. , Press Matthew J. , Jordan Neil , Grant Michael , Livesey Cecilia , Rosenthal Lisa J. , Smith Justin D.
Published: January 2021

Background:

There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492–99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services.

Objectives:

Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes.

Conclusions:

Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.
Long-term Follow-up for Missed Cases of Eosinophilic Esophagitis in Children With Previous Foreign Body in the Esophagus
Authors: Thulin Helena , Nilsson Caroline , Svensson Jan F. , Olén Ola , Altman Maria
Published: January 2021

Objectives:

A foreign body impacted in the esophagus could be a sign of eosinophilic esophagitis (EoE). Our aim was to investigate if children previously diagnosed with a foreign body in the esophagus had a missed diagnosis of EoE.

Methods:

In this population-based longitudinal study, all children (0–18 years) diagnosed with a foreign body in the esophagus in Stockholm, Sweden 2006 to 2016, were identified. In addition to a review of medical files, each family was contacted (n = 325) and asked standardized questions. Children with symptoms indicating EoE were offered esophagogastroduodenoscopy (EGD).

Results:

We found 325 pediatric cases of foreign body. Two hundred and seven (64%) underwent an endoscopy at the event, 3 of these had biopsies taken, whereby 2 were diagnosed with EoE. Six additional patients were diagnosed with EoE between the initial event and the study follow-up. Children with persisting symptoms suggestive of EoE at the follow-up (n = 21), were offered EGD whereof 7 accepted. Four new cases of EoE were found. Hence, 12 (3.7%) of the children with a previous foreign body, either spontaneously released or endoscopically removed, were diagnosed with EoE. In the structured interview, dysphagia, food impactions and drinking excessively with meals, as well as food allergies, were significantly more common in EoE patients.

Conclusions:

Children with a foreign body in the esophagus are at risk of having EoE. Biopsies should be taken during foreign body removal and questions about swallowing problems and allergic diseases should be carefully explored also in children who do not need EGD because of spontaneous release.
Job Satisfaction Among Home Healthcare Nurses
Authors: Garza Jose Abelardo , Taliaferro Donna
Published: January 2021

Understanding the experiences of home healthcare nurses and exploring the factors that influence job satisfaction is important in reducing costly staff turnover. The purpose of the qualitative case study was to describe experiences related to job satisfaction among home healthcare nurses. Herzberg's Two Factor theory was used to frame the study. Twelve home healthcare nurses from an agency in South Texas volunteered to participate in in-depth interviews. Four themes emerged from the data: 1) patients contribute to job satisfaction, 2) autonomy promotes job satisfaction, 3) occupational stressors negatively influenced job satisfaction, and 4) leadership impacts job satisfaction. Home healthcare leadership should take safety concerns seriously and explore innovative ways to promote communication between field nurses and physicians. Further research is needed with a larger and more diverse sample of home healthcare nurses in order to be able to generalize findings.
Home Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge
Authors: Kang Youjeong , Mondesir Favel L. , Young Dawn , Norris Eddie , Hernandez Juan M. , Nativi-Nicolau Jose , Stehlik Josef
Published: January 2021

Frequent rehospitalizations among patients with heart failure (HF) result in patient burden and high cost. Homebound patients with HF qualify for home healthcare after hospital discharge. It is not known if nonhomebound patients with HF could also benefit from home healthcare nursing (HHN) visits to improve the transition from hospital to home. The purpose of this quality-improvement pilot study was to assess the impact of HHN visits provided to nonhomebound HF patients after hospital discharge on 30-day rehospitalization rates. We included patients with HF who were ineligible for home healthcare services due to their nonhomebound status. Home healthcare nurses followed a modified version of the discharge checklist from the American Heart Association's Rise Above Heart Failure materials, and provided education as appropriate based on patients' responses. We enrolled 68 patients in the study. The mean age was 60.2 years; 61.8% were male and 77.9% were White. Based on patient responses to the checklist, key areas addressed during HHN visits were medication management and HF self-care. In the HHN visit group, 15% of the patients experienced rehospitalization within 30 days, compared with 23% in the non-HHN visit group among 540 patients discharged in the same time frame who met the inclusion criteria but were not enrolled in the study (p = .12). Our pilot data show that HHN visits for nonhomebound patients are feasible and result in a numerically lower 30-day rehospitalization rate after discharge. Further study is needed to confirm the clinical efficacy of this approach.
Caregiver Comfort With Telehospice
Authors: Cameron Patricia
Published: January 2021

The purpose of this mixed methods study was to examine comfort and emotional support that caregivers of home hospice patients derived from using electronic tablets for telehospice. The use of technology was intended to increase caregiver confidence in symptom management for individuals receiving home-based hospice care. Caregiver survey data were collected over a 2-year period. The survey included both quantitative and qualitative items. A total of 667 caregivers of home hospice patients participated. Most respondents reported being comfortable using telehospice, and as comfort levels increased, caregivers were more willing to use virtual healthcare again. Positive, negative, and neutral themes emerged from the comments by caregivers. The results of this study provide support for using telehospice with caregivers of home hospice patients. Caring for a person at the end of life is stressful and having the ability to contact a professional 24 hours a day provided comfort to the caregivers. Training is essential for caregivers to use technology and integration of technology in the care plans for all hospice patients is important for success.
Factors Associated With Home-Hospice Utilization
Authors: Osakwe Zainab Toteh , Arora Bhavleen K. , Peterson Mandi-Leigh , Obioha Chinedu U. , Fleur-Calixte Rose Saint
Published: January 2021

Utilization of hospice for end-of-life care is known to be lower among racial and ethnic minority groups than among White populations when controlling for other socioeconomic factors. Certain patient, provider, and community characteristics may influence home-hospice use. We sought to identify patient, provider, and community factors associated with home-hospice use. Our final analytic sample included 1,208,700 hospice patients who received home-hospice from 2,148 Medicare-certified hospice providers in 2016. We found that an increase in the proportion of hospice patients with a primary diagnosis of dementia decreased the odds that home-hospice was provided (OR = 1.42, 95% CI = 1.36-1.48). Patients who received hospice care from a provider with a higher proportion of dually enrolled patients were less likely to receive home-hospice (OR = 1.42, 95% CI = 1.36-1.48) and hospices located in ZIP-codes with higher proportion of Hispanic resident were less likely to provide home-hospice (OR = 1.00, 95% CI = 0.99-0.99). Additional research is needed to clarify the mechanisms underlying these associations.
Antiretroviral Therapy Use and HIV Transmission Among Discordant Couples in Nonresearch Settings in Kigali, Rwanda
Authors: Nyombayire Julien , Ingabire Rosine , Mukamuyango Jeannine , Karita Etienne , Mazzei Amelia , Wall Kristin M. , Parker Rachel , Tichacek Amanda , Allen Susan , Hunter Eric , Price Matt A.
Published: January 2021

Background

Antiretroviral therapy (ART) efficacy for HIV prevention among discordant couples has been demonstrated in clinical trials. Effectiveness outside of research settings is less well understood.

Methods

HIV-discordant couples were enrolled in couples' testing and follow-up at 20 government clinics in Kigali from 2010 to 2014. We performed viral linkage analysis on seroconverting couples to determine infection sources (intracouple vs. extracouple). Antiretroviral therapy use in index partners was collected at baseline and during follow-up by self-report with verification of government medical records.

Results

A total of 3777 HIV-discordant couples were identified and followed up at government health clinics. Fifty-four incident HIV infections were identified, of which 36 were confirmed linked to the index partner, 4 were unlinked, and 14 were unknown. Among the 50 linked or unknown transmission pairs, 38% occurred among couples in which the index partner was on ART (HIV incidence rate of 0.63/100 person-years), whereas 62% occurred among couples in which the index partner was not on ART (HIV incidence rate of 5.51/100 person-years; adjusted rate ratio, 6.9). HIV acquisition was higher in women than in men with non-ART using index partners (P < 0.001).

Conclusions

Couples in a government clinic couples’ HIV testing and follow-up program in Rwanda had an 89% reduction in HIV incidence when index partners were using ART, slightly lower than efficacy estimates from randomized trials. Antiretroviral therapy for prevention should be prioritized for key populations including discordant couples identified via couples’ voluntary counseling and testing, with increased efforts to improve uptake, adherence, and viral load monitoring.
Emergency Department–Based Human Immunodeficiency Virus Preexposure Prophylaxis Referral Program—Using Emergency Departments as a Portal for Preexposure Prophylaxis Services
Authors: Zhao Zezhou , Jones Joyce , Arrington-Sanders Renata , Gladfelter Gaby , McDonald Steven , Reed Christopher , Myer Deanna , Schlenker Noah , Fulton Glenn , Jones Tiana , Saheed Mustapha , Rothman Richard , Hsieh Yu-Hsiang
Published: January 2021

A pilot program was implemented to assess the feasibility of emergency department (ED) preexposure prophylaxis (PrEP) referral. Of 119 eligible patients approached and assessed, 39 (33%) expressed interest and were referred to peer navigators. Of these, 16 (41%) scheduled for appointments; four (10%) initiated PrEP, which demonstrated ED-based PrEP referral was feasible.
Screening and Treatment of Sexually Transmitted Infections Among Medicaid Populations—A 2-State Analysis
Authors: Merrell Melinda A. , Betley Charles , Crouch Elizabeth , Hung Peiyin , Stockwell Ian , Middleton Alice , Pearson William S.
Published: January 2021

Background

Chlamydia, gonorrhea, and syphilis are common, treatable sexually transmitted infections (STIs) that are highly prevalent in the general US population. Costs associated with diagnosing and treating these conditions for individual states' Medicaid participants are unknown. The purpose of this study was to estimate the cost of screening and treatment for 3 common STIs for state Medicaid program budgets in Maryland and South Carolina.

Methods

A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period. Claims were included based on the presence of one of the 3 study conditions in either diagnosis or procedure codes. Descriptive analyses were used to characterize the participant population and expenditures for services provided.

Results

Total Medicaid expenditures for STI care in state fiscal years 2016 and 2017 averaged $43.5 million and $22.3 million for each year in Maryland and South Carolina, respectively. Maryland had a greater proportion of costs associated with outpatient hospital and laboratory settings. Costs for care provided in the emergency department were highest in South Carolina.

Conclusions

Diagnosis and treatment of commonly reported STIs may have a considerable financial impact on individual state Medicaid programs. Public health activities directed at STI prevention are important tools for reducing these costs to states.
New Mexico’s COVID-19 Experience
Authors: Jackson Nicole R. , Zeigler Karen , Torrez Mary , Makino Yohsuke , Adolphi Natalie L. , Lathrop Sarah , Decker Lauren , Dvorscak Lauren , Proe Lori , Paul Ian D. , Zumwalt Ross , Jarrell Heather
Published: January 2021

The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19–related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2–positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.
Early Mobilization Rehabilitation Program for Children With Cerebral Palsy Undergoing Single-Event Multilevel Surgery
Authors: Howard Melissa , Bickley Christina , Linton Judi , Northcutt Leah , Lux Melanie , Scott Allison , Stephenson Lindsay , Barnes Douglas
Published: January 2021

Purpose:

This study investigates functional and technical outcomes to support an early mobilization approach to rehabilitation after single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP), and disseminates innovative guidelines emphasizing early walking.

Methods:

Twenty-three participants with spastic diplegic CP ages 7 through 17 years, Gross Motor Function Classification System levels I to III, who underwent an early mobilization program after SEMLS were reviewed. Outcomes were examined from motion analysis data and clinical documentation.

Results:

All participants were able to return to school walking at discharge. At 1-year postoperatively, participants had returned to their prior walking level or better. Change in Gait Deviation Index and Pediatric Outcomes Data Collection Instrument indicated improvements in functional mobility and gait consistent with or greater than the literature.

Conclusion:

This intensive early mobilization program restores participation in daily activities, walking, and school within the first month postoperatively.
Assimilation of the Pediatric Essential Core Competencies by Professional Physical Therapist Education Programs
Authors: Weaver Priscilla A. , Catalino Tricia , Townsend Elise L. , Martin Kathy , Dole Robin L.
Published: January 2021

Purpose:

This study examined the degree to which pediatric essential core competencies (ECCs) are meeting their intended purpose to provide guidance to pediatric educators in professional physical therapy (PT) education programs and to determine facilitators, barriers, and recommendations to implementation of ECCs in curricula.

Methods:

Pediatric PT educators from professional PT education programs were recruited to participate in a survey. Descriptive statistics were used to analyze close-ended questions for frequency of responses and content analysis to generate themes.

Results:

Of the 162 completed surveys, most participants were aware of the ECCs (96%) and used them to inform pediatric curriculum (88%). A mean proportion (86%-95%) of participants perceived their program curricula addressed the ECCs very or moderately well. Multiple themes of facilitators/barriers/recommendations to ECC implementation were determined.

Conclusions:

Most pediatric educators are aware of and using the ECCs to guide pediatric education to prepare graduates for pediatric patients/clients.
I Want to Play: Children With Cerebral Palsy Talk About Their Experiences on Barriers and Facilitators to Participation in Leisure Activities
Authors: Longo Egmar , Regalado Isabelly Cristina Rodrigues , Galvão Elida Rayane Viana Pinheiro , Ferreira Haryelle Nárima Confessor , Badia Marta , Baz Begonã Orgaz
Published: January 2021

Purpose:

To explore how children with cerebral palsy (CP) experience participation in leisure activities and to describe the environmental barriers and facilitators.

Methods:

Sixteen children with cerebral palsy aged 7 to 17 years participated in 3 focus groups. Data were analyzed thematically by 3 researchers on the basis of the International Classification of Functioning, Disability and Health.

Results:

A total of 38 International Classification of Functioning, Disability and Health categories were identified (4 linked to Body functions; 2 linked to Body structures; 8 linked to Activities & Participation, and 24 to Environmental factors: 10 facilitators and 14 barriers). The most mentioned categories were Voluntary movement control functions, Functions related to gait pattern, Structure of upper arm, Recreation and leisure, Nuclear family and finally, and Individual attitudes of acquaintances.

Conclusions:

The main barriers identified by children with cerebral palsy highlight aspects of the physical, social, and attitudinal environment that could be modified to enhance participation in leisure activities.
Immunohistochemical Loss of DPC4 in Tumors With Mucinous Differentiation Arising in or Involving the Gynecologic Tract
Authors: Kwon Dong Hyang , Malpica Anais , Zaleski Michael , Euscher Elizabeth D. , Ramalingam Preetha
Published: January 2021

DPC4 immunohistochemistry (IHC) is usually part of the work-up of mucinous neoplasms in the ovary where the distinction between an ovarian primary and metastatic pancreaticobiliary adenocarcinoma (PanACa) must be made. Although DPC4 IHC is lost in about 55% (46%–61%) of PanACas and typically retained in most primary ovarian mucinous neoplasms, no study has evaluated the expression of this marker in a large cohort of neoplasms arising in or involving gynecologic (GYN) organs. In this study, we retrospectively analyzed the expression of DPC4 IHC in a total of 251 tumors and lesions related to the GYN tract in which DPC4 IHC stain was performed during the initial pathology evaluation. Of these, 138 were primary GYN tumors and lesions, 31 were metastatic GYN tumors involving non-GYN sites, and 83 were metastatic non-GYN tumors involving the GYN tract. We identified 27 cases with loss of DPC4 IHC expression of which 20 cases met the inclusion criteria (i.e. clinical information was available to determine the site of tumor origin). We observed that loss of DPC4 nuclear expression was most commonly seen in tumors of endocervical origin (n=7), of which 5 were gastric-type cervical adenocarcinomas (GCxACa) and 2 were usual-type cervical adenocarcinomas, either primary or metastatic. This was followed by tumors of the pancreaticobiliary tract (n=5), ovary (n=2), and appendix (n=1). In addition, 1 gastric-type vaginal adenocarcinoma (GVaACa) also showed loss of DPC4. Our findings indicate that in female patients with mucinous neoplasms involving the ovary or other sites, with loss of DPC4 by IHC, and negative pancreaticobiliary imaging, the possibility of an occult GCx/GVaACa, and rarely an ovarian primary must be considered.
A New Onset of Mania in a 49-Year-Old Man: An Interesting Case of Wilson Disease
Authors: SLOAN SILVIA , DOSUMU-JOHNSON RYAN T.
Published: January 2021

Wilson disease is a rare copper metabolism disorder that generally occurs in individuals between 5 and 35 years of age. Common clinical manifestations are hepatic, neurological, and psychiatric symptoms. Roughly, 4% of all cases occur in patients over 40 years of age and, among these patients, the presenting symptoms are generally neuropsychiatric, which often leads to misdiagnosis as a primary psychiatric disorder and a delay in correct diagnosis. This report presents the case of a 49-year-old man with no formal psychiatric history who presented with a new onset of mania. We outline the distinctive characteristics that appeared inconsistent with a primary psychiatric disorder and pointed toward secondary mania. Despite low serum ceruloplasmin, the absence of brain abnormalities more typical of Wilson disease on magnetic resonance imaging led a neurology consultant to advise that the diagnosis was likely primarily psychiatric. Due to atypical components of the patient’s presentation, such as his late age of onset for bipolar disorder and acute cognitive decline, the psychiatric team advocated for further diagnostic workup. The subsequent evaluation confirmed Wilson disease based on specific ophthalmological and hepatic abnormalities and further copper studies. In addition, once diagnosed, the management of Wilson disease involves distinct clinical considerations given patients’ presumed vulnerability to neurological side effects. This case illustrates the role psychiatric providers play in advocating for diagnostic workup in patients with atypical presentations of primary psychiatric disorders and the distinct diagnostic and treatment considerations associated with Wilson disease.
A Reverse Orbicularis-Tarsus Fixation Technique in Double-Eyelid Blepharoplasty: A Novel Fixation Technique Different From Park's Technique
Authors: Liu Hai-Peng , Shen Zheng-Zhou , Zhang Duo
Published: January 2021

Background:

Although Park's “orbicularis-levator fixation technique” has been widely used as a mature double-eyelid surgery in China recently. Shortcomings related to this method cannot be ignored. Thus, a reverse orbicularis-tarsus fixation technique in double-eyelid blepharoplasty has now been devised. The method is to create a physiological double-eyelid fold based on the formation mechanism of double-eyelid creases.

Methods:

A retrospective study of 112 Chinese patients who underwent double-eyelid surgery between October 2017 and September 2019 was undertaken through a review of medical records. All these patients underwent a reverse tarsus and orbicularis oculi muscle fixation technique, with postoperative follow-up ranging from 6 months to 2 years. Postoperative outcomes were reviewed, evaluated, and analyzed.

Results:

Altogether, 112 patients who underwent the double-eyelid surgery were reviewed. Among them, the results were judged as excellent in 104 cases (92.9%), good in 4 cases (3.6%), fair in 3 cases (2.7%), and poor in 1 case (0.8%). Clinical effectiveness was satisfactory in most of the patients (104/112, 92.9%). Only 5 patients (4.5%) expressed subjective dissatisfaction with postoperative outcomes; of these, 3 patients complained of eyelids asymmetry (2.7%). Two patients complained of eyelids scar formation (1.7%); Whereas surgical revision was required in only 1 patient (0.8%).

Conclusions:

The reverse orbicularis-tarsus fixation technique for upper eyelid blepharoplasty is safe and effective, with better biomechanics and a satisfying aesthetic outcome. Therefore, this provides an alternative option in Chinese double-eyelid surgery.

Level of Evidence: Level IV, case studies.
Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients
Authors: Moffatt Joanna , Hughes Declan , Bhatti Nabeel , Holmes Simon
Published: January 2021

The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.

Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.

Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).

In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.
A Posterior Rotational Flap Technique Using Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis
Authors: Kamel George N. , McKee Ryan M. , Carbulido Kristine , Modi Rishi , Belza Caitlyn , Ewing Emily , Segal Rachel M. , O’Connor Alyson , Gholami Parham , Ryan Justin , Lance Samuel H. , Gosman Amanda A.
Published: January 2021

Introduction:

The craniofacial asymmetry seen in unilateral lambdoid craniosynostosis may not be effectively treated by posterior cranial vault remodeling, endoscopic suturectomy, and helmet therapy, or suturectomy and distraction osteogenesis alone due to limitations in soft-tissue envelope expansion and relapse of the deformity. The authors report a series of unilateral lambdoid craniosynostosis patients treated with a posterior rotational cranial-flap technique using internal distraction osteogenesis.

Methods:

Posterior cranial vault reconstruction combined with internal distraction was used, aided by preoperative virtual surgical planning. An in situ posterior rotational flap osteotomy was utilized to maximize dural preservation. Primary outcome measures included age-adjusted volume change and age-adjusted percent volume change per mm distraction. Distraction characteristics and perioperative characteristics were also assessed.

Results:

A total of 5 patients were identified. Mean predistraction intracranial volume was 1087.5 cc (SD 
= 202.3 cc) and mean postdistraction included intracranial volume was 1266.1cc (SD 
= 131.8cc). Mean age-adjusted percent included intracranial volume change was 14.1% (SD 
= 9.6%), and mean percent intracranial volume change per mm distraction was 0.43%/mm distraction (SD 
= 0.37%/mm distraction). One patient developed a distractor site infection postoperatively that was treated successfully with oral antibiotics. All patients had a Whitaker score of 1 at one year follow up.

Conclusions:

Posterior cranial vault remodeling using osteogenesis and a rotational cranial flap technique with dural preservation can be effectively used to maximize bone flap viability and limit postoperative relapse in patients with unilateral lambdoid craniosynostosis. Long term analysis as well as comparison to open techniques will need to be interrogated.
Management of Maxillofacial Trauma in Attempt Suicide Patients During COVID-19 Pandemic
Authors: Riyadh Safaa , Abdulrazaq Saif Saadedeen
Published: January 2021

The maxillofacial surgeon trained well to face the surgical challenges. In case of dealing with self-inflicted trauma, the surgeon must face the surgical as well as the psychological status of the patients. Five patients received in the emergency room suffering from maxillofacial trauma resulted from suicidal attempts. Unfortunately, 1 patient died, the other patients managed by providing surgical and psychological support. The cornerstone of managing such type of trauma needs appropriate communication between the family, surgical team, and the psychiatric.
Debriefing for Simulation-Based Medical Education
Authors: Ing Louise , Cheng Adam , Lin Yiqun
Published: January 2021

Context

Current debriefing approaches and faculty development strategies for simulation educators differ around the world. We aim to describe the status of current debriefing practice and faculty development for simulation educators in this study.

Methods

We distributed a paper-based survey during 2 international conferences to obtain data from active International Network for Simulation-based Pediatric Innovation, Research and Education members. The survey was tested to ensure content validity and consisted of the following 3 constructs: demographic characteristics, current debriefing practice, and issues related to faculty development.

Results

One hundred nine of 114 participants (96%) completed the survey. Debriefing practice differs in terms of timing, duration, framework, and conversational framework. Most debriefings were less than 30 minutes (93/109, 85%), with many educators not using objective data during debriefing (47/109, 43%). Three- or 4-phase debriefing frameworks were used most commonly (66/109, 61%). Most participants have access to some faculty development opportunities (99/109, 91%). Barriers to faculty development are related to time and resource constraints (eg, freeing up facilitator's time: 75/109, 69%, competing priorities 64/109, 59%). Most participants indicated that their needs for debriefing to improve learning outcomes were met (95/109, 87%). The desired content for future faculty development opportunities varies between educators with different levels of expertise.

Conclusions

Approaches to debriefing among members of an international pediatric simulation network vary considerably. Although faculty development opportunities were available to most participants, future simulation programs should work on addressing barriers and optimizing faculty development plans to meet the needs of their educators.
Primary and Specialty Outpatient Visits for Older Women With Urinary Incontinence: A Comparison of Nurses to the General Population
Authors: Erekson Elisabeth , Lane Giulia , Mann Jason , Austin Andrea , Carmichael Donald , Minassian Vatche A. , Grodstein Francine , Bynum Julie P.W.
Published: January 2021

Objective

We evaluated patterns of outpatient visits seen for urinary incontinence (UI) among women 65 years or older in the Nurses’ Health Study and the general Medicare population. We were interested in understanding whether nurses, with high health literacy, may receive more care for UI than the general population.

Methods

Medicare Fee for Service claims data for women aged 66–91 years were compared for Nurses’ Health Study participants (n = 3,213) and a propensity-matched sample from general Medicare Fee for Service beneficiaries (n = 3,213) with 1 or more outpatient evaluation and management visits for UI in 2012. We examined the mean number of outpatient visits for UI and the type of provider seen, using t tests and χ2 tests. Providers were categorized as specialist and nonspecialist providers using taxonomy codes.

Results

The percentage of women 65 years or older who had an outpatient visits for UI over 12 months was 6.4% in the Nurses’ Health Study cohort and 5.4% in the general population. The mean number of office visits for UI in 2012 was similar between nurses and the matched general population (mean = 1.8 vs 1.8; P = 0.3). A small percentage of women saw both nonspecialists and specialists for UI (9.3% in the Nurses’ Health Study and 10.0% in the Center for Medicare Services cohorts).

Conclusions

We found that less than 7% of older women had outpatient evaluation of UI symptoms during a 12-month period, despite UI being very common in this age group. This was similar in nurses and the general population, suggesting that even high health care literacy does not increase UI care seeking.