bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery From Opioid Use Disorder (OUD) After Monthly Long-acting Buprenorphine Treatment: 12-Month Longitudinal Outcomes From RECOVER, an Observational Study
Authors: Ling Walter , Nadipelli Vijay R. , Aldridge Arnie P. , Ronquest Naoko A. , Solem Caitlyn T. , Chilcoat Howard , Albright Victoria , Johnson Courtney , Learned Susan M. , Mehra Vishaal , Heidbreder Christian
Published: March 2020

Objectives:

While evidence has mounted regarding the short-term effectiveness of pharmacotherapy for opioid use disorder (OUD), little is known about longer-term psychosocial, economic, and health outcomes. We report herein 12-month outcomes for an observational study enrolling participants who had previously taken part in a long-acting buprenorphine subcutaneous injection (BUP-XR) trial for moderate to severe OUD.

Methods:

The RECOVER (Remission from Chronic Opioid Use: Studying Environmental and SocioEconomic Factors on Recovery; NCT03604861) study enrolled participants from 35 US community-based sites. Self-reported sustained opioid abstinence over 12 months and self-reported past-week abstinence at 3-, 6-, 9-, and 12-month visits were assessed. Multiple regression models assessed the association of BUP-XR duration with abstinence, controlling for potential confounders. Withdrawal, pain, health-related quality of life, depression, and employment at RECOVER baseline and 12-month visits were also compared to values collected before treatment in the BUP-XR trial.

Results:

Of 533 RECOVER participants, 425 completed the 12-month visit (average age 42 years; 66% male); 50.8% self-reported sustained 12-month and 68.0% past-week opioid abstinence. In multiple regressions, participants receiving 12-month versus ≤2-month BUP-XR treatment duration had significantly higher likelihood of sustained opioid abstinence (75.3% vs 24.1%; P = 0.001), with similar results for past-week self-reported abstinence over time. During RECOVER, participants had fewer withdrawal symptoms, lower pain, positive health-related quality of life, minimal depression, and higher employment versus pre-trial visit.

Conclusions:

RECOVER participants reported positive outcomes over the 12-month observational period, including high opioid abstinence and stable or improved humanistic outcomes. These findings provide insights into the long-term impact of pharmacotherapy in OUD recovery.
Degenerative Spondylolisthesis
Authors: Kulkarni Arvind G. , Kunder Tushar S. , Dutta Shumayou
Published: March 2020

Study Design:

A prospective cohort.

Objective:

The objective of this study was to develop a scoring system for lumbar degenerative spondylolisthesis (LDS) that would guide decision-making.

Background:

The management protocol for LDS has been under debate, with no guidelines. Most studies oversimplify LDS as a homogenous entity.

Materials and Methods:

A retrospective analysis of 131 patients who underwent surgery for LDS between July 2007 and October 2011 with a minimum follow-up of 3 years was carried out on the basis of clinical, radiologic, and technical factors. A scoring system was conceptualized. Clinical: back pain score—2, age younger than 70 years—1, high-demand activity—1. Radiologic: segmental kyphosis—1.5, segmental dynamic translation—1, disk height >50% of adjacent level—1, facet effusion—1, sagittal facet-orientation—1. Technical: feasibility to decompress without causing instability—1.5. Its reliability was ascertained by a univariate analysis. The benchmark was set at 5.5 according to the Youden Index. This was followed by a prospective study for reliability analysis between November 2011 and January 2017 of 52 patients who underwent stand-alone decompression in LDS with a minimum follow-up of 24 months. Outcomes were evaluated using the Oswestry Disability Index and the Visual Analog Scale. Interobserver variability was determined. None of the patients in the retrospective or prospective group had undergone any lumbar surgery previously.

Results:

The mean Oswestry Disability Index and Visual Analog Scale of both the groups in the retrospective and the stand-alone decompression groups in prospective studies showed significant improvement. The interobserver reliability was high, with a κ value of 0.847.

Conclusions:

The proposed scoring system helps view LDS as a heterogenous condition and assists in tailoring treatment for individual patients. For a select subgroup of patients with LDS, minimally invasive decompression (unilateral laminotomy and bilateral decompression using a minimally invasive surgery tubular retractor system) without fusion is adequate.

Level of Evidence:

Level III.
Quantitative Reduction of Basilar Invagination
Authors: Liu Zhenlei , Zhao Xinghua , Guan Jian , Duan Wanru , Goel Atul , Xia Zhiyuan , Jian Fengzeng , Chen Zan
Published: March 2020

Study Design:

A mechanism-based reasoning and case-control study.

Objective:

To introduce correction target of clivo-axial angle (CXA) in quantitative surgical reduction of basilar invagination (BI).

Summary of Background Data:

The exact mechanism of BI with or without atlantoaxial dislocation is still unclear. Sagittal deformity is a key feature of BI. Correction of CXA directly influences subaxial cervical lordosis (increase of CXA equals the decrease of cervical lordosis). However, a quantitative reference for correction surgery has not been established.

Materials and Methods:

CXA was divided by Chamberlain line into clivus tilt (CT) and axial tilt (AT). Patients diagnosed with BI were retrospectively included. Patients with degenerative cervical spine diseases or vascular diseases (without BI) were included as controls. CT, AT, and other common parameters were measured and analyzed with t test and multiple linear regression. Demonstration case was presented.

Results:

A total of 42 BI patients and 23 controls were included. Normal references for CXA, AT, and CT were 162.3±7.1, 93.8±6.5, and 68.6±3.8 degrees, respectively. BI patients had a 30.3-degree smaller CXA, a 15.5-degree smaller AT, and a 14.9-degree smaller CT. Basal angle (P=0.002) independently had a significant influence on extent of BI, while CT and AT did not. Demonstration case showed that CT was fixed and correcting AT to an ideal 94 degrees was optimal for an individual patient.

Conclusions:

Proper quantitative correction of CXA needs to be individualized in consideration of CT and AT. The difference between actual AT and its ideal value (about 94 degrees) is the optimal target of CXA correction to decompress neural elements ventrally and recover better subaxial cervical lordosis.

Level of Evidence:

Level IV.
Osteochondral Autograft Transplantation for Hand and Wrist Articular Problems
Authors: Miller Andrew J. , Bishop Allen T. , Shin Alexander Y.
Published: March 2020

Management of hand and wrist avascular necrosis with osteochondral fragmentation or focal arthritis can be a challenging problem with a variety procedures described for its treatment. Osteochondral autograft transplantation systems have been utilized in various focal defects of the knee, ankle, elbow, and wrist. The same principle for the treatment of focal defects of the proximal scaphoid, proximal capitate as well as metacarpal head as an alternative treatment is described. The main indication for this treatment is to address focal or partial osteochondral defects where the size of the defect is smaller than the isthmus of the involved bone to accommodate a cylindrical osteochondral graft that can be press fit. Larger and complete defects are contraindications to this treatment. We discuss the surgical technique as well as its main indications and expected outcomes
Maternal exercise and its beneficial effects on glucose metabolism in offspring
Authors: Zheng Jia , Zhou Li-Yuan , Xiao Xin-Hua
Published: March 2020

It shows that detrimental exposures and conditions in mothers can lead to the development of obesity and type 2 diabetes in offspring. This can lead to a vicious cycle of metabolic dysfunction, where rising rates of obesity, pre-diabetes, and diabetes in individuals of reproductive age, propagating risks to subsequent generations. It is well established that regular exercise has important health benefits for people with obesity and type 2 diabetes. Recently, increasing studies aim to examine the effects of maternal exercise on metabolic health in offspring. This review aims to demonstrate the evidence linking maternal exercise during critical periods of development and its implications for glucose metabolism in offspring, including intervention timing, sexual dimorphism, different exercise type, and intensity. Then we further examine the potential role of epigenetic modifications in this process.
Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: A subgroup analysis of a nationwide survey in China
Authors: Li Hong-Bin , Wu Li-Jun , Jiang Nan , Yang Ping-Ting , Liu Sheng-Yun , Shi Xiao-Fei , Fang Yong-Fei , Zhao Yi , Xu Jian , Jiang Zhen-Yu , Wu Zhen-Biao , Duan Xin-Wang , Wang Qian , Li Meng-Tao , Tian Xin-Ping , Zeng Xiao-Feng
Published: March 2020

Background

Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patient-assessed) and proportions of treatment cost to household income.

Methods

This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (<10%, 10–30%, 31–50%, and >50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients’ treatment satisfaction.

Results

When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P < 0.001). Effectiveness, side effects, and convenience scores were higher in the <10% subgroup compared to those in the >50% subgroup (all P < 0.05). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 13.183, P = 0.004). For biological disease-modifying anti-rheumatic drugs, effectiveness and convenience scores were lower in the severe RA subgroup than those in the extremely mild RA subgroup (both P < 0.05). Convenience score was higher in the <10% subgroup compared to that in the 31% to 50% and >50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032).

Conclusion

Higher disease severity and higher financial burden were associated with lower patient satisfaction.
Safety of Combined Fractional Microneedle Radiofrequency and CO2 as an Early Intervention for Inflammatory Acne and Scarring Treated With Concomitant Isotretinoin
Authors: Kim Jihee , Lee Young In , Kim Jemin , Jung Jin Young , Lee Won Jai , Lee Ju Hee
Published: March 2020

BACKGROUND

Fractional microneedle radiofrequency (FMRF) systems are popular options for treating acne scars. However, treatment efficacy when used in combination with traditional ablative fractional laser (AFL) and the safety profile with concomitant use of isotretinoin remain unknown.

OBJECTIVE

The aim of this study was to assess the safety and efficacy of an early intervention combination treatment protocol for inflammatory acne and acne scars.

MATERIALS AND METHODS

The electronic records of 71 patients with inflammatory acne and acne scars were included in this retrospective observational study. Data were collected for all patients who received combination FMRF and AFL. Within the study group, 43 patients were receiving low-dose isotretinoin or had completed isotretinoin within the past 3 weeks.

RESULTS

The mean Scar Global Assessment score significantly decreased after 3 sessions of combination treatment (n = 71). Patients with inflammatory acne showed a significant decrease in the number of inflammatory lesions (n = 30). Patients with concomitant low-dose isotretinoin use reported a further decrease in Scar Global Assessment score (n = 43). There were no reported persistent side effects, including prolonged inflammatory reaction or scarring.

CONCLUSION

Combination treatment with FMRF and AFL is an effective and well-tolerated treatment modality for acne scars and inflammatory acne.
A Review of 3-Dimensional Skin Bioprinting Techniques: Applications, Approaches, and Trends
Authors: Ishack Stephanie , Lipner Shari R.
Published: March 2020

BACKGROUND

Tissue engineering is used to fabricate 3-dimensional (3D) artificial scaffolds to create a microenvironment that mimics human tissue. Bioprinting uses biomaterials, cells, and/or bioink to fabricate prospective scaffolds to mirror the structural, compositional, and functional aspects of the skin. Various bioprinting methods (inkjet-based bioprinting, pressure-assisted bioprinting, and laser-assisted bioprinting) have been used for regenerative wound repair and have been characterized based on biocompatibility, cellular microenvironment, cell proliferation, vitality, and morphology.

OBJECTIVE

This article reviews the basic principles of 3D printing, current 3D skin bioprinting applications and approaches, and future directions for regenerative medical skin constructs.

METHODS

A comprehensive literature review was conducted using PubMed with keywords “three-dimensional printing,” “dermatologic surgery,” “bioprinting,” “reconstructive surgical procedures,” “wound healing,” “skin grafts,” “skin scaffolds,” “tissue reconstruction,” and “tissue engineering.”

RESULTS

A summary of the different applications and 3-dimensional skin bioprinting techniques is presented. In addition, synthetic, natural, and combination polymers are reviewed. Advantages, disadvantages, indications, and approaches are discussed in depth.

CONCLUSION

Skin grafting is a dynamic technique of dermal reconstruction that can be successful with comprehensive knowledge of skin bioprinting methods.
Preventive Beneficial Effect of an Aqueous Extract of Phyllanthus amarus Schum. and Thonn. (Euphorbiaceae) on DOCA-Salt–Induced Hypertension, Cardiac Hypertrophy and Dysfunction, and Endothelial Dysfunction in Rats
Authors: Yao N'guessan Alain , Niazi Zahid Rasul , Najmanová Iveta , Kamagaté Mamadou , Said Amissi , Chabert Philippe , Auger Cyril , Die-Kakou Henri , Schini-Kerth Valérie
Published: March 2020

This study investigated the preventive effect of an aqueous extract of the whole plant of Phyllanthus amarus (AEPA) on blood pressure, cardiac, and endothelial function in the deoxycorticosterone acetate (DOCA) salt–induced hypertensive rat model. Male Wistar rats were assigned into 5 groups receiving either vehicle (control and DOCA salt), DOCA salt combined with AEPA at 100 or 300 mg/kg, or AEPA (100 mg/kg) alone for 5 weeks. In addition, DOCA salt–treated rats were allowed free access to water containing 1% NaCl. Systolic blood pressure, left ventricle parameters, vascular reactivity of primary mesenteric artery rings, the vascular level of oxidative stress, and the level of target proteins were determined, using respectively tail-cuff sphygmomanometry, echocardiography, organ chambers, dihydroethidium staining, and immunofluorescence methods. After 5 weeks, AEPA treatments (100 or 300 mg/kg per day) significantly prevented the increase in systolic blood pressure in DOCA salt–treated rats, respectively, by about 24 and 21 mm Hg, improved cardiac diastolic function, and reduced significantly the increased posterior and septum diastolic wall thickness and the left ventricle mass in hypertensive rats. Moreover, the DOCA salt–induced endothelial dysfunction and the blunted nitric oxide- and endothelium-dependent hyperpolarization-mediated relaxations in primary mesenteric artery were improved after the AEPA treatments. AEPA also reduced the level of vascular oxidative stress and the expression level of target proteins (eNOS, COX-2, NADPH oxidase subunit p22phox) in DOCA salt rats. Altogether, AEPA prevented hypertension, improved cardiac structure and function, and improved endothelial function in DOCA salt rats. Such beneficial effects seem to be related, at least in part, to normalization of the vascular level of oxidative stress.
Knowledge, attitude, and practice towards pharmacogenomics among hospital pharmacists in Thailand
Authors: Karuna Narainrit , Tragulpiankit Pramote , Mahasirimongkol Surakameth , Chumnumwat Supatat
Published: March 2020

Background and objectives

Pharmacogenomics (PGx) is the use of human genomic information to avoid toxicity and optimize efficacy of drug therapy in an individual. Hospital pharmacists are the key persons to facilitate the incorporation of PGx into clinical practice. PGx is relatively new to Thai hospital pharmacists. Therefore, this study aimed to evaluate the knowledge, attitude, and practice of Thai hospital pharmacists towards PGx implementation.

Materials and methods

We conducted a cross-sectional questionnaire-based survey among 600 hospital pharmacists in 21 hospitals across Thailand. The questionnaire consisted of 35 questions using comment boxes, Likert scales, and multiple choice answers.

Results

The response rate was 20.5% (n = 123). Nearly half of the hospital pharmacists (46.3%) had low PGx knowledge score (<5 points), particularly for applied PGx knowledge in clinical situations. Concerns regarding PGx reimbursement, privacy issues, and discrimination were mentioned in this survey. However, most hospital pharmacists had positive attitude towards PGx service. Only 7% of hospital pharmacists had recommended or interpreted PGx tests in the past year. National PGx guidelines and government policies were considered the important factors for PGx implementation. Moreover, the most preferred learning format for PGx education was professional academic conferences.

Conclusion

Hospital pharmacists in Thailand had positive attitude towards PGx, despite limited experience and practice of PGx. PGx education to support an application of PGx knowledge in clinical situations is required. National PGx guidelines and government policies may need to be developed to address the concerns for reimbursement, privacy, and discrimination to ensure successful PGx implementation.
Effect of hormone therapy on muscle strength in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials
Authors: Xu Yang , Deng Kai-Li , Xing Tian-Fang , Mei Ya-Qing , Xiao Su-Mei
Published: March 2020

Objective:

This study aimed to evaluate the overall effects of hormone therapy (HT) on muscle strength in postmenopausal women through a systematic review and meta-analysis.

Methods:

PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from the inception dates to August 2019. Randomized controlled trials (RCTs) that compared the effects of HT with either no therapy or placebo on muscle strength in postmenopausal women were eligible. The quality of studies was assessed using the Cochrane risk of bias tool. Measurements of changes in muscle strength compared to baseline were extracted for pooled analysis. The effect size was calculated as standardized mean differences using a random effects model.

Results:

We identified nine studies with a combined population of 2,476 postmenopausal women. The studies included were assessed to be of good quality overall. The results showed that HT was not associated with muscle strength gain in postmenopausal women (standardized mean difference = 0.352; 95% confidence interval, −0.098 to 0.803; P = 0.125; I
2 = 95.3%). The changes in muscle strength in women receiving HT were not significant. The results were unchanged when stratified by treatment type, muscle group, and treatment duration.

Conclusions:

The use of HT was not associated with the improvement of muscle strength in postmenopausal women. This finding suggested that HT might not improve muscle strength or that the effect size was too small to identify significant therapeutic efficacy.
Appendicitis and Cholecystitis in Pregnancy
Authors: WEINSTEIN MICHAEL S. , FEUERWERKER SOLOMON , BAXTER JASON K.
Published: March 2020

Up to 2% of pregnant women develop a disease that requires nonobstetrical operative intervention during pregnancy. We discuss the issues unique to pregnant patients as they pertain to the presentation, diagnosis, and management of nonobstetric surgical disease, with an emphasis on 2 of the most common diseases that affect pregnant women: appendicitis and cholecystitis. Surgery has been demonstrated to be safe and effective during pregnancy, provided proper precautions are taken into account. It is the consensus of multiple professional committees and societies that no pregnant women should be delayed or denied a necessary surgery because of pregnancy.
Trauma in Pregnancy
Authors: LA ROSA MAURICIO , LOAIZA SARA , ZAMBRANO MARIA A. , ESCOBAR MARÍA F.
Published: March 2020

One of the most common causes of obstetric morbidity and mortality is trauma in pregnancy. Several maternal physiological changes during pregnancy have a significant impact on the mechanism, presentation, and management of trauma in this population. It is crucial for health providers dealing with trauma to know and understand these differences between pregnant and nonpregnant patients. The obstetric trauma patient requires a multidisciplinary approach, including obstetrics, maternal fetal medicine, anesthesiology, surgery, and intensive care teams. The aim of this article is to review the most updated information on trauma during pregnancy.
Differential Diagnosis of Sjögren Versus Non-Sjögren Dry Eye Through Tear Film Biomarkers
Authors: Akpek Esen K. , Wu Henry Y. , Karakus Sezen , Zhang Qin , Masli Sharmila
Published: March 2020

Purpose:

Systemic implications necessitate the identification of dry eye patients with Sjögren syndrome (SS). This study aims to explore the utility of tear MUC5AC and inflammatory cytokine levels in the differential diagnosis of SS-related dry eye.

Methods:

A prospective, observational, case-control study was conducted on 62 patients (those with a definitive diagnosis of SS dry eye, non-SS dry eye, and age-matched healthy controls with no dry eye). Clinical evaluations included the following tests in the order listed here: noninvasive tear break-up time, osmolarity, tear sampling, Schirmer test without anesthesia, and ocular surface staining (lissamine green for conjunctiva and fluorescein for cornea). Tear MUC5AC levels were assessed with enzyme-linked immunosorbent assay, and cytokines [interferon-gamma, tumor necrosis factor alpha, interleukin (IL)-6, IL-17a, IL-1β, IL-8, IL-10, and IL-12p70] were measured using a Luminex assay in a masked fashion.

Results:

The Bulbar conjunctival lissamine green staining score was significantly greater in patients or controls with SS versus non-SS dry eye. This greater conjunctival staining was associated with a reduction in tear MUC5AC (B = −17.8 ng/mL, 95% confidence interval = −31.8 to −3.9, P = 0.01). Among the tear cytokines, a significant association was found between IL-8 levels (hazard ratio [HR] = 1.002, 95% confidence interval = 1.000–1.003, P = 0.03) and SS diagnosis. When patients were stratified based on tear MUC5AC levels, significantly increased tear IL-8 levels were detected in patients with SS dry eye but not with non-SS dry eye, in comparison with healthy controls.

Conclusions:

Tear levels of goblet cell-specific MUC5AC combined with IL-8 can potentially serve as a useful biomarker for differential diagnosis of SS dry eye from non-SS dry eye.
Effect of Iris Color on the Outcome of Descemet Membrane Endothelial Keratoplasty
Authors: Hayashi Takahiko , Hos Deniz , Schrittenlocher Silvia , Siebelmann Sebastian , Matthaei Mario , Franklin Jeremy , Clahsen Thomas , Bock Felix , Bachmann Björn , Cursiefen Claus
Published: March 2020

Purpose:

To explore the impact of iris color on the outcome of Descemet membrane endothelial keratoplasty (DMEK).

Methods:

Consecutive cases of Fuchs endothelial dystrophy after DMEK were retrospectively analyzed from the prospective Cologne DMEK database between 2011 and 2017 at the University of Cologne, Germany. Iris pictures were graded by color into blue, green, or brown and compared regarding outcome parameters including best-corrected visual acuity (converted to logarithm of the minimal angle of resolution), central corneal thickness, endothelial cell density (ECD), each at preoperative (baseline) and postoperative 12 months, rebubbling rates, cystoid macular edema (CME), and immune rejections after surgery.

Results:

One thousand one hundred six eyes of 814 patients were included in this study that consisted of 354 blue eyes, 418 green eyes, and 244 brown eyes. There was no significant correlation between iris color and any parameter (best corrected visual acuity;P= 0.064 at preoperatively,P= 0.959 at 12 months) (ECD;P= 0.158 preoperatively,P= 0.859 at 12 months) (central corneal thickness;P= 0.148 preoperatively,P= 0.252 at 12 months). The loss of ECD at 12 months after surgery was 37.2% ± 1.0% in blue eyes, 37.2% ± 0.9% in green eyes, and 37.2% ± 1.2% in brown eyes (P= 0.999). Immune rejections were 1.7%, 2.9%, and 0.8% (P= 0.168) in blue, green, and brown eyes, respectively. Rebubbling rates and CME incidence were similar in each group (P= 0.129, andP= 0.552 respectively).

Conclusions:

The iris color has no significant impact on the outcome after DMEK. Thus, DMEK can be applied effectively, regardless of the iris color.
An Original Use of a Bioluminescence Assay to Test the In Vitro Efficacy of Polihexanide in the Eradication of Acanthamoeba Cysts
Authors: Sudano Roccaro Andrea , Asero Antonino
Published: March 2020

Purpose:

Acanthamoeba keratitis is a rare ocular disease caused by Acanthamoeba spp. The current Acanthamoeba keratitis treatments consist of unlicensed drugs, most commonly polihexanide (PHMB), a biguanide derivative, either as monotherapy or combined with a diamidine. The main purpose of this study was to develop an in vitro bioluminescence assay able to differentiate the antiamoebic activity of PHMB concentrations (0.02%, 0.04%, 0.06%, and 0.08%). Another objective of this study was to evaluate the antiamoebic activity of equal PHMB concentrations at different molecular weights (MWs).

Methods:

Adenosine triphosphate (ATP) bioluminescence assay applicability was established by a linear correlation between amoebae number and relative light unit emitted from cysts. The protocol consisted in a series of sequential tests, the first of which compared relative light unit emission and the hemocytometric method after cysts exposure to the different PHMB concentrations. In this assay, dilutions of the initial PHMB concentrations were used as working solutions. Usually, only 5% or less of the instilled dose into the eye is distributed through the cornea; thus, the antiamoebic activity of initial PHMB concentrations 1/10 and 1/100 diluted can reasonably be considered as representative of their undiluted dose administered in vivo.

Results:

There was no significant difference between the 2 methods. The ATP bioluminescence assay ranked the antiamoebic activity of the working PHMB solutions and showed that the viability of the cysts was equally reduced at fixed PHMB concentration in a wide range of molecular weight.

Conclusions:

The ATP bioluminescence assay showed to be a simple and rapid way for characterizing the in vitro antiamoebic activity of working PHMB solutions at different concentrations.
Reducing Opioid Bias is Necessary (ROBIN)
Authors: Brannock Carrie L. , White Justin , Baker Jo Ann
Published: March 2020

Background

Prescription opioid and heroin use and addiction is a local, national, and worldwide epidemic plaguing over 11 million people. Attitudes toward substance use among the general public were highlighted as an area that needs to be further investigated and addressed. The Reducing Opioid Bias is Necessary (ROBIN) educational project was developed and presented to 21 participants as a one-time, 4-hour pretest and posttest design that included theoretical background, short videos, a documentary film, and writings from individuals and community members affected by opioid use disorder (OUD). Participants were assessed on their familiarity, attitudes, and effectiveness of the ROBIN educational program on their perceptions toward persons with OUD.

Methods

Quantitative data collection included demographic information, level of familiarity, the Attitudes to Mental Illness Questionnaire, and the Drug and Drug Problems Perceptions Questionnaire. Qualitative measures included reflective writing and focus group discussion 2 months after the program. Quantitative measures were completed using descriptive statistics, and qualitative data were sorted for common themes.

Results

Spearman's rank rho of 0.947 (p < .05) indicated less familiarity and more bias attitudes toward people with OUD. The paired-sample t test on the Drug and Drug Problems Perceptions Questionnaire indicated a significant decrease in participant bias in the posttest (M = 59.33, SD = 16.48) when compared with the pretest (M = 74.86, SD = 19.38), t(20) = 5.17, p = .00002. The qualitative data from the written reflection and focus group indicated strong changes in participants' overall understanding, empathy, and desire for promoting the educational program.

Conclusion

The ROBIN program can reduce bias among community and healthcare subjects. Limitations to the study should be addressed in future research on this topic.
An Analysis of Computer Game Addiction in Primary School Children and Its Affecting Factors
Authors: Karayağiz Muslu Gonca , Aygun Ozcan
Published: March 2020

Background

Computer games are included in next-generation technologies in today's developed visual media world. They are attractive to all ages, but the dramatic increase in the use of computer games in children and adolescents is remarkable. This study aims to determine the computer game addiction in primary school children and its affecting factors.

Methods

The study sample consisted of 476 students among 952 students enrolled in three primary schools in Fethiye, Muğla. Data were collected from the students using the “Child Information Form” and the “Computer Game Addiction Scale for Children.” The data were analyzed using numbers, percentages, independent samples, one-way analysis of variance, and regression analysis.

Results

This study found that there was a statistically significant difference between gender, class grade, level of income, mothers' educational level, the presence of a game console/computer at home, and the computer game addiction scale scores (p < .05). It was also found that students who spend more time on the Internet and playing computer game constitute the most at-risk group for computer game addiction (p < .05).

Conclusion

Some interventions can be planned to decrease computer game addiction particularly in male students, children and families with low income and educational level, and students who have computers and game consoles at home with longer duration of gaming and Internet use with the cooperation of schools, school nurses, teachers, and parents.
Higher visit-to-visit blood pressure variability and N-terminal pro-brain natriuretic peptide elevation: influence of left ventricular hypertrophy and left ventricular diastolic function
Authors: Takahari Kosuke , Nagai Michiaki
Published: March 2020

Objective

The issue of whether visit-to-visit blood pressure variability (VVV) is associated with higher levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) has been controversial, and the underlying mechanism is not well understood. We hypothesized that (1) VVV is associated with the NT-proBNP level, and (2) this association is mediated by left ventricular (LV) hypertrophy and LV diastolic dysfunction.

Patients and methods

A total of 72 hypertensive patients were examined. Clinic blood pressure was measured at each visit for 12 months (1×/month or every 2 months), and echocardiography was performed during this period. VVV is expressed as the SD, coefficient of variation (CV), and delta (Δ; the difference between the maximum and the minimum) in SBP and in DBP. We investigated the association between VVV and NT-proBNP and whether the LV mass index (LVMI) and the mitral early diastolic inflow velocity (E) to mitral annular early-diastolic peak velocity (e′) ratio (E/e′) influence this association.

Results

The loge NT-proBNP values were significantly correlated with the CV of SBP (r = 0.42), ΔSBP (r = 0.41), the CV of DBP (r = 0.32), and ΔDBP (r = 0.28). The CV and Δ in SBP or those in DBP were not significantly correlated with LVMI or E/e′. A multiple linear regression analysis revealed that higher CV of SBP and ΔSBP were significantly associated with loge NT-proBNP.

Conclusion

Higher VVV was significantly associated with higher NT-proBNP independently of LV hypertrophy and diastolic function.
Diagnosed in operating room with hypertension: a widespread but unseen affliction
Authors: Balci Eda , Demir Asli , Bahcecitapar Melike , Karadeniz Umit
Published: March 2020

Objective

The present study aims to describe a widely held misconception in the literature concerning preoperative hypertension diagnosis. The blood pressure elevation occurring in the operative room is seen commonly even in subjects considered hitherto fully normotensive. As these patients have a condition which – similar to White Coat Hypertension (WCH) – indicates the presence of hypertension, and thus necessitates more frequent intraoperative checks.

Methods

We have named a condition ‘Diagnosed in Operating Room (DIOR) with Hypertension’, following the preoperative stage at which it is detected.

Result

Our observational study evaluated 718 elective noncardiac surgery adult patients, finding 28% of them (n = 204) to be ‘DIOR-tensive’ and thus at risk for suboptimal intraoperative care.

Conclusion

In addition to recommending a modification to the domain’s best practices, we provide a preliminary description of DIOR hypertension patient identifying characteristics (older, higher body weight and BMI, and higher rates of chronic obstructive pulmonary disease, hypothyroidism and obesity), so that DIOR hypertension patients may be more readily identified, and that future research may build on the findings, and that the operating team may remain generally aware that this problem can occur and be dealt with regardless of the patient’s medical history.
Strategy Configurations Directly Linked to Higher Hepatitis C Virus Treatment Starts
Authors: Yakovchenko Vera , Miech Edward J. , Chinman Matthew J. , Chartier Maggie , Gonzalez Rachel , Kirchner JoAnn E. , Morgan Timothy R. , Park Angela , Powell Byron J. , Proctor Enola K. , Ross David , Waltz Thomas J. , Rogal Shari S.
Published: March 2020

Background:

The Department of Veterans Affairs (VA) cares for more patients with hepatitis C virus (HCV) than any other US health care system. We tracked the implementation strategies that VA sites used to implement highly effective new treatments for HCV with the aim of uncovering how combinations of implementation strategies influenced the uptake of the HCV treatment innovation. We applied Configurational Comparative Methods (CCMs) to uncover causal dependencies and identify difference-making strategy configurations, and to distinguish higher from lower HCV treating sites.

Methods:

We surveyed providers to assess VA sites’ use of 73 implementation strategies to promote HCV treatment in the fiscal year 2015. CCMs were used to identify strategy configurations that uniquely distinguished higher HCV from lower HCV treating sites.

Results:

From the 73 possible implementation strategies, CCMs identified 5 distinct strategy configurations, or “solution paths.” These were comprised of 10 individual strategies that collectively explained 80% of the sites with higher HCV treatment starts with 100% consistency. Using any one of the following 5 solution paths was sufficient to produce higher treatment starts: (1) technical assistance; (2) engaging in a learning collaborative AND designating leaders; (3) site visits AND outreach to patients to promote uptake and adherence; (4) developing resource sharing agreements AND an implementation blueprint; OR (5) creating new clinical teams AND sharing quality improvement knowledge with other sites AND engaging patients. There was equifinality in that the presence of any one of the 5 solution paths was sufficient for higher treatment starts.

Conclusions:

Five strategy configurations distinguished higher HCV from lower HCV treating sites with 100% consistency. CCMs represent a methodological advancement that can help inform high-yield implementation strategy selection and increase the efficiency and effectiveness of future implementation efforts.
Effects of State-level Medicaid Expansion on Veterans Health Administration Dual Enrollment and Utilization
Authors: O’Mahen Patrick N. , Petersen Laura A.
Published: March 2020

Objective:

The objective of this study was to examine how pre-Affordable Care Act (ACA) state-level Medicaid expansions affect dual enrollment and utilization of Veterans Health Administration (VA) and Medicaid-funded care.

Research Design:

We employed difference-in-difference analysis to determine the association between pre-ACA Medicaid expansions in New York and Arizona in 2001 and VA utilization. Participants’ dual enrollment in Medicaid and VA, the distribution of their annual hospital admissions and emergency department (ED) visits between VA and Medicaid were dependent variables. We controlled for age, race, sex, disease burden, distance to VA facilities and income-based eligibility for VA services.

Measures:

Secondary data collected from 1999 to 2006 in 2 states expanding Medicaid and 3 demographically similar nonexpansion states. We obtained residency, enrollment and utilization data from VA’s Corporate Data Warehouse and Medicaid Analytic Extract files.

Results:

For low-income Veterans, Medicaid expansion was associated with increased dual enrollment of 4.87 percentage points (99% confidence interval: 4.48–5.25), a 4.63-point decline in VA proportion of admissions (−5.87 to −3.38), and a 11.70-point decrease in the VA proportion of ED visits (−13.06 to −10.34). Results also showed increases in the number of total (VA plus Medicaid) annual per-capita hospitalizations and ED visits among the group of VA enrollees most likely to be eligible for expansion.

Conclusions:

This study shows slight usage shifts when Veterans gain access to non-VA care. It highlights the need to overcome care-coordination challenges among VA patients as states implement ACA Medicaid expansion and policymakers consider additional expansions of public health insurance programs such as Medicare-for-All.
Tumor-to-liver standard uptake ratio using fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography effectively predict occult lymph node metastasis of non–small cell lung cancer patients
Authors: Shi Yun-Mei , Niu Rong , Shao Xiao-Liang , Zhang Fei-Fei , Shao Xiao-Nan , Wang Jian-Feng , Wang Xiao-Song , Liu Bao , Yu Wen-Ji , Wang Yue-Tao
Published: March 2020

Objectives

We aimed to investigate predictive factors of occult lymph node metastasis and to explore the diagnostic value of various standardized uptake value (SUV) parameters using fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography computed tomography (PET/CT) in predicting occult lymph node metastasis of clinical N0 non–small cell lung cancer patients.

Methods

We retrospectively analyzed PET/computed tomography parameters of tumor and clinical data of 124 clinical N0 non–small cell lung cancer patients who underwent both preoperative 18F-FDG PET/computed tomography and anatomical pulmonary resection with systematic lymph node dissections. The SUVmax, SUVmean, metabolic total volume, and total lesion glycolysis of the primary tumor was automatically measured on the PET/computed tomography workstation. Standardized uptake ratio (SUR) were derived from tumor standardized uptake value divided by blood SUVmean (B-SUR) or liver SUVmean (L-SUR), respectively.

Results

According to postoperative pathology, 19 (15%) were diagnosed as occult lymph node metastasis among 124 clinical N0 non–small cell lung cancer patients. On univariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, lobulation, and all PET parameters were associated with occult lymph node metastasis. The area under the receiver operating characteristic curve, sensitivity, and negative predictive value of L-SURmax were the highest among all PET parameters (0.778, 94.7%, and 98.4%, respectively). On multivariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax were independent risk factors for predicting occult lymph node metastasis. Compared to L-SURmax alone and the combination of carcinoembryonic antigen and cytokeratin 19 fragment, the model consisting of three independent risk factors achieved a greater area under the receiver operating characteristic curve (0.901 vs. 0.778 vs. 0.780, P = 0.021 and 0.0141).

Conclusions

L-SURmax showed the most powerful predictive performance than the other PET parameters in predicting occult lymph node metastasis. The combination of three independent risk factors (carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax) can effectively predict occult lymph node metastasis in clinical N0 non–small cell lung cancer patients.
Burden of metastatic bone disease measured on 18F-NaF PET/computed tomography studies as a prognostic indicator in patients with medullary thyroid cancer
Authors: Ueda Cristina E. , Duarte Paulo S. , de Castroneves Luciana A. , Flávio José , Marin G. , Sado Heitor N. , Sapienza Marcelo T. , Hoff Ana O. , Buchpiguel Carlos A.
Published: March 2020

Purpose

The aim of the study was to assess the association between the burden of metastatic bone disease measured on 18F-NaF PET/computed tomography (CT) studies and the overall survival (OS) of patients with medullary thyroid cancer (MTC).

Methods

We retrospectively analyzed 31 patients with MTC who performed 18F-NaF PET/CT studies to assess skeletal metastases. The outcomes of the patients (dead or alive) were established based on the last information available on their files. In the studies considered positives for skeletal metastases, the burden of metastatic bone disease was established calculating the fluoride tumor volume (FTV). The FTV was defined using isocontour thresholds based on percentages of maximal standardized uptake values (SUVmax) in the lesions. These percentages varied from lesion to lesion and were established by visual analysis. The patients were divided into three groups as follows: without skeletal metastases (n = 11), with low FTV (≤50 cm3; n = 11) and with high FTV (>50cm3; n = 9). The Kaplan–Meier curves were used to analyze the OS in the three groups of patients and the log-rank test was used to determine the statistical significance of the difference between the groups.

Results

There were statistically significant differences in the OS between the group with high FTV and the groups of patients with low FTV (P = 0.036) and without skeletal metastases (P = 0.001). There was not a statistically significant difference between the groups of patients with low FTV and without skeletal metastases (P = 0.147).

Conclusion

In patients with MTC, the burden of metastatic bone disease is associated with OS.
Oncology Nurses' Perspectives and Practices Toward the Delivery of Cancer Survivorship Care in Hong Kong
Authors: Wong Cho Lee , So Winnie K.W. , Choi Kai Chow , Tong Man , Choy Yin Ping , Molassiotis Alex , Yates Patsy , Chan Raymond J.
Published: March 2020

Background

Despite tremendous progress in understanding the unmet needs of cancer survivors, our understanding of oncology nurses' perspectives and practices in the delivery of survivorship care is inadequate.

Objectives

The aims of this study were to assess oncology nurses' perceptions about their responsibility and frequency of delivery of survivorship care to cancer patients and to examine the factors influencing such care.

Methods

A cross-sectional survey was administered to 81 nurses working in the oncology unit of hospitals in Hong Kong. Participants completed an investigator-developed questionnaire designed to assess oncology nurses' perceptions of responsibility, practices, and barriers regarding the provision of survivorship care for cancer patients.

Results

Results revealed discrepancies between oncology nurses' perceptions of responsibility and practices, with high levels of perceptions of various survivorship care as their responsibility but low levels in delivery of such care. Despite that discussing and managing pain was agreed by most oncology nurses as their responsibility (95.1%), 34.6% of them have never managed survivors' pain. Besides, 33.3% of nurses have never discussed and managed survivors' sexuality issues. Lack of time (79.0%), inadequate educational resources for family members (59.3%), and lack of knowledge and skills (54.4%) were major factors that impeded survivorship care provision.

Conclusions

This study provides further evidence for inadequacies of oncology nurses in delivering survivorship care and their perceived barriers. Further studies are required to enhance our understanding of the strategies for improving the quality of cancer survivorship care.

Implications for Practice

Results underscore the need to develop educational resources and enhance training in survivorship care for oncology nurses.
Exploring Young People’s Experience of Ending Active Cancer Treatment
Authors: Lea Sarah , Martins Ana , Cable Maria , Fern Lorna A. , Morgan Sue , Soanes Louise , Whelan Michael , Taylor Rachel M.
Published: March 2020

Background

The end of active cancer treatment is described as a stressful period for adolescents and young adults (AYAs). However, research evidence describing the experience of AYAs as they transition from active treatment into follow-up care is scarce.

Objective

We aimed to understand AYAs’ experiences within the first 12 months of ending active treatment.

Methods

Data were collected using semistructured interviews, which were digitally recorded and transcribed verbatim. Qualitative analysis of transcripts was used to identify key themes/subthemes.

Results

Eleven AYAs (8 female participants), diagnosed with cancer aged 17 to 25 years and 19 to 26 years at point of interview, participated. At time of interview, 7 were within 6 months of treatment completion, and in 4 participants, treatment ended 6 to 12 months prior. Three main themes were identified: (1) challenges of social reintegration and self-identity, (2) expectations versus the lived experience of ending treatment, and (3) sudden loss of the safe “bubble” of treatment.

Conclusions

Adolescents and young adults were underprepared for and challenged by the unexpected emotional and physical consequences of ending active cancer treatment.

Implications for Practice

Young people require information and support to prepare for ending active treatment and reintegration to everyday life. Preparation for the short- and long-term physical, social, and psychological impact of a cancer diagnosis even when treatment ends will assist young people in managing this transition. Further research is required to develop and test interventions to provide timely, structured, and equitable information and support at the end of treatment to better prepare AYAs for the challenges they may face as treatment ends.