bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining the Impact of a Nursing Course Redesign on Student Outcomes, Faculty Workload, and Costs
Authors: Allen Kimberly , DiBartolo Mary C. , Walsh Catherine M. , Freda Kaynabess
Published: November 2021

This study examined the impact of a nursing course redesign from traditional face-to-face to a hybrid format on student outcomes, workload allocation, and associated costs. In this quasi-experimental study, baccalaureate students received either traditional (n = 47) or hybrid delivery (n = 46); each group had equal degree-type representation. Average exam scores were analyzed using an independent t-test, with no significant differences found between groups. Faculty workload decreased by one third, and there was a 16.6 percent reduction in overall costs to implement the course. Course redesign can be effective for reducing faculty workload and costs while achieving course outcomes.
An Online COVID-19 Simulation to Explore Interprofessional Collaboration and Foster Systems Leadership Competencies in Doctor of Nursing Practice Students
Authors: DeClerk Leonie C. , LaBorde Pamela J. , Hughes Marilyn F. , Reeves D. Neal , Hester D. Micah , Cowan Patricia A.
Published: November 2021

Organizational and systems leadership, a competency for doctor of nursing practice students, encompasses the evaluation of care delivery systems, accountable care of populations, and resolution of ethical dilemmas. Faculty created an online simulation in which students developed a management proposal for an impending pandemic. All students agreed or strongly agreed that the simulation increased their skills in systems-based thinking, increased their knowledge of others’ roles and responsibilities in addressing health care crises, and enabled them to balance ethical considerations and societal interests. Online simulations are a feasible, cost-effective method to foster systems leadership competency and ethical decision-making in doctoral students.
Authentic Literature: Literary Fiction as a Textbook to Engage in Nursing Professional Practice Content
Authors: Raber Anjanette M. , Mood Laura , Olsen Joanne
Published: November 2021

This innovative teaching strategy sought to evaluate authentic literature as the primary textbook in a nursing theory course. Arts-based pedagogy can potentiate students’ development of critical thinking skills, which are necessary for sound clinical judgment. At the end of the course, students responded to an online survey to better understand their experience of using authentic literature in nursing. Students reported a high level of agreement on the interconnectedness of themes in the authentic literature with the course purpose and content. Authentic literature provided a contextual perspective for analysis, debate, and formation of clinical nursing judgment.
Low-threshold Buprenorphine Treatment in a Syringe Services Program: Program Description and Outcomes
Authors: Jakubowski Andrea , Norton Brianna L. , Hayes Benjamin T. , Gibson Brent E. , Fitzsimmons Christine , Stern L. Synn , Ramirez Franklin , Guzman Mercedes , Spratt Susan , Marcus Pia , Fox Aaron D.
Published: November 2021

Objectives

Low-threshold buprenorphine treatment aims to reduce barriers to evidence-based opioid use disorder treatment. We aimed to describe the treatment philosophy, practices, and outcomes of a low-threshold syringe services program (SSP)-based buprenorphine program developed through an SSP-academic medical center partnership.

Methods

We included all SSP participants who received 1 or more buprenorphine prescription from Feb 5, 2019 to October 9, 2020. We collected data on patient characteristics, substance use, buprenorphine prescriptions, and urine drug tests (UDTs). We evaluated buprenorphine treatment retention using prescription data and buprenorphine adherence using UDTs. We used 2 retention definitions: (1) percentage of patients with buprenorphine prescriptions at 30, 90, and 180 days; and (2) total percentage of days “covered” with buprenorphine prescriptions through 180 days.

Results

One-hundred and eighteen patients received 1 or more buprenorphine prescriptions. Patients were largely middle-aged (mean age 44, standard deviation 11), male (68%), Hispanic (31%) or Non-Hispanic Black (32%), with heroin (90%) and crack/cocaine (62%) use, and injection drug use (59%). Retention was 62%, 43%, and 31% at 30, 90, and 180 days, respectively. The median percentage of days covered with buprenorphine prescriptions through 180 days was 43% (interquartile range 8%–92%). Of the 82 patients who completed 2 or more UDTs, the median percentage of buprenorphine-positive UDTs was 71% (interquartile range 40%–100%).

Conclusions

In an SSP-based low-threshold buprenorphine treatment program, approximately one-third of patients continued buprenorphine treatment for 180 days or more, and buprenorphine adherence was high. SSPs can be a pathway to buprenorphine treatment for patients at high risk for opioid-related harms.
Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery
Authors: Marrache Majd , Suresh Krishna V. , White Klane K. , Larson A. Noelle , Sponseller Paul D.
Published: November 2021

Study Design:

Multicenter retrospective study.

Background:

Recent studies have demonstrated diminishing returns in patients with early onset scoliosis (EOS) undergoing repeated lengthening of growing rods. Little is known about whether this same phenomenon occurs in patients with lax connective tissue disease (CTD). The primary purpose of this study is to investigate whether EOS patients with connective tissue laxity disorders have diminishing returns during growth friendly surgery.

Methods:

CTD EOS patients below 10 years old, underwent growth friendly spine surgery with distal anchors and at least 1 proximal spine anchor, and had minimum follow-up of 5 years were included in this study. Coronal T1-S1 height at preindex surgery, postindex, and every available lengthening was assessed. Mean coronal height change during early set distractions and late set distractions were calculated for the cohort. To account for varying distraction intervals, we normalized the distractions by the time interval. The outcome parameter was T1-S1 height gain, mm/year.

Results:

Twenty-one CTD patients were included in this study. Total coronal height (T1-S1) was 26.7MHCcm before index, 32.2 cm at D1-D3, 34.7 cm at D4-D6, and 36.7 cm at D7-L10. There were no significant differences in coronal height gains between early and late distractions (P=0.70). Moreover, when normalized for time, there was no significant difference in net gain per year at different lengthening time points for the CTD group, P=0.59.

Conclusion:

There is no evidence of diminishing returns in coronal T1-S1 height gain in patients with EOS in the setting of CTD.

Level of Evidence:

Level III.
The Feasibility of Utilizing Malunion Criteria to Limit Radiographs After Spica Casting for Pediatric Femur Fractures
Authors: Barnett Scott A. , Song Bryant M. , Yan Justin , Lucak Thomas J. , Leonardi Claudia , Kadhim Muayad , Heffernan Michael J.
Published: November 2021

Background:

There are no existing guidelines regarding the timing or frequency of postoperative radiographs following spica casting for pediatric femur fractures. The purpose of this study was to evaluate established femoral malunion criteria as a potential screening tool to limit postoperative radiographs by identifying patients at risk for unacceptable alignment in the early treatment period.

Methods:

A retrospective chart review was conducted for pediatric femoral shaft fractures presenting to a tertiary pediatric referral hospital from 2012 to 2017. Pediatric femur malunion criteria were applied to radiographs at initial presentation, first follow-up visit, and final follow-up visit. The primary outcome was a change in management based on radiographic findings in the early postoperative period. Secondary outcomes included radiographic measures, number of follow-up visits, and complications.

Results:

Of 449 consecutive pediatric femur fractures treated at our center, 149 patients aged 1 to 4 years (mean age: 2.5±1.6 y) met inclusion criteria. At initial presentation, 36.9% (55/149) of patients met malunion criteria. Only 4.0% (6/149) of patients had a change in management following initial closed reduction and spica cast application due to radiographic findings at subsequent follow-up. Of these patients, 67% (4/6) were identified on preoperative imaging, and 83.3% (5/6) were identified by their first clinic appointment. Four of the 149 patients were converted to definitive surgical fixation, and 2 patients required cast wedging due to either unacceptable fracture shortening or coronal/sagittal angulation.

Conclusions:

Routine early postoperative radiographs may not be necessary for all pediatric femur fractures managed with closed reduction and spica casting. The value of this study is that it is the first to demonstrate the feasibility of limiting postoperative radiographs using a preoperative screening tool. However, the established femoral malunion criteria utilized in this study were limited in their predictive value, and further work is necessary to improve the sensitivity and specificity before widespread clinical application.

Level of Evidence:

Level IV.
Does the Deformity Index Reliably Predict the Shape of the Femoral Head at Healing of Legg-Calvé-Perthes Disease?
Authors: Shah Hitesh , Singh Kumar A. , Swarup Ishaan , Morris William , Kim Harry K.W. , Joseph Benjamin
Published: November 2021

Background:

Treatment of Legg-Calvé-Perthes disease (LCPD) aims to preserve the spherical shape of the femoral head. The deformity index (DI) <0.3, measured 2 years from disease onset, is a surrogate measure that predicts that the femoral head will be Stulberg class I or II at skeletal maturity. There is no study that compares the predictive value of DI against a quantitative measure of the shape of the femoral head when the disease heals. We undertook this study to assess the reproducibility of a new method of measurement of DI and see if DI could predict the shape of the femoral head when the disease healed.

Methods:

DI was measured 2 years after disease onset and the Sphericity Deviation Score (SDS) was measured at healing of LCPD on radiographs of 43 children. Reproducibility of measurement was tested. Each healed femoral head was classified as spherical or aspherical based on subjective visual assessment. The DI values were compared with SDS values.

Results:

The reproducibility of measurement of SDS was excellent and superior to that of DI. The mean duration of disease was 3.97±0.96 years. Only 17 of 32 hips with DI values <0.3 at 2 years had spherical femoral heads at healing (SDS <10). Three hips with SDS values <10 had DI values >0.3. The positive and negative predictive values of a DI <0.3 in predicting if the femoral head will be spherical (SDS <10) when the disease healed were 53% and 73%, respectively.

Conclusion:

Though DI can be reproducibly measured the predictive value of a DI <0.3, to accurately identify hips that are likely to heal with spherical femoral heads, is not sufficiently high to justify its use as an outcome measure.
Pedicle Subtraction Osteotomy in Adult Spinal Deformity
Authors: Cho Kyu-Jung , Kim Ki-Tack , Youn Yung-Hun , Song Ju-Sung
Published: November 2021

Study Design/Setting:

Level III—retrospective radiologic and clinical comparative study.

Objective:

This study compares the results of pedicle subtraction osteotomy (PSO) for fixed versus flexible sagittal imbalance in adult spinal deformity.

Summary of Background Data:

The result of PSO may be different according to the flexibility of the deformity.

Methods:

Sixty-one patients who underwent PSO were enrolled with a minimum 2-year follow-up. Twenty-one patients had fixed imbalance resulting from ankylosing spondylitis and iatrogenic flatback deformity, and 40 patients had flexible imbalance resulting from degenerative spinal deformity and posttraumatic kyphosis.

Results:

The mean age was 54.9±9.2 years in the fixed group and 65.9±10.5 years in the flexible group (P<0.01). PSO achieved about 35 degrees of correction of kyphotic angle in both groups, but the loss of correction (LOC) was higher in the flexible group. The correction of Lumbar Lordosis was similar in both groups, at 31.7±15.4 degrees in the fixed group and 32.3±20.8 degrees in the flexible group, although the LOC was also higher in the flexible group than in the fixed group, at 9.8±12.4 and 2.7±3.5 degrees, respectively (P<0.01). The sagittal vertical axis was much more restored in the fixed group than in the flexible group (P=0.002). Postoperative complications were identified in 4 patients in the fixed group, consisting of neurological deficit and screw loosening, and in 15 patients in the flexible group, consisting of proximal junctional kyphosis, screw pullout, rod fracture, and pseudarthrosis.

Conclusions:

PSO for flexible sagittal imbalance resulted in a higher LOC of the osteotomy angle, Lumbar Lordosis, and sagittal vertical axis relative to the fixed deformity. Furthermore, more complications such as implant failure developed in the flexible group.
Prognostic Significance of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression
Authors: Hamid Hytham K.S. , Emile Sameh H. , Davis George N.
Published: November 2021

BACKGROUND:

The low lymphocyte-to-monocyte ratio and high platelet-to-lymphocyte ratio have been reported to be poor prognostic indicators in various solid tumors, but the prognostic significance in rectal cancer remains controversial.

OBJECTIVES:

We sought to determine the prognostic value of the lymphocyte-to-monocyte ratio and the platelet-to-lymphocyte ratio following curative-intent surgery for rectal cancer.

DATA SOURCES:

Following PRISMA guidelines (PROSPERO, ID: CRD42020190880), PubMed and Embase databases were searched through January 2021 including 3 other registered medical databases.

STUDY SELECTION:

Studies evaluating the impact of pretreatment lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio on overall or disease-free survival in patients undergoing curative rectal cancer resection were selected.

MAIN OUTCOMES MEASURES:

The main outcome measures were overall and disease-free survival.

RESULTS:

A total of 23 studies (6683 patients) were included; lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio were evaluated in 14 and 16 studies. A low lymphocyte-to-monocyte ratio was associated with poorer overall survival (HR, 1.57; 95% CI, 1.29–1.90; p < 0.001) and disease-free survival (HR, 1.29; 95% CI, 1.13–1.46; p < 0.001). However, when the analysis was limited to patients treated with surgery alone or to those with stage I to III tumors, lymphocyte-to-monocyte ratio was not a predictor of overall survival and disease-free survival. The platelet-to-lymphocyte ratio did not predict for overall or disease-free survival, regardless of the treatment modality, studied population, tumor stage, or cutoff value. Finally, a low lymphocyte-to-monocyte ratio, but not a high platelet-to-lymphocyte ratio, was inversely correlated with complete pathologic response rate.

LIMITATIONS:

The retrospective nature of most included studies was a limitation.

CONCLUSIONS:

Pretreatment lymphocyte-to-monocyte ratio, but not platelet-to-lymphocyte ratio, correlates with tumor response to neoadjuvant chemoradiotherapy and poorer prognosis after curative-intent surgery for rectal cancer, and it potentially represents a simple and reliable biomarker that could help optimize individualized clinical decision-making in high-risk patients.

REGISTRATION:

https://www.crd.york.ac.uk/prospero/; ID: CRD42020190880
Metformin Prevents Low-dose Isoproterenol-induced Cardiac Dilatation and Systolic Dysfunction in Male Sprague Dawley Rats
Authors: Peterson Vernice R. , Norton Gavin R. , Madziva Michael T. , Makaula Siyanda
Published: November 2021

Myocardial metabolic abnormalities are well-recognized alterations in chronic heart failure, effects that may contribute to progressive cardiac dysfunction. However, whether metabolic alterations in-part mediate their deleterious effects by modifying the chronic impact of excess low-dose sympathetic stimulation on cardiac chamber dilatation is uncertain. We therefore aimed to determine the effect of metformin administration on cardiac function and mitochondrial architectural changes in a rat model of chronic sympathetic-induced left ventricular (LV) remodeling and systolic dysfunction [daily subcutaneous isoproterenol (ISO) injection at a low dose of 0.02 mg/kg for 7 months]. Echocardiography was used to assess in vivo LV dimensions and function, and mitochondrial and myofibril arrangement was assessed using transmission electron microscopy. Seven months of low-dose ISO administration increased LV diastolic diameter (in mm) [control (CONT): 7.29 ± 0.19 vs. ISO: 8.76 ± 0.21; P = 0.001], an effect that was attenuated by metformin (ISO + MET: 7.63 ± 0.29 vs. ISO: P = 0.001) administration. Similarly, ISO increased LV end-systolic diameter (CONT: 4.43 ± 0.16 vs. ISO: 5.49 ± 0.16: P < 0.0001), an effect prevented by metformin (ISO + MET: 4.04 ± 0.25 vs. ISO: P < 0.0001). Moreover, chronic ISO administration reduced LV endocardial fractional shortening (P = 0.0001), midwall fractional shortening (P = 0.0001), and ejection fraction (P = 0.0001), effects similarly prevented by metformin administration. Furthermore, changes in mitochondrial arrangement and relative mitochondrial area (CONT: 37.7 ± 2.2 vs. ISO: 28.1 ± 2.9; P = 0.05) were produced by ISO administration, effects prevented by metformin. In conclusion, metformin offers cardiac protection against chronic sympathetic-induced LV dilatation and systolic dysfunction. These data support a role for myocardial metabolic changes in mediating LV dilatation and LV dysfunction produced by chronic neurohumoral activation in cardiac disease.
Digoxin in Patients With Advanced Heart Failure and Sinus Rhythm Submitted to Cardiac Resynchronization Therapy—Is There Any Benefit?
Authors: Fernandes Cláudia , António Natália , Marinho Vera , Milner James , Madeira Marta , Sousa Pedro A. , Ventura Miguel , Cristóvão João , Elvas Luís , Gonçalves Lino
Published: November 2021

Digoxin (DG) use in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm remains controversial. We aimed to assess the prognostic effect of DG in patients in sinus rhythm submitted to cardiac resynchronization therapy (CRT). Retrospective study including 297 consecutive patients in sinus rhythm, with advanced HFrEF submitted to CRT. Patients were divided into 2 groups: with DG and without DG (NDG). During a mean follow-up of 4.9 ± 3.4 years, we evaluated the effect of DG on the composite end point defined as cardiovascular hospitalization, progression to heart transplantation, and all-cause mortality. Previous to CRT, 104 patients (35%) chronically underwent DG and 193 patients (65%) underwent NDG treatment. The 2 groups did not differ significantly regarding HF functional class, HF etiology, QRS, and baseline left ventricular ejection fraction. The proportion of responders to CRT was similar in both groups (54% in DG vs. 56% in NDG; P = 0.78). During the long-term follow-up period, the primary end point occurred in a higher proportion in DG patients (67 vs. 48%; P = 0.002). After adjustment for potential confounders, DG use remained as an independent predictor of the composite end point of CV hospitalization, heart transplantation, and all-cause mortality [hazards ratio = 1.58; confidence interval, 95 (1.01–2.46); P = 0.045]. In conclusion, in patients in sinus rhythm with HFrEF submitted to CRT, DG use was associated with CV hospitalization, progression to heart transplant, and all-cause mortality.
CHARACTERISTICS AND MANAGEMENT OF MYOPIC TRACTION MACULOPATHY IN MYOPIC EYES WITH AXIAL LENGTH LESS THAN 26.5 mm
Authors: Chen Jing , Chen Shida , Zhao Xiujuan , Lian PING , Yu Xiling , Huang Xia , Liu Bingqian , Li Yonghao , Lu Lin
Published: November 2021

Purpose:

To explore the characteristics and underlying mechanisms of myopic traction maculopathy (MTM) with axial length less than 26.5 mm and to assess the effectiveness of macular buckling for the treatment of MTM.

Methods:

Thirty-eight MTM eyes with axial length less than 26.5 mm were prospectively enrolled. Thirty-one eyes received surgery, and they were followed up for at least 6 months. Characteristics of MTM and surgical outcomes were evaluated.

Results:

Of the MTM eyes, 92.11% (35/38) showed posterior staphyloma. Narrow macular staphyloma was the most common type (54.29%, 19/35), followed by peripapillary (37.14%, 13/35). Three cases (8.57%) had wide macular staphyloma, and 44.74% of cases (17/38) had vitreoretinal traction. Twenty-two MTM eyes of type T3 underwent macular buckling surgery, and all the cases achieved foveal reattachment after the surgery. The mean best-corrected visual acuity improved significantly at the 6-month follow-up (P < 0.001). Nine MTM eyes of type T4 or T5 received combined surgery, all macular holes recovered, and the best-corrected visual acuity also improved postoperatively (P = 0.008) as of the 6-month visit.

Conclusion:

Posterior staphyloma might serve as the initial force of the pathogenesis of MTM in eyes with axial length ˂26.5 mm. Macular buckling is a productive way to improve the MTM.
IMPAIRMENTS OF L-CONE/M-CONE AND S-CONE–MEDIATED COLOR DISCRIMINATION IN MACULAR TELANGIECTASIA TYPE II
Authors: Simunovic Matthew P. , Gillies Mark C.
Published: November 2021

Purpose:

To characterize red–green and tritan color discrimination in eyes with macular telangiectasia Type II (MacTel).

Methods:

Color discrimination was assessed by metameric matching methods using an Oculus MR Anomaloscope. Red–green color discrimination was assessed using the Rayleigh equation, and tritan color discrimination was assessed using the Moreland equation. Results were expressed as anomalquotient (AQ) and tritanomalquotient (TAQ) units, respectively.

Results:

Seventeen eyes with MacTel were compared with 16 control eyes with normal vision. Twelve eyes with MacTel demonstrated abnormal color matches; except for two eyes with red-shifted Rayleigh matches, the primary abnormality evident was reduced color discrimination. On average, Rayleigh matching ranges were significantly widened in MacTel (0.518 ± 0.066 AQ units) compared with normal (0.14 ± 0.03 AQ units; P < 0.0001). Similarly, Moreland matching ranges were significantly wider (0.794 ± 0.109 TAQ units) than normal control subjects (0.204 ± 0.070 TAQ units; P < 0.0001). Losses in color discrimination did not correlate significantly with the best-corrected visual acuity, although Moreland matching ranges were significantly correlated to Rayleigh matching ranges.

Conclusion:

MacTel results in a combined acquired red–green and tritan color vision deficiency. A minority of eyes demonstrated red-shifted Rayleigh matches, consistent with decreases in cone photopigment optical density.
Evaluation of Visual Outcome of 2 Phakic Posterior Chamber Implantable Lenses in High Myopia: A Comparative Study
Authors: Sinha Ayushi , Sinha Rajesh , Gupta Vinay , Agarwal Rinky , Maharana Prafulla K. , Agarwal Tushar , Sharma Namrata , Titiyal Jeewan Singh
Published: November 2021

Purpose:

To evaluate and compare the visual outcomes of two phakic intraocular lenses in high myopia.

Methods:

A prospective comparative study was undertaken on 50 eyes of 26 patients {age ≥21 years and divided into two groups (implantable collamer lens [ICL] V4c, n=25 eyes and refractive implantable lens [RIL], n=25 eyes)}. Patients were evaluated for uncorrected distance visual acuity (UCVA), best-corrected distance visual acuity, manifest refractive spherical equivalent (MRSE), contrast sensitivity, intraocular pressure, dilated fundus examination, trabecular-iris angle (TIA), anterior chamber depth, horizontal white-to-white diameter, wavefront aberrometry, and endothelial cell (EC) count. All patients were followed up until 6 months and additionally evaluated for anterior chamber inflammation, cataract, and lens vault.

Results:

The baseline parameters (UCVA, MRSE, and EC count) and postoperative improvement in UCVA, contrast sensitivity, MRSE, EC loss, safety index, and efficacy index were comparable between both the lenses. The improvement in aberrometric profile was significantly better in the ICL group. The mean postoperative vault was higher in RIL group (434.88±162.48 μm vs. 547.24±159.83 μm, P=0.0173); however, the vault was within normal range in both the groups. The decrease in mean TIA was significantly higher in RIL group (8.58 vs. 13.45 μm, P=0.0073).

Conclusion:

Acrylic phakic lens can be considered as a suitable alternative to collamer lens for refractive correction of high myopia. The collamer lenses showed slight superiority in some qualitative visual parameters; however, collamer lenses do not present with subjective complaints in the patients.
Comparison of Corneal Tissue Profile of Pseudophakic and Phakic Donors
Authors: Sahoo Sonali , Jamil Zeeshan , Sahu Srikant K. , Ali Mohammad H. , Priyadarshini Smruti R. , Das Sujata
Published: November 2021

Purpose:

To compare the endothelial quality of corneas obtained from pseudophakic donors with age-matched phakic controls.

Methods:

Retrospective analysis of 100 corneas each from pseudophakic and phakic eyes with donor age ≥60 years in both the groups was performed. The endothelial cell density, coefficient of variation, and percentage of hexagonal cells obtained by specular microscopy were compared between the two groups. The cut-off level of endothelial cell density (ECD) taken for optical keratoplasty was 2,000 cells/mm2.

Results:

The male and female donors constituted 60% (n=120) and 40% (n=80), respectively. The mean age of the donors was 66.9±7.3 years in the phakic group and 69.9±7.7 years in pseudophakic group. The mean ECD in the phakic group was 2757.6±328.5 cells/mm2 and that in the pseudophakic group was 2225.5±471.9 cells/mm2 (P<0.0001). The mean coefficient of variation in the phakic group was 37.1±5.0 and that in the pseudophakic group was 38.6±11.1 (P=0.234). The mean percentage of hexagonality in the phakic group and the pseudophakic group was 52.0±6.4% and 51.2±7.2%, respectively (P=0.414). Both in univariate and multivariate linear regression analysis, age of the donor was found to be negatively associated in predicting ECD (P=0.002 and P=0.003, respectively). Sixty-nine and thirty-three corneas from the phakic and pseudophakic donor pool were used respectively.

Conclusion:

Difference in ECD between the phakic and the pseudophakic donor group was found to be statistically significant. The ECD in the pseudophakic group was found to be above the cut-off limit required for keratoplasty. Hence, pseudophakic corneas may also be used for transplantation.
Evaluation of the vitreolenticular interface with intraoperative OCT
Authors: Vael Arnout , Van Os Luc , Melis Kirsten , Tassignon Marie-José
Published: November 2021

Purpose:

To determine the prevalence of anterior vitreous detachment (AVD) in routine bag-in-the-lens (BIL) cataract cases and possibly to identify risk factors for its presence.

Setting:

University Hospital of Antwerp, Belgium.

Design:

Prospective cross-sectional study.

Methods:

Patients having routine BIL cataract surgery were included. Patients with traumatic cataract, previous intraocular surgeries, YAG laser treatment, intravitreal injection, or medical conditions that might affect normal ophthalmologic anatomy were excluded. Several parameters were collected from the patients’ records, and their surgical videos/photographs/optical coherence tomography were evaluated.

Results:

99 eyes of 99 patients were included. Detectable AVD was observed in 62 eyes (63%). AVD was not present in 37 eyes (37%). The difference in prevalence of AVD between men and women was not statistically significant (P = .55, Pearson χ2 test). The Mann-Whitney U test for axial length was not statistically significant (P = .38). However, it was statistically significant for age (P < .005). A logistic regression model to ascertain the effect of age on the likelihood that patients had AVD did reach statistical significance (χ2 (1) = 8.246, P < .005).

Conclusions:

The prevalence of AVD in a routine cataract population was 63%. Age was identified as a risk factor. This study model determined that the odds for AVD increase 5.3% with each year of patient age. These data allowed for better preoperative and postoperative assessment of complications. The BIL, by its mandatory primary posterior continuous curvilinear capsulorhexis, did not increase the risk for postoperative ocular complications in the posterior segment of the eye.
Investigation of Medication Adherence and Factors Affecting It in Patients With Stroke
Authors: Arkan Gulcihan , Sarigol Ordin Yaprak , Ozturk Vesile , Ala Rahmi Tümay
Published: November 2021

BACKGROUND: Medication adherence is important in reducing the rate of secondary stroke in patients previously given a diagnosis of stroke. Therefore, there is a need to examine medication adherence and the factors affecting it in these patients. This study aimed to examine medication adherence in patients with stroke and the factors affecting it. METHODS: This study adopted a descriptive and cross-sectional design carried carried out on 183 stroke patients. Data were obtained between January and December 2019 using a sociodemographic and clinical characteristics form, the Morisky's Questions – Self-Reported Measure of Medication Adherence, the Turkish translation of the Beliefs about Medicines Questionnaire, the Nottingham Extended Activities of Daily Living Scale, and the revised Turkish version of Mini-Mental State Examination. RESULTS: The proportion of patients with high medication adherence was 33.9%. The sociodemographic and clinical characteristics of patients with stroke were found as not effective factors in medication adherence. Specific concerns and general overuse in the Turkish translation of the Beliefs about Medicines Questionnaire were found as factors affecting medication adherence. The Nottingham Extended Activities of Daily Living Scale and its subscales were found to be not effective factors in medication adherence. CONCLUSION: According to the results, the proportion of patients with high medication adherence was low. Patients' concerns about the possible side effects of their prescribed medications and beliefs about the overuse of medications negatively affected their medication adherence. It is recommended that nurses evaluate patients' medication adherence and beliefs about medications during hospitalization, discharge, or home visits. Structured nurse-led intervention programs are needed to enhance patients' medication adherence and beliefs about their medications.
Perception Differences in Burnout
Authors: Dharani Babar , Guntern Stefan , April Kurt
Published: November 2021

Objective:

Burnout differences between management and subordinates can affect preventative interventions chosen by management. Our study investigated if these differences in experiences of burnout (1) are dimension specific (2) correspond to differences in perceptions of the effectiveness of burnout prevention methods.

Methods:

Two hundred thirty nine managers and 217 subordinates completed an online survey that categorized their self-reported experiences into the three dimensions of burnout and investigated their perceptions of the effectiveness of burnout prevention techniques.

Results:

Contrary to the literature, Swiss-German managers experienced greater exhaustion than subordinates. Despite this experiential difference, their perceived effectiveness of burnout prevention methods did not differ.

Conclusions:

Contextual differences explain dimension-specific differences in self-reported experiences of burnout at different hierarchal levels; however, these did not contribute to leader distance or perception gap either due to foundational or context-specific factors.
The Validity and Reliability of a Treadmill Test for Structural Firefighter Applicants
Authors: Scarlett Michael P. , Ehnes Cameron M. , Adams Eric M. , Dreger Randy W. , Petersen Stewart R.
Published: November 2021

Objective:

This 2-part study evaluated validity and reliability of a treadmill test for structural firefighters.

Methods:

Wearing fire protective ensemble, 260 participants walked at 1.56 m-s–1, completing a 5-min warm-up, an 8-min stage at a 5.71° incline, then graded stages to exhaustion. In Part 2, 21 participants completed the test on 3 separate days under standardized conditions.

Results:

Average (±SD) oxygen uptake (

) during minutes 1 – 13 was similar to reported values for simulated fire-rescue work. During the 13th min,

was consistent with

recommendations for firefighters in Part 2, exercise duration increased between trials 1 and 2 before stabilizing but

was consistent.

Conclusions:

Congruence with reported

during simulated firefighting and recommendations for

confirmed validity. Acceptable test-retest reliability was demonstrated. We conclude that the test is valid and reliable for evaluating cardiorespiratory endurance for firefighting.
Testing for SARS-CoV-2 in Symptomatic Vaccinated and Unvaccinated Health Care Workers During the Delta Variant Surge
Authors: Lopez Anthony , Kosnik Robert , Blanc Paul D. , Taylor Brian R. , Guntur Sandeep
Published: November 2021

Background:

Infection with SARS- CoV- 2 in health care workers (HCWs) challenges employee health services.

Methods:

We analyzed telephone Coronavirus Disease 2019 (COVID-19) hotline data over 8 weeks in 2021 during SARS- CoV- 2 Delta variant surge. We calculated COVID-19 case rates among persons-under-investigation (PUIs) for illness at two health care centers (HCs).

Results:

There were 41 COVID-19 cases among the 285 PUIs (14.4%) at the study HC and 549 (16.9%) of 3244 at the comparison HC. At the study HC, 11.7% of vaccinated PUIs versus 36.6% of unvaccinated PUIs were COVID-19 positive. The COVID-19 positivity rates among vaccinated and unvaccinated PUIs at the comparison HC were 16.1% and 33.3%, respectively.

Discussion:

In the SARS-CoV-2 Delta variant surge, COVID-19 test positivity rates among unvaccinated symptomatic HCWs are dramatically elevated. Aggressive testing of HCW PUIs is particularly critical during periods of disease upsurge.
Suffering in Silence
Authors: Ellison Jared M. , Jaegers Lisa A.
Published: November 2021

Objective:

Correctional officers are exposed to violence more often than many other public service workers, yet little is known about the traumatic nature of these risks. We examine violence exposure and post-traumatic stress disorder (PTSD) among a large, multi-facility sample of jail officers.

Method:

One thousand three hundred and sixty five officers working in 20 jails were surveyed regarding background characteristics, exposure to violence at work, and post-traumatic stress symptoms measured by the PTSD Checklist for DSM-5 (PCL-5).

Results:

About one-third of the sample met the criteria for a “provisional PTSD Diagnosis” or “probable PTSD”.’ Victimization and exposure to violence, both in and outside of work, significantly contributed to PTSD symptoms.

Conclusions:

Findings highlight the severity of, and link between, exposure to violence and PTSD among jail officers. Implications for diagnosing, treating, and preventing PTSD among jail officers are discussed.
Pelvic Floor Mobility Measured by Transperineal Ultrasound Imaging in Women With and Without Urgency and Frequency Predominant Lower Urinary Tract Symptoms
Authors: Foster Stefanie N. , Spitznagle Theresa M. , Tuttle Lori J. , Lowder Jerry L. , Sutcliffe Siobhan , Steger-May Karen , Ghetti Chiara , Wang Jinli , Burlis Taylor , Meister Melanie R. , Mueller Michael J. , Harris-Hayes Marcie
Published: November 2021

Background:

Women with urgency/frequency predominant lower urinary tract symptoms (UF-LUTS) may have elevated pelvic floor muscle (PFM) position at rest and limited mobility with PFM contraction and bearing down, but this has not been quantified.

Objectives:

To compare PFM position and mobility using transperineal ultrasound (TPUS) at rest, maximal PFM contraction (perineal elevation), and bearing down (perineal descent) in women with and without UF-LUTS. We hypothesized that women with UF-LUTS would demonstrate elevated resting position and decreased excursion of pelvic landmarks during contraction and bearing down as compared with women without UF-LUTS.

Study Design:

A case-control study

Methods:

Women with UF-LUTS were matched 1:1 on age, body mass index, and vaginal parity with women without UF-LUTS. TPUS videos were obtained during 3 conditions: rest, PFM contraction, and bearing down. Levator plate angle (LPA) and puborectalis length (PR length) were measured for each condition. Paired t tests or Wilcoxon signed rank tests compared LPA and PR length between cases and controls.

Results:

Among 21 case-control pairs (42 women), women with UF-LUTS demonstrated greater LPA at rest (66.8°± 13.2° vs 54.9°± 9.8°; P= .006), and less PR lengthening from rest to bearing down (0.2 ± 3.1 mm vs 2.1 ± 2.9 mm; P= .03).

Conclusion:

Women with UF-LUTS demonstrated more elevated (cranioventral) position of the PFM at rest and less PR muscle lengthening with bearing down. These findings highlight the importance of a comprehensive PFM examination and possible treatment for women with UF-LUTS to include PFM position and mobility.
From the Core to the Floor—Utilizing a Webinar to Provide Pelvic Health Education
Authors: Morrison Cara , Pereira Angela , Masuda Kim , Bargstadt-Wilson Kari , Peterson Julie , Snyder Kailey
Published: November 2021

Background:

Childbirth can increase the risk of urinary and fecal incontinence and pelvic organ prolapse; however, research indicates postpartum women have limited knowledge of these conditions.

Objectives:

(1) To determine whether a webinar can improve postpartum women's knowledge related to the structures, functions, muscles, and strengthening of the pelvic floor and (2) to explore changes in perception of postpartum women's understanding of the core/pelvic floor and their role in urinary incontinence (UI) and pelvic organ prolapse (POP).

Methods:

Women who had given birth within the last year and were older than 19 years were recruited via social media. Women completed a demographic survey, Prolapse and Incontinence Knowledge Questionnaire (PIKQ), and a telephonic interview before and after viewing a 1-time online webinar produced by a Women's Health Physical Therapy (DPT) Resident. Survey data were analyzed via independent t tests. Qualitative data were analyzed via a latent content recurrent cross-sectional analysis.

Results:

A total of 16 women participated in this study. There were significant improvements in pre- versus postwebinar. Specific to qualitative findings, the main knowledge changes seen from pre- to postwebinar interviews included greater awareness of specific exercises with proper progression and sequencing, improved descriptions of UI and POP, and improved cuing of a Kegel.

Conclusion:

A pelvic health education webinar can result in improvements in pelvic health knowledge. More research is needed to determine whether this increase in knowledge translates to a greater likelihood to engage in pelvic floor strengthening exercises and ultimately whether it reduces pelvic floor dysfunction.
Controversial risk factors for cholangiocarcinoma
Authors: Baidoun Firas , Sarmini Muhammad Talal , Merjaneh Zahi , Moustafa Muhamad Alhaj
Published: November 2021

Introduction

Cholangiocarcinoma is a rare malignancy accounting for 3% of gastrointestinal cancers in the USA. While multiple risk factors for cholangiocarcinoma are established, other potential risk factors are still controversial. Herein, we used a large national database to investigate possible risk factors and associations.

Method

We used the National Inpatient Sample database to review all admissions between 2011 and 2015. We grouped patients based on the presence and absence of cholangiocarcinoma. Using multivariate logistic regression analysis, we assessed the association between obesity, alcohol abuse, smoking, diabetes mellitus and cholangiocarcinoma.

Results

Out of 30 9552 95 admissions, 20 030 had cholangiocarcinoma. Cholangiocarcinoma patients were older (67 ± 12.8 vs. 57 ± 20.6; P < 0.001) and had fewer female patients (48 vs. 59%; P < 0.001). Multivariate logistic regression analysis showed that diabetes mellitus was associated with cholangiocarcinoma (OR, 1.04; 95% CI, 1.01–1.08; P < 0.001). On the other hand, alcohol, smoking and obesity were all inversely associated with cholangiocarcinoma (OR, 0.75; 95% CI, 0.69–0.81; P < 0.001), (OR, 0.75; 95% CI, 0.71–0.79; P < 0.001) and (OR, 0.71; 95% CI, 0.67–0.75; P < 0.001), respectively. In addition, compared to Whites, Hispanic and Asian/Pacific Islander races were more associated with cholangiocarcinoma (OR, 1.27; 95% CI, 1.21–1.34) and (OR, 1.79; 95% CI, 1.67–1.92) (P < 0.001 for all), respectively, whereas African American race was inversely associated with cholangiocarcinoma (OR, 0.85; 95% CI, 0.81–0.89; P < 0.001).

Conclusion

Patients with a diagnosis of diabetes mellitus or from certain ethnic groups (Hispanic and Asian/Pacific Islander) are associated with increased risk for cholangiocarcinoma.
Out-of-hospital cardiac arrest in the Algarve region of Portugal: a retrospective registry trial with outcome data
Authors: Mourão Carvalho Nuno , Martins Cláudia , Cartaxo Vera , Marreiros Ana , Justo Emília , Raposo Carlos , Binnie Alexandra
Published: November 2021

Background and importance

Out-of-hospital cardiac arrest is a leading cause of death in Europe. An understanding of region-specific factors is essential for informing strategies to improve survival.

Design

This retrospective observational study included all out-of-hospital cardiac arrest patients attended by the Emergency Medical Service of the Algarve in 2019. Outcome data were derived from hospital records.

Main results

In 2019, there were 850 out-of-hospital cardiac arrests treated with cardiopulmonary resuscitation in the Algarve, representing a population incidence of 189/100 000. Return of spontaneous circulation occurred in 83 patients (9.8%), of whom 17 (2.0%) had survival to hospital discharge and 15 (1.8%) had survival with good neurologic outcome. Among patients in the Utstein comparator group, survival to hospital discharge was 21.4%. Predictors of return of spontaneous circulation were age, witnessed arrest, initial shockable rhythm, time of year, time to cardiopulmonary resuscitation, and time to advanced life support. Predictors of survival to hospital discharge were age, initial shockable rhythm, time to rhythm analysis, and time to advanced life support. Predictors of survival with good neurologic outcome were age, initial shockable rhythm, and time to return of spontaneous circulation.

Conclusions

The incidence of out-of-hospital cardiac arrest with cardiopulmonary resuscitation in the Algarve was higher than in other jurisdictions while return of spontaneous circulation, survival to hospital discharge, and survival with good neurologic outcome were comparatively low. An aging population, a geographically diverse region, and a low incidence of bystander cardiopulmonary resuscitation may have contributed to these outcomes. These results confirm the importance of early cardiopulmonary resuscitation, early rhythm assessment, and early advanced life support, all of which are potentially modifiable through public education, broadening of the defibrillator network and increased availability of advanced life support teams.
Functional Outcomes After Surgery for Total Colonic, Long‐Segment, Versus Rectosigmoid Segment Hirschsprung Disease
Authors: Verkuijl Sanne J. , Meinds Rob J. , van der Steeg Alida F.W. , van Gemert Wim G. , de Blaauw Ivo , Witvliet Marieke J. , Sloots Cornelius E.J. , van Heurn Ernst , Vermeulen Karin M. , Trzpis Monika , Broens Paul M.A.
Published: November 2021

Objectives:

Knowledge on long‐term outcomes in patients with Hirschsprung disease is progressing. Nevertheless, differences in outcomes according to aganglionic lengths are unclear. We compared long‐term bowel function and generic quality of life in Hirschsprung patients with total colonic or long‐segment versus rectosigmoid aganglionosis.

Methods:

In this nationwide, cross‐sectional study participants with proven Hirschsprung disease received the Defecation and Fecal Continence questionnaire, and the Child Health Questionnaire Child Form‐87, or the WHO Quality of Life‐100. We excluded deceased patients, patients who were younger than 8 years, lived abroad, had a permanent enterostomy, or were intellectually impaired.

Results:

The study population (n = 334) was operated for rectosigmoid (83.9%), long‐segment (8.7%), or total colonic aganglionosis (7.5%). Fecal incontinence in general was not significantly different between the three groups, but liquid fecal incontinence was significantly associated with total colonic aganglionosis (odds ratio [OR] = 6.00, 95% confidence interval [CI] 2.07–17.38, P = 0.001). Regarding constipation, patients with total colonic or long‐segment aganglionosis were less likely to suffer from constipation than the rectosigmoid group (OR = 0.21, 95% CI, 0.05–0.91, P = 0.038 and OR = 0.11, 95% CI, 0.01–0.83, P = 0.032). Quality of life was comparable between the three groups, except for a lower physical score in children with total colonic aganglionosis (P = 0.016).

Conclusions:

Over time Hirschsprung patients with total colonic or long‐segment aganglionosis do not suffer from worse fecal incontinence in general. A difference in stool consistency may underlie the association between liquid fecal incontinence and total colonic aganglionosis and constipation in patients with rectosigmoid aganglionosis. Despite these differences, generic quality of life is comparable on reaching adulthood.
The efficacy of robot-assisted training for patients with upper limb amputations who use myoelectric prostheses: a randomized controlled pilot study
Authors: Aydin Tuğba , Kesiktaş Fatma Nur , Akbulut Yusuf Doğan , Çorum Mustafa , Öneş Kadriye , Kizilkurt Taha , Buğdayci Nazli Derya , Karacan Ilhan
Published: November 2021

The aim of this pilot study was to investigate whether a movement therapy robot can improve skills in using a myoelectric prosthesis by patients with upper limb amputations. This prospective randomized, controlled study included a total of eleven patients with upper limb amputations who use myoelectric prostheses. The patients were randomized into a robot-assisted exercise group (n = 6) and a control group (n = 5). The robot group received robot-assisted training. No training program was provided to the control group. The outcome measure was kinematic data (A-goal hand–path ratio, A-goal deviation, A-goal instability and A-move) evaluated by the Armeo®Spring movement therapy robot. Significant improvements were noted in the A-goal hand–path ratio; A-goal deviation and A-goal instability in the robot group after treatment while compared with control group. No significant changes in A-move scores. We concluded that robot-assisted training may improve myoelectric prosthesis use skills in patients with upper limb amputation.